Experience with vortioxetine in the treatment of post-stroke depression

Post-stroke depression significantly impairs functional recovery in patients and their quality of life.
Objective: to evaluate the efficacy of vortioxetine in correcting depressive symptoms in the early recovery period of ischemic stroke, as well as its effect on the cognitive functions of patients.
Patients and methods. The investigation enrolled 60 patients with ischemic stroke in the carotid bed with symptoms of mild and moderate depression according to the Montgomery-Asberg Depression Rating Scale (MADRS). Group 1 (a study group) included 30 patients who received vortioxetine 10 mg/day for 8 weeks; Group 2 (a comparison group) consisted of 30 patients who refused to take an antidepressant. The investigators evaluated the severity of focal neurological deficit using the US National Institutes of Health Stroke Scale (NIHSS), the degree of functional deficit with the modified Rankin Scale (mRS) and the Functional Independence Measure (FIM). The diagnosis of poststroke depression was established according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria; the authors analyzed the severity of depression using the Hospital Anxiety and Depression Scale (HADS) and MADRS and cognitive functions with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). For evaluation of higher mental dysfunctions, they used a set of neuropsychological techniques developed by A.R. Luria and his followers, by applying the classic stimulus materials.
Results and discussion. At 8-week follow-up, in Group 1 there were no patients with symptoms of moderate depression, only 14 (46.7%) patients had symptoms of mild depression, and the remaining 16 (53.3%) patients did not have emotional disturbances. At the same time, in Group 2, 14 (46.7%) patients were observed to have signs of moderate depressive disorder and 15 (50%) had symptoms of mild depression; 1 (0.3%) patient had symptoms of major depressive disorder. During treatment with vortioxetine, there was a considerable decrease in the severity of depressive symptoms according to the total MADRS score (U=87.0; p<0.0001) and a better functional recovery after a stroke, as shown by FIM (U=296.0, p= 0.023) and NIHSS scores (p<0.05). Analyzing the MoCA subtest scores revealed that Group 1 patients statistically significantly better coped with attention tasks (U=237.0; p<0.001).
Conclusion. Vortioxetine significantly reduces the severity of depressive symptoms, has an obvious positive effect on the cognitive status of patients, by improving neurodynamic functions and memory in patients in the early recovery period of ischemic stroke.

stroke, depression, cognitive functions, vortioxetine

1. Gusev EI, Gekht AB, Martynov MYu, editors. Materialy mezhdunarodnogo kongressa, posvyashchennogo Vsemirnomu dnyu insul'ta [Materials of the international Congress dedicated to world stroke day]. Moscow; 2017.

2. M∅rk A, Pehrson A, Brennum LT, et al. Pharmacological effects of Lu AA21004: a novel multimodal compound for the treatment of major depressive disorder. J Pharmacol Exp Ther. 2012 Mar;340(3):666-75. doi: 10.1124/jpet.111.189068. Epub 2011 Dec 9.

3. Baune BT, Brignone M, Larsen KG. A network meta-analysis comparing effects of various antidepressant classes on the Digit Symbol substitution test (DSST) as a measure of cognitive dysfunction in patients with major depressive disorder. Int J Neuropsychopharmacol. 2018 Feb 1; 21(2):97-107. doi: 10.1093/ijnp/pyx070.

4. McIntyre RS, Harrison J, Loft H, et al. The Effects of Vortioxetine on Cognitive Function in Patients with Major Depressive Disorder: A Meta-Analysis of Three Randomized Controlled Trials. Int J Neuropsychopharmacol. 2016 Jun 15;19(10). pii:

5. pyw055. doi: 10.1093/ijnp/pyw055.

6. Carta MG, Pala AN, Finco G, et al. Depression and cerebrovascular disease: could vortioxetine represent a valid treatment option? Clin Pract Epidemiol Ment Health. 2015 Feb 27; 11:144-9. doi: 10.2174/1745017901511010144. eCollection 2015.

7. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70.

8. Balashova EYu, Kovyazina MS. Neiropsikhologicheskaya diagnostika. Klassicheskie stimul'nye materialy [Neuropsychological diagnostics. Classic incentive materials]. 3rd ed. Moscow: Genezis; 2012.

9. Glozman ZhM. Neiropsikhologicheskoe obsledovanie: kachestvennaya i kolichestvennaya otsenka dannykh [Neuropsychological examination: qualitative and quantitative assessment of data]. Moscow: Smysl; 2012.

10. Yakhno NN. Dementsii: rukovodstvo dlya vrachei [Dementia: a guide for doctors]. Moscow: MEDpress-inform; 2011. 272 p.

11. Towfighi A, Ovbiagele B, El Husseini N, et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2017 Feb;48(2): e30-e43. doi: 10.1161/STR.0000000000000113. Epub 2016 Dec 8.

12. Alexopoulos GS, Meyers BS, Young RC. Vascular depression hypothesis. Arch Gen Psychiatry. 1997 Oct;54(10):915-22.

13. Chollet F, Tardy J, Albucher JF, et al. Fluoxetine for Motor Recovery After Acute Ischaemic Stroke (FLAME): A Randomised Placebo-Controlled Trial. Lancet Neurol. 2011 Feb;10(2):123-30. doi: 10.1016/S1474-4422(10)70314-8. Epub 2011 Jan 7.

14. Mead GE, Hsieh CF, Lee R, et al. Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery. Cochrane Database Syst Rev. 2012 Nov 14;11:CD009286. doi: 10.1002/14651858.CD009286.pub2.

15. Daroff R. Bradley's Neurology in Clinical Practice. 7th ed. Vol. 1. London: Elsevier; 2015. P. 92-115.

16. Bogolepova NA. Vascular depression and cognitive dysfunction. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3S):26-31. (In Russ.). doi: 10.14412/2074-2711-2019-3S-26-31

17. Parfenov VA. Poststroke cognitive impairment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):22–7. (In Russ.). doi: 10.14412/2074-2711-2019-4-22-27