Vortioxetine: A New Multimodal Antidepressant
Keywords:
antidepressant, vortioxetine, cognitive dysfunctionAbstract
Currently, there are several effective antidepressant medications available for treating depression. However, some patients still do not fully recover and may experience residual symptoms. In addition to manage mood aspect, the management of cognitive function in depressive patient is important otherwise symptom will exacerbate. Vortioxetine is a multimodal antidepressant that blocks the serotonin reuptake transporter and several serotonin receptors. As a consequence, it can manage depression and reduce symptom of cognitive function. The drug is well absorbed with an average half-life of 66 hours and undergoes metabolism primarily via the CYP2D6 enzyme. Clinical efficacy of vortioxetine has been demonstrated in many studies both short term (6-12 weeks) and long term (52 weeks) studies. But the study that compared to other antidepressants shows no evidence for vortioxetine superiority in depression treatments. The most reported adverse effect is nausea. Vortioxetine dose of 10-20 mg/day has been approved by USFDA for treatment of depression in adults. The role of vortioxetine may be beneficial for patients with cognitive impairment or experiencing sexual dysfunction as adverse effects from other antidepressants.
References
Marx W, Penninx BWJH, Solmi M, Furukawa TA, Firth J, Carvalho AF, et al. Major depressive disorder. Nat Rev Dis Primers. 2023;9(1):44. doi: 10.1038/s41572-023-00454-1.
Kennedy SH, Lam RW, McIntyre RS, Tourjman SV, Bhat V, Blier P, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder: section 3. pharmacological treatments. Can J Psychiatry. 2016;61(9):540-60. doi: 10.1177/0706743716659417.
Richelson E. Multi-modality: a new approach for the treatment of major depressive disorder. Int J Neuropsychopharmacol. 2013;16(6):1433-42. doi: 10.1017/S1461145712001605.
Zajecka JM. Residual symptoms and relapse: mood, cognitive symptoms, and sleep disturbances. J Clin Psychiatry. 2013;74(Suppl 2):9-13. doi: 10.4088/JCP.12084su1c.02.
Gibb A, Deeks ED. Vortioxetine: first global approval. Drugs. 2014;74(1):135-45. doi: 10.1007/s40265-013-0161-9.
Sanchez C, Asin KE, Artigas F. Vortioxetine, a novel antidepressant with multimodal activity: review of preclinical and clinical data. Pharmacol Ther. 2015;145:43-57. doi: 10.1016/j.pharmthera.2014.07.001.
Mørk A, Pehrson A, Brennum LT, Nielsen SM, Zhong H, Lassen AB, et al. Pharmacological effects of Lu AA21004: a novel multimodal compound for the treatment of major depressive disorder. J Pharmacol Exp Ther. 2012;340(3):666-75. doi: 10.1124/jpet.111.189068.
Bang-Andersen B, Ruhland T, Jørgensen M, Smith G, Frederiksen K, Jensen KG, et al. Discovery of 1-[2-(2,4-dimethylphenylsulfanyl)phenyl]piperazine (Lu AA21004): a novel multimodal compound for the treatment of major depressive disorder. J Med Chem. 2011;54(9):3206-21. doi: 10.1021/jm101459g.
Areberg J, Luntang-Jensen M, Søgaard B, Nilausen DØ. Occupancy of the serotonin transporter after administration of Lu AA21004 and its relation to plasma concentration in healthy subjects. Basic Clin Pharmacol Toxicol. 2012;110(4):401-4. doi: 10.1111/j.1742-7843.2011.00810.x.
Alvarez E, Perez V, Artigas F. Pharmacology and clinical potential of vortioxetine in the treatment of major depressive disorder. Neuropsychiatr Dis Treat. 2014;10:1297-307. doi: 10.2147/NDT.S41387.
Al-Sukhni M, Maruschak NA, McIntyre RS. Vortioxetine: a review of efficacy, safety and tolerability with a focus on cognitive symptoms in major depressive disorder. Expert Opin Drug Saf. 2015;14(8):1291-304. doi: 10.1517/14740338.2015.1046836.
Areberg J, Søgaard B, Højer AM. The clinical pharmacokinetics of Lu AA21004 and its major metabolite in healthy young volunteers. Basic Clin Pharmacol Toxicol. 2012;111(3):198-205. doi: 10.1111/j.1742-7843.2012.00886.x.
Garnock-Jones KP. Vortioxetine: a review of its use in major depressive disorder. CNS Drugs. 2014;28(9):855-74. doi: 10.1007/s40263-014-0195-x.
Areberg J, Petersen KB, Chen G, Naik H. Population pharmacokinetic meta-analysis of vortioxetine in healthy individuals. Basic Clin Pharmacol Toxicol. 2014;115(6):552-9. doi: 10.1111/bcpt.12256.
Chen G, Lee R, Højer AM, Buchbjerg JK, Serenko M, Zhao Z. Pharmacokinetic drug interactions involving vortioxetine (Lu AA21004), a multimodal antidepressant. Clin Drug Investig. 2013;33(10):727-36. doi: 10.1007/s40261-013-0117-6.
H. Lundbeck A/S, Takeda Pharmaceuticals America, Inc. Brintellix® (vortioxetine) tablets, for oral use. n.p.: U.S. Food and Drug Administration; 2013 [cited 2022 Oct 25]. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/204447s000lbl.pdf
Alvarez E, Perez V, Dragheim M, Loft H, Artigas F. A double-blind, randomized, placebo-controlled, active reference study of Lu AA21004 in patients with major depressive disorder. Int J Neuropsychopharmacol. 2012;15(5):589-600. doi: 10.1017/S1461145711001027.
Henigsberg N, Mahableshwarkar AR, Jacobsen P, Chen Y, Thase ME. A randomized, double-blind, placebo-controlled 8-week trial of the efficacy and tolerability of multiple doses of Lu AA21004 in adults with major depressive disorder. J Clin Psychiatry. 2012;73(7):953-9. doi: 10.4088/JCP.11m07470.
Mahableshwarkar AR, Jacobsen PL, Chen Y. A randomized, double-blind trial of 2.5 mg and 5 mg vortioxetine (Lu AA21004) versus placebo for 8 weeks in adults with major depressive disorder. Curr Med Res Opin. 2013;29(3):217-26. doi: 10.1185/03007995.2012.761600.
Baldwin DS, Loft H, Dragheim M. A randomised, double-blind, placebo controlled, duloxetine-referenced, fixed-dose study of three dosages of Lu AA21004 in acute treatment of major depressive disorder (MDD). Eur Neuropsychopharmacol. 2012;22(7):482-91. doi: 10.1016/j.euroneuro.2011.11.008.
Boulenger JP, Loft H, Olsen CK. Efficacy and safety of vortioxetine (Lu AA21004), 15 and 20 mg/day: a randomized, double-blind, placebo-controlled, duloxetine-referenced study in the acute treatment of adult patients with major depressive disorder. Int Clin Psychopharmacol. 2014;29(3):138-49. doi: 10.1097/YIC.0000000000000018.
Mahableshwarkar AR, Jacobsen PL, Chen Y, Serenko M, Trivedi MH. A randomized, double-blind, duloxetine-referenced study comparing efficacy and tolerability of 2 fixed doses of vortioxetine in the acute treatment of adults with MDD. Psychopharmacology (Berl). 2015;232(12):2061-70. doi: 10.1007/s00213-014-3839-0.
Jacobsen PL, Mahableshwarkar AR, Serenko M, Chan S, Trivedi MH. A randomized, double-blind, placebo-controlled study of the efficacy and safety of vortioxetine 10 mg and 20 mg in adults with major depressive disorder. J Clin Psychiatry. 2015;76(5):575-82. doi: 10.4088/JCP.14m09335.
Montgomery SA, Nielsen RZ, Poulsen LH, Häggström L. A randomised, double-blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine. Hum Psychopharmacol. 2014;29(5):470-82. doi: 10.1002/hup.2424.
Meeker AS, Herink MC, Haxby DG, Hartung DM. The safety and efficacy of vortioxetine for acute treatment of major depressive disorder: a systematic review and meta-analysis. Syst Rev. 2015;4:21. doi: 10.1186/s13643-015-0001-y.
Pae CU, Wang SM, Han C, Lee SJ, Patkar AA, Masand PS, et al. Vortioxetine: a meta-analysis of 12 short-term, randomized, placebo-controlled clinical trials for the treatment of major depressive disorder. J Psychiatry Neurosci. 2015;40(3):174-86. doi: 10.1503/jpn.140120.
Gao S, Xie X, Fan L, Zhang D. Efficacy and safety of vortioxetine (Lu AA21004) in the treatment of adult patients with major depressive disorder: a systematic review and a meta-analysis of randomized controlled trials. Exp Ther Med. 2023;26(5):515. doi: 10.3892/etm.2023.12214.
Boulenger JP, Loft H, Florea I. A randomized clinical study of Lu AA21004 in the prevention of relapse in patients with major depressive disorder. J Psychopharmacol. 2012;26(11):1408-16. doi: 10.1177/0269881112441866.
Baldwin DS, Hansen T, Florea I. Vortioxetine (Lu AA21004) in the long-term open-label treatment of major depressive disorder. Curr Med Res Opin. 2012;28(10):1717-24. doi: 10.1185/03007995.2012.725035.
Alam MY, Jacobsen PL, Chen Y, Serenko M, Mahableshwarkar AR. Safety, tolerability, and efficacy of vortioxetine (Lu AA21004) in major depressive disorder: results of an open-label, flexible-dose, 52-week extension study. Int Clin Psychopharmacol. 2014;29(1):36-44. doi: 10.1097/YIC.0000000000000010.
Zhang X, Cai Y, Hu X, Lu CY, Nie X, Shi L. Systematic review and meta-analysis of vortioxetine for the treatment of major depressive disorder in adults. Front Psychiatry. 2022;13:922648. doi: 10.3389/fpsyt.2022.922648.
Montejo AL, Prieto N, de Alarcón R, Casado-Espada N, de la Iglesia J, Montejo L. Management strategies for antidepressant-related sexual dysfunction: a clinical approach. J Clin Med. 2019;8(10):1640. doi: 10.3390/jcm8101640.
Li Z, Liu S, Wu Q, Li J, Yang Q, Wang X, et al. Effectiveness and safety of vortioxetine for the treatment of major depressive disorder in the real world: a systematic review and meta-analysis. Int J Neuropsychopharmacol. 2023;26(6):373-84. doi: 10.1093/ijnp/pyad018.
Christensen MC, Schmidt SN, Grande I. Effectiveness of vortioxetine in patients with major depressive disorder and early-stage dementia: the MEMORY study. J Affect Disord. 2023;338:423-31. doi: 10.1016/j.jad.2023.06.024.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Association of Hospital Pharmacy (Thailand)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
ข้อความภายในบทความที่ตีพิมพ์ในวารสารเภสัชกรรมโรงพยาบาลทั้งหมด รวมถึงรูปภาพประกอบ ตาราง เป็นลิขสิทธิ์ของสมาคมเภสัชกรรมโรงพยาบาล (ประเทศไทย) การนำเนื้อหา ข้อความหรือข้อคิดเห็น รูปภาพ ตาราง ของบทความไปจัดพิมพ์เผยแพร่ในรูปแบบต่าง ๆ เพื่อใช้ประโยชน์ในเชิงพาณิชย์ ต้องได้รับอนุญาตจากกองบรรณาธิการวารสาร (สมาคมเภสัชกรรมโรงพยาบาล (ประเทศไทย)) อย่างเป็นลายลักษณ์อักษร
สมาคมเภสัชกรรมโรงพยาบาล (ประเทศไทย) อนุญาตให้สามารถนำไฟล์บทความไปใช้ประโยชน์และเผยแพร่ต่อได้ โดยอยู่ภายใต้เงื่อนไขสัญญาอนุญาตครีเอทีฟคอมมอน (Creative Commons License: CC) โดย ต้องแสดงที่มาจากวารสาร – ไม่ใช้เพื่อการค้า – ห้ามแก้ไขดัดแปลง, Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
ข้อความที่ปรากฏในบทความในวารสารเป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับสมาคมเภสัชกรรมโรงพยาบาล (ประเทศไทย) และบุคลากรในสมาคมฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเอง ตลอดจนความรับผิดชอบด้านเนื้อหาและการตรวจร่างบทความเป็นของผู้เขียน ไม่เกี่ยวข้องกับกองบรรณาธิการ
.png){kind=spacer}
