1. Using early changes in cold cognition to predict response to vortioxetine in major depressive disorder.
- Author
-
Park C, Zuckerman H, Subramaniapillai M, Mansur RB, Rosenblat JD, Cao B, Iacobucci M, Lee Y, Levitan R, Blumberger DM, and McIntyre RS
- Subjects
- Adult, Antidepressive Agents pharmacology, Cognition physiology, Cognitive Dysfunction diagnosis, Cognitive Dysfunction drug therapy, Cognitive Dysfunction epidemiology, Depressive Disorder, Major epidemiology, Female, Humans, Male, Middle Aged, Ontario epidemiology, Predictive Value of Tests, Treatment Outcome, Vortioxetine pharmacology, Antidepressive Agents therapeutic use, Cognition drug effects, Depressive Disorder, Major diagnosis, Depressive Disorder, Major drug therapy, Vortioxetine therapeutic use
- Abstract
Antidepressant pharmacotherapy dominates current treatment in psychiatry, including treatment for major depressive disorder (MDD). However, the current trial-and-error process of medication selection contributes to treatment failure and unnecessarily exposes patients to lengthy and insufficient treatment trials. Notably, improvements in measures of cognition have been demonstrated to occur early during treatment and prior to improvements in clinical state. Cognitions have been categorized based on emotional valence (i.e., cold versus hot cognitions). Cold cognitions describe cognitive operations that are relevant to the processing of non-emotional information. The current analysis investigates whether early changes in cold cognition can predict response after 8 weeks of vortioxetine treatment in adults with MDD. This was secondary analysis of an 8-week, open-label study. Cognition was assessed at week 0 and week 2 to measure early cognitive change. Depressive symptom severity was assessed at week 0 and week 8 to measure treatment response. Eighty-one subjects were analyzed using binomial logistic regression models. Early change in cognition was a non-significant predictor of response (p = 0.845, SE = 0.599, OR = 1.124), which may have resulted from high data variability. The overall predictive accuracy of the model was low (sensitivity = 37.5%, specificity = 89.8%, PPV = 70.6%, NPV = 68.8%). Future studies should include larger samples and stratify patients based on potentially moderating variables, such as baseline cognitive impairment and occupation. Stratification would likely produce more homogenous samples, reducing the amount of variability observed for early cognitive change., Competing Interests: Declaration of Competing Interest Roger S. McIntyre is a consultant to speak on behalf for, and/or has received research support from Lundbeck, Janssen, Shire, Purdue, Pfizer, Otsuka, Allergan, Takeda, Neurocrine, Sunovion, Stanley Medical Research Institute, and CIHR/GACD/Chinese National Natural Research Foundation. All other authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF