A New Antidepressant That Helps With Cognition
I would like to introduce to you a new antidepressant with the trade name of Brintellix and the generic name of Vortioxetine that has been found via research to help with cognition in addition and separate to it’s antidepressant effect. Too early to make any statements about the possible uses for this medication outside of psychiatry but suffice it to say much research is being conducted.
It’s hypothesized mechanism of action is via not only it’s SSRI mechanism of action, but also via it’s multiple direct 5-HT receptors activity. The two receptors that give it it’s purported cognitive effects are it’s 5-HT7 receptor and 5-HT3 receptor antagonism. The benefits of SSRI’s have been shown to have the ability to assist the body in taking stem cells and aiding in the regeneration of brain cells that have been killed by depression.
The cognitive effects that have been found to improve with this medication is one’s executive function (cognitive flexibility), attention and processing speed, learning and memory. This is an important difference, in that, there is little evidence thus far that the other current antidepressants improve cognitive function in patients with Major Depressive Disorder outside of their effects on the depressive symptoms.
In a paper by R.S. McIntyre et al., regarding their study on a group of 602 patients with moderate to severe MDD treated over eight weeks with either 10 mg or 20 mg of Vortioxetine, patients’ self-reported PDQ assessing their cognitive function, it was found that in the domains of prospective/retrospective memory, attention/concentration, and planning and organization, patients’ subjective measures of cognitive function improved.
Also, in the same study, objective measures revealed that patients’ cognitive measures improved independent of the antidepressant effect. The antidepressant effect was dose dependent (i.e. the higher the dose 20 mg vs. 10 mg) the greater the antidepressant effect. Whereas, the cognitive effect was not dose dependent, with the higher dose of Vortioextine not yielding greater cognitive benefits.
This test appears to be the first large randomized study in adult (aged 18 to 65y/o) to document a beneficial effect on a composite measure of cognitive function in MDD, where a pre-determined clinical outcome was cognitive performance as well as consistent improvement across a range of neuropsychological tests.
In this study, the most common side effects were nausea 1.9% and headache 1.0%. What I have seen clinically with the side effects of nausea and headache is similar.
Much of time, though, most patients tolerate this medication very well, especially in regards to other fairly common side effects common to the SSRI class of medications, namely sexual dysfunction in males, which is in this medication only 3 to 5% in the different doses in comparison to placebo of 2% or < 1 to 2% in females in comparison to placebo of < 1%. As far as possible weight gain, Brintellix was equivalent to placebo.
With regards to cognition, my patients have been noted saying to me things like, “The fog is clearing”, which isn’t very typical of the majority of antidepressants that are commonly prescribed. This is a welcome addition to the antidepressant class of medications.