Background: Anxiety disorders are a common comorbidity of depression. A comorbidity of depression and anxiety is more difficult to treat than depression alone.
In September 2013, a new antidepressant (vortioxetine) was approved for the U.S. market for the treatment of major depression in adults. The drug has also been approved and available in Switzerland since August 17, 2016. Vortioxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) that acts antagonistically on the 5-HT3, 5-HT7, and 5-HT1D receptors, partialagonistically on 5-HT1B, and agonistically on the 5-HT1A receptors. Vortioxetine modulates various neurotransmitter systems, resulting in an increase in serotonin, norepinephrine, dopamine, acetylcholine, histamine, glutamate, and a reduction in GABA. The aim of the study and meta-analysis was to determine the efficacy, safety, and tolerability of vortioxetine in MDD patients with high anxiety symptoms (baseline Hamilton Anxiety Rating Scale [HAM-A] total score ≥20).
PATIENT AND METHODS: Efficacy was analyzed using a randomized placebo-controlled trial of vortioxetine 5-20 mg for depression treatment over a 6- to 8-week period in two different age groups (18-75 years and ≥65 years) separately. Changes in Montgomery Asberg Depression Rating Scale (MADRS) scores, HAM-A total, and HAM-A subscales should be noted. Safety and tolerability were assessed by treatment-emergent adverse events (TEEE).
Results: A total of 1497 patients (48.6%) were treated with vortioxetine and 860 patients (49.1%) with placebo. All patients had a HAM-A ≥20 before treatment. There were significant differences compared with placebo on the HAM-A mental subscale for all doses. The greatest differences compared with placebo were found with doses of 10 and 20 mg.
The most common adverse reactions (≥5.0%) were nausea, gastrointestinal tract discomfort, dizziness, and headache. The incidence of serious adverse events was 1.3% (placebo) and ≤1.3% (vortioxetine).
According to the authors, vortioxetine was effective in reducing anxiety and depressive symptomatology in patient with MDD and severe anxiety symptomatology.
InFo PSYCHIATRY & NEUROLOGY 2017; 15(2): 24.
