Depression in the elderly – the position of vortioxetine

In Poland, almost 25% of seniors experience symptoms of depression, which worsen with age. This has a devastating impact on mental health, including cognitive function, physical function and role in society. This results in striving for disability and giving up on life. The occurrence of somatic diseases, so common in this population, is one of the important risk factors for depression, which significantly influences the initiation of appropriate treatment. Therefore, the incorporated pharmaceuticals should be characterized by high safety of use, low risk of interactions and good tolerance profile.

The pro-cognitive effect of an antidepressant is also extremely important in the treatment of major depressive disorder (MDD) in older people, as cognitive impairment may persist despite the disappearance of the patient’s depressive symptoms.

Although depression is common in patients with dementia, data on the effectiveness and safety of antidepressants in this population is limited. Vortioxetine acts as a modulator of 5-HT receptor activity and as an inhibitor of the 5-HT transporter, influencing the activity of several neurotransmitter systems involved in the regulation of mood and cognition, as the serotonergic system, but also the norepinephrine, dopamine and histamine, acetylcholine, gamma-aminobutyric acid and glutamate and opioids.

For older patients suffering from depressive disorders, particularly attractive features of vortioxetine include the marked lack of sedation, weight changes, changes in vital signs or electrocardiogram parameters, as well as the low risk of intersegmental interactions or serious side effects. Vortioxetine has a positive effect on psychomotor and cognitive performance, which may translate into additional benefits related to the safety of this drug compared to other antidepressants. This substance is both effective in alleviating the symptoms of depression, including cognitive impairment, and safe, which is important when introducing the drug to older people. Vortioxetine is recommended as a first-line drug in the treatment of depression in older people by both the Polish Psychiatric Association (PTP) and Canadian Network for Mood and Anxiety Treatments (CANMAT). PTP additionally recommends the use of this substance as the first-line drug in the treatment of depression in patients with concomitant somatic diseases.