The use of vortioxetine for depression in patients with Parkinson's disease in the early and advanced stages of the disease

Abstract

Depression is one of the most common non-motor manifestations of Parkinson's disease (PD), which largely determines both the severity of the course of the disease and the life expectancy of patients, as well as the compliance of patients to and the efficiency of antiparkinsonian therapy. In this connection, the search for a safe and effective antidepressant for patients with PD is of particular relevance.Objective: to evaluate the efficacy and safety of vortioxetine in patients with PD complicated by mild to moderate depression.Patients and methods. Examinations were made in 150 patients with PD in its early and advanced stages (Hoehn-Yahr stages: 1.0 to 3.0). All the patients were treated with vortioxetine at a dose of 15 or 20 mg/day for 8 months. The investigators used clinical and psychopathological rating scales, such as the Hospital Depression Scale (HADS-D), the Hospital Anxiety Scale (HADS-A), the Beck Depression Inventory (BDI), and the Montgomery-Asberg Depression Rating Scale (MADRS). The severity of PD motor manifestations was assessed according to the Unified PD Rating Scale (UPDRS) Part III.Results and discussion. During the follow-up period corresponding to 12 weeks of vortioxetine use, all the patients showed a significant decrease in MARDS, HADS-A and HADS-D, and BDI scores for depression and anxiety (p < 0.001). Vortioxetine demonstrated an optimal balance between tolerability and clinical efficacy in correcting affective disorders in this patient group. In addition, analysis of the dynamics of motor disorders yielded data on the improvement of movement functions while correcting depression as lower UPDRS Part III total scores (p < 0.001).Conclusion. The findings suggest that vortioxetine has a significant effect on depression and anxiety in patients with PD in its early and advanced stages, good tolerability, and a rapid-onset effect.

Vortioxetine Improves Depressive Symptoms and Cognition in Parkinson’s Disease Patients with Major Depression: An Open-Label Prospective Study

“…involved in PD [ 46 ]; in this context, vortioxetine—an antidepressant agent with a unique pharmacological profile and a multimodal mechanism of action, with the possibility of increasing levels in the brain of five neurotransmitters (serotonin, dopamine, histamine, noradrenaline, and acetylcholine) [ 47 ]—could be a good option for trying to improve not only depressive symptoms, but also other NMSs in patients with PD. Despite this, the evidence on the use of vortioxetine in patients with PD is very scarce [ 19 , 20 , 21 , 22 ]—this was the justification for proposing the VOPARK study.…”

“…However, the data are not published [ 19 ]. Miliukhina (article written in Russian) observed in 150 PD patients with mild to moderate depression treated with vortioxetine, a significant improvement in depressive symptoms and anxiety after 12 weeks of treatment—with good tolerability and without motor function impairment [ 20 ]. A phase IV trial on the “Tolerability, Safety and Efficacy of Vortioxetine” (VorDe-PD; NCT04301492) in patients with a diagnosis of sustained depression and a HAM-D 17 ≥ 14 is ongoing.…”

“…Our recommendation to prevent this complication is to take vortioxetine after eating on a full stomach or before going to bed, and always starting with 5 mg per day for a few days. In PD patients, previous, very limited data suggest that vortioxetine is safe and well-tolerated [ 19 , 20 ] and that it does not seem to worsen motor symptoms [ 19 ]. In fact, a very recent study conducted in rats reported that vortioxetine ameliorated motor impairments in rotenone-induced PD via the targeting of TLR-2-mediated neuroinflammation [ 67 ].…”

“…For all this, vortioxetine could be a useful antidepressant agent with interesting possibilities in the treatment of depression in PD patients. However, there is limited evidence on the use of vortioxetine in patients with PD [ 19 , 20 , 21 , 22 ]. Some data suggest that vortioxetine may improve depression severity without significant worsening of motor symptoms and with a remarkable safety profile in PD patients [ 19 , 20 ].…”

“…However, there is limited evidence on the use of vortioxetine in patients with PD [ 19 , 20 , 21 , 22 ]. Some data suggest that vortioxetine may improve depression severity without significant worsening of motor symptoms and with a remarkable safety profile in PD patients [ 19 , 20 ].…”