In addition to the more well known emotional symptoms of depression, such as a lack of interest, low self-esteem and hopelessness, patients can also suffer from cognitive problems including memory loss, attention and poor decision making. Finding medical treatments that can manage both sets of conditions has been difficult but a new study from Danish pharmaceutical company Lundbeck shows promise for their antidepressant Brintellix (vortioxetine). Confirmed by neuropsychological tests from Cogstate, enrolled patients taking Brintellix not only found relief from common depression symptoms but also showed an improvement in cognitive function.
Last year, Cogstate scientists confirmed the prevalence of brain dysfunction in depressed patients noting the need to focus on the whole person. “The old mythology in psychiatry that diseases such as Major Depression and Bipolar Disorder are purely disorders of mood is finally being overturned,” said Judith Jaeger PhD, Vice President of Clinical Trials at Cogstate. “Not only is there cognitive dysfunction when a patient is in the throes of a severe episode of depression, but research is increasingly showing that, at least for some patients, dysfunction continues between episodes. And this residual cognitive dysfunction seems to underlie much of the disability that persists.”
At last month’s American Psychiatric Association’s 2014 annual meeting in New York City, the results of a randomized, double-blind, placebo-controlled trial of Brintellix (vortioxetine) for inpatients with major depressive disorder were presented. Concluded last fall, the eight-week study, known as FOCUS, included 598 patients, ages 18 to 65. Divided into three groups, one third of the patients received vortioxetine 20 mg daily, one third received a 10 mg daily dose while the third group served as a control receiving only a placebo.
At the beginning and the end of the trial period, all patients were tested with a variety of cognitive assessments, including DSST (executive function, speed of processing, attention), RAVLT (learning, memory), Trail Making Test A/B (TMT-A: speed of processing; TMT-B: executive function), Stroop test (congruent and incongruent: executive function); and two Cogstate tests, a simple reaction time task and a choice reaction time task for attention. In addition, the patient-reported cognitive measure, Perceived Deficits Questionnaire (PDQ) comprising four subscales: attention/concentration, prospective memory, planning/organization, and retrospective memory was taken at Weeks 1 and 8.
As expected, patients who received doses of vortioxetine, a drug previously approved by the FDA, showed improvement for their depression symptoms. Their mean scores on the Montgomery–Åsberg Depression Rating Scale improved by 15.6 for the 10mg dosage group and 17.6 for the 20 mg group, versus only 10.9 for the control group.
The surprising and encouraging result was that patients treated with vortioxetine also significantly increased their scores on the cognitive assessments, independently of whether their depressive symptoms improved.
The study was recently published in the International Journal of Neuropsychopharmacology.
“Neuropsychological tests are powerful indicators of cognitive function but are not routinely used in everyday, busy clinical practice, so it was equally important to understand how patients reported changes in cognitive symptoms that they experienced,” explained Dr. Roger McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto and lead author of the study. “We are encouraged that Brintellix not only showed benefits in cognitive function in patients with major depression based on the neuropsychological tests, but that patients themselves also reported noticeable improvements in their cognitive symptoms.”
Being able to double the impact of a medicine by treating the direct and indirect symptoms is good news for patients diagnosed with depression.
“Reducing highly prevalent symptoms beyond mood, including those related to cognition, remains a huge challenge to achieving full disease remission,” said Dr. McIntyre. “While further studies are needed to confirm these findings, it is truly encouraging to have a new treatment option that may target a dimension of major depression that not only is a principal mediator of functional impairment (for example, workforce performance and attendance) but also a domain so highly related to patient reported quality of life and to feeling themselves again.”
Questions or comments? Please contact Dan Peterson