Experience with vortioxetine in the treatment of post-stroke depression

Abstract

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.