Comparison of the efficacy of the multimodal serotonergic antidepressants trazodone and vortioxetine in the treatment of patients with endogenous depression: A meta-analysis of double-blind randomized placebo-controlled trials

Selective serotonergic antidepressants with a miltimodal mechanism of action are a new group of antidepressants, which includes trazodone and vortioxetine. Data on the efficacy of trazodone and vortioxetine in treating endogenous depression (major depressive disorder) appear to be rather uncertain now. There have been no direct comparative trials of the efficiency of therapy with trazodone and vortioxetine.

Objective: to compare the efficiency of therapy with trazodone and vortioxetine in treating patients with endogenous depression on the basis of statistical generalization of the results of studies of the efficacy of each antidepressant alone.

Material and methods. On the basis of the selection criteria, 7 double-blind, randomized, placebo-controlled trials of the efficiency of therapy with trazodone or vortioxetine in patients with endogenous depression were chosen from the PubMed database. The trials were divided into 2 groups according to the comparability of original samples of patients, methods for evaluating their state, and duration of follow-up. The efficiency of therapy with trazodone and that of vortioxetine were compared by determining the statistical significance of differences in the ratio of responders/nonresponders or remitters/nonremitters in Groups 1 and 2 separately.

Results. 1) Comparison of the values of 8-week therapy efficiency in Group 1: a) therapy with trazodone at an average dose of about 300 mg/day significantly more frequently results in the alleviation of depressive symptoms to the level of classifying patients into the category of responders than that with vortioxetine at an average dose of about 9 mg/day; b) therapy with trazodone at an average dose of about 300 mg/day significantly more often relieves depressive symptoms to the level of classifying patients into a category of remitters than that with vortioxetine at average dose of about 9 mg/day; c) therapy with trazodone at an average dose of about 300 mg/day and that with vortioxetine at an average dose of about 18.5 mg/day lead to the comparable reduction of depressive symptoms to the level of referring patients to a category of responders or remitters. 2) Comparison of the values of of 6-week treatment efficacy in Group 2: therapy with trazodone at an average dose of about 300 mg/day is statistically significantly less frequently accompanied by the attenuation of depressive symptoms to the level of assigning patients to a category of responders than that with vortioxetine at average dose of about 7.5 mg/day. The validity of the results of comparing the efficiency of therapy in Group 2 is constrained by incomplete comparability of the clinical and demographic characteristics of initial patient samples.

Conclusion. The findings suggest the higher efficacy of trazodone 300 mg/day versus vortioxetine 5–10 mg/day and the comparable efficacy of trazodone 300 mg/day and vortioxetine 15–20 mg/day in treating patients with endogenous depression.

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