28 Sep, 2023

Treatment options for a MDD patient like Tiffany*

Comparison of tolerability among antidepressants
 

Tolerability is an important factor when choosing an antidepressant in view of commonly observed side effects such as gastrointestinal symptoms, sexual dysfunction, and weight changes.1

* Based on unadjusted rates from product monographs, including Agomelatine (Valdoxano®) Summary of Product
Characteristics. 2018. Brintellix®, Cipralex®, Cipramil® are indicated for the treatment of major depressive episodes
in adults. Lundbeck: Vortioxetine (Brintellix®) Summary of Product Characteristics. 2019. Escitalopram (Cipralex®)
Summary of Product Characteristics. 2018; Citalopram (Cipramil®) Summary of Product Characteristics. 2018.

The CANMAT 2016 clinical guidelines provides a summary of the prevalence of common adverse events as reported in the product monographs.2 Overall, escitalopram, agomelatine and Brintellix®(vortioxetine) showed lower incidences of adverse events when compared to newer commonly used second-generation antidepressants.2 The safety profile of Brintellix® is further supported by its broad efficacy data.

*p<0.05, **p<0.01, ***p0.001 vs placebo
Meta-analysis includes 11 studies: HLu 11492A, HLu 1t1t984A, TAK 305, HLu
13267A, TAK 315, TAK 316, TAK 303, TAK 304, TAK 317, HLu 14122A, and CCT-002
FAS=full analysis set; MMRM=mixed model for repeated measures
MADRS: Montgomery–Åsberg Depression Rating Scale

In a meta-analysis of 11 randomized, placebo-controlled trials of 6/8 weeks’ duration, Brintellix® 10 mg/day and 20 mg/day significantly improved all symptoms of MDD, as assessed by the Montgomery–Åsberg depression rating scale (MADRS), compared with placebo.3 These improvements are associated with improved patient functioning.4,5,6 Thus, Brintellix® is a viable treatment option for Tiffany* in view of the broad effects on individual symptoms of MDD and its safety profile.

Tiffany* is a 24 year old student and in her final year of university. She is suffering from MDD and is currently receiving an SSRI for her depression. However, she is still experiencing residual symptoms of sadness, lack of energy, trouble concentrating, low motivation, etc. and does not feel like her true self.


Tiffany* wants to be able to feel, think and do as before.

A shared decision-making approach between Tiffany* and her clinician to bring her back to her true self could be a viable approach.

*fictitious character
Abbreviations
MDD, major depressive disorder; SSRI, selective serotonin reuptake inhibitor; MADRS, Montgomery–Åsberg Depression Rating Scale;
CANMAT, Canadian Network for Mood and Anxiety Treatments

References

1. Goethe JW et al. J Clin Psychopharmacol. 2007;27(5):451-458.
2. Kennedy SH et al. Can J Psychiatry 2016;61(9): 540–60.
3. Thase M et al. Eur Neuropsychopharmacol 2016;26(6):979-99.
4. Mahableshwarkar AR et al. Neuropsychopharmacology. 2015 Jul;40(8):2025-37.
5. Florea I et al. Brain Behav. 2017 Mar; 7(3): e00622.
6. Montgomery SA et al. Hum Psychopharmacol. 2014;29:470-82.

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