Vortioxetine Improves Symptoms in Patients With Post-Stroke Depression

 But what would be even better is fixing the cause of the depression.  LACK OF EXACT STROKE PROTOCOLS LEADING TO 100% RECOVERY.

Vortioxetine Improves Symptoms in Patients With Post-Stroke Depression

By Shazia Qureshi

VIRTUAL -- June 21, 2021 -- In patients with post-stroke depression, treatment with vortioxetine appears to safely improve depression symptoms as well as cognitive measures, according to a small, non-randomised study presented at the Virtual 7th Congress of the European Academy of Neurology (EAN).

Claudio Solaro, MD, Luigi Novarese, Moncrivello, Italy, and colleagues prospectively evaluated 176 consecutive patients aged 18 to 85 years who were admitted to their neurorehabilitation department between July 2018 and July 2020 due to a stroke. Those who showed a score ≥21 on the Beck Depression Inventory II (BDI-II) were invited to join the study.

After excluding patients who were already receiving antidepressant medications, or who had aphasia, the research team enrolled a total of 21 patients (17 patients who had experienced ischaemic stroke and 4 with haemorrhagic stroke), with a mean age ± SD of 77 ± 33 years.

Vortioxetine was given to all 21 patients, dosed initially at 5 mg orally once a day for the first week, followed by 10 mg/day for 3 weeks.

Previous studies have indicated that vortioxetine does not appear to increase adverse events (AEs) when administered with other medications or affect the QT interval or blood pressure in elderly patients, the study authors noted, but the drug has not previously been studied in patients with post-stroke depression.

As a comparison group, the researchers looked at 10 matched controls treated for post-stroke depression between April 2017 and April 2018. All 10 had received selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), or noradrenergic and specific serotonergic antidepressants (NaSSAs) as first-line therapy for depression, and were matched with the vortioxetine group for baseline levels of age, sex, Barthel Index for Activities of Daily Living scores, BDI-II scores, and Montreal Cognitive Assessment (MoCA) scores. The mean age of the patients in the matched-control group was 70.5 ± 26 years.

For the vortioxetine group, the safety analysis over 8 weeks -- which was the primary outcome of the study -- found that the only AEs reported were mild nausea in 2 patients in week 1.

The secondary outcomes were depression and cognition scores, which were assessed by a rater who was blinded to the patients’ baseline scores on the same instruments. These treatment effects were compared with the matched-control group.

The results showed that after 8 weeks of treatment with vortioxetine, patients’ scores on the BDI-II were reduced significantly, indicating an improvement in depression symptoms, from 24 ± 10 at baseline to 8 ± 29 (mean ± SD; P> .001). In the matched-control group, BDI-II scores also showed significant improvement from baseline levels, from 28 ± 9 to 11 ± 23 (P = .009), with no significant difference between the vortioxetine group and the controls (P = .181).

Looking at cognition scores, the MoCA raw score among vortioxetine-treated patients increased from 16 ± 14 at baseline to 19 ± 13 at week 8, indicating a significant improvement (mean ± SD; P = .010). The MoCA raw score also increased numerically in the matched-control group, but this was not found to be significant versus baseline levels (from 17 ± 16 to 21.5 ± 21; P = .285).

Previous studies have indicated that 18% to 33% of subacute stroke survivors develop depression, making it the most frequent post-stroke neuropsychiatric complication, noted Dr. Solaro.

[Presentation title: Safety and Efficacy of Vortioxetine on Depressive Symptoms and Cognition in Post-Stroke Patients: a Pilot Study. Abstract EPO-156]