Depression has a significant effect on the health and well-being of individuals. It currently affects approximately 1.54 million Australians each year and places a strain on the economy through reduced productivity. Research has shown that job strain-attributable depression costs the Australian economy $730 million per year. Hence, recognising depression and providing the necessary treatment and support is essential.

Vortioxetine is an antidepressant approved for the treatment of major depressive disorder (MDD) in adults including the prevention of relapse. MDD is characterised by the presence of one or more major depressive episodes (MDEs), with manifestations of depressed mood, loss of interest or pleasure, disturbed sleep or appetite, low energy, and feelings of guilt or low self-worth. Vortioxetine is thought to work through a combination of two pharmacological modes of action namely, serotonin (5-HT) reuptake inhibition and direct activity at 5-HT receptors.

The recommended starting dose of vortioxetine in adults less than 65 years old is 10mg once daily. The dose may be increased to a maximum of 20mg daily or reduced to a minimum of 5mg daily according to individual response. For patients over 65 years of age, the recommended starting dose is 5mg once daily. The antidepressant effect of vortioxetine is often evident after two weeks of treatment with full clinical effect observed after four to six weeks. If the depressive symptoms are resolved, a treatment of at least six months is usually recommended to prevent relapse.

In order to test the efficacy, tolerability, and safety profile of vortioxetine, a series of clinical trials were conducted on adults and groups of elderly patients who have MDD. These studies demonstrate that vortioxetine is efficacious and well tolerated. The effect of vortioxetine on the cognitive function of depressed adults was also investigated. These results demonstrate that vortioxetine can improve the cognitive function of a depressed adult independent of its beneficial effects on depressive symptoms. In addition, vortioxetine has also been shown to be effective in preventing relapse of MDD in adults, with short-term benefits maintained over long-term treatment. Vortioxetine may be considered as a second-line antidepressant treatment when first-line agents such as selective serotonin reuptake inhibitors (SSRIs) or serotonin and noradrenaline reuptake inhibitors (SNRIs) are not effective.

The most commonly reported side effects of vortioxetine are nausea, vomiting, constipation, and dry mouth. Sexual dysfunction, a common symptom of depression, is also a side effect of many antidepressants particularly SNRIs and SSRIs. A study was undertaken to compare the effects of vortioxetine and escitalopram on sexual function in adults with well-treated MDD who were experiencing treatment-emergent sexual dysfunction (TESD). Participants who had been responding to citalopram, paroxetine, or sertraline were randomised to switch to either vortioxetine or escitalopram. The results of the trial showed that patients treated with vortioxetine experienced a statistically significant improvement in sexual function compared to patients treated with escitalopram.

Patients who are prescribed vortioxetine are encouraged to join the Brintellix® (vortioxetine) Patient Program. The purpose of this program is to assist pharmacists in providing vortioxetine patients with additional medication support and to ensure that patients get the best results from their therapy. The Brintellix® (vortioxetine) Patient Program Web Portal can be used to access approved patient information and updated documents concerning vortioxetine.

References:

  1. Alvarez E, Perez V, Dragheim M, Loft H, Artigas F. A double-blind, randomised, placebo-controlled, active reference study of Lu AA21004 in patients with major depressive disorder. Int J Neuropsychopharmacol. 2012; 15(5): 589-600.
  2. Boulenger J, Loft H, Florea I. A randomized clinical study of Lu AA21004 in prevention of relapse in patients with major depressive disorder. J Psychopharmacol. 2012; 26(11): 1408-16.
  3. Brintellix® (vortioxetine) Australian approved product information. North Ryde. Lundbeck Australia Pty Ltd. Approved 31st March 2014.
  4. Brintellix® (vortioxetine) Patient Program Implementation Checklist. North Ryde. Lundbeck Australia Pty Ltd. Approved February 2015.
  5. Brintellix® (vortioxetine) Patient Program Information. North Ryde. Lundbeck Australia Pty Ltd. Approved December 2014.
  6. Jacobsen P, Mahableshwarkar A, Chen Y, Chrones L, Clayton AH. Effect of vortioxetine vs. escitalopram on sexual functioning in adults with well-treated major depressive disorder experiencing SSRI-induced sexual dysfunction. J Sex Med. 2015; 12(10): 2036-48.
  7. Katona C, Hansen T, Kurre Olsen C. A randomized, double-blind, placebo-controlled, duloxetine-referenced, fixed-dose study comparing the efficacy and safety of Lu AA21004 in elderly patients with major depressive disorder. Int Clin Psychopharmacol. 2012; 27(4): 215-23.
  8. Mahableshwarkar AR, Zajecka J, Jacobson W, Chen Y, Keefe RS. A randomized, placebo-controlled, active-reference, double-blind, flexible-dose study of the efficacy of vortioxetine on cognitive function in major depressive disorder. Neuropsychopharmacology. 2015; 40(8): 2025-37.
  9. Mcintyre RS, Lophaven S, Olsen C K. A randomized, double-blind, placebo-controlled study of vortioxetine on cognitive function in depressed adults. Int J Neuropsychopharmacol. 2014; 17(10): 1557-67.
  10. Montgomery SA, Nielsen RZ, Poulsen LH, Häggström L. A randomised, double-blind study in adults with major depressive disorder with an inadequate response to a single course of selective serotonin reuptake inhibitor or serotonin-noradrenaline reuptake inhibitor treatment switched to vortioxetine or agomelatine. Hum Psychopharmacol. 2014; 29(5): 470-82.
  11. VicHealth. Estimating the economic benefits of eliminating job strain as a risk factor for depression. Carlton: Victorian Government, 2010.

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