Clinical implications of directly switching antidepressants in well-treated depressed patients with treatment-emergent sexual dysfunction: a comparison between vortioxetine and escitalopram

CNS Spectrums ◽  
2019 ◽  
Vol 25 (1) ◽  
pp. 50-63 ◽  
Author(s):  
Paula L. Jacobsen ◽  
George G. Nomikos ◽  
Wei Zhong ◽  
Andrew J. Cutler ◽  
John Affinito ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Sexual Functioning ◽  
Rating Scale ◽  
Primary Study ◽  
Major Depressive ◽  
Double Blind ◽  
Scale Scores ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Ssri Treatment

Objective:The objective of this work was to describe treatment-emergent sexual dysfunction (TESD) and tolerability following a switch from selective serotonin reuptake inhibitor (SSRI: citalopram, paroxetine, or sertraline) monotherapy to vortioxetine or escitalopram monotherapy in adults with well-treated major depressive disorder (MDD) and SSRI-induced sexual dysfunction.Methods:Data were analyzed from the primary study, an 8-week, randomized, double-blind, head-to-head study in which participants with well-treated depressive symptoms but experiencing TESD with SSRIs were directly switched to flexible doses (10/20 mg) of vortioxetine or escitalopram. Sexual functioning was assessed by the Changes in Sexual Functioning Questionnaire-14 (CSFQ-14), efficacy by the Montgomery–Åsberg Depression Rating Scale scores (MADRS) and Clinicians Global Impression of Severity/Improvement (CGI-S/CGI-I), and tolerability by adverse events. Efficacy and tolerability were assessed by pre-switch SSRI therapy where possible, and by participant characteristics.Results:Greater improvements in TESD were seen in the vortioxetine compared with escitalopram groups based on: participant demographics (≤45 years, women; P = 0.045), prior SSRI treatment (P = 0.044), number of prior major depressive episodes (MDEs) (1–3; P = 0.001), and duration of prior SSRI therapy (>1 year; P = 0.001). Prior SSRI treatment did not appear to influence the incidence or severity of TEAEs, except for nausea. Regardless of prior SSRI, both treatments maintained antidepressant efficacy after 8 weeks.Conclusion:Results suggest that vortioxetine is a safe and effective switch therapy for treating SSRI-induced sexual dysfunction in adults with well-treated MDD. Also, improvement in sexual dysfunction with vortioxetine or escitalopram may be influenced by prior SSRI usage, sex, age, and history of MDEs.

A Double-blind Comparative Trial of Moclobemide v. Imipramine and Placebo in Major Depressive Episodes

1989 ◽  
Vol 155 (S6) ◽  
pp. 72-77 ◽  
Author(s):  
M. Versiani ◽  
U. Oggero ◽  
P. Alterwain ◽  
R. Capponi ◽  
F. Dajas ◽  
...  
Keyword(s):  
Rating Scale ◽  
Comparative Trial ◽  
Placebo Treatment ◽  
Major Depressive ◽  
Double Blind ◽  
Poor Tolerance ◽  
The Mean ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Important Drug

Patients (n = 490) suffering from a major depressive episode according to DSM-III criteria were randomly allocated to groups receiving either moclobemide, imipramine, or placebo treatment. Subjects were treated as out-patients for 6 weeks. On overall assessment of efficacy and on results of the Hamilton Rating Scale for Depression, both moclobemide and imipramine were superior to placebo, but the differences between moclobemide and imipramine were not significant. Premature termination due to insufficient efficacy was more frequent with placebo than with moclobemide or with imipramine, these differences being significant. The overall assessment of tolerance clearly favoured placebo and moclobemide over imipramine. This was also reflected in the frequency of premature terminations due to poor tolerance, as well as in the frequency of adverse events, which were highest in the imipramine group. The only cardiovascular finding was an increase of the mean heart rate with imipramine, maximum at the end of week 1, while placebo and moclobemide displayed no relevant changes. There were no other important drug-related changes.

scholarly journals Lurasidone for the treatment of depressive symptoms in schizophrenia: analysis of 4 pooled, 6-week, placebo-controlled studies

CNS Spectrums ◽  
2014 ◽  
Vol 20 (2) ◽  
pp. 140-147 ◽  
Author(s):  
Henry A. Nasrallah ◽  
Josephine B. Cucchiaro ◽  
Yongcai Mao ◽  
Andrei A. Pikalov ◽  
Antony D. Loebel
Keyword(s):  
Depressive Symptoms ◽  
Rating Scale ◽  
Antipsychotic Agent ◽  
Pooled Analysis ◽  
Double Blind ◽  
Madrs Score ◽  
Level Data ◽  
Post Hoc ◽  
Major Depressive Episodes ◽  
Depressive Episodes

ObjectiveDepressive symptoms are common in schizophrenia and can worsen outcomes and increase suicide risk. Lurasidone is an atypical antipsychotic agent indicated for the treatment of schizophrenia and for the treatment of major depressive episodes associated with bipolar I disorder. This post hoc analysis evaluated the effect of lurasidone on depressive symptoms in patients with schizophrenia.MethodsPatient-level data were pooled from 4 similarly designed, double-blind, placebo-controlled, 6-week registration studies of lurasidone (40–160 mg/d) in adult patients with an acute exacerbation of schizophrenia. Changes in depressive symptoms, measured by the Montgomery–Åsberg Depression Rating Scale (MADRS), were analyzed for the overall sample and for subgroups of patients stratified by baseline MADRS scores.ResultsMADRS assessments at baseline and endpoint (day 42 or last observation carried forward [LOCF]) were available for 1330 patients. Patients receiving lurasidone experienced significantly greater decreases in MADRS score (–2.8, least-squares [LS] mean change, LOCF) compared with patients receiving placebo (–1.4, P < .001, effect size 0.24). Analysis of change in MADRS score (LOCF) by baseline symptom severity (MADRS score of ≥12, ≥14, ≥16, ≥18) showed significantly greater improvement for lurasidone-treated patients across all severity groups; effect sizes ranged from 0.25 to 0.34. Among patients with a baseline MADRS score of ≥12, depressive symptom remission (defined as MADRS score <10 at LOCF endpoint) was attained by 45.0% of lurasidone-treated patients and 36.3% of patients receiving placebo (P < .05).ConclusionsIn a pooled analysis of short-term, placebo-controlled studies, lurasidone significantly improved depressive symptoms in patients with schizophrenia.

A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes

2014 ◽  
Vol 45 (4) ◽  
pp. 693-704 ◽  
Author(s):  
A. McGirr ◽  
M. T. Berlim ◽  
D. J. Bond ◽  
M. P. Fleck ◽  
L. N. Yatham ◽  
...  
Keyword(s):  
Clinical Remission ◽  
Bipolar Depression ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Number Needed To Treat ◽  
Major Depressive ◽  
Double Blind ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Rapid Treatment

BackgroundThere is growing interest in glutamatergic agents in depression, particularly ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist. We aimed to assess the efficacy of ketamine in major depressive episodes.MethodWe searched EMBASE, PsycINFO, CENTRAL, and Medline from 1962 to January 2014 to identify double-blind, randomized controlled trials with allocation concealment evaluating ketamine in major depressive episodes. Clinical remission, response and depressive symptoms were extracted by two independent raters. The primary outcome measure was clinical remission at 24 h, 3 days and 7 days post-treatment. Analyses employed a random-effects model.ResultsData were synthesized from seven RCTs employing an intravenous infusion and one RCT employing intranasal ketamine, representing 73 subjects in parallel arms and 110 subjects in cross-over designs [n = 34 with bipolar disorder (BD), n = 149 with major depressive disorder (MDD)]. Ketamine was associated with higher rates of clinical remission relative to comparator (saline or midazolam) at 24 h [OR 7.06, number needed to treat (NNT) = 5], 3 days (OR 3.86, NNT = 6), and 7 days (OR 4.00, NNT = 6), as well as higher rates of clinical response at 24 h (OR 9.10, NNT = 3), 3 days (OR 6.77, NNT = 3), and 7 days (OR 4.87, NNT = 4). A standardized mean difference of 0.90 in favor of ketamine was observed at 24 h based on depression rating scale scores, with group comparisons revealing greater efficacy in unipolar depression compared to bipolar depression (1.07 v. 0.68). Ketamine was associated with transient psychotomimetic effects, but no persistent psychosis or affective switches.ConclusionOur meta-analysis suggests that single administrations ketamine are efficacious in the rapid treatment of unipolar and bipolar depression. Additional research is required to determine optimal dosing schedules, route, treatment schedules, and the potential efficacy of other glutamatergic agents.

Vortioxetine vs. Other Antidepressants in Patients with Major Depressive Episode With or Without Substance Use Disorder

2021 ◽  
Vol 19 ◽  
Author(s):  
Georgios D. Kotzalidis ◽  
Ginevra Lombardozzi ◽  
Marta Matrone ◽  
Emanuela Amici ◽  
Filippo Perrini ◽  
...  
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Rating Scale ◽  
New Drugs ◽  
Schizophrenia Spectrum Disorders ◽  
Major Depressive ◽  
Severity Rating ◽  
Major Depressive Episodes ◽  
Depressive Episodes ◽  
Better Than

Background: Major Depressive Episodes (MDEs) may characterise many psychiatric disorders. Its pharmacotherapy is laid with unmet needs, rendering the testing of new drugs necessary. Objective: To compare the effects of vortioxetine with those of other antidepressants (OADs) in a 1-year naturalistic setting. Methods: We included 126 adult patients with a MDE in the course of major depressive (MDD), bipolar (BD), or schizophrenia spectrum disorders (SSOPDs), with or without substance use disorder (SUD), who received 5-20 mg/day oral vortioxetine, and compared them with 100 patients receiving OADs at baseline and after 1, 3, 8, and 12 months on their scores on the MADRS, the CGI-S, the 24-item BPRS, the YMRS, the Hamilton Anxiety Rating Scale, a Visual Analogue Scale for craving, the Columbia-Suicide Severity Rating Scale, and the WHOQOL-BREF. Results: Patients on vortioxetine improved similarly to those on OADs on all measures, independently from having or not a comorbid SUD. However, they improved with time better than their OADs counterparts if affected by BD or SSOPDs, but not MDD, on the CGI-S, BPRS depression, anxiety, and manic symptoms. SUD hampered the response of anxiety to treatment. Men improved on depression with time better than women. Conclusion: MDEs responded to vortioxetine similarly to OADs by improving in depression general psychopathology, anxiety, suicidal thinking, and quality-of-life, independently from SUD comorbidity. MDEs of patients with BD or SSOPDs on vortioxetine responded better than that of patients on OADs.

scholarly journals Clinical Features of A Depressive Episode in People Who Had and Haven’t Had Covid-19

2021 ◽  
Vol 4 (2) ◽  
Keyword(s):  
Clinical Features ◽  
Depressive Episode ◽  
Rating Scale ◽  
Visual Hallucinations ◽  
Major Depressive ◽  
Dsm 5 ◽  
The One ◽  
Anxiety Depression ◽  
Major Depressive Episodes ◽  
Depressive Episodes

Objective: In publications, indicate increased anxiety, depression, and aggression of other mental disorders. The literature on psychiatric disorders associated with the depressive episode in people who had COVID-19. However, there are practically is not study clinical features of a depressive episode in people who had and haven’t had COVID-19. Materials and Methods: Eligible 100 participants all women to meeting the DSM-5 criteria, Hamilton Depression Rating Scale and PHQ-9 for depressive episode. Results: Patients who had a depressive episode after the COVID-19 disease were clinically different from those who had had major depressive episodes before COVID-19. On the one hand, this was expressed as a share in the fact that, in the clinical picture of a depressive episode manifested after the COVID-19 disease, visual hallucinations of various contents were encountered. On the other hand, patients who could not tolerate COVID-19, the presence of a pandemic exacerbated the onset of a depressive episode. Conclusion: Clinical features of a depressive episode in people who had and haven’t had COVID-19 dramatically differ from each other. Accordingly, therapy for these conditions is recommended.

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