Key Takeaways
Extended Takeaways
- The cohort was clinically difficult to treat: treatment-resistant depression required failure of 2 or more different oral antidepressants, baseline severity was high with a Montgomery-Asberg Depression Rating Scale score ≥ 20, and 38 patients were receiving concomitant medications when vortioxetine was escalated.
- Symptom burden improved over a short observation window, with CGI-S decreasing from 4.45 ± 0.74 at T0 to 2.63 ± 1.05 at T1 after 8 weeks of supratherapeutic vortioxetine, supporting dose escalation as a potential strategy in partial responders who can tolerate slow titration.
- Tolerability was limited mainly by nausea rather than serious toxicity: 35 patients required dose reduction to ≤ 20 mg before 8 weeks, including 22 for nausea and 13 for lack of improvement, so early follow-up after escalation is important.
- Among adverse effects specifically tracked, nausea was common and weight gain occurred, but no serious adverse events, no symptoms or signs of serotonin syndrome, and no worsening of suicidal ideation or suicidal behaviors were recorded during the observation period.
- Use above the labeled maximum was split between vortioxetine 30 mg/d in 37 patients and 40 mg/d in 19 patients, suggesting clinicians considering supratherapeutic dosing may start with 30 mg/d before attempting 40 mg/d in selected patients.
