Functional improvement as a treatment goal in major depressive disorder: a narrative review of the evidence for vortioxetine

This narrative review used manufacturer-sponsored vortioxetine clinical trial database (doses of 5-20 mg) to evaluate the effect of vortioxetine treatment on short- and long- term functional outcomes in major depressive disorder (MDD), in both the clinical trial setting and in routine practice. The Sheehan Disability Scale (SDS) was the most used functional scale and, based on this measure, short-term, placebo-controlled studies demonstrated significant improvements with vortioxetine 10 mg (reductions ranged from -0.92 to -2.10 points vs placebo after 6-8 weeks treatment) and 20 mg (reductions ranged from -0.88 to -3.92 vs placebo). Of note, the acute beneficial effects of vortioxetine on functionality were seen in patients with severe baseline depressive symptoms as well as those with significant anxiety. Long-term open-label extension studies further showed that maintenance treatment was associated with continued functional improvements over one year (reaching an average reduction of -6.2 SDS points from baseline) that were correlated with continued improvements in residual symptoms. Evidence from real-world studies, using multiple functional outcomes, further demonstrated generalizability to routine practice where patients are living with multiple comorbidities previously excluded from the randomized controlled trials. Taken overall, the findings from several head-to-head studies indicated a functional advantage of vortioxetine compared with other classes of antidepressants and demonstrated the effectiveness of vortioxetine as first-line treatment while also confirming its effectiveness in improving functional outcomes when given later in the treatment journey. In summary, vortioxetine is an effective treatment option for improving functional outcomes in people living with MDD.