Dziwota Ewelina, Olajossy Marcin
Acta Pol Pharm. 2016 Nov;73(6):1433-1437.
Depression symptoms resulting from cognitive function impairment are emphasized by both DSM-5 and ICD-10 diagnostic criteria for major depressive disorder and depressive episodes. Nonetheless, the role of cognitive dysfunctions seem to remain underestimated in case of depressive disorders, thus they are rarely perceived as therapeutic target. Vortioxetine is a relatively new, multi-functional agent. With its unique properties and strong affinity towards serotonin transporter (5-HTT), vortioxetine is a modulator and stimulator of serotonergic transmission. Vortioxetine is an antidepressant drug suitable for therapy in various types of depression: severe, anxiety-associated, and of elders. It acts equally strong as SNRIs or agomelatine and has favorable effects on cognitive functioning. Although vortioxetine has not undergone comprehensive preclinical testing, the available data indicate that this particular agent may be more advantageous in terms of its procognitive effects, as compared to other drugs - which often seemed to be analogous in preclinical and clinical testing. In vitro examination of hippocampal pyramidal cells revealed that vortioxetine improves both synaptic transmission and neuroplasticity responsible for memory and learning patterns. Contrary to fluoxetine, the long-term treatment with use of vortioxetine on mice resulted in enhanced visual and spatial memory, along with reduced occurrence of typical depressive behavior. In addition, vortioxetine is a very first drug efficiently augmenting cognitive function in adults diagnosed with severe depressive episode, irrespective of its curative potential on the affective sphere. It may exert even stronger direct effect (assessed with DSST) on cognitive functions than duloxetine. With its supplementary capacity of acting directly on several subtypes of serotonin receptors, vortioxetine is certainly more than just a SSRI. It has been proved that it is as effective as venlafaxine and more efficient than agomelatine in MDD treatment, additionally exerting procognitive effects. In addition, vortioxetine may be beneficial in overcoming sexual dysfunction in patients, who have been suffering from such condition as a result of treatment with other antidepressant agents. The drug is generally well tolerated with the most prevalent side effects being mild to moderate nausea along with (mostly transient) headaches. Vortioxetine may significantly improve the quality of life in patients suffering from depression.
《精神疾病诊断与统计手册》第5版（DSM - 5）和《国际疾病分类》第10版（ICD - 10）中关于重度抑郁症和抑郁发作的诊断标准都强调了认知功能损害导致的抑郁症状。尽管如此，在抑郁症病例中，认知功能障碍的作用似乎仍被低估，因此它们很少被视为治疗靶点。伏硫西汀是一种相对较新的多功能药物。凭借其独特的性质和对5 - 羟色胺转运体（5 - HTT）的强大亲和力，伏硫西汀是5 - 羟色胺能传递的调节剂和刺激剂。伏硫西汀是一种适用于治疗各种类型抑郁症的抗抑郁药物，包括重度、伴有焦虑的以及老年抑郁症。它的作用强度与5 - 羟色胺 - 去甲肾上腺素再摄取抑制剂（SNRIs）或阿戈美拉汀相当，并且对认知功能有良好影响。尽管伏硫西汀尚未经过全面的临床前测试，但现有数据表明，与其他药物相比，这种特定药物在其促认知作用方面可能更具优势，而其他药物在临床前和临床试验中往往表现相似。对海马锥体细胞的体外检查显示，伏硫西汀可改善负责记忆和学习模式的突触传递和神经可塑性。与氟西汀不同，长期给小鼠使用伏硫西汀会增强视觉和空间记忆，并减少典型抑郁行为的发生。此外，伏硫西汀是第一种能有效增强被诊断为重度抑郁发作的成年人认知功能的药物，无论其对情感领域的治疗潜力如何。它对认知功能的直接影响（通过数字符号替换测验评估）可能比度洛西汀更强。凭借其直接作用于几种5 - 羟色胺受体亚型的补充能力，伏硫西汀肯定不仅仅是一种选择性5 - 羟色胺再摄取抑制剂（SSRI）。事实证明，它在治疗重度抑郁症方面与文拉法辛一样有效，且比阿戈美拉汀更有效，此外还具有促认知作用。此外，伏硫西汀可能有助于克服因使用其他抗抑郁药物而出现性功能障碍的患者的性功能问题。该药物总体耐受性良好，最常见的副作用是轻度至中度恶心以及（大多为短暂性的）头痛。伏硫西汀可显著改善抑郁症患者的生活质量。
