Title:Differential Response to Three Antidepressants in Patients with Major
Depressive Episode Who Suffered Covid-19-Related Trauma
Volume: 20
Issue: 12
Author(s): Sergio De Filippis, Ginevra Lombardozzi*, Marta Matrone, Emanuela Amici, Giada Trovini, Filippo Perrini, Alessandro Di Giovanni, Valeria Giovanetti and Georgios D. Kotzalidis*
Affiliation:
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
- Von Siebenthal Neuropsychiatric Clinic and Hospital, Via della Madonnina 1, Genzano di Roma 00045 RM, Italy
- NESMOS Department, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
Keywords:
Covid-19, major depressive episode, vortioxetine, sertraline, trazodone, pandemic-related trauma, anxiety, quality of Life, craving, substance use disorders, hospitalization.
Abstract:
Background: The Covid 19 pandemic might have impacted response to drug treatment in
major depressive episode (MDE). We compared responses to three different antidepressant drugs,
i.e., vortioxetine, sertraline, and trazodone, in outpatients with MDE during Major Depressive Disorder
(MDD), Bipolar Disorder (BD), or schizophrenia and related psychoses (SSOPDs) during two
time periods, i.e., before and after suffering Covid-19-related trauma.
Methods: We conducted an observational study on clinically stabilised for at least 6 months outpatients
with MDE during the course of MDD (N=58), BD (N=33), or SSOPDs (N=51). Patients, whose baseline
assessments of Montgomery-Åsberg Rating Scale (MADRS), Hamilton Anxiety Rating Scale
(Ham-A), Brief Psychiatric Rating Scale (BPRS), Visual Analogue Scale for Craving (VAS-crav) and
World Health Organization Quality of Life, Brief version (WHOQOL-BREF) were available, were recruited
at the time they suffered Covid-19-related traumas. Fifty patients, prior to the pandemic, when
they were clinically stable, were treated with 15 mg/die vortioxetine, 44 with 450 mg/die trazodone,
and 48 with 150 mg/die sertraline. After experiencing a major Covid-19-related personal trauma, patients
showed clinical worsening which required dosage adjustment (20 mg/day vortioxetine; 600
mg/day trazodone, and 200 mg/day sertraline) and, for some of them, hospitalisation. Scores on the
MADRS, Ham-A, BPRS, VAS-crav and WHOQOL-BREF were compared drug-wise and genderwise
with Student’s t test for continuous variables and Χ2 for categorical variables.
Results: The sample consisted of 142 outpatients (age, mean 39.63 ± 16.84; 70 men and 72 women);
women were older than men (mean age 43.18 ± 17.61 vs. 35.98 ± 15.30; p=0.01). The two genders
did not differ on other variables. For all treatments, worsening symptoms were observed at the
time of trauma, followed by slow recovery with treatment readjustment. Trauma-related worsening
in patients on vortioxetine was less intense than patients on the other two antidepressants and
recovery was faster. All drugs were associated with an improvement in QoL. The vortioxetine group
showed a lower hospitalisation rate (24%) than sertraline (35.4%) and trazodone (38.6%), but this
was not significant (p=0.27).
Conclusion: All drugs improved symptoms of Covid-19 trauma in patients with MDE, with vortioxetine
showing a small advantage. No differences between vortioxetine, sertraline and trazodone
were found as concerning the need for hospitalisation.
