Vortioxetine improves physical and cognitive symptoms in patients with post-COVID-19 major depressive episodes

Nicola, Marco Di; Pepe, Maria; Montanari, Silvia; Spera, Maria Chiara; Panaccione, Isabella; Simonetti, Alessio; Sani, Gabriele

doi:10.1016/j.euroneuro.2023.02.006

Cited by 14 publications

(9 citation statements)

References 42 publications

(52 reference statements)

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“…Investigating the relationship between psychiatric symptomatology and inflammation was beyond our primary aims; however, it could be presumed that the decrease of low-grade systemic inflammation might have sustained the antidepressant response. These findings seem to further support preliminary evidence about the immune-modulatory effects of SSRIs in post-COVID-19 depression [ 19 , 20 ] and the anti-inflammatory and antiviral properties of antidepressants that showed to contrast COVID-19 severe outcomes [ 47 ]. Such effects could be explained through an indirect downregulation of the cytokine storm and a direct interference with the viral cell invasion exerted by some antidepressants [ 9 , 18 , 48 , 49 ].…”

Section: Discussionsupporting

confidence: 81%

“…Immune-modulatory effects have been reported for most antidepressants and emerging literature described the anti-inflammatory and antiviral properties of these compounds in the treatment of SARS-CoV-2 infection [ 17 , 18 ]. Consistently, several antidepressants were shown to be effective in treating post-COVID-19 depression at short- and medium-term follow-up [ 17 , 19 ], with similar improvements in both first-onset and recurrent depressive episodes [ 20 ]. These observations led to hypothesize that response to antidepressants in this clinical population could be mediated, at least in part, by their ability to modulate neuroinflammation triggered by SARS-CoV-2 [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Physical and cognitive correlates, inflammatory levels, and treatment response in post-COVID-19 first-onset vs. recurrent depressive episodes

Nicola

Pepe

Mori

et al. 2023

Eur Arch Psychiatry Clin Neurosci

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Psychiatric symptoms have been frequently reported in patients affected by COVID-19, both as new occurring and recurrences of pre-existing diseases. Depressive symptoms are estimated to affect at least 30% of patients following infection, with specific physical and cognitive features and relevant immune-inflammatory alterations. This study aimed to retrospectively characterize post-COVID-19 first-onset and recurrent major depressive episodes (MDE) and to evaluate the effects of antidepressants on physical and cognitive correlates of depression, in addition to mood, anxiety, and underlying inflammatory status. We evaluated 116 patients (44.8% males, 51.1 ± 17 years) with post-COVID-19 first-onset (38.8%) and recurrent (61.2%) MDE at baseline and after one- and three-month treatment with antidepressants (31% SSRIs, 25.9% SNRIs, 43.1% others). We assessed sociodemographic and clinical features and psychopathological dimensions through: Hamilton Depression and Anxiety Rating Scales; Short Form-36 Health Survey Questionnaire; Perceived Deficits Questionnaire-Depression 5-items. The systemic immune-inflammatory index was calculated to measure inflammation levels. Alongside the reduction of depression and anxiety ( p < 0.001), physical and cognitive symptoms improved ( p < 0.001) and inflammatory levels decreased ( p < 0.001) throughout treatment in both groups. Post-COVID-19 recurrent MDE showed a significantly more severe course of physical and cognitive symptoms and persistently higher levels of inflammation than first-onset episodes. Antidepressants proved to be effective in both post-COVID-19 first-onset and recurrent MDE. However, a sustained inflammatory status might blunt treatment response in patients with recurrent depression in terms of physical correlates and cognition. Therefore, personalized approaches, possibly involving combinations with anti-inflammatory compounds, could promote better outcomes in this clinical population. Supplementary Information The online version contains supplementary material available at 10.1007/s00406-023-01617-7.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Physical and cognitive correlates, inflammatory levels, and treatment response in post-COVID-19 first-onset vs. recurrent depressive episodes

Nicola

Pepe

Mori

et al. 2023

Eur Arch Psychiatry Clin Neurosci

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“…These findings suggest that vortioxetine’s anti-inflammatory activity may be particularly relevant in the context of post-COVID-19 depression. Patients with post-COVID-19 major depressive episodes treated with vortioxetine experienced significant improvements in physical and cognitive symptoms, as well as a reduction in inflammatory markers [ 68 ]. Given the high prevalence and clinical implications of post-COVID-19 depression, further research on the potential benefits of vortioxetine in this population is warranted (Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine

Cuomo,

Aguglia,

De Berardis

et al. 2024

Ann Gen Psychiatry

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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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“…Two studies dealt with outcomes related to coronavirus disease 2019 (COVID-19): one showed that vortioxetine treatment in patients with post-COVID-19 major depression was associated with a significant reduction in depressive, cognitive and physical symptoms after three months [101]; the other reported data suggesting that vortioxetine is associated with a significantly greater reduction in depressive symptoms worsening after a COVID-19related trauma compared to sertraline and trazodone [102]. An Italian study demonstrated that vortioxetine was associated with significantly higher therapeutic adherence relative to SSRIs and dual selective antidepressants (among the latter, the lowest risk of poor adherence was observed with sertraline and the highest with venlafaxine) [103].…”

Section: Analytical Observational Studiesmentioning

confidence: 99%

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

Weiss,

Pacciardi,

D’Alessandro

et al. 2024

JCM

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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.

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Vortioxetine improves physical and cognitive symptoms in patients with post-COVID-19 major depressive episodes

Cited by 14 publications

References 42 publications

Physical and cognitive correlates, inflammatory levels, and treatment response in post-COVID-19 first-onset vs. recurrent depressive episodes

Physical and cognitive correlates, inflammatory levels, and treatment response in post-COVID-19 first-onset vs. recurrent depressive episodes

Individualized strategies for depression: narrative review of clinical profiles responsive to vortioxetine

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

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