Effectiveness of Vortioxetine in Patients with Major Depressive Disorder Associated with Chronic Pain: An Observational Study in a Spanish Population

Abstract

Introduction Chronic pain (CP) and depression/anxiety often coexist, worsening each other's symptoms. Treating this comorbidity is challenging. Tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors are the first-line treatment options for this comorbidity, although sometimes they are not effective and/or well tolerated by patients, and there is little clinical evidence that selective serotonin reuptake inhibitors are useful for controlling CP. The antidepressant vortioxetine, with a multimodal mechanism that may help reduce pain, has proven clinical efficacy in patients with major depressive disorder (MDD). This study investigated vortioxetine's effectiveness for MDD and CP in clinical practice. Methods This was a 3-month, multicenter, prospective, open-label, non-interventional pharmacoepidemiologic study. Patients ( n = 64) with MDD (9-item Patient Health Questionnaire [PHQ-9] score ≥ 15) and CP (visual analogue scale [VAS] score ≥ 4) were treated with vortioxetine for 3 months (initiated with 10 mg/day, with flexible dosing thereafter [5–20 mg/day]). VAS, Clinical Global Impression (CGI), and Patient Global Impression (PGI) scales were used at baseline and at 1 and 3 months. Brief Pain Inventory (BPI), PHQ-9 scale, and Satisfaction with Medicines Questionnaire (SATMED-Q) were used at baseline and at 3 months. Adverse Events (AEs) were recorded. Descriptive statistics, chi-square tests, and Student's t -tests were used for paired data. Results MDD patients showed a statistically significant improvement in VAS from baseline (mean [standard deviation (SD)]: 7.42 [0.69]) to 1 month (mean [SD]: 6.1 [0.81], P < 0.001) and 3 months (mean [SD]: 5.09 [1.26], P < 0.0001). Similarly, BPI and PHQ-9 scores showed significant improvement from baseline (mean [SD]: 6.20 [0.80] and 16.63 [1.47], respectively) to 3 months (mean [SD]: 4.73 [0.98] and 7.30 [2.60], P < 0.0001, respectively). Patients showed clinical improvement with CGI and PGI scales and reported being satisfied with the treatment in the SATMED-Q. A few mild EAs were registered. Conclusion Vortioxetine can relieve depressive and pain symptoms, with a good safety profile, in patients with MDD and CP. Supplementary Information The online version contains supplementary material available at 10.1007/s40122-024-00597-3.

Vortioxetine treatment for neuropathic pain in major depressive disorder: a three-month prospective study

“…Chronic pain is a devastating clinical situation characterized by persistent or recurrent pain lasting more than 3 months ( 1 ). There are a variety of chronic pain conditions with different etiologies, including neuropathic, visceral, musculoskeletal, and cancer-related pain ( 2 ).…”

“…Patients with chronic pain often simultaneously experience depression associated with the stressful state of chronic pain. Reduced pain threshold, increased pain perception, more pronounced functional limitations, and worse analgesic response are common denominators of patients with chronic pain complicated by depression ( 1 ).…”

“…Vortioxetine (Vo) is a novel antidepressant with a multimodal mechanism of action ( 1 – 3 ). Vo, the chemical formula of which is 1-[2-(2,4-dimethyl phenyl sulfanyl)-phenyl]-piperazine, is a bis-aryl sulfanyl amine compound.…”

“…Vo’s multimodal mechanisms of action enable it also to be used as a sleep modulator. Vo can also be used as a painkiller medication by reducing hyperalgesia and increasing analgesia ( 1 , 2 ).…”

“…Vo has a better safety profile than other antidepressants due to a lower incidence of side effects such as weight gain, sexual dysfunction, and cardiovascular side effects, as well as more consistent procognitive effects ( 3 ). These advantages benefit specific patient groups, such as those with higher comorbidities and cognitive disorders ( 1 – 3 ).…”