Anxiety symptoms in working patients with major depressive disorder treated with vortioxetine: associations with clinical and treatment outcomes in the AtWoRC study

Abstract

Background: Anxiety symptoms are common in patients with major depressive disorder (MDD) and usually confer worse treatment outcomes. The long-term, open-label AtWoRC study in working patients with MDD treated with vortioxetine demonstrated a significant correlation between severity of anxiety symptoms and impaired work productivity. This analysis was undertaken to further explore clinical characteristics and treatment outcomes in patients with different levels of severity of anxiety symptoms at baseline. Methods: Post hoc analysis in 199 working patients with MDD treated with vortioxetine (10–20 mg/day), stratified by Generalized Anxiety Disorder 7-item (GAD-7) score at baseline [mild/moderate anxiety (GAD-7 ⩽14), n = 83; severe anxiety (GAD-7 ⩾15), n = 116]. Associations were examined between GAD-7 and other outcome assessment scores at baseline. Observed mean changes from baseline to week 52 were compared between groups. Results: Patients with severe anxiety had significantly worse depressive and cognitive symptoms, functioning, and work productivity at baseline than those with mild/moderate anxiety, but similar cognitive performance. Statistically significant improvements from baseline were seen for all outcomes after 52 weeks of vortioxetine treatment, with no significant differences observed between the two groups after adjustment for baseline anxiety scores. Conclusion: Treatment with vortioxetine was associated with long-term improvement in clinical symptoms and measures of work productivity in patients with MDD in a real-world setting, irrespective of severity of anxiety symptoms at the start of treatment.

Effectiveness of vortioxetine in patients with major depressive disorder and co-morbid generalized anxiety disorder in routine clinical practice: A subgroup analysis of the RELIEVE study

“…Before the current analysis, only the recent 8-week, open-label RECONNECT study had examined the effectiveness of vortioxetine on cognitive function in patients with MDD and co-morbid GAD (severe disease) and, consistent with our findings in the RELIEVE subgroup analysis, demonstrated effectiveness by significantly improving cognitive function (Christensen et al, 2022). The severity of anxiety symptoms has also been associated with functional outcomes in patients with MDD (Chokka et al, 2020(Chokka et al, , 2021. Moreover, as cognitive issues such as impaired attention and concentration deficits are a common feature of anxiety (Vytal et al, 2012), due to symptom overlap the treatment/ relief of anxiety is likely to contribute to cognitive improvement in MDD, and thus overall treatment benefits.…”

“…The severity of anxiety symptoms has also been associated with functional outcomes in patients with MDD ( Chokka et al., 2020 , 2021 ). Moreover, as cognitive issues such as impaired attention and concentration deficits are a common feature of anxiety ( Vytal et al, 2012 ), due to symptom overlap the treatment/relief of anxiety is likely to contribute to cognitive improvement in MDD, and thus overall treatment benefits.…”

Effectiveness of Vortioxetine in Patients With Major Depressive Disorder in Real-World Clinical Practice: Results of the RELIEVE Study

“…Concurrent anxiety symptoms are common in patients with MDD (60-65) and have been shown to contribute to poor response to antidepressant treatment, lower rates of remission, increased risk of recurrence, and greater functional impairment (60,61,63,64,(66)(67)(68). Significant correlation between severity of anxiety symptoms and functional outcomes has also been reported in patients with MDD (69,70). Vortioxetine has been shown to be effective for the treatment of MDD in patients with high levels of anxiety symptoms (16,23), and in patients with comorbid anxiety disorders (71)(72)(73).…”

Effectiveness of vortioxetine in patients with major depressive disorder comorbid with generalized anxiety disorder: Results of the RECONNECT study

“…Vortioxetine is a novel drug for depression with a multimodal mechanism of action, acting both as an inhibitor of the serotonin (5-HT) transporter as well as a modulator of several 5-HT receptor subtypes (5-HT 3 , 5-HT 7 and 5-HT 1D receptor antagonist, 5-HT 1B receptor partial agonist and 5-HT 1A receptor agonist) ( Gonda et al, 2019 ; Sanchez et al, 2015 ). Vortioxetine has been shown to be effective and well tolerated for the treatment of depressive, cognitive and physical symptoms in patients with MDD across the approved dose range of 5–20 mg/day ( Christensen et al, 2018 ; Gonda et al, 2019 ), and has also demonstrated anxiolytic effects in patients with MDD experiencing severe concurrent anxiety ( Baldwin et al, 2016 ; Chokka et al, 2021 ). In patients with GAD, a short-term, randomized controlled trial demonstrated that vortioxetine 5 mg/day was significantly more efficacious than placebo for the relief of anxiety symptoms ( Bidzan et al, 2012 ).…”