Efficacy and Safety of Escitalopram, Desvenlafaxine, and Vortioxetine in the Acute Treatment of Anxious Depression: A Randomized Rater-blinded 6-week Clinical Trial

Vortioxetine versus reuptake inhibitors in adults with major depressive disorder: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Although vortioxetine demonstrates superior efficacy relative to placebo, there is still a lack of robust evidence to determine whether it offers advantages over commonly prescribed antidepressants for treating major depressive disorder (MDD). Thus, we aimed to perform a systematic review and meta-analysis comparing vortioxetine vs reuptake inhibitors in adults with MDD, analyzing two classes separately: (i) vortioxetine vs SSRIs and (ii) vortioxetine vs SNRIs.

METHODS

We searched MEDLINE, Embase, and Cochrane Library databases for randomized controlled trials comparing vortioxetine with SSRIs or SNRIs in adults with a primary diagnosis of MDD following standardized diagnostic criteria. Independent examiners conducted the literature search, study selection, data extraction, and risk of bias assessment. Data were pooled in random-effects analyses. Statistical significance was considered at p<0.05.

RESULTS

We included 6 trials (n=478) in the vortioxetine vs SSRIs analysis and 11 (n=4230) in the vortioxetine vs SNRIs analysis. There were no significant differences between vortioxetine and SSRIs/SNRIs in the probability of response, remission, overall dropouts, and dropout due to lack of efficacy. Vortioxetine provided a significantly lower risk of dropout due to adverse events compared with SNRIs, while not significant compared with SSRIs. Vortioxetine did not differ significantly from SNRIs regarding variation in MADRS score post-treatment. In general, vortioxetine exhibited a statistically lower risk of individual adverse events compared with SNRIs, while not significant compared with SSRIs.

CONCLUSIONS

Our study reveals that vortioxetine is as effective as SSRIs and SNRIs for treating MDD, with safety equivalent to SSRIs and superior to SNRIs.

Vortioxetine for depression in adults: A systematic review and dose-response meta-analysis of randomized controlled trials

AIM

Major depressive disorder (MDD) is a prevalent psychiatric condition and vortioxetine offers promising antidepressant effects due to its unique pharmacological profile. However, the dose-response relationships of vortioxetine for MDD is not well established. We aimed to conduct dose-response meta-analyses to fill this gap.

METHODS

We systematically searched multiple electronic databases for randomized controlled trials of vortioxetine for MDD, with the last search conducted on 08 February, 2024. The dose-response relationship was evaluated using a one-stage random-effects dose-response meta-analysis with restricted cubic spline model. The primary outcome was efficacy (mean change in depression scale score), with secondary outcomes including response, dropout for any reasons (acceptability), dropout for adverse events (tolerability), and any adverse events (safety).

RESULTS

The dose-response meta-analysis comprised 16 studies, with 4,294 participants allocated to the vortioxetine group and 2,299 participants allocated to the placebo group. The estimated 50% effective dose was 4.37 mg/day, and the near-maximal effective dose (95% effective dose) was 17.93 mg/day. Visual inspection of the dose-efficacy curve suggests that a plateau possibly had not been reached yet at 20 mg/day. Acceptability, tolerability and safety decreased as the dose increased. Subgroup analysis indicated that no significant differences were observed in acceptability, tolerability and safety among the dosage groups.

CONCLUSIONS

Vortioxetine may potentially provide additional therapeutic benefits when exceeding the current licensed dosage without significantly impacting safety. Conducting clinical trials exceeding the current approved dosage appears necessary to fully comprehend its efficacy and risk.

Current Understanding on Psilocybin for Major Depressive Disorder: A Review Focusing on Clinical Trials

Previous studies suggested effectiveness of psilocybin in the field of mental health. FDA designated psilocybin as a "breakthrough therapy" for the treatment of treatment-resistant depression (TRD) in 2018. This paper provided a review of psilocybin's potential role in treatment of depression by focusing on published clinical trials. Studies showed that psilocybin, an agonist on 5-HT2A receptors, manifests antidepressant and anxiolytic effects by increasing glutamate transmission, reducing brain inflammation, decreasing default mode network activity. In terms of clinical trials, eleven studies (six open-label and five double blinded randomized clinical trials [DB-RCTs]) trials exploring psilocybin's impact on depression were found. Among open-label studies, a pilot study on TRD patients demonstrated significant reductions in depressive symptoms after two psilocybin sessions. Psilocybin also improved cognitive bias associated with depression. Extension studies confirmed sustained improvements and high remission rates. Among five DB-RCTs, two showed that psilocybin led to significant reductions in anxiety and depression in cancer patients, and the improvements sustained for over six months. In MDD, psilocybin showed rapid reductions in depression, with higher remission rates compared to escitalopram in a DB-RCT. Another DB-RCT showed that psilocybin induced higher decrease in depression around 6 hours after their administrations than placebo. The last DB-RCT showed that in patients with TRD, a single dose of psilocybin 25 mg, but not psilocybin 10 mg, resulted in superior antidepressant effect than psilocybin 1 mg. Overall, psilocybin showed promise in treating depression and anxiety, with notable safety profiles. Further research should explore optimal dosages and long-term effects.

The Potential Role of Aripiprazole Augmentation for Major Depressive Disorder with Anxious Distress in Naturalistic Treatment Setting

Objective

: This study tried to observe clinical benefit of aripiprazole augmentation (ARPA) treatment for major depressive disorder with anxious distress (MDDA) in routine practice.

Methods

: Retrospective chart review (n = 41) was conducted for clinical benefit of ARPA in patients with MDDA in routine practice. The primary endpoint was the mean change of Hamilton Anxiety Rating scale (HAMA) total scores from baseline to the endpoint. Additional secondary endpoints were also retrieved.

Results

: The changes of primary endpoint HAMA (t = 5.731, -4.6, p = 0.001), and secondary endpoints including Hamilton Depression Rating scale (HAMD, t = 4.284, -3.4, p ＜ 0.001), Clinical Global Impression-Clinical Benefit (CGI-CB, -0.9, t = 1.821, p = 0.026), and Clinical Global Impression Score-Severity (CGI-S, t = 3.556, -0.4, p ＜ 0.001) scores were also significantly improved during the study. No significant adverse events were observed.

Conclusion

: This study has shown additional benefit of ARPA treatment for MDDA patients in routine practice. However, adequately-powered and well-controlled studies are necessary for generalization of the present findings.

The Role of Vortioxetine in the Treatment of Depressive Symptoms in General Hospital Psychiatry: A Case-Series and PRISMA-Compliant Systematic Review of the Literature

Depressive symptoms are a customary finding in hospitalized patients, particularly those who are undergoing long hospitalizations, underwent major surgical procedures or suffer from high levels of multimorbidity and frailty. The patients included in this case series shared high degrees of frailty-complexity and were evaluated within the ordinary consultation and liaison psychiatry service of the University Hospital in Pisa, Italy, from September 2021 to June 2023. Patients were administered at least one follow-up evaluation after a week and before discharge. To relate this case series to the extant literature, a comprehensive systematic review of vortioxetine safety and efficacy was performed. None of the six patients included developed serious safety issues, but one patient complained of mild-to-moderate nausea for some days after the vortioxetine introduction. Five out of six patients exhibited at least a slight clinical benefit as measured by the clinical global impression scale. Of the 858 entries screened via Scopus and Medline/PubMed, a total of 134 papers were included in our review. The present case series provides preliminary evidence for vortioxetine's safety in this healthcare domain. The literature reviewed in this paper seems to endorse a promising safety profile and a very peculiar efficacy niche for vortioxetine in consultation and liaison psychiatry.

Sex differences in prevalence and clinical correlates of suicide attempts in first-episode and drug-naïve patients with anxious depression in a Chinese Han population: A large-scale cross-sectional study

BACKGROUNDS

Anxious depression (AD) has been extensively studied. However, fewer studies have examined sex differences in the prevalence of suicide attempts among AD patients. This study aimed to explore sex differences in suicide attempts and risk factors in patients with AD.

METHODS

1380 first episode drug-naïve patients with AD were recruited. Sociodemographic and clinical characteristics were measured using a self-administered demographic questionnaire. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Inventory (HAMA), and positive subscale of the Positive and Negative Syndrome Scale (PANSS) were used to assess patients' clinical symptoms. We also measured the patient's blood glucose, lipids, and thyroid axis hormone levels.

RESULTS

There were no sex differences in the prevalence of suicide attempts in patients with FEDN anxious depression. In addition, binary logistic regression analysis showed that HAMA score, TSH levels, and TPOAb levels significantly predicted suicide attempts in both male and female patients with AD, while HAMD score significantly predicted suicide attempts in female patients with AD only.

CONCLUSIONS

The severity of anxiety and higher levels of TSH and TPOAb were associated with an increased risk for suicide attempts in both male and female patients with AD, whereas the severity of depression was only associated with suicide attempts in females.

Role of Selective Serotonin Reuptake Inhibitors in the Treatment of Hypochondriasis: A Systematic Review

Hypochondriasis is a condition characterized by an unrealistic fear of having a serious medical illness resulting in health anxiety. Currently, no evidence-based pharmacological treatment options are available for the treatment of hypochondriasis. Since selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment option for anxiety disorders, they may be useful for relieving hypochondriasis symptoms. Moreover, off-label use of SSRIs in these cases is highly prevalent in clinical practice. Thus, in this study, we aimed to review the available literature to assess the role of SSRIs in the treatment of hypochondriacal symptoms. A systematic search was conducted in PubMed, Scopus, ScienceDirect, Embase, and Cochrane Database of Systematic Reviews from the date of inception to December 2022. We included only randomized clinical trials (RCTs) investigating the effect of SSRIs in the treatment of hypochondriacal symptoms. Non-RCTs, observation studies, and animal studies were excluded. The Risk of Bias 2 tool was used to assess the quality of included studies. Out of 2264 articles, six RCTs met our inclusion criteria. Studies have been conducted using different SSRIs in the treatment of primary hypochondriasis and hypochondriacal symptoms associated with other psychiatric disorders. All the studies have found that the use of SSRIs has some beneficial role in improving hypochondriacal symptoms. This suggests that SSRIs may be one of the promising pharmacological interventions in the treatment of hypochondriasis.

Additional Clinical Benefit of Agomelatine Treatment for Major Depressive Disorder in Naturalistic Treatment Setting

Objective

This study tried to observe additional benefit of agomelatine (AGO) treatment for major depressive disorder (MDD) in routine practice.

Methods

Retrospective chart review (n = 63) was conducted for additional benefit of combination with or switching to AGO in MDD patients without full remission. The primary endpoint was the mean change of Clinical Global Impression-Clinical Benefit (CGI-CB) total scores from baseline to the endpoint. Additional secondary endpoints were also collected.

Results

The changes of CGI-CB (Z = -3.073, p = 0.002) and Montgomery-Åsberg Depression Rating Scale (Z = -3.483, p < 0.001) total scores were significantly decreased from baseline to the endpoint, respectively. At the endpoint, the remission rate was 22.6% (n = 18) and 28.6% of patient had improvement in CGI-CB total scores at the endpoint. No significant adverse events were observed.

Conclusion

This study has shown additional benefit of AGO treatment as combination or switching agent for MDD patients without full remission in routine practice. However, adequately-powered and well-controlled studies are necessary for generalization of the present findings.