Vortioxetine vs. Other Antidepressants in Patients with Major Depressive Episode With or Without Substance Use Disorder

Kotzalidis, Georgios D.; Lombardozzi, Ginevra; Matrone, Marta; Amici, Emanuela; Perrini, F; Cuomo, Ilaria; Filippis, Sergio De

doi:10.2174/1570159x19666210113150123

Cited by 3 publications

(3 citation statements)

References 72 publications

(74 reference statements)

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“…Our finding of a decreased relapse rate with venlafaxine is in line with a Cochrane review 22 . To our knowledge, there are no pre vi ous data on vortioxetine, while some preliminary evidence sug gests that this drug may be more efficacious than other antide pres sants in depressive episodes associated with schizophrenia spec trum disorders 23 . Vortioxetine is the only antidepressant with sub stantial 5-HT7 antagonism, and results from animal and hu man stem cell studies suggest that antagonists of 5-HT7 receptors may be efficacious in psychosis 24,25 .…”

Section: Discussionmentioning

confidence: 96%

Real‐world effectiveness of antidepressants, antipsychotics and their combinations in the maintenance treatment of psychotic depression. Evidence from within‐subject analyses of two nationwide cohorts

Taipale,

Lieslehto,

Lähteenvuo

et al. 2024

World Psychiatry

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Psychotic depression (PD) is a severe mental disorder leading to functional disability and high risk of suicide, but very little is known about the comparative effectiveness of medications used in its maintenance treatment. The objective of this study was to investigate the comparative effectiveness of specific antipsychotics and antidepressants, and their combinations, on the risk of psychiatric hospitalization among persons with PD in routine care. Persons aged 16‐65 years with a first‐time diagnosis of PD were identified from Finnish (years 2000‐2018) and Swedish (years 2006‐2021) nationwide registers of inpatient care, specialized outpatient care, sickness absence, and disability pension. The main exposures were specific antipsychotics and antidepressants, and the main outcome measure was psychiatric hospitalization as a marker of severe relapse. The risk of hospitalization associated with periods of use vs. non‐use of medications (expressed as adjusted hazard ratio, aHR) was assessed by a within‐individual design, using each individual as his/her own control, and analyzed with stratified Cox models. The two national cohorts were first analyzed separately, and then combined using a fixed‐effect meta‐analysis. The Finnish cohort included 19,330 persons (mean age: 39.8±14.7 years; 57.9% women) and the Swedish cohort 13,684 persons (mean age: 41.3±14.0 years; 53.5% women). Individual antidepressants associated with a decreased risk of relapse vs. non‐use of antidepressants were bupropion (aHR=0.73, 95% CI: 0.63‐0.85), vortioxetine (aHR=0.78, 95% CI: 0.63‐0.96) and venlafaxine (aHR=0.92, 95% CI: 0.86‐0.98). Any long‐acting injectable antipsychotic (LAI) (aHR=0.60, 95% CI: 0.45‐0.80) and clozapine (aHR=0.72, 95% CI: 0.57‐0.91) were associated with a decreased risk of relapse vs. non‐use of antipsychotics. Among monotherapies, only vortioxetine (aHR=0.67, 95% CI: 0.47‐0.95) and bupropion (aHR=0.71, 95% CI: 0.56‐0.89) were associated with a significantly decreased risk of relapse vs. non‐use of both antidepressants and antipsychotics. In an exploratory analysis of antidepressant‐antipsychotic combinations, a decreased relapse risk was found for amitriptyline‐olanzapine (aHR=0.45, 95% CI: 0.28‐0.71), sertraline‐quetiapine (aHR=0.79, 95% CI: 0.67‐0.93) and venlafaxine‐quetiapine (aHR=0.82, 95% CI: 0.73‐0.91) vs. non‐use of antidepressants and antipsychotics. Benzodiazepines and related drugs (aHR=1.29, 95% CI: 1.24‐1.34) and mirtazapine (aHR=1.17, 95% CI: 1.07‐1.29) were associated with an increased risk of relapse. These data indicate that, in the maintenance treatment of PD, bupropion, vortioxetine, venlafaxine, any LAI, clozapine, and only few specific antidepressant‐antipsychotic combinations are associated with a decreased risk of relapse. These findings challenge the current recommendation by treatment guidelines to combine an antipsychotic with an antidepressant (without further specification) as standard treatment in PD.

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Section: Discussionmentioning

confidence: 96%

Real‐world effectiveness of antidepressants, antipsychotics and their combinations in the maintenance treatment of psychotic depression. Evidence from within‐subject analyses of two nationwide cohorts

Taipale,

Lieslehto,

Lähteenvuo

et al. 2024

World Psychiatry

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“…While there is basic science support to the use of trazodone in opioid withdrawal syndrome [ 27 ], and a possible involvement of opioid receptors has been hypothesized in its hypnotic action [ 28 ], no interference with cannabinoid mechanisms has been described heretofore for trazodone; hence, we are unable to explain the anti-cannabinoid craving effect it showed in all three cases we here reported. However, a variety of drugs used to treat psychiatric disorders comorbid with substance use disorders have shown anti-craving effects [ 29 , 30 , 31 ], the mechanism of which is unknown. To our knowledge, this is the first report of the use of trazodone in people with cannabis use disorder.…”

Section: Discussionmentioning

confidence: 99%

Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

Mazza

Caroppo

Marano

et al. 2022

IJERPH

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(1) Background: During the SARS-CoV-2 (COVID-19) pandemic, cannabis use increased relative to pre-pandemic levels, while forced home confinement frequently caused sleep/wake cycle disruptions, psychological distress, and maladaptive coping strategies with the consequent appearance of anxiety symptoms and their potential impact on substance use problems. (2) Aim: Long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. The present work aims to investigate the effectiveness of trazodone in optimizing the condition of people with cannabis dependence under pandemic conditions. (3) Methods: All cases with cannabis use disorder were uniformly treated with long-acting trazodone 150 mg or 300 mg/day; their craving and clinical status were monitored through appropriate psychometric scales. Side effects were recorded as they were reported by patients. We described the cases of three young patients—one man and two women—who were affected by chronic cannabis use disorder and who experienced lockdown-related psychological distress and sought psychiatric help. (4) Results: The described cases highlight that the once-a-day formulation of trazodone seems to have a therapeutic role in patients with cannabis use disorder and to guarantee tolerability and efficacy over time. No significant side effects emerged. (5) Conclusions: The use of long-acting trazodone (150 mg or 300 mg daily) has a potential benefit as monotherapy in patients with cannabis use disorder. Trazodone deserves to be studied in terms of its efficacy for cannabis use disorder.

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“…Vortioxetine has shown effectiveness in MDEs during the course of MDD, BD or schizophrenia spectrum and other psychotic disorders in patients with or without substance use disorder (SUD) and showed few and tolerable adverse events [ 23 ]. Its mechanism of action is claimed to be related to its multimodal activity.…”

Section: Methodsmentioning

confidence: 99%

Differential Response to Three Antidepressants in Patients with Major Depressive Episode Who Suffered Covid-19-Related Trauma

Filippis¹,

Lombardozzi

Matrone³

et al. 2022

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Background: The Covid 19 pandemic might have impacted response to drug treatment in major depressive episode (MDE). We compared responses to three different antidepressant drugs, i.e., vortioxetine, sertraline, and trazodone, in outpatients with MDE during Major Depressive Disorder (MDD), Bipolar Disorder (BD), or schizophrenia and related psychoses (SSOPDs) during two time periods, i.e., prior to suffering Covid-19–related trauma and after suffering such trauma. Methods: We conducted an observational study on clinically stabilised for at least 6 months outpatients with MDE during the course of MDD (N=58), BD (N=33), or SSOPDs (N=51). Patients, whose baseline assessments of Montgomery-Åsberg Rating Scale (MADRS), Hamilton Anxiety Rating Scale (Ham-A), Brief Psychiatric Rating Scale (BPRS), Visual Analogue Scale for Craving (VAS-crav) and World Health Organization Quality of Life, Brief version (WHOQOL-BREF) were available, were recruited at the time they suffered Covid-19–related traumas. Fifty patients, prior to the pandemic, when they were clinically stable, were treated with 15 mg/die vortioxetine, 44 with 450 mg/die trazodone, and 48 with 150 mg/die sertraline. After experiencing a major Covid-19–related personal trauma, patients showed clinical worsening which required dosage adjustment (20 mg/day vortioxetine; 600 mg/day trazodone, and 200 mg/day sertraline) and, for a part of them, a month of hospitalisation. Scores on the MADRS, Ham-A, BPRS, VAS-crav and WHOQOL-BREF were compared drug-wise and gender-wise with Student’s t test for continuous variables and χ2 for categorical variables. Result: The sample consisted of 142 outpatients (age, mean 39.63 ± 16.84; 70 men and 72 women); women were older than men (mean age 43.18 ± 17.61 vs. 35.98 ± 15.30; p=0.01). The two genders did not differ on other variables). For all treatments, symptoms worsening was observed at the time of trauma, followed by slow recovery with treatment readjustment. Trauma-related worsening in patients on vortioxetine was less intense than patients on the other two antidepressants and recovery was faster. All drugs were associated with an improvement in QoL. The vortioxetine group showed a lower hospitalisation rate (24%) than sertraline (35.4%) and trazodone (38.6%), but this was not significant (p=0.27). Conclusion: All drugs improved symptoms after Covid-19 trauma in patients with MDE, with vortioxetine showing a small advantage. No differences between vortioxetine, sertraline and trazodone were found as concerns the need for hospitalisation.

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Vortioxetine vs. Other Antidepressants in Patients with Major Depressive Episode With or Without Substance Use Disorder

Cited by 3 publications

References 72 publications

Real‐world effectiveness of antidepressants, antipsychotics and their combinations in the maintenance treatment of psychotic depression. Evidence from within‐subject analyses of two nationwide cohorts

Real‐world effectiveness of antidepressants, antipsychotics and their combinations in the maintenance treatment of psychotic depression. Evidence from within‐subject analyses of two nationwide cohorts

Trazodone Prolonged-Release Monotherapy in Cannabis Dependent Patients during Lockdown Due to COVID-19 Pandemic: A Case Series

Differential Response to Three Antidepressants in Patients with Major Depressive Episode Who Suffered Covid-19-Related Trauma

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