Adjunctive vortioxetine for SSRI-resistant major depressive disorder: a “real-world” chart review study

Abstract

Objective: Selective serotonin reuptake inhibitors (SSRIs) are the cornerstone of treatment of major depressive disorder (MDD). However, non-response is common, often necessitating combination strategies. The present study assessed the efficacy of vortioxetine as an add-on therapy in patients with SSRI-resistant MDD. Methods: The charts of 36 adult outpatients with DSM-IV-TR MDD who had not achieved a response after at least 8 weeks of treatment with an SSRI were reviewed retrospectively. Subjects were treated with vortioxetine (5-20 mg/day) for 8 weeks added to the current SSRI. The main outcome measures were change from baseline in total Hamilton Scale for Depression (HAM-D) score and the rate of response (a 50% or greater reduction in HAM-D score and a Clinical Global Impression-Improvement module [CGI-I] score of 1 or 2 at endpoint). HAM-D scores p 7 were considered as remission. Additional outcome measures included the Snaith-Hamilton Pleasure Scale (SHAPS) and the Scale for Suicide Ideation (SSI). Results: 32 patients completed the 8 weeks of treatment. At 8 weeks, a significant reduction in HAM-D score was observed (p p 0.001), with response obtained by 41.7% and remission by 33.3% of patients. Significant reductions in SHAPS and SSI were also observed (p p 0.001 for both scales). Conclusions: Adjunctive vortioxetine may be useful and well-tolerated in stage I treatment-resistant depression. However, the limitations of this study (such as small sample size, absence of randomization and control group, retrospective design, etc.) must be considered.

Gut Microbiota Changes in Patients With Major Depressive Disorder Treated With Vortioxetine

“…Vortioxetine hydrobromide is an innovative drug for the treatment of adult depression. The discovery of this class of drugs has opened up a new era of multidimensional and multimodal mechanisms for the treatment of depression (37). The results of existing clinical studies have shown that vortioxetine hydrobromide helps improve the affective symptoms of depression and improves their cognitive symptoms; this improvement is independent of improvements in affective symptoms.…”

Omega-3 Fatty Acids Supplementation in the Treatment of Depression: An Observational Study

“…Recent reports suggested that, the Hamilton scale for measuring depression symptoms showed a significant improvement when omega-3 fatty acids were added to a typical antidepressant regimen in the majority of patients with treatment-resistant depression, in this regard to improvise the treatment targets a “Neurobiological targeted” techniques, focused on the glutamate system, are being promoted with the objective of encouraging new lines of research aiming at creating therapies that cross the monoaminergic barriers to enhance the treatment of depression disorders [ 7 , 8 , 9 ].…”

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“…Due to their improved tolerability and safety profile, the second generation has largely replaced the use of the first generation of antidepressants in treatment [40]. However, it should not go unmentioned that there are also other, more recently developed multimodal antidepressants such as vortioxetine, which increases both serotonergic and acetylcholinergic signaling and is receiving increasing attention as an add-on therapy in patients with SSRI-resistant depression, and might also benefit cognition [41]. Aside from the monoamine hypothesis, alterations in glutamate receptors, neuronal plasticity, GABAergic transmission, stress/hypothalamic pituitar y adrenal(HPA)-axis, and neuroinflammation have also been suggested to contribute to depressive symptoms and thus provide potential alternative targets for pharmacological intervention [42].…”