4.6 Article

Effect of vortioxetine vs. escitalopram on plasma BDNF and platelet serotonin in depressed patients

Publisher

PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.pnpbp.2020.110016

Keywords

Depression; Escitalopram; Plasma BDNF; Platelet serotonin; Patients; Vortioxetine

Funding

  1. University of Zagreb [BM126]

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Escitalopram and vortioxetine are effective antidepressants that target the serotonin system, with vortioxetine having a unique mechanism of action compared to SSRIs. Vortioxetine was found to significantly increase plasma BDNF concentration and decrease platelet 5-HT concentration, while escitalopram mainly reduced platelet 5-HT concentration. Response to vortioxetine was not predicted by baseline BDNF or platelet 5-HT concentration, highlighting the need for further research on the long-term effects and clinical implications.
Escitalopram and vortioxetine are efficacious antidepressants. They directly target serotonin (5-HT) system, but vortioxetine mechanism of action is distinct from the one of selective serotonin reuptake inhibitors (SSRIs). Treatment with SSRIs decrease platelet 5-HT concentration and increase peripheral brain-derived neurotrophic factor (BDNF) levels. Since vortioxetine has a multimodal mechanism of action, it is expected to have a greater effect on circulatory BDNF concentration, compared to conventional antidepressants. This longitudinal study aimed to explore and compare the effects of 4-weeks of treatment with vortioxetine and escitalopram on plasma BDNF and platelet 5-HT concentration in patients with major depressive disorder (MDD). The results revealed that vortioxetine significantly increased plasma BDNF concentration (p = .018) and significantly decreased platelet 5-HT concentration (p < .001). Treatment with escitalopram significantly decreased platelet 5-HT concentration (p < .001), but it did not affect plasma BDNF concentration (p = .379). Response to vortioxetine was not predicted by baseline plasma BDNF or platelet 5-HT concentration, but response to escitalopram was predicted by baseline platelet 5-HT concentration. These effects might be due to vortioxetine unique mechanism of action, but the clinical implications are unclear. It remains to be determined whether this finding extends during long-term vortioxetine treatment, and which, if any, clinical effects emerge from BDNF increase.

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