Efficacy and tolerability of vortioxetine versus agomelatine, categorized by previous treatment, in patients with major depressive disorder switched after an inadequate response

Papakostas, George I.; Nielsen, Rebecca; Dragheim, M.; Tonnoir, Brigitte

doi:10.1016/j.jpsychires.2018.02.017

Cited by 20 publications

(13 citation statements)

References 18 publications

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“…Despite several compounds being approved for the treatment of MDD, roughly half of affected patients report an inadequate response to first‐line antidepressant treatment (Papakostas, Nielsen, Dragheim, & Tonnoir, 2018). Moreover, even though antidepressants represent the cornerstone in the treatment of MDD, available therapies often show several side effects (Rizvi & Kennedy, 2011).…”

Section: Introductionmentioning

confidence: 99%

“…New generations of antidepressants aim at optimizing treatment efficacy and tolerability. Vortioxetine, for instance, is a novel antidepressant with multimodal activity (Papakostas et al, 2018), approved for the treatment of MDD in the last decade in many countries worldwide (European Medicines Agency [EMA], 2014; Food and Drug Administration [FDA], 2013). Its mechanism of action combines the inhibition of the serotonin transporter and the direct modulation of serotonin (5‐HT) receptor activity, being it a 5‐HT1A receptor agonist, a 5‐HT1B receptor partial agonist, a 5‐HT3, a 5‐HT7, and a 5‐HT1D receptor antagonist and an inhibitor of the 5‐HT transporter (Bang‐Andersen et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness, tolerability, and dropout rates of vortioxetine in comorbid depression: A naturalistic study

Carlo

Vismara

Grancini

et al. 2020

Human Psychopharmacology

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Objective Vortioxetine is a novel antidepressant whose safety, tolerability, and therapeutic action have been supported by several studies. The present naturalistic study aimed to characterize its effectiveness, tolerability, and dropout rate in the real world. Methods Total sample consisted of 66 outpatients with major depressive episode, treated with vortioxetine, whose clinical variables were evaluated over three time points. Results Most common primary diagnoses were major depressive disorder (45.5%) and bipolar disorder (33.4%), with an overall comorbidity rate of 48.5% and concomitant medications in the 89.4%. The mean vortioxetine daily dosage was 12.90 ± 5.65 mg. Effectiveness of vortioxetine through a significant improvement on specific psychometric scales emerged, while only a nonsignificant trend of association between higher dosage and effectiveness was found. In the total sample, 51.5% were classified as responders and 36.4% as remitters. Two‐thirds of subjects did not report side effects, while in the remaining patients, gastrointestinal ones were the most frequent (72.7%). Almost two‐thirds of the sample could complete the follow‐up, while 36.4% dropped out; the main reasons for dropout were side effects (37.5%) and lack of efficacy (29.2%). Conclusions Larger sample studies are warranted to better characterize vortioxetine effectiveness and tolerability in the real world.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness, tolerability, and dropout rates of vortioxetine in comorbid depression: A naturalistic study

Carlo

Vismara

Grancini

et al. 2020

Human Psychopharmacology

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“…The results of the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) clinical trial indicated that fewer than 30% of depressive patients had a sufficient response to a single antidepressant (8) and that remission was lower in patients with two failed treatments (9). Approximately half of patients respond poorly to first-line antidepressant treatment (10). Moreover, current treatments often have side effects (11).…”

Section: Editorialmentioning

confidence: 99%

“…Several randomized, double-blind, placebo-controlled (RDBPC) studies of patients diagnosed with MDD have evaluated the efficacy of multiple vortioxetine doses (5,10,15, or 20 mg/day) for different short periods (6, 8, or 12 weeks). In most of these studies, drug-treated MDD patients showed significant improvement compared with a placebo (19,(28)(29)(30)(31)(32).…”

Section: Efficacy and Tolerability -Short-term Clinical Trialsmentioning

confidence: 99%

“…Montgomery et al (33) found that vortioxetine may be more effective than agomelatine in patients who did not have an adequate response to SSRI or SNRI treatment. Another 12-week RDB of a similar structure aimed to evaluate whether the efficacy and tolerability of vortioxetine were independent of previous SSRI (citalopram, escitalopram, paroxetine, sertraline) or SNRI (duloxetine, venlafaxine) treatment (10). The patients were randomized to vortioxetine (n=252, 10-20 mg/day) or agomelatine (n=241, 25-50 mg/day).…”

Section: -Comparison Of Vortioxetine With Other Antidepressantsmentioning

confidence: 99%

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Vortioxetine: a comprehensive update on a new-generation antidepressant

Evren¹

2021

Dusunen Adam

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The combined mechanisms of action of new-generation antidepressants may provide greater therapeutic benefits (14).New-generation antidepressants were designed with the goal of optimizing treatment efficacy and tolerability. Vortioxetine is one of the new antidepressants with multimodal activity (10). It is the first mixed serotonin agonist and antagonist antidepressant (7). It has been approved for the treatment of MDD in many countries, including European nations (15) and the United States (16). The antidepressant mechanism of action of vortioxetine combines serotonin transporter (5-HTT) inhibition and direct modulation of serotonin receptor activity; it is a 5-HT1A receptor agonist; a 5-HT1B receptor partial agonist; a 5-HT3, 5-HT7, and 5-HT1D receptor antagonist; and a 5-HTT inhibitor (14,17,18). These additional serotonin receptor targets distinguish vortioxetine from other SSRIs and SNRIs, and this activity may provide unique clinical benefits for symptomatic recovery in MDD patients ( 7). Vortioxetine increases the extracellular concentration of various neurotransmitters, such as dopamine, histamine, noradrenaline, and acetylcholine, in addition to providing a regulatory effect on serotonin receptors and 5-HTT (14,18). The serotonin system has a positive effect on mood, affect, and cognition. Vortioxetine also modulates key neurotransmitters involved in cognitive regulation, such as glutamate, acetylcholine, histamine, dopamine, and noradrenaline (17). Dose and PharmacokineticsVortioxetine is available in 5-, 10-, and 20-mg tablets. Vortioxetine was found to be less effective at low doses of 2.5-5 mg, while a dose range of 5-20 mg is effective (17). The maximum dose of 20 mg vortioxetine has demonstrated a better clinical response than lower doses (19)(20)(21)(22). However, the 20-mg dose has also been associated with a higher risk of side effects ( 14). An initial 10-mg dose once a day may be increased to 20 mg according to tolerability and clinical response (14). The pharmacokinetics of vortioxetine are linear and dose-proportional (23). Since the binding rate of vortioxetine to plasma proteins is 80-90%, it has a wide distribution volume (steady-state distribution volume of approximately 2600 L) (14,23). It has been reported that vortioxetine at higher doses (20 mg) was significantly superior to a placebo ( 14). It takes 3-16

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