Vortioxetine may reduce MDD-related cognitive impairment

Vortioxetine appeared to reduce cognitive impairment among patients with major depressive disorder, according to results of a systematic review published in Journal of Clinical Psychiatry.

“In clinical research for depression, the emphasis tends to be on remission from mood symptoms, helping people to feel ‘less sad,’” Sophie R. Vaccarino, BScH, of the Centre for Depression and Suicide Studies at St. Michael’s Hospital in Toronto, told Healio Psychiatry. “Although this is a key diagnostic criterion for depression, we see so many patients come in complaining of other symptoms, like trouble remembering things or concentrating, which is affecting their ability to work or interact with friends and family. Also, many of these symptoms can stick around long after low mood symptoms have remitted.”

Despite most patients with MDD having experienced these cognitive symptoms, neither the FDA nor Health Canada have approved an agent for cognitive dysfunction in MDD, Vaccarino said. She and colleagues sought to address this treatment gap by reviewing the efficacy of antidepressants and other therapeutic agents for treating this patient population. They searched three databases using the terms “Major Depressive Disorder,” “depress,” “cognit” and therapeutics, with no restrictions regarding year of publication. They included 26 clinical trials of antidepressants and other therapeutic agents among populations with MDD. Inclusion criteria were being aged 18 years to 65 years and having an MDD diagnosis according to the DSM-III, -IV or -5.

Results showed no association between use of tricyclic antidepressants and procognitive effects; however, vortioxetine (Trintellix, Takeda/Lundbeck) and bupropion demonstrated these effects relative to selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Multiple non-antidepressant agents, including erythropoietin, amphetamines and modafinil also significantly improved cognition among this patient population.

“Right now, vortioxetine is the only medication with strong evidence for its direct effects on cognition in MDD,” Vaccarino told Healio Psychiatry. “We also found in our research that SSRIs, SNRIs and bupropion may help cognition, but the evidence base is still weak and we don’t know if these effects are direct or simply a result of mood improvement (mood and cognition are highly intercorrelated).

“All in all, although several studies have looked at both classic antidepressants and other agents, such as modafinil or lisdexamfetamine (Vyvanse), for cognition in MDD, we don’t have a lot of answers regarding what will help people recover cognitively from depression. Cognition isn’t a primary outcome in most clinical trials for MDD but is a major outcome of interest for patients. There is a real need for larger, well-controlled studies to really identify which drugs will help relieve cognitive symptoms of depression.”