Vortioxetine: A Review of Its Use in Major Depressive Disorder

Abstract

Vortioxetine (Brintellix(®)) is a serotonin (5-HT) transporter inhibitor that also acts on several 5-HT receptors, such as the 5-HT3 and 5-HT1A receptors. It is approved in the US and the EU for the treatment of adult patients with major depressive disorder (MDD); this article reviews the pharmacological properties of oral vortioxetine and its clinical efficacy and tolerability in these patients. Vortioxetine is generally efficacious in patients with MDD in acute treatment trials (including elderly patients), in a relapse-prevention trial, and in open-label extension trials. It is associated with improved cognitive function in patients with MDD; this does not occur solely via improvement in depressive symptom severity. It is well tolerated, but is associated with significantly increased sexual dysfunction at the highest dosage; however, vortioxetine was shown to improve previous-treatment-emergent sexual dysfunction in patients with well-treated MDD to a greater degree than escitalopram. Vortioxetine extends the available treatment options for patients with MDD, and further investigation into its comparative efficacy versus other antidepressants will allow for more accurate placement among these treatment options.

Assessment in Work Productivity and the Relationship with Cognitive Symptoms (AtWoRC): primary analysis from a Canadian open-label study of vortioxetine in patients with major depressive disorder (MDD)

“…Comparing with previous studies with vortioxetine, the response and remission rates were high, which were consistent with previous studies with vortioxetine 30 , 38 , 39 …”

“…Vortioxetine is a multimodal antidepressant that is indicated for the treatment of MDD in adults. It differs from selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors due to its direct effect on 5-hydroxytryptamine (5-HT) receptors, including 5-HT 1A receptor agonism, 5-HT 1B receptor partial agonism, and 5-HT 3 , 5-HT 1D , and 5-HT 7 receptor antagonism 30 …”

Vortioxetine: Clinical Pharmacokinetics and Drug Interactions

“…Several therapeutic agents are currently used as first-line therapy for MDD, including selective serotonin [5-hydroxytryptamine (5-HT)] reuptake inhibitors and serotonin norepinephrine reuptake inhibitors [ 2 ]. Compared with other therapeutic agents for MDD, vortioxetine has a unique mechanism of action with a distinct clinical profile, which may prove effective as an alternative first-line agent or subsequent therapy for patients with documented failure of other antidepressants [ 3 – 7 ].…”

Relative short‐term efficacy and acceptability of agomelatine versus vortioxetine in adult patients suffering from major depressive disorder

“…Vortioxetine has a multimodal mechanism of action based on its ability to inhibit serotonin reuptake via serotonin transporter blockade in addition to acting on multiple serotonin receptor subtypes (agonist of 5‐HT1A, partial agonist of 5‐HT1B and antagonist of 5‐HT1D, 5‐HT3 and 5‐HT7 serotonergic receptors; Orsolini et al, ; Zhang et al, ): hence its classification as “multimodal.” Clinical studies indicate that, within the recommended dose range of 10–20 mg, vortioxetine is effective in the treatment of adult patients with MDD, though there is no suggestion of superiority over active comparators (Llorca et al, ; Meeker, Herink, Haxby, & Hartung, ; Pae et al, ; Pearce & Murphy, ). Vortioxetine's adverse event profile is similar to that of selective serotonin reuptake inhibitors (SSRIs; Zhang et al, ), with nausea, constipation, and vomiting as most frequently reported side effects, and sexual dysfunction at higher doses (Garnock‐Jones, ; Pearce & Murphy, ).…”