Gill Hartej, McIntyre Roger S, Christensen Michael Cronquist
Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
J Affect Disord. 2025 Nov 1;388:119563. doi: 10.1016/j.jad.2025.119563. Epub 2025 May 31.
Anhedonia is a hallmark symptom of major depressive disorder (MDD), associated with impairments in various aspects of reward. VIVRE is the first study in patients with MDD receiving antidepressant therapy to include longitudinal assessment of reward behavior using the Effort-Expenditure for Rewards Task (EEfRT), a validated behavioral paradigm for the objective assessment of reward and effort-based decision-making in patients with MDD.
Randomized, double-blind study of vortioxetine (10 or 20 mg/day) versus desvenlafaxine (50 mg/day) in adults with MDD and partial response to selective serotonin reuptake inhibitor monotherapy. Motivation for reward based on the proportion of hard trial choices was assessed at baseline and after 8 weeks of treatment.
There was no difference in the proportion of hard trial choices between the vortioxetine (n = 288) and desvenlafaxine (n = 300) treatment groups at baseline. Minimal change in parameters of reward motivation was seen over the 8-week treatment period in either group. The between-group difference in the proportion of hard trial choices at week 8 was not statistically significant (odds ratio: 0.97 [95 % CI: 0.82, 1.14]; P = 0.72). Similar results were obtained when controlling for reward probability, reward magnitude, trial number, and sex, or when limiting to the first 50 trials (excluding computer-selected trials).
Exploratory analyses evaluating the utility of the EEfRT in clinical populations.
Experience from the VIVRE study suggests that further research is required to fully determine the clinical utility of the EEfRT for assessment of antidepressant treatment effects in patients with MDD.
NCT04448431.
快感缺失是重度抑郁症（MDD）的标志性症状，与奖赏各方面的损害有关。VIVRE研究是首个针对接受抗抑郁治疗的MDD患者开展的研究，该研究使用奖赏努力任务（EEfRT）对奖赏行为进行纵向评估，EEfRT是一种经过验证的行为范式，用于客观评估MDD患者基于奖赏和努力的决策。
对中度抑郁且对选择性5-羟色胺再摄取抑制剂单药治疗有部分反应的成年人进行随机、双盲研究，比较伏硫西汀（10或20毫克/天）与去甲文拉法辛（50毫克/天）的疗效。基于困难试验选择比例的奖赏动机在基线和治疗8周后进行评估。
伏硫西汀组（n = 288）和去甲文拉法辛组（n = 300）在基线时困难试验选择比例无差异。在8周治疗期内，两组奖赏动机参数变化均极小。第8周时两组间困难试验选择比例的差异无统计学意义（优势比：0.97 [95%CI：0.82，1.14]；P = 0.72）。在控制奖赏概率、奖赏大小、试验次数和性别后，或仅分析前50次试验（不包括计算机选择的试验）时，得到了相似结果。
探索性分析评估了EEfRT在临床人群中的效用。
VIVRE研究的经验表明，需要进一步研究以充分确定EEfRT在评估MDD患者抗抑郁治疗效果方面的临床效用。
NCT04448431。
