The latest antidepressant vortioxetine has a new mechanism of action that combines direct 5-HT receptor modulation and SERT inhibition. In fact it is a 5-HT3, 5-HT7 and 5-HT1D receptor antagonist, 5-HT1B receptor partial agonist, 5-HT1A receptor agonist and serotonin (5-HT) transporter (SERT) inhibitor. The result of this target profile seems to be the modulated control of neuronal activity in key areas of the brain involved in MDD but also the enhancing of synaptic plasticity and cognitive function.
Any clinical experience of effectiveness in the treatment of cognitive disorders?
Please look in the Attachment some information from my library.
Thank you for your contribution Vladimir, it was really helpful.
But I think it would be interesting to know if anyone has a personal clinical experience on Vortioxetine effectiveness in treatment of cognitive disorders and in short and medium-term memory deficit. I know that neurological studies are ongoing about the ability of Vortioxetine to modify memory deficits also in non-psychiatric patients
It is a very interesting question about vortioxetine and its possible role to control cognitive disorders associated with depressed mood or any other psychiatric disorders according to age, degree of cognitive impairment and duration of administration of selected doses of the drug:
Please find the following links on animal model
https://academic.oup.com/ijnp/article/20/4/316/2632172/Chronic-Vortioxetine-Treatment-Reduces-Exaggerated
Also a RCT published on patients with major depressive disorders :
https://www.ncbi.nlm.nih.gov/labs/articles/27780334/
An RCT has a high level of evidence and recommendations.
However, it is better to discuss the case personally with a psychiatrist who has a clinical experience with patients
Good Luck
Thank you Sahar Kamal for your contribution. Lately I've been using vortioxetine in ward and outpatient hospital activity and in some cases here where the depressive state of the patient was no longer responding to therapy, switching from an SSRI to vortioxetine has produced an excellent outcome. However, I have not noticed any positive activity on the cognitive sphere so far.
Thanks a lot Francesco Lusciano for your kind consideration. Actually, emergence of resistance to antidepressants may be referred to pharmacogenetic problems related to cytochrome enzyme system and this is the state of the art in many researches of genotyping and phenotyping of many psychiatric diseases involving antidepressants metabolized by cytochromes notably SSRIs and SNRIs to help psychiatrists to see to prescribe correctly the suitable antidepressant by lab.test. As for example done with venlafaxine and escitalopram. This may be one of causes of failure of therapeutic response in some persons according to "personalized medicine" point of view. GOOD LUCK
As far as cognitive disorder associated with depressive disorder is concerned, our clinical experience was positive, in spite of the fact that cognitive improvement was quite slow.
Possibly, SSRI resistant depressive disorders would present connections to extra hidden biological / psychological issues, demanding larger periods of time for cognitive improvement.
However, a recent systematic review could not find evidence to recommend a wider use of procognitive treatments in major depressive disorders, due to heterogeneities in current avaliable studies:
https://www.ncbi.nlm.nih.gov/pubmed/28651185
Thank you Sahal, what you said is very important and it's also one of the reasons why psychiatrists often associate two or more antidepressants in selected cases resistant to therapy
Thank you Almir Riberio Tavares, I absolutely agree with what you said. However, my question was exclusively focused on vortioxetine, because from preliminary studies it would seem to get positive effects not only on cognitive disorders but also on short and medium-term memory deficits
I am not convinced that neuroprotective properties of a drug would necessarily translate to any clinical benefit. This is based on our studies of many compounds that could be strong neuroprotectors (in a variety of models) in vitro but show no benefit clinically. It could be even worse, e.g. Lilly examined effects of olanzapine (neuroprotective) on 300 patients with a mild dementia and observed them do worse. Regarding the cognitive deficits associated with depression, they are most likely not related to deficits in encoding but are problems with the working memory as is common in depression. You may try to distinguish between the two by using Hopkins Verbal Learning Test (HVLT).
It seems to me there is no effective evidence of improvement of cognitive disorders in patients in treatment with vortioxetine so far. There are only a few positive spots from Neurologists, but I think we should go into more detail with other systematic studies
https://www.sciencedirect.com/science/article/pii/S0165032717313642
We have reported on a successful add-on of vortioxetine to MPH in an adolescent ADHD. It helped mitigating MPH-induced dysphoria and strikingly complemented the cognitive response.
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