Lu AA21004, a novel multimodal antidepressant, produces regionally selective increases of multiple neurotransmitters—A rat microdialysis and electrophysiology study

Vortioxetine: a review of efficacy, safety and tolerability with a focus on cognitive symptoms in major depressive disorder

“…Non-inferiority was also noted in the secondary efficacy analyses, which included both clinician-rated assessments and patient-reported outcomes. Treatment-emergent AEs were generally comparable between vortioxetine-and Receptor/protein Affected neurotransmitter(s) Vortioxetine action Significance/proposed clinical effect SERT 5-HT Inhibition Improve mood via increased synaptic serotonin levels [7] 5-HT1A 5-HT; glutamate Agonist Accelerate vortioxetine action via presynaptic autoreceptor desensitization and postsynaptic activation [7][8][9][10] Anxiolytic effects [7] Alvarez et al [19] venlafaxine-treated patients, although significantly more patients in the venlafaxine group withdrew from the study as compared to the vortioxetine group.…”

“…Namely, it acts as an agonist at 5-HT1A, a partial agonist at 5-HT1B and an antagonist at 5-HT1D, 5-HT3 and 5-HT7 [3,4,7]. The foregoing serotonergic actions are hypothesized to be relevant to the downstream modulation of other neurotransmitters implicated in mood and cognitive dysfunction, including NE, acetylcholine (ACh) and glutamate [7][8][9][10]. In preclinical studies, vortioxetine was found to increase extracellular levels of 5-HT, NE, ACh, HA and dopamine in brain regions relevant to mood and cognition [8,9,11].…”

Neuroadaptations of the 5-HT System Induced by Antidepressant Treatments: Old and New Strategies

“…This markedly faster recovery was associated with 5-HT3 receptor antagonism and reduced SERT occupancy [93]. Additional data showed that acute or subchronic 3-day administration of vortioxetine caused robust dose-dependent increase of extracellular 5-HT levels in the ventral hippocampus and the median PFC, with a greater effect on the former compared to the latter [92]. This increase seems to occur at low levels of SERT occupancy.…”

“…Undoubtedly, further studies are needed to determine other effects of this new antidepressant on the 5-HT system. Another multimodal-acting antidepressant is vortioxetine which acts as a 5-HT3, 5-HT7 and 5-HT1D receptor antagonist, 5-HT1B receptor partial agonist, 5-HT1A receptor agonist and SERT inhibitor [92][93][94]. Strikingly, 1-day treatment with vortioxetine is sufficient to induce a recovery of the 5-HT neuronal firing activity in the DRN, an effect observed after 14 days of fluoxetine treatment [93].…”

Modes and nodes explain the mechanism of action of vortioxetine, a multimodal agent (MMA): enhancing serotonin release by combining serotonin (5HT) transporter inhibition with actions at 5HT receptors (5HT1A, 5HT1B, 5HT1D, 5HT7 receptors)

“…Agents that can change more than one neurotransmitter's release in more than one site (ie, multiple modes of action at multiple nodes within brain networks) at least theoretically have the possibility of changing multiple symptoms linked to multiple circuits. 2,11,12 Thus, it is useful to understand the net effect of the multiple, simultaneous actions of vortioxetine on neurotransmitter release in order to gain insight into its pharmacologic mechanism of action.…”