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Wang P, Wang WW, Liu YQ, Li WQ, Hu JX, Su YA, Li JT, Li N, Si TM. The dose-response relationship of vortioxetine on major depressive disorder: an umbrella review. Psychiatry Res 2024; 340:116118. [PMID: 39121757 DOI: 10.1016/j.psychres.2024.116118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024]
Abstract
Vortioxetine is a novel multimodal antidepressant, but its precise efficacy and dose-response relationship for treating different symptoms in major depressive disorder (MDD) is still unclear. This umbrella review aims to assess the effectiveness, tolerability, and dose-response relationship of vortioxetine across a comprehensive range of clinical features in adults with MDD, including cognition, depression, anxiety, quality of life, and side effects. We meticulously searched eight electronic databases and included systematic reviews (SRs) and meta-analyses (MAs) of vortioxetine. The methodological quality of each included SR was independently assessed using the AMSTAR2 tool. To evaluate the credibility of the evidence, we utilized the GRADE framework and the Ioannidis criteria. In total, 35 SRs with 278 MAs met the inclusion criteria and based on these studies we performed 56 MAs of interest. While vortioxetine has been consistently shown to have positive effects on various domains, the evidence regarding cognitive performance and depression symptoms is notably robust compared to placebo, despite of relatively overall low quality of evidence. Finally, a dose-response relationship was observed across all categories within the treatment range of 5-20 mg/d and a dosage of vortioxetine 20 mg/d is recommended for adult MDD patients to achieve full functional recovery.
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Affiliation(s)
- Ping Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China; Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Wei-Wei Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing 100088, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
| | - Yi-Qi Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Wen-Qiang Li
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Jian-Xin Hu
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
| | - Yun-Ai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Ji-Tao Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
| | - Nan Li
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China; Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China.
| | - Tian-Mei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China.
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Christensen MC, Canellas F, Loft H, Montejo ÁL. Effectiveness of Vortioxetine for the Treatment of Emotional Blunting in Patients with Major Depressive Disorder Experiencing Inadequate Response to SSRI/SNRI Monotherapy in Spain: Results from the COMPLETE Study. Neuropsychiatr Dis Treat 2024; 20:1475-1489. [PMID: 39100571 PMCID: PMC11297586 DOI: 10.2147/ndt.s473056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Background The multinational, open-label COMPLETE study (NCT03835715) investigated the effectiveness of vortioxetine in alleviating emotional blunting in patients with major depressive disorder (MDD) experiencing inadequate response and emotional blunting while being treated with a selective serotonin reuptake inhibitor (SSRI) or serotonin-noradrenaline reuptake inhibitor (SNRI). This paper presents results for the subgroup of patients enrolled in Spain. Methods Patients with MDD (n = 67) experiencing partial response and emotional blunting during monotherapy with an SSRI or SNRI were switched to vortioxetine (10-20 mg/day) for 8 weeks. The primary study outcome was emotional blunting, assessed by the Oxford Depression Questionnaire (ODQ). Results After 8 weeks of vortioxetine, the mean (SE) change in ODQ total score from baseline was -26.0 (2.9) (P < 0.001). Respective changes in Montgomery-Åsberg Depression Rating Scale (MADRS), Motivation and Energy Inventory, Digit Symbol Substitution Test, and Sheehan Disability Scale (SDS) total scores were -14.9 (0.8), +34.2 (4.5), +6.3 (1.6), and ‒9.0 (1.3) (all P < 0.001 vs baseline). At week 8, 70.4% of patients no longer reported emotional blunting and 53.7% had achieved remission from their depressive symptoms (defined as a MADRS total score ≤10). Mediation analysis showed 77.1% of the change in SDS total score to be a direct effect of the improvement in ODQ total score after switching to vortioxetine. Adverse events were reported by 35 patients (52.2%), most commonly nausea (14 patients, 20.9%). At week 8, 33/54 patients (61.1%) were receiving vortioxetine 20 mg/day. Conclusion In this study investigating the effectiveness of vortioxetine in Spanish patients with MDD who experienced inadequate response and emotional blunting on SSRI/SNRI monotherapy, significant improvements in emotional blunting, core depressive symptoms (including anhedonia), sleep duration, motivation and energy, cognitive performance, and overall patient functioning were observed during the 8 weeks of treatment. Two-thirds of patients no longer reported emotional blunting and over half were in remission from their depressive symptoms at week 8.
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Affiliation(s)
| | - Francesca Canellas
- Psychiatric Department, Son Espases University Hospital, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | | | - Ángel L Montejo
- Institute of Biomedicine of Salamanca (IBSAL), Salamanca, Spain
- Psychiatric Service, University of Salamanca Health Care Complex, Salamanca, Spain
- University of Salamanca, Faculty of Nursing, Salamanca, Spain
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Christensen MC, Schmidt SN, Grande I. The functioning assessment short test (FAST): Clinically meaningful response threshold in patients with major depressive disorder receiving antidepressant treatment. J Affect Disord 2024:S0165-0327(24)01076-0. [PMID: 39019235 DOI: 10.1016/j.jad.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/21/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Functional impairment is common in patients with major depressive disorder (MDD). The Functioning Assessment Short Test (FAST) provides a detailed clinician-rated assessment of functioning across multiple aspects of daily life. This study aimed to establish clinically relevant response thresholds for the FAST in patients with MDD receiving antidepressant treatment. METHODS Data were derived from three 8-week clinical trials of antidepressant therapy in patients with MDD that included assessment of functioning using the FAST as a pre-specified endpoint. The minimal clinically important difference (MCID) and threshold for response in terms of change in FAST total score were determined using anchor-based methods. RESULTS After 8 weeks of antidepressant treatment, the mean reduction in FAST total score in patients considered clinically minimally improved (Clinical Global Impression-Improvement [CGII] score of 3) was 7-9 points (~20 % reduction). The threshold for functional response (reduction in FAST total score from baseline in patients with a CGI-I score of ≤2 at week 8) was 16-19 points (~50 % reduction). The threshold for functional response was higher in patients with MDD and comorbid generalized anxiety disorder than in those with MDD alone (mean reduction in FAST total score at 8 weeks: 26 points [63 %]). LIMITATIONS Short-term studies. CONCLUSIONS These results provide further validation of the FAST for assessing functioning in patients with MDD. In patients with MDD, the suggested MCID for FAST total score is 7-9 points and the proposed threshold for response is a reduction from baseline of approximately 50 %.
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Affiliation(s)
| | | | - Iria Grande
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences of the University of Barcelona (UBNeuro), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Di Nicola M, Adair M, Rieckmann A, Christensen M C. Effectiveness of vortioxetine in elderly patients with major depressive disorder in real-world clinical practice: Results from the RELIEVE study. J Psychopharmacol 2024; 38:615-623. [PMID: 39077889 PMCID: PMC11290038 DOI: 10.1177/02698811241260996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Data demonstrating the real-world, long-term effectiveness of vortioxetine in elderly patients with major depressive disorder (MDD) are clinically useful to confirm findings from randomized trials. METHODS RELIEVE was a multinational, 24-week, observational, prospective study in outpatients with MDD initiating vortioxetine treatment in routine care settings (NCT03555136). Here, we report data from a subgroup of 130 patients aged ⩾ 65 years. The primary study outcome was changed from baseline in patient functioning assessed using the Sheehan Disability Scale (SDS). Other clinical outcomes included depression severity (Patient Health Questionnaire-9 [PHQ-9] and Clinical Global Impressions-Severity [CGI-S]), cognitive performance (Digit Symbol Substitution Test [DSST]) and symptoms (Perceived Deficits Questionnaire - Depression-5 item [PDQ-D-5]), and health-related quality of life (HRQoL) (EuroQoL 5 Dimensions 5 Levels [EQ-5D-5L]). RESULTS Clinically meaningful and statistically significant improvements in patient functioning, depressive symptoms, cognitive function, and HRQoL were observed at week 24. Least squares mean SDS, PHQ-9, CGI-S, PDQ-D-5, DSST, and EQ-5D-5L scores improved from baseline by 6.5, 5.7, 1.2, 3.2, 4.4, and 0.11 points, respectively (p < 0.01 for all). Adverse events were observed in 23.1% of patients. CONCLUSIONS Consistent with previous clinical studies of vortioxetine, this study supports the effectiveness and safety of vortioxetine in treating elderly patients with MDD in a real-world setting over a 6-month period. Patients showed clinically relevant and sustained improvements in psychosocial functioning, depressive symptoms, and cognitive function after receiving vortioxetine, which was generally well tolerated. Main study limitations include the open-label study design and lack of a placebo or comparator group.
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Affiliation(s)
- M Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Adair
- H. Lundbeck A/S, Valby, Denmark
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Wang G, Si T, Rieckmann A, Ma J, Christensen MC. Effectiveness of Vortioxetine in Working Patients with Major Depressive Disorder in China: A Subgroup Analysis of the RELIEVE China Study. Neuropsychiatr Dis Treat 2024; 20:1211-1223. [PMID: 38863483 PMCID: PMC11166150 DOI: 10.2147/ndt.s460408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024] Open
Abstract
Background Major depressive disorder (MDD) causes significant functional impairments that impact on all aspects of patients' daily lives, including their ability to work, work productivity, and social life. Purpose To assess the real-world effectiveness of the multimodal antidepressant vortioxetine in working patients with MDD in China. Patients and methods RELIEVE China was an observational, prospective cohort study. Patients (aged ≥18 years) with MDD initiating treatment with vortioxetine in routine clinical practice settings were followed for 24 weeks. In this subgroup analysis, functioning was assessed using the Sheehan Disability Scale (SDS) in patients in full- or part-time work or education at baseline who remained on treatment at all follow-up visits (n=424). Depressive, cognitive, and anxiety symptoms were also assessed. For all endpoints, mean change from baseline at weeks 8 and 24 was analyzed using mixed models for repeated measures. Results Clinically relevant and sustained improvements in patient functioning and measures of work productivity were observed over the 24 weeks of vortioxetine treatment. The adjusted mean (standard error) reduction in SDS total score from baseline was 5.4 (0.3) points at week 8 and 8.7 (0.3) points at week 24 (both P<0.001 vs baseline). Significant improvements were observed across all SDS domains and in levels of absenteeism and presenteeism (P<0.001 vs baseline for all endpoints at both time points). Significant improvements in depressive, cognitive, and anxiety symptoms were also observed over the study period (all P<0.001 vs baseline). The proportion of patients in remission (ie, 17-item Hamilton Depression Rating Scale score ≤7) after 24 weeks of vortioxetine treatment was 65.4%. Vortioxetine was well tolerated; nausea was the most common adverse event, reported by 18.6% of patients. Conclusion These findings support the effectiveness and tolerability of vortioxetine in working patients with MDD receiving treatment in routine clinical practice settings in China.
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Affiliation(s)
- Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & The Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People’s Republic of China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, People’s Republic of China
| | | | - Jingdong Ma
- Medical Affairs, Lundbeck China, Beijing, People’s Republic of China
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Haniff ZR, Bocharova M, Mantingh T, Rucker JJ, Velayudhan L, Taylor DM, Young AH, Aarsland D, Vernon AC, Thuret S. Psilocybin for dementia prevention? The potential role of psilocybin to alter mechanisms associated with major depression and neurodegenerative diseases. Pharmacol Ther 2024; 258:108641. [PMID: 38583670 DOI: 10.1016/j.pharmthera.2024.108641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
Major depression is an established risk factor for subsequent dementia, and depression in late life may also represent a prodromal state of dementia. Considering current challenges in the clinical development of disease modifying therapies for dementia, the focus of research is shifting towards prevention and modification of risk factors to alter the neurodegenerative disease trajectory. Understanding mechanistic commonalities underlying affective symptoms and cognitive decline may reveal biomarkers to aid early identification of those at risk of progressing to dementia during the preclinical phase of disease, thus allowing for timely intervention. Adult hippocampal neurogenesis (AHN) is a phenomenon that describes the birth of new neurons in the dentate gyrus throughout life and it is associated with spatial learning, memory and mood regulation. Microglia are innate immune system macrophages in the central nervous system that carefully regulate AHN via multiple mechanisms. Disruption in AHN is associated with both dementia and major depression and microgliosis is a hallmark of several neurodegenerative diseases. Emerging evidence suggests that psychedelics promote neuroplasticity, including neurogenesis, and may also be immunomodulatory. In this context, psilocybin, a serotonergic agonist with rapid-acting antidepressant properties has the potential to ameliorate intersecting pathophysiological processes relevant for both major depression and neurodegenerative diseases. In this narrative review, we focus on the evidence base for the effects of psilocybin on adult hippocampal neurogenesis and microglial form and function; which may suggest that psilocybin has the potential to modulate multiple mechanisms of action, and may have implications in altering the progression from major depression to dementia in those at risk.
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Affiliation(s)
- Zarah R Haniff
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
| | - Mariia Bocharova
- Department of Old Age Psychiatry, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Tim Mantingh
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - James J Rucker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, United Kingdom
| | - Latha Velayudhan
- Department of Old Age Psychiatry, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - David M Taylor
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, United Kingdom
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, United Kingdom
| | - Dag Aarsland
- Department of Old Age Psychiatry, Division of Academic Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Wolfson Centre for Age Related Diseases, Division of Neuroscience of the Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; Stavanger University Hospital, Stavanger, Norway
| | - Anthony C Vernon
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; MRC Centre for Neurodevelopmental Disorders, King's College London, United Kingdom.
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
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Cuomo A, Aguglia A, De Berardis D, Ventriglio A, Gesi C, Fagiolini A. Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine. Ann Gen Psychiatry 2024; 23:20. [PMID: 38755657 PMCID: PMC11097484 DOI: 10.1186/s12991-024-00505-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Depression is a highly heterogeneous disorder, often resulting in suboptimal response and remission rates. This underscores the need for more nuanced clinical characterization of patients to tailor individualized treatment plans. Emerging evidence highlights the critical role of cognitive and emotional dysfunction in major depression, prompting the exploration of novel therapeutic interventions that target these specific symptom domains. MAIN TEXT Vortioxetine, a multimodal antidepressant, enhances serotonergic activity while also modulating several other neurotransmitter systems involved in depressive symptoms such as emotional blunting, anhedonia, and cognitive dysfunction. Numerous randomized, placebo-controlled trials have demonstrated vortioxetine's efficacy and safety in treating depression, particularly in specific subgroups of depressed patients, including those with cognitive deficits and comorbid anxiety symptoms or disorders. Although not randomized or placebo-controlled, studies have also shown vortioxetine's efficacy in depressed patients with emotional blunting or anhedonia. Vortioxetine's ability to effectively treat a range of depressive symptoms, including anhedonia, emotional blunting, anxiety, and cognitive dysfunction, provides an individualized treatment solution for depressed individuals suffering from these symptoms. The purpose of this paper is to identify clinical profiles of patients who may benefit from vortioxetine, with the goal of optimizing therapeutic outcomes. CONCLUSION Vortioxetine has been shown to be effective for patients with depression and symptoms such as anhedonia, emotional blunting, anxiety, and cognitive dysfunction. Tailoring treatment plans to individual needs and personalizing treatment choices based on the specific symptoms presented by depressed patients improve treatment outcomes.
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Affiliation(s)
- Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy.
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Camilla Gesi
- Department of Mental Health and Addiction, ASST Fatebenfratelli-Sacco, Milan, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena, Italy
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Cuomo A, Barillà G, Cattolico M, Pardossi S, Mariantoni E, Koukouna D, Carmellini P, Fagiolini A. Perspectives on the impact of vortioxetine on the treatment armamentarium of major depressive disorder. Expert Rev Neurother 2024; 24:465-476. [PMID: 38536761 DOI: 10.1080/14737175.2024.2333394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/18/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Major Depressive Disorder (MDD) is a mental health issue that significantly affects patients' quality of life and functioning. Despite available treatments, many patients continue to suffer due to incomplete symptom resolution and side effects. AREAS COVERED This manuscript examines Vortioxetine's role in Major Depressive Disorder (MDD) treatment, highlighting its potential to reshape therapeutic strategies due to its unique Multimodal action and proven broad-spectrum efficacy in multiple depressive domains. A detailed examination of Vortioxetine's pharmacological aspects, including indications, dosage, pharmacodynamics, and pharmacokinetics, is provided, emphasizing its safety and effectiveness. The discussion extends to Vortioxetine's role in acute-phase treatment and maintenance of MDD and its profound impact on specialized depression domains. EXPERT OPINION Vortioxetine is distinguished for its novel multimodal serotonin modulation mechanism, showcasing significant promise as an innovative treatment for MDD. Its efficacy, which is dose-dependent, along with a commendable tolerability profile, positions it as a potential leading option for initial treatment strategies. The discourse on dosage titration, particularly the strategy of initiating treatment at lower doses followed by gradual escalation, underscores the approach toward minimizing initial adverse effects while optimizing therapeutic outcomes, aligning with the principles of personalized medicine in psychiatric care.
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Kwan ATH, Guo Z, Ceban F, Le GH, Wong S, Teopiz KM, Rhee TG, Ho R, Di Vincenzo JD, Badulescu S, Meshkat S, Cao B, Rosenblat JD, d'Andrea G, Dev DA, Phan L, Subramaniapillai M, McIntyre RS. Assessing the Effects of Metabolic Disruption, Body Mass Index and Inflammation on Depressive Symptoms in Post-COVID-19 Condition: A Randomized Controlled Trial on Vortioxetine. Adv Ther 2024; 41:1983-1994. [PMID: 38520501 DOI: 10.1007/s12325-024-02826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION To date, there are no therapeutics that have gained regulatory approval by the United States Food and Drug Administration (FDA) for the treatment of post-COVID-19 condition (PCC), a debilitating condition characterized by cognitive impairment and mood symptoms. Additionally, persistent inflammation, metabolic dysfunction, and risks associated with an elevated body mass index (BMI) have been observed. Herein, we aimed to assess the efficacy of vortioxetine in improving depressive symptoms among individuals with PCC, as modulated by inflammation, metabolic dysfunction, and BMI. METHODS In this post-hoc analysis, we present preliminary data obtained from an 8-week randomized, double-blind, placebo-controlled trial. Participants included adults aged 18 years and older residing in Canada who were experiencing symptoms of World Health Organization (WHO)-defined PCC. Recruitment began November 2021 and ended January 2023. Of the 200 participants enrolled, 147 were randomized (1:1) to receive vortioxetine (5-20 mg, n = 73) or placebo (n = 74) for daily treatment under double-blind conditions. The primary outcome measure was the change from baseline to endpoint in the 16-Item Quick Inventory of Depressive Symptomatology Self-Report Questionnaire (QIDS-SR-16). RESULTS Our findings revealed significant effects for time (χ2 = 9.601, p = 0.002), treatment (χ2 = 9.135, p = 0.003), and the treatment × time × CRP × TG-HDL × BMI interaction (χ2 = 26.092, p < 0.001) on PCC-related depressive symptoms in the adjusted model. Moreover, the between-group analysis showed a significant improvement with vortioxetine at endpoint as compared to placebo (mean difference = - 5.41, SEM = 1.335, p < 0.001). CONCLUSION Overall, vortioxetine significantly improved depressive symptoms among participants with PCC in the adjusted model. Notably, individuals with baseline markers of increased inflammation, metabolic disruption, and elevated BMI exhibited a more pronounced antidepressant effect at endpoint. TRIAL REGISTRATION NUMBER NCT05047952 (ClinicalTrials.gov).
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Affiliation(s)
- Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Ziji Guo
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Sabrina Wong
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, USA
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | | | - Sebastian Badulescu
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Shakila Meshkat
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, People's Republic of China
| | - Joshua D Rosenblat
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Giacomo d'Andrea
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Donovan A Dev
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Lee Phan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | | | - Roger S McIntyre
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada.
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McIntyre RS, Phan L, Kwan ATH, Mansur RB, Rosenblat JD, Guo Z, Le GH, Lui LMW, Teopiz KM, Ceban F, Lee Y, Bailey J, Ramachandra R, Di Vincenzo J, Badulescu S, Gill H, Drzadzewski P, Subramaniapillai M. Vortioxetine for the treatment of post-COVID-19 condition: a randomized controlled trial. Brain 2024; 147:849-857. [PMID: 37936330 DOI: 10.1093/brain/awad377] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Hitherto no therapeutic has received regulatory approval for the treatment of post-COVID-19 condition (PCC). Cognitive deficits, mood symptoms and significant reduction in health-related quality of life (HRQoL) are highly replicated and debilitating aspects of PCC. We sought to determine the impact of vortioxetine on the foregoing symptoms and HRQoL in persons living with PCC. An 8-week randomized, double-blind, placebo-controlled study of adults ≥ 18 years of age residing in Canada and who are experiencing symptoms of World Health Organization (WHO)-defined PCC, with a history of confirmed SARS-CoV-2 infection, was conducted. Recruitment began November 2021 and ended January 2023. Of the 200 participants enrolled (487 invited: 121 ineligible and 59 eligible but declined participation; 307 cleared pre-screening stage), a total of 149 participants were randomized (1:1) to receive either vortioxetine (5-20 mg, n = 75) or placebo (n = 74) daily for 8 weeks of double-blind treatment (i.e. end point). The primary outcome was the change from baseline-to-end point in the Digit Symbol Substitution Test. Secondary outcomes included the effect on depressive symptoms and HRQoL, as measured by changes from baseline-to-end point on the Quick Inventory of Depressive Symptomatology 16-item and WHO Wellbeing Scale 5-item, respectively. A total of 68 (90.7%) participants randomized to vortioxetine and 73 (98.6%) participants randomized to placebo completed all 8 weeks. Between-group analysis did not show a significant difference in the overall change in cognitive function [P = 0.361, 95% confidence interval (CI) (-0.179, 0.492)]. However, in the fully adjusted model, a significant treatment × time interaction was observed in favour of vortioxetine treatment with baseline c-reactive protein (CRP) as a moderator (P = 0.012). In addition, a significant improvement in Digit Symbol Substitution Test scores were observed in vortioxetine versus placebo treated participants in those whose baseline CRP was above the mean (P = 0.045). Moreover, significant improvement was obtained in measures of depressive symptoms [P < 0.001, 95% CI (-4.378, -2.323)] and HRQoL [P < 0.001, 95% CI (2.297, 4.647)] in vortioxetine-treated participants and between the treatment groups [depressive symptoms: P = 0.026, 95% CI (-2.847, -0.185); HRQoL: P = 0.004, 95% CI (0.774, 3.938)]. Although vortioxetine did not improve cognitive function in the unadjusted model, when adjusting for CRP, a significant pro-cognitive effect was observed; antidepressant effects and improvement in HRQoL in this debilitating disorder were also noted.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Lee Phan
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Rodrigo B Mansur
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Joshua D Rosenblat
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Ziji Guo
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Leanna M W Lui
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON L8P 1H6, Canada
| | - Yena Lee
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Julia Bailey
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | - Ranuk Ramachandra
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
| | | | - Sebastian Badulescu
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Hartej Gill
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Pawel Drzadzewski
- Brain and Cognition Discovery Foundation, Toronto, ON M5S 1M2, Canada
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11
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Kwan ATH, Le GH, Guo Z, Ceban F, Teopiz KM, Rhee TG, Ho R, Di Vincenzo JD, Badulescu S, Meshkat S, Cao B, Rosenblat JD, Dev DA, Phan L, Subramaniapillai M, McIntyre RS. Impacts of metabolic disruption, body mass index and inflammation on cognitive function in post-COVID-19 condition: a randomized controlled trial on vortioxetine. Ann Gen Psychiatry 2024; 23:10. [PMID: 38424537 PMCID: PMC10905871 DOI: 10.1186/s12991-024-00494-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Post-COVID-19 Condition (PCC), as defined by the World Health Organization (WHO), currently lacks any regulatory-approved treatments and is characterized by persistent and debilitating cognitive impairment and mood symptoms. Additionally, metabolic dysfunction, chronic inflammation and the associated risks of elevated body mass index (BMI) have been reported. In this study, we aim to investigate the efficacy of vortioxetine in improving cognitive deficits in individuals with PCC, accounting for the interaction of metabolic dysfunction, elevated inflammation and BMI. METHODS This is a post-hoc analysis of an 8-week randomized, double-blind, placebo-controlled trial that was conducted among adults aged 18 years and older living in Canada who were experiencing WHO-defined PCC symptoms. The recruitment of participants began in November 2021 and concluded in January 2023. A total of 200 individuals were enrolled, where 147 were randomized in a 1:1 ratio to receive either vortioxetine (5-20 mg, n = 73) or placebo (n = 74) for daily treatment under double-blind conditions. The primary outcome measure was the change in the Digit Symbol Substitution Test (DSST) score from baseline to endpoint. RESULTS Our findings showed significant effects for time (χ2 = 7.771, p = 0.005), treatment (χ2 = 7.583, p = 0.006) and the treatment x time x CRP x TG-HDL x BMI interaction (χ2 = 11.967, p = 0.018) on cognitive function. Moreover, the between-group analysis showed a significant improvement with vortioxetine at endpoint (mean difference = 0.621, SEM = 0.313, p = 0.047). CONCLUSION Overall, vortioxetine demonstrated significant improvements in cognitive deficits among individuals with baseline markers of metabolic dysfunction, elevated inflammation and higher BMI at endpoint as compared to placebo. TRIAL REGISTRATION NCT05047952 (ClinicalTrials.gov; Registration Date: September 17, 2021).
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Affiliation(s)
- Angela T H Kwan
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ziji Guo
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Public Health Sciences, University of Connecticut School of Medicine, Storrs, USA
| | - Roger Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Joshua D Di Vincenzo
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Sebastian Badulescu
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Shakila Meshkat
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, 400715, P. R. China
| | - Joshua D Rosenblat
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Donovan A Dev
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Lee Phan
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Mehala Subramaniapillai
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, 77 Bloor Street West, Suite 617, Toronto, ON, M5S 1M2, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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12
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Gil-Sanchez A, Canudes M, Valcheva P, Nogueras L, González-Mingot C, Hervás JV, Peralta S, Solana M, Brieva L. Effects of Vortioxetine on Cognition and Fatigue in Patients with Multiple Sclerosis and Depression: A Case Series Study. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:395-401. [PMID: 36944623 DOI: 10.2174/1871527322666230321093133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Vortioxetine is a multimodal antidepressant drug that has been reported to have a positive impact on cognition, social function, and fatigue. Nevertheless, it has not been widely studied. Our objective was to explore the effects of vortioxetine on these and other parameters in patients with multiple sclerosis (MS) and depression. PATIENTS AND METHODOLOGY This observational case series study included patients with MS and depression who received treatment with vortioxetine for at least 6 months. The patient history of depression and depressive symptoms was assessed. A neuropsychiatric evaluation was carried out using different scales, both before and after treatment. RESULTS Of the 25 patients who enrolled in the study, 17 completed the treatment. Significant improvements were observed in health status (EQ-5D; p = 0.002), mood (Beck's Depression Inventory, BDI-II; p = 0.006), anxiety (State-Trait Anxiety Inventory, STAI-State; p = 0.021, and STAI-Trait; p = 0.011), and in the general health test (Short Form Health Survey, SF-36) for the vitality (p = 0.028) and mental health (p = 0.025) domains of the patients who completed the treatment. However, no statistically significant differences were observed in the cognitive tests related to attention, information processing speed, or fatigue. CONCLUSION In this population, vortioxetine treatment was effective in reducing the symptoms of depression and improving anxiety, vitality, and mental health. In contrast, it did not produce any improvement in cognition or fatigue but an increase in sample size would be necessary to confirm these results.
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Affiliation(s)
- Anna Gil-Sanchez
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Marc Canudes
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Petya Valcheva
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Lara Nogueras
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
| | - Cristina González-Mingot
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - José Vicente Hervás
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Silvia Peralta
- Multiple Sclerosis Foundation (FEM) of Lleida, Lleida, España
| | - Maria Solana
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
| | - Luis Brieva
- Institute of Biomedical Research (IRB) of Lleida, Neuroimmunology Group, Lleida, Spain
- Neurology Department, Arnau de Vilanova University Hospital of Lleida, Lleida, Spain
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13
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Vaiana AM, Asher AM, Tapia K, Morilak DA. Vortioxetine Reverses Impairment of Visuospatial Memory and Cognitive Flexibility Induced by Degarelix as a Model of Androgen Deprivation Therapy in Rats. Neuroendocrinology 2023; 114:279-290. [PMID: 38104552 PMCID: PMC10911168 DOI: 10.1159/000535365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Androgen deprivation therapy (ADT) is a mainstay treatment for prostate cancer, but many patients experience cognitive impairment in domains mediated by the medial prefrontal cortex (mPFC) and hippocampus. Prostate cancer typically occurs in older patients (>65 years). As age is often accompanied by cognitive decline, it may impact the efficacy of any treatment aimed at restoring cognitive impairment induced by ADT. Vortioxetine, a multimodal antidepressant that improves cognition in depression, has been shown to be efficacious in elderly patients. Therefore, vortioxetine may improve cognition in older patients who experience cognitive decline after ADT. METHODS Young (3 months) and middle-aged (13 months) rats were used to investigate the influence of age on treating ADT-induced cognitive decline. As our previous studies used surgical castration, we tested if vortioxetine would reverse cognitive deficits associated with more translationally relevant chemical castration using degarelix. Vortioxetine was given in the diet for 21 days. Animals underwent behavioral testing to assess visuospatial memory mediated by the hippocampus and cognitive flexibility mediated by the mPFC. We also investigated changes in afferent-evoked responses in these regions in middle-aged rats. RESULTS Degarelix induced impairments in both visuospatial memory and cognitive flexibility that were reversed by vortioxetine. Vortioxetine also rescued afferent-evoked responses in the mPFC and hippocampus. However, modest age-related reductions in baseline visuospatial memory limited our ability to detect further decreases induced by degarelix in middle-aged rats due to a floor effect. CONCLUSION These results suggest that vortioxetine may be a treatment option for older prostate cancer patients who experience cognitive decline after ADT.
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Affiliation(s)
- Alexandra M. Vaiana
- Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, USA
| | - Amber M. Asher
- Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, USA
| | - Karla Tapia
- Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA
| | - David A. Morilak
- Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, USA
- South Texas Veterans Health Care System, San Antonio, TX, USA
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14
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Vaiana AM, Chen Y, Gelfond J, Johnson-Pais TL, Leach RJ, Ramamurthy C, Thompson IM, Morilak DA. Effects of vortioxetine on hippocampal-related cognitive impairment induced in rats by androgen deprivation as a model of prostate cancer treatment. Transl Psychiatry 2023; 13:307. [PMID: 37788996 PMCID: PMC10547695 DOI: 10.1038/s41398-023-02600-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023] Open
Abstract
Advances in prostate cancer treatment have significantly improved survival, but quality of life for survivors remains an under-studied area of research. Androgen deprivation therapy (ADT) is a foundational treatment for advanced prostate cancer and is used as an adjuvant for prolonged periods in many high-risk, localized tumors. More than half of patients treated with ADT experience debilitating cognitive impairments in domains such as spatial learning and working memory. In this study, we investigated the effects of androgen deprivation on hippocampal-mediated cognition in rats. Vortioxetine, a multimodal antidepressant, has been shown to improve cognition in depressed patients. Thus, we also tested the potential efficacy of vortioxetine in restoring impaired cognition after ADT. We further investigated mechanisms that might contribute to these effects, measuring changes in the circuitry and gene expression within the dorsal hippocampus. ADT via surgical castration induced impairments in visuospatial cognition on the novel object location test and attenuated afferent-evoked local field potentials recorded in the CA1 region of the dorsal hippocampus. Chronic dietary administration of vortioxetine effectively reversed these deficits. Castration significantly altered gene expression in the hippocampus, whereas vortioxetine had little effect. Pathway analysis revealed that androgen depletion altered pathways related to synaptic plasticity. These results suggest that the hippocampus may be vulnerable to ADT, contributing to cognitive impairment in prostate cancer patients. Further, vortioxetine may be a candidate to improve cognition in patients who experience cognitive decline after androgen deprivation therapy for prostate cancer and may do so by restoring molecular and circuit-level plasticity-related mechanisms compromised by ADT.
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Affiliation(s)
- Alexandra M Vaiana
- Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Yidong Chen
- Greehey Children's Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Jonathan Gelfond
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Teresa L Johnson-Pais
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Department of Urology, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Robin J Leach
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Department of Cell Systems & Anatomy, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Chethan Ramamurthy
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, 78229, USA
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - Ian M Thompson
- Department of Urology, University of Texas Health Science Center, San Antonio, TX, 78229, USA
| | - David A Morilak
- Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, 78229, USA.
- Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, 78229, USA.
- Mays Cancer Center, University of Texas Health Science Center, San Antonio, TX, 78229, USA.
- South Texas Veterans Health Care System, San Antonio, TX, 78229, USA.
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15
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Christensen MC, Schmidt SN, Grande I. Effectiveness of vortioxetine in patients with major depressive disorder and early-stage dementia: The MEMORY study. J Affect Disord 2023; 338:423-431. [PMID: 37315590 DOI: 10.1016/j.jad.2023.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Depression and dementia are highly prevalent in older adults and often co-occur. This Phase IV study investigated the effectiveness and tolerability of vortioxetine in improving depressive symptoms, cognitive performance, daily and global functioning and health-related quality of life (HRQoL) in patients with major depressive disorder (MDD) and comorbid early-stage dementia. METHODS Patients (n = 82) aged 55-85 years with a primary diagnosis of MDD (onset before age 55 years) and comorbid early-stage dementia (diagnosed ≥6 months before screening and after onset of MDD; Mini-Mental State Examination-2 total score, 20-24) received vortioxetine for 12 weeks (initiated at 5 mg/day and up-titrated to 10 mg/day at day 8, with flexible dosing thereafter [5-20 mg/day]). The primary endpoint was change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total score at week 12. RESULTS Significant improvement in depressive symptom severity was seen from week 1 onwards (P < 0.0001). At week 12, the least-square mean (standard error) change in MADRS total score from baseline was -12.4 (0.78). Significant improvements in cognitive performance were observed (from week 1 for the Digit Symbol Substitution Test and week 4 for the Rey Auditory Verbal Learning Test). Patients also experienced significant improvements in daily and global functioning, and HRQoL. Vortioxetine was well tolerated. From week 4 onwards, more than 50 % of patients were receiving 20 mg/day. LIMITATIONS Open-label study. CONCLUSIONS Vortioxetine demonstrated effectiveness in clinically significantly improving depressive symptoms, cognitive performance, daily and global functioning, and HRQoL in patients with MDD and comorbid early-stage dementia treated for 12 weeks. TRIAL REGISTRATION ClinicalTrials.gov/ct2/show/NCT04294654.
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Affiliation(s)
| | | | - Iria Grande
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, University of Barcelona, Barcelona, Spain; Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Neurosciences of the University of Barcelona (UBNeuro), Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Subhas N, Ang JK, Tan KA, Ahmad SNA. Relations between clinical characteristics and cognitive deficits among adult patients diagnosed with major depressive disorder. Int J Psychiatry Clin Pract 2023; 27:219-231. [PMID: 36448673 DOI: 10.1080/13651501.2022.2149415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/20/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The present study examined the relations between clinical characteristics and cognitive deficits in adult patients with major depressive disorder (MDD) from a local outpatient psychiatric clinic in Malaysia. METHODS The present sample included 110 participants aged 20-60 years old. Participants were invited to provide their information on sociodemographic variables (age, gender, and educational level) and clinical characteristics (age at onset of depression and duration of illness) and to complete a series of cognitive performance measures including the Trail Making Tests A (psychomotor speed) and B (executive function), the Digit Symbol Substitution Test (attention), and the Auditory Verbal Learning Test (immediate free recall, acquisition phase, and delayed recall). The Mini International Neuropsychiatric Interview Version 6.0 was used to confirm the diagnosis of MDD and the Montgomery-Åsberg Depression Rating Scale was used to assess illness severity. RESULTS At the bivariate level, relations of age and educational level to all cognitive deficit domains were significant. At the multivariate level, only educational level and illness severity consistently and significantly predicted all cognitive deficits domains. CONCLUSIONS Therapeutic modalities should be individualised whilst considering the impacts of cognitive deficits in an attempt to prevent further deterioration in psychosocial functioning of MDD patients.KEY POINTSCognitive deficits are an elemental component of Major Depressive Disorder (MDD) persisting during a current major depressive episode or during remission, altering individuals' ability to process information and changes the way they perceive and interact with the environment.Cognitive deficits in MDD are evident among the upper-middle income groups in South-Eastern Asian countries warranting more local research as such deficits could lead to functional decline and work performance such as absenteeism and presenteeism.Therapeutic modalities should be individualised by taking the impacts of cognitive deficits into consideration to promote psychosocial functioning of MDD patients.
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Affiliation(s)
- Natasha Subhas
- Department of Psychiatry and Mental Health, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Jin Kiat Ang
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Siti Nor Aizah Ahmad
- Department of Psychiatry and Mental Health, Hospital Umum Sarawak, Ministry of Health, Kuching, Malaysia
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Mouta S, Fonseca Vaz I, Pires M, Ramos S, Figueiredo D. What do we know about pseudodementia? Gen Psychiatr 2023; 36:e100939. [PMID: 37622032 PMCID: PMC10445398 DOI: 10.1136/gpsych-2022-100939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 07/26/2023] [Indexed: 08/26/2023] Open
Abstract
Depression and dementia can lead to generalised cognitive and memory dysfunction. Thus, differentiating these disorders is important and challenging. Pseudodementia is a term used clinically to describe symptoms that resemble dementia but are caused by other conditions (most frequently depression), rather than being recognised as an official diagnosis. Pseudodementia is characterised by a cognitive impairment that mimics dementia but which does not have its origin in neurological degeneration, deriving instead from functional psychiatric conditions. This condition is more commonly observed in older adults (particularly those over the age of 50 or 60 years), and its risk factors overlap with those for depression. Pseudodementia is essentially characterised by deficits in memory, executive function and speech and, therefore, can easily be confused with dementia, although there are aspects that allow its differentiation. Diagnosing pseudodementia can be difficult, especially as there is significant overlap between its symptoms and those of other conditions. However, it is important to recognise characteristic aspects of this disorder, as its correct identification is essential for proper treatment.
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Affiliation(s)
- Salomé Mouta
- Departamento de Psiquiatria e Saúde Mental, Unidade Local de Saude da Guarda EPE, Guarda, Portugal
| | - Isabel Fonseca Vaz
- Departamento de Psiquiatria e Saúde Mental, Unidade Local de Saude da Guarda EPE, Guarda, Portugal
| | - Miguel Pires
- Departamento de Psiquiatria e Saúde Mental, Unidade Local de Saude da Guarda EPE, Guarda, Portugal
| | - Sara Ramos
- Departamento de Saúde Mental, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Portugal
| | - Diana Figueiredo
- Departamento de Psiquiatria e Saúde Mental, Unidade Local de Saude da Guarda EPE, Guarda, Portugal
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Zhang J, Zhang A. Relationships between serum Klotho concentrations and cognitive performance among older chronic kidney disease patients with albuminuria in NHANES 2011-2014. Front Endocrinol (Lausanne) 2023; 14:1215977. [PMID: 37560310 PMCID: PMC10407554 DOI: 10.3389/fendo.2023.1215977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
Background The potential relationship between Klotho and cognitive function is limited and controversial. This study aimed to quantify the association of Klotho and cognitive impairment in chronic kidney disease (CKD) patients with albuminuria. Methods Serum Klotho was measured by enzyme-linked immunosorbent assay. Patients with urine albumin to creatinine ratio (UACR) > 30mg/g from the National Health and Nutrition Survey (NHANES) 2011-2014 were divided into 4 groups according to the quartile of Klotho. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), Digit Symbol Substitution Test (DSST), and Animal Fluency Test. The relationship between Klotho and cognitive function was analyzed by multivariable regression and subgroup analysis. Results Among 368 CKD patients with albuminuria, we found that Klotho was negatively associated with creatinine, and positively associated with hemoglobin, and estimated glomerular filtration rate. No significant linear relationship was showed between Klotho (as a continuous variable) and cognitive function. When regarded Klotho as a category variable, patients in the quartile 3 group were at a better cognitive performance for CEARD-word learning subset and DSST, especially in the CKD patients with 30 mg/g < UACR <300 mg/g, but not in participants with UACR > 300 mg/g. Conclusions The increased Klotho was associated with an increased cognitive function in CKD patients with microalbuminuria. Further studies are needed to demonstrate whether Klotho may be a beneficial biomarker of cognitive health and neurodegeneration.
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Affiliation(s)
- Jialing Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
- The National Clinical Research Center for Geriatric Disease, Xuanwu Hospital, Capital Medical University, Beijing, China
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19
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Witkin JM, Golani LK, Smith JL. Clinical pharmacological innovation in the treatment of depression. Expert Rev Clin Pharmacol 2023; 16:349-362. [PMID: 37000975 DOI: 10.1080/17512433.2023.2198703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Deficiencies in standard of care antidepressants are driving novel drug discovery. A new age of antidepressant medications has emerged with the introduction of rapid-acting antidepressants with efficacy in treatment-resistant patients. AREAS COVERED The newly approved medicines and those in clinical development for major depressive disorder (MDD) are documented in this scoping review of newly approved and emerging antidepressants. Compounds are evaluated for clinical efficacy, tolerability, and safety and compared to those of standard of care medicines. EXPERT OPINION A new age of antidepressant discovery relies heavily on glutamatergic mechanisms. New medicines based upon the model of ketamine have been delivered and are in clinical development. Rapid onset and the ability to impact treatment-resistant depression, raises the question of the best first-line medicines for patients. Drugs with improvements in tolerability are being investigated (e.g. mGlu2/3 receptor antagonists, AMPA receptor potentiators, and novel NMDA receptor modulators). Multiple companies are working toward the identification of novel psychedelic drugs where the requirement for psychedelic activity is not fully known. Gaps still exist - methods for matching patients with specific medicines are needed, and medicines for the prevention of MDD and its disease progression need research attention.
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Affiliation(s)
- Jeffrey M Witkin
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent Hospital, Indianapolis, IN, USA
- Departments of Neuroscience and Trauma Research, Ascension St. Vincent Hospital, Indianapolis, IN USA
| | - Lalit K Golani
- Department of Chemistry and Chemical Biology, Northeastern University, Boston, MA, USA
| | - Jodi L Smith
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent Hospital, Indianapolis, IN, USA
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20
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Johnson DE, McIntyre RS, Mansur RB, Rosenblat JD. An update on potential pharmacotherapies for cognitive impairment in bipolar disorder. Expert Opin Pharmacother 2023; 24:641-654. [PMID: 36946229 DOI: 10.1080/14656566.2023.2194488] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Cognitive impairment is a core feature of bipolar disorder (BD) that impedes recovery by preventing the return to optimal socio-occupational functioning and reducing quality of life. Presently, there are no efficacious treatments for cognitive impairment in BD, but many pharmacological interventions are being considered as they have the potential to target the underlying pathophysiology of the disorder. AREAS COVERED This review summarizes the available evidence for pharmacological interventions for cognitive impairment in bipolar disorder. We searched PubMed, MedLine, and PsycInfo from inception to December 1st, 2022. Traditional treatments, such as lithium, anticonvulsants (lamotrigine), antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, and olanzapine), antidepressants (vortioxetine, fluoxetine, and tianeptine) and psychostimulants (modafinil), and emerging interventions, such as acetylcholinesterase inhibitors (galantamine and donepezil), dopamine agonists (pramipexole), erythropoietin, glucocorticoid receptor antagonists (mifepristone), immune modulators (infliximab, minocycline and doxycycline), ketamine, metabolic agents (insulin, metformin, and liraglutide), probiotic supplements, and Withania somnifera are discussed. EXPERT OPINION The investigation of interventions for cognitive impairment in BD is a relatively under-researched area. In the past, methodological pitfalls in BD cognition trials have also been a critical limiting factor. Expanding on the existing literature and identifying novel pharmacological and non-pharmacological treatments for cognitive impairment in BD should be a priority.
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Affiliation(s)
- Danica E Johnson
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Institute of Medical Science, University of Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry and Pharmacology, University of Toronto, Canada
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit (MDPU), Toronto Western Hospital, University Health Network, Canada
- Department of Psychiatry, University of Toronto, Canada
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21
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Di Nicola M, Pepe M, Montanari S, Spera MC, Panaccione I, Simonetti A, Sani G. Vortioxetine improves physical and cognitive symptoms in patients with post-COVID-19 major depressive episodes. Eur Neuropsychopharmacol 2023; 70:21-28. [PMID: 36808043 PMCID: PMC9905099 DOI: 10.1016/j.euroneuro.2023.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
Major Depressive Episodes (MDE) following COVID-19 are frequent, can have a characteristic clinical picture, and are associated with immune-inflammatory changes. Vortioxetine is known to improve physical and cognitive performance in patients with depression and shows anti-inflammatory and anti-oxidative activities. This study aimed to retrospectively evaluate the effects of vortioxetine after 1 and 3 months of treatment in 80 patients (44.4% males, 54±17.2 years) with post-COVID-19 MDE. The primary outcome was improvement in physical and cognitive symptoms measured by specific items of Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), Short Form-36 Health Survey Questionnaire (SF-36), Digit Symbol Substitution Test (DSST), Perceived Deficits Questionnaire for Depression (PDQ-D5). Changes in mood, anxiety, anhedonia, sleep, and quality of life were also investigated, as well as the underlying inflammatory status. Results show that, alongside reduction of depressive symptoms (HDRS, p<0.001), vortioxetine (mean dose: 10.1±4.1 mg/day) significantly improved physical features (all measurements p<0.001) and cognitive functioning (DDST, p=0.02; PDQ-D5, p<0.001) throughout treatment. We also observed significant reductions in inflammatory indexes. Therefore, vortioxetine might be a favorable therapeutic choice in post-COVID-19 patients with MDE because of its beneficial effects on physical complaints and cognition, features that appear to be specifically affected in relation to SARS-CoV-2 infection, and its good safety/tolerability profile. High prevalence and clinical and socioeconomic implications of COVID-19 consequences are a major public health concern and developing tailored, safe interventions is crucial to promote full functional recovery.
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Affiliation(s)
- Marco Di Nicola
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Maria Pepe
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Montanari
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Chiara Spera
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alessio Simonetti
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Gabriele Sani
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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22
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Cumbo E, Adair M, Åstrom DO, Christensen MC. Effectiveness of vortioxetine in patients with major depressive disorder and comorbid Alzheimer's disease in routine clinical practice: An analysis of a post-marketing surveillance study in South Korea. Front Aging Neurosci 2023; 14:1037816. [PMID: 36698860 PMCID: PMC9868833 DOI: 10.3389/fnagi.2022.1037816] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/28/2022] [Indexed: 01/12/2023] Open
Abstract
Background Vortioxetine has demonstrated procognitive effects in patients with major depressive disorder (MDD). We assessed the effectiveness and safety of vortioxetine in a cohort of patients with MDD and comorbid Alzheimer's disease participating in a large post-marketing surveillance study in South Korea. Methods Subgroup analysis of a 6-month, prospective, multicenter, non-interventional cohort study in outpatients with MDD with a pre-baseline diagnosis of Alzheimer's disease receiving vortioxetine in routine care settings (n = 207). Patients were assessed at baseline and after 8 weeks; a subset of patients was also assessed after 24 weeks. Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) scale, cognitive symptoms using the Perceived Deficits Questionnaire-Depression, Korean version (PDQ-K), and cognitive performance using the Digit Symbol Substitution Test (DSST). Results Most patients were receiving a mean daily vortioxetine dose of 5 mg/day (174/190 patients; 91.6%). After 24 weeks of vortioxetine treatment, 71.4% of patients (40/56) had experienced overall clinical improvement (i.e., CGI-Improvement score ≤3) and 51.9% (28/54) had achieved remission from depressive symptoms (i.e., MADRS total score ≤10 points). Respective mean changes in MADRS, PDQ-K, and DSST total scores from baseline to week 24 were -11.5 (p < 0.0001), -5.1 (p = 0.03), and +3.8 points (p = 0.0524). Adverse events were reported by 27 patients (13.0%) and were mostly mild (89.2%). Conclusion Patients with MDD and comorbid Alzheimer's disease receiving vortioxetine in routine care settings in South Korea demonstrated clinically meaningful improvements in depressive symptoms, cognitive symptoms, and objective cognitive performance over the 6-month treatment period. Treatment with vortioxetine was well tolerated in this patient cohort, with reported adverse events consistent with the established tolerability profile of vortioxetine.
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Affiliation(s)
- Eduardo Cumbo
- Neurodegenerative Disorders Unit, ASP 2 Caltanissetta, Caltanissetta, Italy
| | - Michael Adair
- H. Lundbeck A/S, Valby, Denmark,*Correspondence: Michael Adair,
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23
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Sun X, Yu W, Wang M, Hu J, Li Y. Association between rest-activity rhythm and cognitive function in the elderly: The U.S. National Health and Nutrition Examination Survey, 2011-2014. Front Endocrinol (Lausanne) 2023; 14:1135085. [PMID: 36967786 PMCID: PMC10034093 DOI: 10.3389/fendo.2023.1135085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Circadian rhythm plays an essential role in various physiological and pathological processes related to cognitive function. The rest-activity rhythm (RAR) is one of the most prominent outputs of the circadian system. However, little is known about the relationships between RAR and different domains of cognitive function in older adults. The purpose of this study was to examine the relationships between RAR and various fields of cognitive function in older Americans. METHODS This study included a total of 2090 older adults ≥ 60 years old from the National Health and Nutrition Examination Survey (NHANES) in 2011-2014. RAR parameters were derived from accelerometer recordings. Cognitive function was assessed using the word learning subtest developed by the Consortium to Establish a Registry for Alzheimer's disease (CERAD W-L), the Animal Fluency Test (AFT) and the Digital Symbol Substitution Test (DSST). Linear regression was used to determine the relationships between RAR parameters (IS, IV, RA, L5, M10) and cognitive function scores (CERAD W-L, AFT, DSST). RESULTS After adjusting for potential confounders, lower IS and M10 were associated with lower CERAD W-L scores (P=0.033 and P=0.002, respectively). Weaker RA and higher L5 were associated with lower AFT scores (P<0.001 and P=0.001, respectively). And lower IS, RA, and higher L5 were associated with lower DSST scores (P=0.019, P<0.001 and P<0.001, respectively). In addition, the results of sensitivity analysis were similar to those of our main analyses. The main correlation results between the RAR indicators and cognitive function were robust. CONCLUSIONS This study suggested that the weakened and/or disrupted RAR was associated with cognitive decline in different domains in Americans over the age of 60.
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Affiliation(s)
- Xinyi Sun
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- National Key Discipline, Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, China
| | - Weiwei Yu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Mingsi Wang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
- *Correspondence: Yunong Li, ; Jun Hu, ; Mingsi Wang,
| | - Jun Hu
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Yunong Li, ; Jun Hu, ; Mingsi Wang,
| | - Yunong Li
- Department of Neurology, Peking University Shenzhen Hospital, Shenzhen, China
- *Correspondence: Yunong Li, ; Jun Hu, ; Mingsi Wang,
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24
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Perlman G, Cogo-Moreira H, Wu CY, Herrmann N, Swardfager W. Depression interacts with allostatic load to predict cognitive decline in middle age. Psychoneuroendocrinology 2022; 146:105922. [PMID: 36150368 DOI: 10.1016/j.psyneuen.2022.105922] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Allostatic load (AL) indicates the cumulative impact of stress on homeostatic mechanisms. Depression and AL have been associated with cognitive deficits, but it is unclear if they do so independently. METHODS Using data from middle-aged participants in the observational longitudinal Midlife in the United States (MIDUS) study (n = 704, 57.5 % female, 63.8 ± 10.6 years old in 2014), we assessed whether the effect of prior depression (Composite International Diagnostic Interview Short-Form in 1995) on cognitive decline between 2004 and 2013 (composite Z-scores derived from the Brief Test of Adult Cognition by Telephone and the Stop & Go Switch Task) was moderated by AL Z-scores in 2004 (calculated from biomarkers in blood, urine, and electrocardiography). RESULTS A significant depression × AL interaction predicted a decline in a composite cognitive score (β = -0.066, SE=0.029, p = 0.024) and executive function (β = -0.068, SE=0.025, p = 0.007). Depression predicted a decline in composite cognition among those with AL Z-scores above - 0.055. AL subdomains of inflammation and lipid metabolism showed evidence of moderation. CONCLUSION Middle-aged adults with depression who had higher allostatic load were at greater risk of cognitive decline. Future studies should evaluate whether the interaction predicts incident dementia, and whether interventions targeting depression or elevated AL in people who have both can attenuate cognitive decline.
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Affiliation(s)
- George Perlman
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada
| | - Hugo Cogo-Moreira
- Department of Education, ICT and Learning, Østfold University College, P.O.Box 700, NO-1757, Halden, Norway
| | - Che-Yuan Wu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto M5T 1R8, Canada
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto M4N 3M5, Canada; Department of Pharmacology & Toxicology, University of Toronto, 1 King's College Circle, Toronto M5S 1A8, Canada; Sleep and Cardiopulmonary Program, University Health Network - Toronto Rehabilitation Institute, 347 Rumsey Road, Toronto M4G 2V6, Canada.
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25
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Colwell MJ, Tagomori H, Chapman S, Gillespie AL, Cowen PJ, Harmer CJ, Murphy SE. Pharmacological targeting of cognitive impairment in depression: recent developments and challenges in human clinical research. Transl Psychiatry 2022; 12:484. [PMID: 36396622 PMCID: PMC9671959 DOI: 10.1038/s41398-022-02249-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/18/2022] Open
Abstract
Impaired cognition is often overlooked in the clinical management of depression, despite its association with poor psychosocial functioning and reduced clinical engagement. There is an outstanding need for new treatments to address this unmet clinical need, highlighted by our consultations with individuals with lived experience of depression. Here we consider the evidence to support different pharmacological approaches for the treatment of impaired cognition in individuals with depression, including treatments that influence primary neurotransmission directly as well as novel targets such as neurosteroid modulation. We also consider potential methodological challenges in establishing a strong evidence base in this area, including the need to disentangle direct effects of treatment on cognition from more generalised symptomatic improvement and the identification of sensitive, reliable and objective measures of cognition.
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Affiliation(s)
- Michael J Colwell
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Hosana Tagomori
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sarah Chapman
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Amy L Gillespie
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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26
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Almeida SS, Christensen MC, Simonsen K, Adair M. Effectiveness of vortioxetine in patients with major depressive disorder and co-morbid generalized anxiety disorder in routine clinical practice: A subgroup analysis of the RELIEVE study. J Psychopharmacol 2022; 37:279-288. [PMID: 36377523 PMCID: PMC10076342 DOI: 10.1177/02698811221132468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is commonly co-morbid with major depressive disorder (MDD) and is associated with greater functional impairment and poorer treatment outcomes than MDD alone. However, studies on treatment with drugs for depression in patients with MDD and co-morbid GAD are limited. AIMS To examine the effectiveness of vortioxetine treatment in patients with MDD and co-morbid GAD in a subgroup analysis of the real-world RELIEVE study. METHODS The analysis included outpatients diagnosed with MDD and co-morbid GAD who initiated vortioxetine treatment at their physician's discretion in the 24-week, observational RELIEVE study. Primary outcome was patient functioning (Sheehan Disability Scale (SDS)) after 12 and 24 weeks of vortioxetine treatment; secondary outcomes included depression severity (9-item Patient Health Questionnaire (PHQ-9)), cognitive symptoms (5-item Perceived Deficits Questionnaire - Depression (PDQ-D-5)) and cognitive performance (Digit Symbol Substitution Test (DSST)). RESULTS Overall, 180 patients with MDD and co-morbid GAD were included in the analysis. Following vortioxetine initiation, clinically significant improvements in patient functioning (SDS total score) were observed at week 12 (least-squares (LS) mean reduction from baseline, 7.5 points), sustained through week 24 (9.2 points) (both p < 0.0001). LS mean PHQ-9, PDQ-D-5 and DSST scores improved by 7.9, 4.8 and 7.4 points at week 24, respectively (all p < 0.0001 vs baseline). Adverse events were reported by 33.9% of patients (most commonly nausea, 13.3%). CONCLUSIONS In routine clinical practice, vortioxetine was associated with clinically meaningful, sustained improvements in functioning, and depressive and cognitive symptoms, in patients with MDD and co-morbid GAD. CLINICAL TRIALS REGISTRY NAME AND IDENTIFIER Real-life Effectiveness of Vortioxetine in Depression (RELIEVE) (NCT03555136) https://clinicaltrials.gov/ct2/show/NCT03555136.
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Affiliation(s)
- Susana S Almeida
- Psychiatry Service, Instituto Português de Oncologia, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
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27
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McIntyre RS, Lipsitz O, Rodrigues NB, Subramaniapillai M, Nasri F, Lee Y, Fehnert B, King J, Chrones L, Kratiuk K, Uddin S, Rosenblat JD, Mansur RB, McCue M. An App-Based Digit Symbol Substitution Test for Assessment of Cognitive Deficits in Adults With Major Depressive Disorder: Evaluation Study. JMIR Ment Health 2022; 9:e33871. [PMID: 36301615 PMCID: PMC9650567 DOI: 10.2196/33871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 06/29/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is an impairing core symptom of depression. Among adults with major depressive disorder (MDD) treated with antidepressants, residual cognitive symptoms interfere with patient-reported outcomes. The foregoing characterization of cognitive symptoms provides the rationale for screening and assessing the severity of cognitive symptoms at point of care. However, clinical neurocognitive assessments are time-consuming and difficult, and they require specialist expertise to interpret them. A smartphone-delivered neurocognitive test may offer an effective and accessible tool that can be readily implemented into a measurement-based care framework. OBJECTIVE We aimed to evaluate the use of a smartphone-delivered app-based version of the established Cognition Kit Digit Symbol Substitution Test (DSST) neurocognitive assessment compared to a traditional paper-and-pencil version. METHODS Convergent validity and test-retest reliability of the 2 versions were evaluated. Patient satisfaction with the app was also assessed. RESULTS Assessments made using the app-based Cognition Kit DSST were highly correlated with the standard paper-and-pencil version of the test, both at the baseline visit (r=0.69, df=27; P<.001) and at the end-of-study visit (r=0.82, df=27; P<.001), and they were positively evaluated by 30 patients as being user-friendly, easy to navigate, and preferable over the paper-and-pencil version of the DSST. However, although the app-based Cognition Kit DSST was validated in patients with MDD, it still needs to be evaluated in healthy controls. CONCLUSIONS App-based DSST may facilitate a more personalized, convenient, and cost-effective method of cognitive assessment, helping to guide measurement-based care and psychotherapeutic and pharmacologic treatment options for patients with MDD. TRIAL REGISTRATION ClinicalTrials.gov NCT03999567; https://tinyurl.com/2p8pnyv7.
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Affiliation(s)
- Roger S McIntyre
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Orly Lipsitz
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Nelson B Rodrigues
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Mehala Subramaniapillai
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Flora Nasri
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada
| | - Ben Fehnert
- Ctrl Group, London, United Kingdom.,Cognition Kit, Cambridge, United Kingdom
| | - James King
- Cognition Kit, Cambridge, United Kingdom
| | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Sharif Uddin
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Joshua D Rosenblat
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Brain and Cognition Discovery Foundation, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Rodrigo B Mansur
- University Health Network, Mood Disorders Psychopharmacology Unit, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
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28
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Pilc A, Machaczka A, Kawalec P, Smith JL, Witkin JM. Where do we go next in antidepressant drug discovery? A new generation of antidepressants: a pivotal role of AMPA receptor potentiation and mGlu2/3 receptor antagonism. Expert Opin Drug Discov 2022; 17:1131-1146. [PMID: 35934973 DOI: 10.1080/17460441.2022.2111415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Major depressive disorder remains a prevalent world-wide health problem. Currently available antidepressant medications take weeks of dosing, do not produce antidepressant response in all patients, and have undesirable ancillary effects. AREAS COVERED The present opinion piece focuses on the major inroads to the creation of new antidepressants. These include N-methyl-D-aspartate (NMDA) receptor antagonists and related compounds like ketamine, psychedelic drugs like psilocybin, and muscarinic receptor antagonists like scopolamine. The preclinical and clinical pharmacological profile of these new-age antidepressant drugs is discussed. EXPERT OPINION Preclinical and clinical data have accumulated to predict a next generation of antidepressant medicines. In contrast to the current standard of care antidepressant drugs, these compounds differ in that they demonstrate rapid activity, often after a single dose, and effects that outlive their presence in brain. These compounds also can provide efficacy for treatment-resistant depressed patients. The mechanism of action of these compounds suggests a strong glutamatergic component that involves the facilitation of AMPA receptor function. Antagonism of mGlu2/3 receptors is also relevant to the antidepressant pharmacology of this new class of drugs. Based upon the ongoing efforts to develop these new-age antidepressants, new drug approvals are predicted in the near future.
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Affiliation(s)
- Andrzej Pilc
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.,Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Agata Machaczka
- Department of Neurobiology, Maj Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland
| | - Paweł Kawalec
- Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Jodi L Smith
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA
| | - Jeffrey M Witkin
- Laboratory of Antiepileptic Drug Discovery, Ascension St. Vincent, Indianapolis, IN, USA
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Vortioxetine for Major Depressive Disorder in Adolescents: 12-Week Randomized, Placebo-Controlled, Fluoxetine-Referenced, Fixed-Dose Study. J Am Acad Child Adolesc Psychiatry 2022; 61:1106-1118.e2. [PMID: 35033635 DOI: 10.1016/j.jaac.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 11/23/2021] [Accepted: 01/06/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of vortioxetine in adolescents with major depressive disorder (MDD). METHOD After 4 weeks of single-blind lead-in treatment with a Brief Psychosocial Intervention (BPI) plus placebo, patients (aged 12-17 years) with MDD (DSM-5) who did not meet response criteria (Children's Depression Rating Scale-Revised [CDRS-R]; total score ≥40 plus <40% reduction and a Parent Global Assessment score >2) were randomized 1:1:1:1 to 8 weeks of BPI plus double-blind treatment with vortioxetine 10 mg, vortioxetine 20 mg, fluoxetine 20 mg, or placebo. The primary endpoint was change from randomization in CDRS-R total score at week 8; the primary comparison was the average effect of 2 vortioxetine doses vs placebo. RESULTS Of 784 patients enrolled in the lead-in, 616 were randomized. At week 8, the mean change in CDRS-R total score averaged for vortioxetine doses was -18.01 (SE = 0.98) and the mean difference vs placebo was 0.21 (P = .878; not significant). For fluoxetine, the mean change in CDRS-R total score was -21.95 and the mean difference vs placebo was -3.73 (P = .015). Treatment-emergent adverse events occurring in ≥5% of patients in either vortioxetine arm and at least twice more frequently than placebo were nausea, headache, vomiting, and dizziness. CONCLUSION Patients in all groups showed reduction in CDRS-R scores by the end of the study, with no difference between combined doses of vortioxetine and placebo. The primary endpoint was not met, thereby rendering the study negative. The overall favorable safety profile of vortioxetine in an adolescent patient population was consistent with that seen in adults. CLINICAL TRIAL REGISTRATION INFORMATION Active Reference (Fluoxetine) Fixed-Dose Study of Vortioxetine in Paediatric Patients Aged 12 to 17 Years With Major Depressive Disorder (MDD); http://clinicaltrials.gov; NCT02709746.
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Hong J, Vernon D, Kunovac J, Stahl S. Emerging drugs for the treatment of major depressive disorder. Expert Opin Emerg Drugs 2022; 27:263-275. [PMID: 36039863 DOI: 10.1080/14728214.2022.2117297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Major depressive disorder (MDD) continues to be one of the highest contributors to disease burden and years lived with disability in the world. Current existing treatments have been associated with intolerable side effects, long onset of action and suboptimal remission rates. Newer agents are being developed that will be reviewed here, such as glutamate and gamma-aminobutyric acid (GABA) and the reinvigorated testing of psychedelic drugs. This review will summarize the target mechanisms of the newer ADTs currently in development and available on the market. AREAS COVERED It briefly covers the existing agents for MDD and treatment-resistant depression (TRD) and the need for new agents with higher efficacy. Therapeutic agents currently in Phase II or later clinical trials are listed and discussed, based on a thorough review of the US National Institutes of Health clinicaltrials.gov index and a search of the Informa Pharmaprojects database. Compounds of interest are grouped into scientific rationale and include atypical antipsychotics, GABA positive allosteric modulators, glutamatergic agents, opioids, orexin 2 receptor antagonists, and psychedelics. EXPERT OPINION New therapeutic agents currently in development are promising, with a more rapid onset of action and the ability to augment and treat TRD.
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Affiliation(s)
- Jennifer Hong
- Department of Psychiatry, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Darian Vernon
- Department of Psychiatry, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Jelena Kunovac
- Department of Psychiatry, University of Nevada Las Vegas, Las Vegas, NA, USA
| | - Stephen Stahl
- Department of Psychiatry, University of California, San Diego, CA, USA
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Huang IC, Chang TS, Chen C, Sung JY. Effect of Vortioxetine on Cognitive Impairment in Patients With Major Depressive Disorder: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Int J Neuropsychopharmacol 2022; 25:969-978. [PMID: 35981958 PMCID: PMC9743961 DOI: 10.1093/ijnp/pyac054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/26/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Dementia and depression are increasingly common worldwide, and their effective control could ease the burden on economies, public health systems, and support networks. Vortioxetine is a new antidepressant with multipharmacologic actions that elevate the concentration of serotonin and modulate multiple neurotransmitter receptors in the brain. We conducted a meta-analysis to explore whether the cognitive function of patients with major depressive disorder (MDD) treated with vortioxetine would improve. METHODS We systematically reviewed randomized controlled trials (RCTs) in the PubMed, Embase, and Cochrane databases to assess the treatment effects of vortioxetine on the cognitive function of patients with MDD. The outcome measures included the Digit Symbol Substitution Test (DSST), Perceived Deficits Questionnaire (PDQ), and Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Pooled results were calculated using a fixed-effects or random-effects model according to the heterogeneity of the included trials. RESULTS Six RCTs with a total of 1782 patients were included in the meta-analysis, which demonstrated that vortioxetine improved DSST, PDQ, and MADRS scores in patients with MDD. The results were consistent at the 10- and 20-mg doses. In the 20-mg group, the decrease in MADRS scores was more significant than that in the placebo group. CONCLUSIONS Both the 10- and 20-mg doses of vortioxetine can significantly increase DSST scores and decrease PDQ and MADRS scores in patients with MDD and cognitive dysfunction, but further studies with longer follow-up periods to assess mental function are required.
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Affiliation(s)
- I-Chen Huang
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsui-San Chang
- Department of Neurology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chiehfeng Chen
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
| | - Jia-Ying Sung
- Correspondence: Jia-Ying Sung, MD, PhD, Department of Neurology, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd, Wenshan Dist, Taipei City 116, Taiwan ()
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Wang X, Wang R, Zhang Z, Luo C, Zhao Z, Ruan J, Huang R, Zhang H, Wu Q, Yu S, Tang J, Zhao X. Level-specific associations of urinary antimony with cognitive function in US older adults from the National Health and Nutrition Examination Survey 2011-2014. BMC Geriatr 2022; 22:663. [PMID: 35962346 PMCID: PMC9375424 DOI: 10.1186/s12877-022-03351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have looked at antimony (Sb) as a new neurotoxin which causes neuronal apoptosis in animal studies. At the population level, however, there is no direct evidence for a relationship between Sb exposure and cognitive performance. METHOD The study comprehensively assessed the correlation between urinary antimony levels and cognitive test scores in 631 creatinine-corrected older persons using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2014. RESULTS Using logistic regression, the study looked at the prevalence of cognitive impairment at different levels of urine antimony concentrations and found that, after controlling for covariates, higher doses of urinary antimony were positively associated with cognitive function compared to controls, odds ratio (ORs) with 95% confidence interval (CI) were 0.409 (0.185-0.906) and 0.402 (0.186-0.871) respectively. Restricted cubic spline curves showed a non-linear and dose-specific correlation between urinary antimony and cognitive performance, with lower doses associated with better cognitive performance, while higher doses may be associated with cognitive impairment. CONCLUSIONS Our data provide evidence for a correlation between Sb and cognitive function at the population level, although the specific mechanisms need to be investigated further.
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Affiliation(s)
- Xiangdong Wang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Rui Wang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Zeyao Zhang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Chao Luo
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Zixuan Zhao
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Junpu Ruan
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Rongrong Huang
- Department of Pharmacy, Affiliated Hospital of Nantong University, Nantong, China
| | - Hongbing Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
| | - Qiyun Wu
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Shali Yu
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China
| | - Juan Tang
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China.
| | - Xinyuan Zhao
- Department of Occupational Medicine and Environmental Toxicology, Nantong Key Laboratory of Environmental Toxicology, School of Public Health, Nantong University, Nantong, 226019, China.
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Papalexi E, Galanopoulos A, Kontis D, Markopoulou M, Balta G, Karavelas E, Panagiotidis P, Vlachos T, Ettrup A. Real-world effectiveness of vortioxetine in outpatients with major depressive disorder: functioning and dose effects. BMC Psychiatry 2022; 22:548. [PMID: 35962369 PMCID: PMC9373318 DOI: 10.1186/s12888-022-04109-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Functional recovery is an important treatment goal in major depressive disorder (MDD). This study assessed the real-world effectiveness of vortioxetine in patients with MDD, with particular focus on functioning; dose-response was also assessed. METHODS This was a non-interventional, prospective, multicenter study conducted in Greece. Adult outpatients with MDD (n = 336) initiating vortioxetine (5-20 mg/day flexible dosing) as treatment for a current major depressive episode were followed for 3 months. Analyses were stratified according to vortioxetine dosage at 3 months: 5-10 mg/day versus 15-20 mg/day. Functioning was assessed using the Sheehan Disability Scale (SDS). RESULTS Mean ± standard error SDS total score decreased (improved) from 18.7 ± 0.3 at baseline to 12.9 ± 0.3 after 1 month of vortioxetine treatment and 7.8 ± 0.4 after 3 months (p < 0.001 vs. baseline for all comparisons). Functional recovery (SDS score ≤ 6) was achieved in 14.6% of patients after 1 month of treatment and 48.4% of patients after 3 months. Improvement from baseline in SDS total and domain scores at 3 months was more pronounced in patients receiving vortioxetine 15-20 mg/day than in those receiving vortioxetine 5-10 mg/day. The mean ± standard error change in SDS total score from baseline was 9.2 ± 0.8 in the 5-10 mg/day group and 12.1 ± 0.4 in the 15-20 mg/day group (p < 0.001). Limitations of this study include its non-interventional study design and lack of a control group or active comparator. CONCLUSIONS Statistically significant and clinically relevant improvements in functioning were seen in patients with MDD treated with vortioxetine in a real-world setting. Higher doses of vortioxetine were associated with significantly greater improvements in functioning.
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Affiliation(s)
- Eugenia Papalexi
- Lundbeck Hellas, 109 Kifisias Avenue & Sina, 15124, Maroussi, Athens, Greece.
| | | | - Dimitrios Kontis
- 4th Psychiatric Department, Psychiatric Hospital of Attica, Athens, Greece
| | - Maria Markopoulou
- Department of Forensic Psychiatry, Psychiatric Hospital of Thessaloniki, Stavroupolis, Thessaloniki, Greece
| | - Georgia Balta
- grid.5216.00000 0001 2155 0800Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Panagiotis Panagiotidis
- grid.413162.30000 0004 0385 7982Department of Psychiatry, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Anders Ettrup
- grid.424580.f0000 0004 0476 7612H. Lundbeck A/S, Valby, Denmark
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Keefe RSE, Cañadas E, Farlow D, Etkin A. Digital Intervention for Cognitive Deficits in Major Depression: A Randomized Controlled Trial to Assess Efficacy and Safety in Adults. Am J Psychiatry 2022; 179:482-489. [PMID: 35410496 DOI: 10.1176/appi.ajp.21020125] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors evaluated AKL-T03, an investigational digital intervention delivered through a video game-based interface, designed to target the fronto-parietal network to enhance functional domains for attentional control. AKL-T03 was tested in adult patients with major depressive disorder and a demonstrated cognitive impairment at baseline. METHODS Adults ages 25-55 years on a stable antidepressant medication regimen with residual mild to moderate depression and an objective impairment in cognition (as measured using the symbol coding test) were enrolled in a double-blind randomized controlled study. Participants were randomized either to AKL-T03 or to an expectation-matched digital control intervention. Participants were assessed at baseline and after completion of their 6-week at-home intervention. The primary outcome measure was improvement in sustained attention, as measured by the Test of Variables of Attention (TOVA). RESULTS AKL-T03 (N=37) showed a statistically significant medium-effect-size improvement in sustained attention compared with the control intervention on the TOVA primary outcome (N=37) (partial eta-squared=0.11). Additionally, a composite score derived from all cognitive measures demonstrated significant improvement with AKL-T03 over the control intervention. Individual secondary and exploratory endpoints did not demonstrate statistically significant between-group differences. No serious adverse events were reported, and two patients (5.5%) in the AKL-T03 group reported an intervention-related adverse event (headache). CONCLUSIONS Treatment with AKL-T03 resulted in significant improvement in sustained attention, as well as in cognitive functioning as a whole, compared with a control intervention. AKL-T03 is a safe digital intervention that is effective in the treatment of cognitive impairment associated with major depression. Further research will be needed to understand the clinical consequences of this treatment-induced change.
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Affiliation(s)
- Richard S E Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Elena Cañadas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Deborah Farlow
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
| | - Amit Etkin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, N.C. (Keefe); VeraSci, Durham, N.C. (Keefe); Akili Interactive, Boston (Cañadas, Farlow); Department of Psychiatry and Behavioral Sciences and Wu Tsai Neurosciences Institute, Stanford University, Stanford, Calif. (Etkin); Alto Neuroscience, Los Altos, Calif. (Etkin)
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Zhang X, Cai Y, Hu X, Lu CY, Nie X, Shi L. Systematic Review and Meta-Analysis of Vortioxetine for the Treatment of Major Depressive Disorder in Adults. Front Psychiatry 2022; 13:922648. [PMID: 35815048 PMCID: PMC9263295 DOI: 10.3389/fpsyt.2022.922648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objective We aimed to compare the efficacy, acceptability, and tolerability of vortioxetine in the treatment of Major Depressive Disorder (MDD) in adults. Method We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Clinical Trials (CENTRAL), and www.ClinicalTrials.gov for randomized controlled trials that examined vortioxetine vs. placebo or other antidepressants for the treatment of MDD from database inception to August 30, 2021, using keywords Vortioxetine, Brintellix, Trintellix, LuAA21004, major depressive disorder, mood disorder, affective disorder, and MDD. We identified 789 publications after removing duplicates. After screening, 20 eligible randomized controlled trials were identified, of which 19 were included in the final meta-analysis. We included adults (aged 18 years and older) with a primary diagnosis of MDD. Two review authors independently selected the studies and extracted data. We extracted data on study characteristics, participant characteristics, intervention details and outcome measures in terms of efficacy, acceptability, and tolerability. Analyses were performed using random-effects models, and outcomes were pooled as risk ratios (RRs) and standardized mean differences (SMDs). Results In total, 20 studies (8,547 participants) met the inclusion criteria. Vortioxetine outperformed the placebo in efficacy outcomes, including response (RR 1.35, 95% CI 1.23-1.48; P < 0.001), remission (RR 1.33, 95% CI 1.17-1.52; P < 0.001), and cognitive function (SMD 0.34, 95% CI 0.16-0.52; P = 0.0003). Compared with the serotonin noradrenaline reuptake inhibitors (SNRIs), vortioxetine had better tolerability (RR 0.90, 95% CI 0.86-0.94; P < 0.001) but no significant difference in response (RR 0.91, 95%CI 0.82-1.00; P = 0.06) or remission (RR: 0.99, 95% CI 0.81-1.20, P = 0.88). Vortioxetine had no difference in response (RR 1.08, 95% CI 0.88-1.32; P = 0.46), remission (RR 1.00, 95% CI 0.41-2.44; P = 1.00) comparing with selective serotonin reuptake inhibitors (SSRIs). Conclusions Vortioxetine is more advantageous over placebo in treating MDD among adults, but no significant difference compared to SNRIs and SSRIs in general. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021278355, identifier: CRD42021278355.
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Affiliation(s)
- Xinyan Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Yuchun Cai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Xiaowen Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Christine Y. Lu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Xiaoyan Nie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Lewis V, Rodrigue B, Arsenault E, Zhang M, Taghavi-Abkuh FF, Silva WCC, Myers M, Matta-Camacho E, Aguilar-Valles A. Translational control by ketamine and its implications for comorbid cognitive deficits in depressive disorders. J Neurochem 2022. [PMID: 35680556 DOI: 10.1111/jnc.15652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
Ketamine has shown antidepressant effects in patients with major depressive disorder (MDD) resistant to first-line treatments and approved for use in this patient population. Ketamine induces several forms of synaptic plasticity, which are proposed to underlie its antidepressant effects. However, the molecular mechanism of action directly responsible for ketamine's antidepressant effects remains under active investigation. It was recently demonstrated that the effectors of the mammalian target of rapamycin complex 1 (mTORC1) signalling pathway, namely, eukaryotic initiation factor 4E (eIF4E) binding proteins 1 and 2 (4E-BP1 and 4E-BP2), are central in mediating ketamine-induced synaptic plasticity and behavioural antidepressant-like effect. 4E-BPs are a family of messenger ribonucleic acid (mRNA) translation repressors inactivated by mTORC1. We observed that their expression in inhibitory interneurons mediates ketamine's effects in the forced swim and novelty suppressed feeding tests and the long-lasting inhibition of GABAergic neurotransmission in the hippocampus. In addition, another effector pathway that regulates translation elongation downstream of mTORC1, the eukaryotic elongation factor 2 kinase (eEF2K), has been implicated in ketamine's behavioural effects. We will discuss how ketamine's rapid antidepressant effect depends on the activation of neuronal mRNA translation through 4E-BP1/2 and eEF2K. Furthermore, given that these pathways also regulate cognitive functions, we will discuss the evidence of ketamine's effect on cognitive function in MDD. Overall, the data accrued from pre-clinical research have implicated the mRNA translation pathways in treating mood symptoms of MDD. However, it is yet unclear whether the pro-cognitive potential of subanesthetic ketamine in rodents also engages these pathways and whether such an effect is consistently observed in the treatment-resistant MDD population.
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Affiliation(s)
- Vern Lewis
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Brandon Rodrigue
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Emily Arsenault
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Molly Zhang
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | | | | | - Mysa Myers
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
| | - Edna Matta-Camacho
- Department of Neuroscience, Carleton University, Ottawa, Ontario, Canada
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Miskowiak KW, Seeberg I, Jensen MB, Balanzá‐Martínez V, del Mar Bonnin C, Bowie CR, Carvalho AF, Dols A, Douglas K, Gallagher P, Hasler G, Lafer B, Lewandowski KE, López‐Jaramillo C, Martinez‐Aran A, McIntyre RS, Porter RJ, Purdon SE, Schaffer A, Stokes P, Sumiyoshi T, Torres IJ, Van Rheenen TE, Yatham LN, Young AH, Kessing LV, Burdick KE, Vieta E. Randomised controlled cognition trials in remitted patients with mood disorders published between 2015 and 2021: A systematic review by the International Society for Bipolar Disorders Targeting Cognition Task Force. Bipolar Disord 2022; 24:354-374. [PMID: 35174594 PMCID: PMC9541874 DOI: 10.1111/bdi.13193] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive impairments are an emerging treatment target in mood disorders, but currently there are no evidence-based pro-cognitive treatments indicated for patients in remission. With this systematic review of randomised controlled trials (RCTs), the International Society for Bipolar Disorders (ISBD) Targeting Cognition Task force provides an update of the most promising treatments and methodological recommendations. METHODS The review included RCTs of candidate pro-cognitive interventions in fully or partially remitted patients with major depressive disorder or bipolar disorder. We followed the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE and Cochrane Library from January 2015, when two prior systematic reviews were conducted, until February 2021. Two independent authors reviewed the studies with the Revised Cochrane Collaboration's Risk of Bias tool for Randomised trials. RESULTS We identified 16 RCTs (N = 859) investigating cognitive remediation (CR; k = 6; N = 311), direct current or repetitive magnetic stimulation (k = 3; N = 127), or pharmacological interventions (k = 7; N = 421). CR showed most consistent cognitive benefits, with two trials showing improvements on primary outcomes. Neuromodulatory interventions revealed no clear efficacy. Among pharmacological interventions, modafinil and lurasidone showed early positive results. Sources of bias included small samples, lack of pre-screening for objective cognitive impairment, no primary outcome and no information on allocation sequence masking. CONCLUSIONS Evidence for pro-cognitive treatments in mood disorders is emerging. Recommendations are to increase sample sizes, pre-screen for impairment in targeted domain(s), select one primary outcome, aid transfer to real-world functioning, investigate multimodal interventions and include neuroimaging.
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Affiliation(s)
- Kamilla W. Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Ida Seeberg
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of PsychologyUniversity of CopenhagenCopenhagenDenmark
| | - Mette B. Jensen
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Vicent Balanzá‐Martínez
- Teaching Unit of Psychiatry and Psychological MedicineDepartment of MedicineUniversity of ValenciaCIBERSAMValenciaSpain
| | - Caterina del Mar Bonnin
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | | | - Andre F. Carvalho
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment)Deakin UniversityGeelongVic.Australia
| | - Annemieke Dols
- Department of Old Age PsychiatryGGZ in GeestAmsterdam UMC, Location VUmcAmsterdam NeuroscienceAmsterdam Public Health Research InstituteAmsterdamThe Netherlands
| | - Katie Douglas
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Peter Gallagher
- Translational and Clinical Research InstituteFaculty of Medical SciencesNewcastle UniversityNewcastle‐upon‐TyneUK
| | - Gregor Hasler
- Psychiatry Research UnitUniversity of FribourgFribourgSwitzerland
| | - Beny Lafer
- Bipolar Disorder Research ProgramInstitute of PsychiatryHospital das ClinicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil
| | - Kathryn E. Lewandowski
- McLean HospitalSchizophrenia and Bipolar Disorder ProgramBelmontMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Carlos López‐Jaramillo
- Research Group in PsychiatryDepartment of PsychiatryUniversidad de AntioquiaMedellínColombia
| | - Anabel Martinez‐Aran
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Brain and Cognition Discovery FoundationUniversity of TorontoTorontoCanada
| | - Richard J. Porter
- Department of Psychological MedicineUniversity of OtagoChristchurchNew Zealand
| | - Scot E. Purdon
- Department of PsychiatryUniversity of AlbertaEdmontonCanada
| | | | - Paul Stokes
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Tomiki Sumiyoshi
- Department of Preventive Intervention for Psychiatric DisordersNational Institute of Mental HealthNational Center of Neurology and PsychiatryTokyoJapan
| | - Ivan J. Torres
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Tamsyn E. Van Rheenen
- Melbourne Neuropsychiatry CentreDepartment of PsychiatryUniversity of MelbourneCarltonAustralia,Centre for Mental HealthFaculty of Health, Arts and DesignSwinburne UniversityAustralia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverCanada
| | - Allan H. Young
- Department of Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Lars V. Kessing
- Copenhagen Affective Disorder Research Centre (CADIC)Psychiatric Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Katherine E. Burdick
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA,Department of PsychiatryBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Eduard Vieta
- Clinical Institute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPSCIBERSAMBarcelonaSpain
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Effect of vortioxetine in subjects with major depressive and alcohol use disorders: a 6-month retrospective analysis. CNS Spectr 2022; 27:73-81. [PMID: 32772956 DOI: 10.1017/s109285292000173x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) and alcohol use disorder (AUD) are highly comorbid, with greater clinical complexity and psychosocial impairment. Several antidepressants have been used in this population, with mixed results. This preliminary study aims to investigate the effects of the multimodal antidepressant vortioxetine in MDD + AUD subjects. METHODS We retrospectively evaluated 57 MDD + AUD and 56 MDD outpatients, matched for baseline characteristics. Patients were assessed after 1, 3, and 6 months treatment with vortioxetine (10-20 mg/d, flexibly dosed) in combination with continuous psychosocial support. The primary outcome was improvement in depressive symptoms measured by the Montgomery-Åsberg Depression Rating Scale. We also investigated changes in anxiety, anhedonia, cognition, functioning, quality of life, and clinical global severity using the following instruments: Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale, Digit Symbol Substitution Test, Perceived Deficits Questionnaire-Depression, Functioning Assessment Short Test, Quality of Life Index, and Clinical Global Impression-Severity Scale. RESULTS Vortioxetine significantly improved mood in MDD + AUD patients (P < .001), with no differences when compared to MDD (P = .36). A substantial rate (45.6%) of comorbid subjects obtained clinical remission at endpoint (P = .36 vs MDD). We additionally observed baseline to endpoint improvements on all secondary outcomes (P < .001), with no significant difference between groups. Overall, vortioxetine was safe and well tolerated. CONCLUSIONS Given its effectiveness on mood, cognition, and functioning, its good safety and tolerability profile, and low potential for abuse, vortioxetine could represent a valid pharmacological intervention in MDD + AUD patients as part of an integrated therapeutic-rehabilitation program.
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Caruso G, Grasso M, Fidilio A, Torrisi SA, Musso N, Geraci F, Tropea MR, Privitera A, Tascedda F, Puzzo D, Salomone S, Drago F, Leggio GM, Caraci F. Antioxidant Activity of Fluoxetine and Vortioxetine in a Non-Transgenic Animal Model of Alzheimer's Disease. Front Pharmacol 2022; 12:809541. [PMID: 35002742 PMCID: PMC8740153 DOI: 10.3389/fphar.2021.809541] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
Depression is a risk factor for the development of Alzheimer’s disease (AD). A neurobiological and clinical continuum exists between AD and depression, with neuroinflammation and oxidative stress being involved in both diseases. Second-generation antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), are currently investigated as neuroprotective drugs in AD. By employing a non-transgenic AD model, obtained by intracerebroventricular (i.c.v.) injection of amyloid-β (Aβ) oligomers in 2-month-old C57BL/6 mice, we recently demonstrated that the SSRI fluoxetine (FLX) and the multimodal antidepressant vortioxetine (VTX) reversed the depressive-like phenotype and memory deficits induced by Aβ oligomers rescuing the levels of transforming growth factor-β1 (TGF-β1). Aim of our study was to test FLX and VTX for their ability to prevent oxidative stress in the hippocampus of Aβ-injected mice, a brain area strongly affected in both depression and AD. The long-term intraperitoneal (i.p.) administration of FLX (10 mg/kg) or VTX (5 and 10 mg/kg) for 24 days, starting 7 days before Aβ injection, was able to prevent the over-expression of inducible nitric oxide synthase (iNOS) and NADPH oxidase 2 (Nox2) induced by Aβ oligomers. Antidepressant pre-treatment was also able to rescue the mRNA expression of glutathione peroxidase 1 (Gpx1) antioxidant enzyme. FLX and VTX also prevented Aβ-induced neurodegeneration in mixed neuronal cultures treated with Aβ oligomers. Our data represent the first evidence that the long-term treatment with the antidepressants FLX or VTX can prevent the oxidative stress phenomena related to the cognitive deficits and depressive-like phenotype observed in a non-transgenic animal model of AD.
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Affiliation(s)
- Giuseppe Caruso
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
| | - Margherita Grasso
- Department of Drug and Health Sciences, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
| | - Annamaria Fidilio
- Department of Drug and Health Sciences, University of Catania, Catania, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Nicolò Musso
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Federica Geraci
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Maria Rosaria Tropea
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Anna Privitera
- Department of Drug and Health Sciences, University of Catania, Catania, Italy
| | - Fabio Tascedda
- Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy.,Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Puzzo
- Oasi Research Institute-IRCCS, Troina, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Salvatore Salomone
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Gian Marco Leggio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, Catania, Italy.,Oasi Research Institute-IRCCS, Troina, Italy
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De Filippis S, Pugliese A, Christensen MC, Rosso G, Di Nicola M, Simonsen K, Ren H. Effectiveness of Vortioxetine in Patients with Major Depressive Disorder in Real-World Clinical Practice in Italy: Results from the RELIEVE Study. Neuropsychiatr Dis Treat 2022; 18:1665-1677. [PMID: 35971416 PMCID: PMC9375568 DOI: 10.2147/ndt.s375294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Vortioxetine has demonstrated efficacy in randomized controlled trials and is approved for the treatment of major depressive disorder (MDD); however, data are limited concerning its effectiveness when used in routine clinical care. The Real-Life Effectiveness of Vortioxetine in Depression (RELIEVE) study aimed to assess the effectiveness and tolerability of vortioxetine for the treatment of MDD in routine clinical practice in Canada, France, Italy, and the USA. This paper presents findings for the patient cohort in Italy. PATIENTS AND METHODS RELIEVE was a 6-month, international, observational, prospective cohort study in outpatients initiating vortioxetine treatment for MDD in routine care settings at their physician's discretion (NCT03555136). Patient functioning was assessed using the Sheehan Disability Scale (SDS). Secondary outcomes included depression severity (9-item Patient Health Questionnaire [PHQ-9]), cognitive symptoms (5-item Perceived Deficits Questionnaire-Depression [PDQ-D-5]), and quality of life (EuroQol 5-Dimensions 5-Levels questionnaire [EQ-5D-5L]). Changes from baseline to month 6 were assessed using mixed models for repeated measures, adjusted for relevant confounders. RESULTS Data are available for 231 patients enrolled in Italy (mean age, 55.5 years; 27% >65 years). Overall, 69% of patients reported at least one comorbidity, 55% were overweight/obese, and 47% had current anxiety symptoms. Adjusted least-squares mean (standard error) change in SDS score from baseline to week 24 was -6.6 (0.6) points (P < 0.001). Respective changes in PHQ-9, PDQ-D-5, and EQ-5D-5L scores were -5.9 (0.5), -3.6 (0.4), and +0.13 (0.01) points (all P < 0.0001). Adverse events were reported by 29 patients (13%), most commonly nausea (n = 14, 6%). Eleven patients (5%) discontinued treatment due to adverse events. CONCLUSION Clinically relevant and sustained improvements in overall functioning, symptoms of depression, cognitive symptoms, and health-related quality of life were observed in patients with MDD treated with vortioxetine over a period of 6 months in routine care in Italy, including a high proportion of elderly patients.
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Affiliation(s)
- Sergio De Filippis
- Department of Neuropsychiatry, Villa Von Siebenthal Neuropsychiatric Clinic, Genzano di Roma, Italy
| | - Anna Pugliese
- Medical Department, Lundbeck Italy S.p.A, Milan, Italy
| | | | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Hongye Ren
- Medical Affairs, H. Lundbeck A/S, Valby, Denmark
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Wang G, Xiao L, Ren H, Simonsen K, Ma J, Xu X, Guo P, Wang Z, Bai L, Heldbo Reines E, Hammer-Helmich L. Effectiveness and Safety of Vortioxetine for Major Depressive Disorder in Real-World Clinical Practice: Results from the Single-Arm RELIEVE China Study. Neuropsychiatr Dis Treat 2022; 18:1939-1950. [PMID: 36065389 PMCID: PMC9440675 DOI: 10.2147/ndt.s358253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) affects >163 million people worldwide and is a leading cause of disability in China. Functional impairment occurs alongside cognitive symptoms, anxiety, and depression, reducing quality of life and productivity in patients with MDD. PURPOSE The multimodal antidepressant vortioxetine has demonstrated efficacy in relieving depressive and functional symptoms of MDD in randomized controlled trials (RCTs). The RELIEVE China study aimed to investigate the real-world effectiveness of vortioxetine in China. PATIENTS AND METHODS This was an observational, prospective cohort study in patients with MDD initiating treatment with vortioxetine at physician's discretion in China. Participants were followed up for 24 weeks and assessed at 3 time points: baseline, week 8, and week 24. The primary objective was to assess the change from baseline to weeks 8 and 24 in functional impairment as measured by Sheehan Disability Scale (SDS) total score. Additional assessments included SDS subdomains, measures of depression severity, anxiety, and cognition. The safety and tolerability of vortioxetine were also examined. RESULTS In total, 859 patients were included in the analysis. A consistent and significant improvement in functional impairment was observed during the study, with baseline mean SDS total score (16.7 points) decreasing by 5.42 (SE, 0.22) and 8.71 (SE, 0.226) points at week 8 and week 24, respectively (P<0.0001). Improvements in other functioning, cognitive, and anxiety assessments were also observed (all P<0.0001). A total of 74.7% of patients had responded, and 63.9% had reached remission at week 24. The tolerability profile of vortioxetine in this real-world population was consistent with the established tolerability profile for this drug. CONCLUSION This study demonstrated the short- and long-term effectiveness and tolerability of vortioxetine for patients with MDD in a real-world setting in China. These findings are consistent with the efficacy and safety profile observed during RCTs.
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Affiliation(s)
- Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, People's Republic of China
| | - Hongye Ren
- Medical Affairs, H. Lundbeck A/S, Valby, Denmark
| | | | - Jingdong Ma
- Medical Affairs, Lundbeck China, Beijing, People's Republic of China
| | - Xiangdong Xu
- Department of Psychiatry, Xinjiang Mental Health Center, Xinjiang, People's Republic of China
| | - Ping Guo
- Department of Psychosomatic Disorders, The 3rd People's Hospital of Huzhou City, Huzhou, People's Republic of China
| | - Zhiren Wang
- Department of Science & Technology, Beijing Huilongguan Hospital, Beijing, People's Republic of China
| | - Ludong Bai
- Department of Psychiatry, Shandong Mental Health Center, Shandong, People's Republic of China
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Xiong S, Li W, Zhou Y, Ren H, Lin G, Zhang S, Xiang X. Vortioxetine Modulates the Regional Signal in First-Episode Drug-Free Major Depressive Disorder at Rest. Front Psychiatry 2022; 13:950885. [PMID: 35845440 PMCID: PMC9277001 DOI: 10.3389/fpsyt.2022.950885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/08/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Previous studies on brain functional alterations associated with antidepressants for major depressive disorder (MDD) have produced conflicting results because they involved short treatment periods and a variety of compounds. METHODS Resting-state functional magnetic resonance imaging scans were obtained from 25 first-episode drug-free patients with MDD and 25 healthy controls. The patients, who were treated with vortioxetine for 8 weeks, were scanned at two-time points (baseline and week 8 of treatment). The amplitude of low-frequency fluctuation (ALFF) in the imaging data was used to analyze local brain signal alterations associated with antidepressant treatment. RESULTS Compared with the controls, the patients at baseline showed decreased ALFF values in the right inferior temporal gyrus and increased ALFF values in the left inferior cerebellum, right cingulate gyrus and postcentral gyrus. After 8 weeks of vortioxetine treatment, patients showed increased ALFF values in the bilateral cingulate gyrus, middle temporal gyrus, medial superior frontal gyrus, and inferior cerebellum. CONCLUSION This study provided evidence that vortioxetine modulates brain signals in MDD sufferers. These findings contribute to the understanding of how antidepressants effect brain function.
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Affiliation(s)
- Shihong Xiong
- Department of Nephrology, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Wei Li
- Department of Otolaryngology-Head and Neck Surgery, Wuhan Asia General Hospital, Wuhan, China
| | - Yang Zhou
- Wuhan Mental Health Center, Wuhan, China
| | - Hongwei Ren
- Department of Medical Imaging, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | | | - Sheng Zhang
- Liyuan Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Xiang
- Department of Spine and Orthopedics, Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
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Petrova N, Mukhin A. Mechanisms of action and clinical effects of vortioxetine. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:84-90. [DOI: 10.17116/jnevro202212206284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mattingly GW, Ren H, Christensen MC, Katzman MA, Polosan M, Simonsen K, Hammer-Helmich L. Effectiveness of Vortioxetine in Patients With Major Depressive Disorder in Real-World Clinical Practice: Results of the RELIEVE Study. Front Psychiatry 2022; 13:824831. [PMID: 35356713 PMCID: PMC8959350 DOI: 10.3389/fpsyt.2022.824831] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/27/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Randomized controlled clinical trials have shown vortioxetine to be efficacious and well tolerated for the treatment of major depressive disorder (MDD). The Real-Life Effectiveness of Vortioxetine in Depression (RELIEVE) study was undertaken to demonstrate the effectiveness and safety of vortioxetine for the treatment of MDD in routine clinical practice. METHODS RELIEVE was a 24-week, observational, prospective cohort study in outpatients with MDD initiating treatment with vortioxetine at their physician's discretion in routine care settings in Canada, France, Italy, and the USA (NCT03555136). The primary study outcome was patient functioning assessed by the Sheehan Disability Scale (SDS). Secondary outcomes included depression severity [9-item Patient Health Questionnaire (PHQ-9)], cognitive symptoms [5-item Perceived Deficits Questionnaire-Depression (PDQ-D-5)], and cognitive performance [Digit Symbol Substitution Test (DSST)]. Mixed models of repeated measures were used to assess change from baseline at week 24, adjusted for relevant confounders. RESULTS A total of 737 patients were eligible for inclusion in the full analysis set. Most patients (73.7%) reported at least one comorbid medical condition, 56.0% had comorbid anxiety and 24.4% had comorbid generalized anxiety disorder. Improvement in least-squares (LS) mean SDS score from baseline to week 24 was 8.7 points. LS mean PHQ-9, PDQ-D-5 and DSST scores improved by 7.4, 4.6, and 6.2 points, respectively. Adverse events were observed in 21.2% of patients [most commonly, nausea (8.2% of patients)]. CONCLUSIONS These results demonstrate the effectiveness and tolerability of vortioxetine for the treatment of MDD in a large and heterogeneous patient population representative of that encountered in routine clinical practice.
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Affiliation(s)
- Gregory W Mattingly
- St Charles Psychiatric Associates & Midwest Research Group, St Charles, MO, United States
| | - Hongye Ren
- Medical Affairs, H. Lundbeck A/S, Valby, Denmark
| | | | - Martin A Katzman
- START Clinic for Mood and Anxiety Disorders, Toronto, ON, Canada.,Department of Psychology, Adler Graduate Professional School, Toronto, ON, Canada.,Department of Psychiatry, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.,Department of Psychology, Lakehead University, Thunder Bay, ON, Canada.,The Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, CHU de Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), Grenoble, France
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Polosan M, Rabbani M, Christensen MC, Simonsen K, Ren H. Effectiveness of Vortioxetine in Patients with Major Depressive Disorder in Real-World Clinical Practice: French Cohort Results from the Global RELIEVE Study. Neuropsychiatr Dis Treat 2022; 18:1963-1974. [PMID: 36068858 PMCID: PMC9441174 DOI: 10.2147/ndt.s374635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
AIM Functional recovery is an important treatment goal in patients with major depressive disorder (MDD). The Real-Life Effectiveness of Vortioxetine in Depression (RELIEVE) study assessed the effectiveness of vortioxetine in patients with MDD receiving treatment in routine clinical care settings in France, Italy, Canada, and the United States. This paper presents the study data for the cohort enrolled in France. METHODS RELIEVE was a 6-month, international, observational, prospective cohort study in outpatients initiating vortioxetine treatment for MDD at their physician's discretion (NCT03555136). Patients were assessed at routine clinic visits at study entry (baseline) and after 12 and 24 weeks of vortioxetine treatment. The primary study outcome was patient functioning, assessed by the Sheehan Disability Scale (SDS). Secondary outcomes included depression severity (assessed by the Patient Health Questionnaire [PHQ-9]), cognitive symptoms (assessed by the Perceived Deficits Questionnaire-Depression [PDQ-D-5]), and cognitive performance (Digit Symbol Substitution Test [DSST]). Changes from baseline to week 24 were assessed using mixed models for repeated measures, adjusted for relevant confounders. Adverse events spontaneously reported by the patient or observed by the investigator were recorded. RESULTS Data are available for 184 patients in France (mean age, 50.2 years; 65.2% female). Overall, 67.9% of patients had at least one comorbidity and 46.2% reported current anxiety symptoms at baseline. Adjusted least-squares mean (standard error) change in SDS score from baseline to week 24 was -10.9 (0.6) points (P < 0.001). Respective changes for PHQ-9, PDQ-D-5 and DSST scores were -9.3 (0.5), -6.1 (0.4), and +6.9 (1.0) points (all P < 0.0001). Adverse events were reported by 29 patients (15.8%), most commonly nausea (11 patients, 6.0%). CONCLUSION Clinically relevant and sustained improvements in overall functioning, depressive symptoms, cognitive symptoms, and cognitive performance were observed in patients with MDD treated with vortioxetine for 6 months in routine clinical practice settings in France.
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Affiliation(s)
- Mircea Polosan
- Adult Psychiatry Department, Université Grenoble Alpes, Inserm U1216, Grenoble Institut de Neurosciences, CHU de Grenoble, Grenoble, France
| | | | | | | | - Hongye Ren
- Medical Affairs, H. Lundbeck A/S, Valby, Denmark
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Mattingly G, Brunner E, Chrones L, Lawrence DF, Simonsen K, Ren H. Effectiveness of vortioxetine for major depressive disorder in real-world clinical practice: US cohort results from the global RELIEVE study. Front Psychiatry 2022; 13:977560. [PMID: 36683990 PMCID: PMC9845760 DOI: 10.3389/fpsyt.2022.977560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Effective treatment of major depressive disorder (MDD) involves addressing both depressive and functional symptoms, increasing patients' overall sense of well-being and quality of life (QoL). METHODS RELIEVE was an international observational, prospective study in patients ≥18 years with a current diagnosis of a major depressive episode (MDE) initiating vortioxetine in routine clinical practice; outcomes for the cohort of participants from the United States are presented here. Functioning was assessed at weeks 12 and 24 versus baseline using the Sheehan Disability Scale (SDS). Secondary effectiveness analyses assessed changes from baseline to weeks 12 and 24 in functioning, depression severity, cognitive symptoms, sexual function, and QoL. RESULTS 244 participants had an average of 8.2 previous MDEs; mean duration of their current MDE at baseline was 93.5 weeks. Vortioxetine was used as second- or later-line treatment for 80.5% of participants. Least-squares mean (SE) SDS total score significantly decreased from baseline by 7.19 (0.52) points at week 12 and 8.19 (0.56) points at week 24 (p < 0.0001 for both). Significant improvements were also reflected across SDS subscores, depression severity, cognitive function, sexual function, and QoL. Healthcare resource utilization and productivity parameters also improved. Adverse events were observed in 21.8% of patients, with nausea being the most common (7.3%). CONCLUSION This real-world study demonstrated improvements in functioning, depressive symptoms, and cognitive function in patients with MDD treated with vortioxetine in routine clinical practice in the cohort of patients enrolled in the United States. Outcomes were consistent with the efficacy and safety profile of vortioxetine in randomized controlled trials.
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Affiliation(s)
| | | | - Lambros Chrones
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
| | - Debra F Lawrence
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, MA, United States
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De Diego-Adeliño J, Crespo JM, Mora F, Neyra A, Iborra P, Gutiérrez-Rojas L, Salonia SF. Vortioxetine in major depressive disorder: from mechanisms of action to clinical studies. An updated review. Expert Opin Drug Saf 2021; 21:673-690. [PMID: 34964415 DOI: 10.1080/14740338.2022.2019705] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Vortioxetine is a multimodal-acting antidepressant that provides improvements on cognitive function aside from antidepressants and anxiolytic effects. Vortioxetine has been found to be one of the most effective and best tolerated options for major depressive disorder (MDD) in head-to-head trials. AREAS COVERED The present review intends to gather the most relevant and pragmatic data of vortioxetine in MDD, specially focusing on new studies that emerged between 2015 and 2020. EXPERT OPINION Vortioxetine is the first antidepressant that has shown improvements both in depression and cognitive symptoms, due to the unique multimodal mechanism of action that combine the 5-HT reuptake inhibition with modulations of other key pre- and post-synaptic 5-HT receptors (agonism of 5-HT1A receptor, partial agonism of 5-HT1B receptor, and antagonism of 5-HT3, 5-HT1D and 5-HT7 receptors). This new mechanism of action can explain the dose-dependent effect and can be responsible for its effects on cognitive functioning and improved tolerability profile. Potential analgesic and anti-inflammatory properties observed in preclinical studies as well as interesting efficacy and tolerability results of clinical studies with specific target groups render it a promising therapeutic option for patients with MDD and concomitant conditions (as menopause symptoms, pain, inflammation, apathy, sleep and/or metabolic abnormalities).
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Affiliation(s)
- Javier De Diego-Adeliño
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau (Iib-sant Pau), Universitat Autònoma de Barcelona (Uab), Centro de Investigación Biomédica En Red de Salud Mental (Cibersam), Spain
| | - José Manuel Crespo
- Department of Psychiatry, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Fernando Mora
- Department of Psychiatry, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Adrián Neyra
- Department of Psychiatry, Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Pedro Iborra
- Department of Psychiatry, San Juan University Hospital, Alicante, Spain
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McCue M, Sarkey S, Eramo A, François C, Parikh SV. Using the Goal Attainment Scale adapted for depression to better understand treatment outcomes in patients with major depressive disorder switching to vortioxetine: a phase 4, single-arm, open-label, multicenter study. BMC Psychiatry 2021; 21:622. [PMID: 34895181 PMCID: PMC8665619 DOI: 10.1186/s12888-021-03608-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is the leading cause of disability worldwide. Response to pharmacologic treatment is generally evaluated by traditional clinician- and patient-reported rating scales. Assessing therapeutic efficacy using the Goal Attainment Scale offers a complementary measure that focuses on recovery-oriented outcomes that patients consider valuable and vital to their well-being. This study aimed to examine outcomes using the Goal Attainment Scale adapted for depression (GAS-D). METHODS A phase 4, single-arm, open-label, multicenter study enrolled patients with MDD who were switching antidepressant medication. Patients received vortioxetine 10-20 mg over 12 weeks. Three specific, measurable, attainable, relevant, and time-bound goals were collaboratively set by patients with their clinicians. One goal was determined by the patient's self-defined objectives; 2 were related to predefined domain categories. Prespecified domains included psychological, motivational, emotional, physical/functional, and cognitive categories. The primary endpoint was the proportion of patients who achieved a GAS-D score ≥ 50 at week 12. Secondary and exploratory endpoints included changes from baseline in several clinical and patient-reported measures of depression and cognitive function. Safety and tolerability were also assessed. RESULTS At week 12, of the 122 adults participating in the study, 57.8% achieved a GAS-D score ≥ 50. Depression severity, cognitive function, cognitive performance, well-being, employment, and quality of life also significantly improved. Treatment response and remission rates were 65 and 40%, respectively. Vortioxetine was well tolerated, with adverse events consistent with product labeling. CONCLUSIONS A majority of patients with MDD switching to vortioxetine achieved their treatment goals, including improvement in specific functional outcomes relating to physical and emotional goals, as assessed by the GAS-D and standard patient- and clinician-reported measures. When assayed for convergent validity in a separate analysis, changes in goal scores on the GAS-D were statistically significantly correlated with multiple commonly used clinical measures of depression assessed in this study. The GAS-D approach provides a new patient-centric paradigm for the collaborative development and assessment of progress toward meaningful treatment goals, contributing to a comprehensive evaluation of treatment outcomes in patients with MDD. Longer studies against a control intervention are justified. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02972632 . Registered 21 November 2016.
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Affiliation(s)
- Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Avenue, Lexington, MA, 02421, USA.
| | - Sara Sarkey
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Avenue, Lexington, MA 02421 USA
| | - Anna Eramo
- grid.419796.4Lundbeck LLC, 6 Parkway North Blvd, Deerfield, IL 60015 USA
| | - Clement François
- grid.419796.4Lundbeck LLC, 6 Parkway North Blvd, Deerfield, IL 60015 USA
| | - Sagar V. Parikh
- grid.412590.b0000 0000 9081 2336University of Michigan Health, 1500 E. Medical Center Dr, Ann Arbor, MI 48109 USA
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Kim H, Baik SY, Kim YW, Lee SH. Improved cognitive function in patients with major depressive disorder after treatment with vortioxetine: A EEG study. Neuropsychopharmacol Rep 2021; 42:21-31. [PMID: 34894110 PMCID: PMC8919117 DOI: 10.1002/npr2.12220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Vortioxetine has a positive effect on cognitive function in patients with major depressive disorder (MDD). This study aimed to examine the changes in cognitive function and EEG (spectral power and mismatch negativity (MMN)) in patients with MDD pre‐ and postvortioxetine treatment. Methods Thirty patients with MDD were included in the study. They were given vortioxetine (10‐20mg po per day) for eight weeks. Depression and anxiety severities, social function (Korean version of the social adjustment scale (K‐SAS)), and cognitive function (digit‐symbol substitution Test (DSST), Korean version of the attentional control questionnaire (K‐ACQ), and Korean version of the perceived deficits questionnaire for depression (K‐PDQD)) were evaluated. Spectral power of EEG and MMN was also measured pre‐ and postvortioxetine treatment. Results Depression and anxiety severity, social function, and cognitive functioning significantly improved after vortioxetine treatment. Also, there was a significant decrease in the right central delta band and an increase in the right central beta 2 band following vortioxetine treatment. The changes in EEG spectral power were not related to changes in cognitive functions. Baseline MMN significantly predicted changes in DSST score after controlling for the baseline clinical variables. Conclusion Vortioxetine treatment improved cognitive function and induced changes in EEG (decreased theta power and increased beta power) in patients with MDD. Our results suggest that greater negative MMN amplitude is associated with greater potential for cognitive improvement following vortioxetine treatment. BLURB FOR ETOC:Vortioxetine treatment improved cognitive function and induced changes in EEG (decreased theta power and increased beta power) in patients with MDD. Our results suggest that greater negative MMN amplitude is associated with greater potential for cognitive improvement following the vortioxetine treatment.![]()
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Affiliation(s)
- Hong Kim
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seung Yeon Baik
- Department of Psychology, Penn State University, Pennsylvania, USA
| | - Yong Wook Kim
- Clinical Emotion and Cognition Research Laboratory, Department of Psychiatry, Inje University, Goyang, Republic of Korea.,Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea.,Clinical Emotion and Cognition Research Laboratory, Department of Psychiatry, Inje University, Goyang, Republic of Korea.,Bwave Inc, Goyang, Republic of Korea
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Yang YK, Chen CS, Tsai CF, Chang CM, Lai TJ, Lee CT, Lin CC, Lan TH, Herr KJ. A Taiwanese study on real-world evidence with vortioxetine in patients with major depression in Asia (TREVIDA). Curr Med Res Opin 2021; 37:2163-2173. [PMID: 34515596 DOI: 10.1080/03007995.2021.1980869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The TREVIDA study aimed to evaluate vortioxetine for the treatment of major depressive disorder (MDD) in Taiwanese adults. METHODS Patients with active depressive episode were recruited in this non-interventional, prospective, multi-site study conducted between June 2019 and August 2020 in Taiwan. Patient eligibility was independent of the physician's decision to prescribe vortioxetine for an MDD episode. Vortioxetine was initiated on the first visit. Depression severity, cognitive function, work productivity, functioning and safety were evaluated over 3 months. RESULTS Overall, 242 patients were analyzed. At baseline, 70.7% and 90.4% of patients had moderately severe-to-severe depression based on PHQ-9 (Patient Health Questionnaire-9) and TDQ (Taiwanese Depression Questionnaire), respectively. By Month 3, significant improvements from baseline in depression severity (mean [SD] changes in PHQ-9, TDQ and CGI-S [Clinical Global Impression-Severity]: -6.3 [7.3]; -13.2 [14.0]; -1.5 [1.3], respectively), cognitive function (mean [SD] change in PDQ-D: -8.0 [17.5]), functioning (mean [SD] change in SDS: -5.4 [7.6]), and presenteeism (38.9% from 56.3%), work productivity loss (40.9% from 58.7%) and activity impairment (43.2% from 61.0%) were observed (p < .001 for all). By month 3, patient-reported (PHQ-9) response and remission rates were 43.4% and 52.9%, respectively; physician-reported (CGI-S) response and remission rates were 29.0% and 31.6%, respectively. Vortioxetine was well-tolerated and no unexpected side effects were reported. CONCLUSIONS Vortioxetine reduced depression severity and improved cognitive function, work productivity, and functioning in Taiwanese patients with MDD in the real-world setting. Vortioxetine was well-tolerated in this Taiwanese population.
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Affiliation(s)
- Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Cheng-Sheng Chen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | - Chia-Fen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Te-Jen Lai
- Department of Psychiatry, Chung Shan Medical University & Hospital, Taichung City, Taiwan
| | - Chun-Te Lee
- Department of Psychiatry, Chung Shan Medical University & Hospital, Taichung City, Taiwan
| | - Chih-Chien Lin
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Tsuo-Hung Lan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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