A New Antidepressant Without Psychomotor Side Effects

Summary and Comment |
July 2, 2013

A New Antidepressant Without Psychomotor Side Effects

  1. Steven Dubovsky, MDAU107

Early news on an experimental antidepressant

  1. Steven Dubovsky, MDAU107

Sedating antidepressants tend to cause psychomotor impairment, including in drivers. In an industry-funded study, researchers examined psychomotor function while driving in 24 healthy volunteers who received 2 weeks' treatment at bedtime with 10 mg of the new antidepressant vortioxetine, 30 mg of mirtazapine, or placebo. Not yet FDA-approved, vortioxetine is a bis-aryl-sulfanyl amine that acts as a serotonin (5-HT) transporter inhibitor, a 5-HT1A receptor agonist, a 5-HT1B receptor partial agonist, and an antagonist of 5-HT3, 5-HT7, and 5-HT1D receptors.

Mirtazapine was associated with greater road tracking errors than placebo on treatment day 2 but not after day 15, with worse performance than placebo on critical tracking and reaction time on day 2, and with worse performance than vortioxetine on both measures after day 15. Driving performance with vortioxetine was similar with one or multiple doses and did not differ from performance with placebo at either point.

Comment

Vortioxetine shows promise as a nonsedating antidepressant that has several unique actions and does not impair driving. Once mirtazapine was in a steady state, some cognitive impairment persisted although tolerance developed to impaired driving. Patients should be warned that taking multiple doses of mirtazapine or taking it during the day, rather than dosing at nighttime, could continue to impair driving, which could also be an issue for slow mirtazapine metabolizers.

Editor Disclosures at Time of Publication

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / research support Amgen; Janssen; Otsuka; Sunovion; Takeda Editorial boards Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

Citation(s):

Reader Comments (2)

THOMAS RUSK Physician, Psychiatry, Assistance Plus Benton Maine

Mirtazapine a reasonable comparator -- perhaps the most effective antidepressant with huge advantages for some patients who need sleep & weight gain, e.g. undergoing chemo.
But we could use a broad spectrum SSRI with a non- sedating side effect profile like Wellbutrin. It's not as if any of our pharmacotherapeutic agents are as predictably effective as we had hoped . We could use more non-me-too meds.
This study was directed toward side effects. Other studies explored efficacy.
Tom Rusk MD
Dresden, ME

paulmatthews3939 Physician, Psychiatry, Hospital/clinics

Very poor comparison using Mertazapine.
I have always dosed Mirtazapine at HS and never used if patients would be driving while it's still active in their system. It's rarely my first drug of choice u less insomnia is a sig. target.
Another costly med. on the market?
How about we push for more head to head studies with efficacy of treatment for the PRIMARY target- depression- so we can justify the cost of patented medications to our patients ?

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