Effect of vortioxetine in subjects with major depressive and alcohol use disorders: a 6-month retrospective analysis

Abstract

Background Major depressive disorder (MDD) and alcohol use disorder (AUD) are highly comorbid, with greater clinical complexity and psychosocial impairment. Several antidepressants have been used in this population, with mixed results. This preliminary study aims to investigate the effects of the multimodal antidepressant vortioxetine in MDD + AUD subjects. Methods We retrospectively evaluated 57 MDD + AUD and 56 MDD outpatients, matched for baseline characteristics. Patients were assessed after 1, 3, and 6 months treatment with vortioxetine (10-20 mg/d, flexibly dosed) in combination with continuous psychosocial support. The primary outcome was improvement in depressive symptoms measured by the Montgomery-Åsberg Depression Rating Scale. We also investigated changes in anxiety, anhedonia, cognition, functioning, quality of life, and clinical global severity using the following instruments: Hamilton Anxiety Rating Scale, Snaith-Hamilton Pleasure Scale, Digit Symbol Substitution Test, Perceived Deficits Questionnaire-Depression, Functioning Assessment Short Test, Quality of Life Index, and Clinical Global Impression-Severity Scale. Results Vortioxetine significantly improved mood in MDD + AUD patients (P < .001), with no differences when compared to MDD (P = .36). A substantial rate (45.6%) of comorbid subjects obtained clinical remission at endpoint (P = .36 vs MDD). We additionally observed baseline to endpoint improvements on all secondary outcomes (P < .001), with no significant difference between groups. Overall, vortioxetine was safe and well tolerated. Conclusions Given its effectiveness on mood, cognition, and functioning, its good safety and tolerability profile, and low potential for abuse, vortioxetine could represent a valid pharmacological intervention in MDD + AUD patients as part of an integrated therapeutic-rehabilitation program.

Vortioxetine: a comprehensive update on a new-generation antidepressant

“…Improvements in general functionality, quality of life, and anxiety have also been reported with vortioxetine (14). The data of vortioxetine use in cases of comorbid AUD and MDD are limited, but the results also appear to be promising (83).…”

“…Despite the high prevalence of alcohol use disorder (AUD) and MDD comorbidity, and the severity and adverse consequences of both diseases, the available evidence is still inadequate to even outline the treatment strategies for these patients, and the treatment guidelines have failed to reach consensus on the issue (83). Systematic reviews have reported that SSRIs, SNRIs, and TSAs show some efficacy in improving both depressive symptoms and some AUD-related traits, including the number of drinks per drinking days and the number of patients who abstained from alcohol use (84)(85)(86).…”

“…However, in depression secondary to alcohol use, the antidepressant effect remains even more modest than the effect on independent primary depression (85). Treatment of this clinical population is further complicated by the frequent occurrence of alcoholrelated medical comorbidities that may limit the range of drugs available for use (83). A recent study evaluated the therapeutic effect of vortioxetine (10-20 mg/day, flexible-dose) with psychosocial support in patients with MDD and comorbid AUD (n=57) and patients with MDD alone (n=56) paired for baseline features (83).…”

“…Treatment of this clinical population is further complicated by the frequent occurrence of alcoholrelated medical comorbidities that may limit the range of drugs available for use (83). A recent study evaluated the therapeutic effect of vortioxetine (10-20 mg/day, flexible-dose) with psychosocial support in patients with MDD and comorbid AUD (n=57) and patients with MDD alone (n=56) paired for baseline features (83). Vortioxetine significantly improved depression in patients with comorbid MDD and AUD, and a significant proportion of participants (45.6%) achieved clinical remission for depression.…”

The Association of P300 Components With Clinical Characteristics and Efficacy of Pharmacotherapy in Alcohol Use Disorder

“…As AUD is often comorbid with different neuropsychiatric disorders, antidepressants and antipsychotics are often potential alternatives. For example, recently given its effectiveness on mood, cognition, and functioning; its good safety and tolerability profile; and its low potential for abuse, vortioxetine could represent a valid pharmacological intervention in AUD-comorbid MDD patients as part of an integrated therapeutic rehabilitation program ( 49 ).…”