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Sleep and Mood Disorders

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Front. Psychiatry | doi: 10.3389/fpsyt.2019.00017

The Efficacy of Vortioxetine on Anhedonia in Patients with Major Depressive Disorder

 Roger Mcintyre1*, Bing Cao2, 3,  Caroline Park3, 4, Mehala Subramaniapillai3,  Yena Lee3, 4,  Michelle Iacobucci3, Rodrigo B. Mansur3,  Hannah Zuckerman3 and  Lee Phan3
  • 1University of Toronto, Canada
  • 2Peking University, China
  • 3Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Canada
  • 4Institute of Medical Science, University of Toronto, Canada

Background
Anhedonia is a common, persistent and disabling phenomenon in treated adults with Major Depressive Disorder (MDD). Hitherto, relatively few antidepressant agents have been evaluated with respect to their effect on anhedonia in MDD.
Methods
This is a post-hoc analysis of a primary study that sought to evaluate the sensitivity to change of the THINC-integrated tool (THINC-it) in MDD (ClinicalTrials.gov Identifier: NCT03053362). Adults meeting DSM-5 criteria for MDD with at least moderate depressive symptom severity [i.e. Montgomery Åsberg Depression Rating Scale (MADRS) total score ≥ 20] were eligible. Subjects were recruited between October 2017 and August 2018 in Toronto, Ontario at the Brain and Cognition Discovery Foundation. All subjects received open-label vortioxetine (10-20 mg/day, flexibly-dosed) for 8 weeks. Herein, the primary outcome of interest was the change from baseline to endpoint in the Snaith-Hamilton Pleasure Scale (SHAPS) total score, as well as the MADRS anhedonia factor. The mediational effects of improvements in anhedonia on general function and quality of life, as measured by the Sheehan Disability Scale (SDS) and the 5-Item World Health Organization Well-Being Index (WHO-5), were secondarily assessed.
Results
A total of 100 subjects with MDD were enrolled in the primary study and began treatment with vortioxetine. Vortioxetine significantly improved anhedonia as evidenced by significant baseline to endpoint improvements in SHAPS and MADRS anhedonia factor scores (p < 0.0001). Improvements in the SHAPS and the MADRS anhedonia factor correlated with improvements in general function (i.e. SDS) and quality of life (i.e. WHO-5) (p < 0.0001). Notably, improvements in anhedonia were found to mediate the association between improvements in overall depressive symptom severity (i.e., MADRS total score) and social functioning (i.e., social life component of the SDS) (p=0.026).
Conclusion
The unmet need in depression is to improve patient functioning and other patient-reported outcomes (e.g. quality of life). Antidepressant interventions capable of attenuating anhedonia as well as cognitive dysfunction in MDD may help in this regard, as improvement in these domains have been associated with improvement in psychosocial function and quality of life.

Keywords: Major Depressive Disorder, Anhedonia, function, Vortioxetine, Quality of Life, Antidepressants

Received: 03 Nov 2018; Accepted: 11 Jan 2019.

Edited by:

Baoman Li, China Medical University, China

Reviewed by:

Mitul A. Mehta, King's College London, United Kingdom
Paul Moser, Independent researcher  

Copyright: © 2019 Mcintyre, Cao, Park, Subramaniapillai, Lee, Iacobucci, Mansur, Zuckerman and Phan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Roger Mcintyre, University of Toronto, Toronto, Canada, roger.mcintyre@uhn.ca