Depression and Cerebrovascular Disease: Could Vortioxetine Represent a Valid Treatment Option?



Mauro Giovanni Carta1, *, Andrea Norcini Pala2, Gabriele Finco3, Mario Musu3, Maria Francesca Moro1
1 Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
2 New York State Psychiatric Institute (NYSPI), New York, NY, USA
3 Department of Medical Science, University of Caglairi, Italy


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© Carta et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Public Health and Clinical and Molecular Medicine, University of Cagliari, SS 554, Bivio Sestu, 09142 Monserrato (CA), Italy; Tel: +39 070 499994; Fax: +39 070 6093498; E-mail: mgcarta@tiscali.it


Abstract

Introduction : Depression and cerebrovascular atherosclerosis often occur in comorbidity showing neuropsychological impairment and poor response to antidepressant treatment. Objective is to evaluate if new antidepressant vortioxetine may be a potential treatment option. Mechanism of Action : Vortioxetine has 5-HT3, 5-HT7 and 5-HT1D antagonists, 5-HT1B partial agonist and a 5-HT1A agonist and serotonin transporter inhibitor property. Efficacy and safety in Major Depressive Disorders and in cognitive impairment : The majority of trials (one of them in older people) showed efficacy for vortioxetine against placebo and no differences against other active treatments. The Adverse Effects ranged from 15.8% more to 10.8% less than placebo. In the elderly, only nausea was found higher than placebo. Effects on arterial blood pressure and cardiac parameters including the ECG-QT segment were similar to placebo. Elderly depressive patients on vortioxetine showed improvement versus placebo and other active comparators in Auditory Verbal Learning Test and Digit Symbol Substitution Test scores. The inclusion criteria admitted cases with middle cerebrovascular disease. Conclusion : The mechanism of action, the efficacy on depression and safety profile and early data on cognitive impairment make Vortioxetine a strong candidate for use in depression associated with cerebrovascular disease. This information must be supported by future randomized controlled trials.

Keywords: Cerebrovascular disease, major depressive disorders, vascular depression, vortioxetine.