The Efficacy Of Vortioxetine On Improving The Cognitive Function In Patients With Depression And Its Mechanism Of Action- Versus With Esitalopram Oxalate

Objective: Vortioxetine(VOR),a new multimodality antidepressant,has a higher cognitive function improvement rate in clinical depression patients among other antidepressants.However,the exact mechanism under which VOR improves cognitive function remains unclear.VOR mediates macrophages differentiate,from pro-inflammatory phenotype to anti-inflammatory phenotype,suggesting that VOR inhibits inflammatory response.Whether VOR improves cognitive function through regulating inflammatory response deserves further explore.Our study was designed to observe the curative effect of VOR in improving depression and cognitive function in first-episode clinical depression patients and test the change of the serum levels of inflammatory cytokines due to treatment.Moreover,we explored the potential relationship between cognitive function improvement and serum inflammatory factors,unfolding the mechanism of cognitive function improvement by VOR.We hope to provide a possible new way of drug selection for clinical depression patients.Methods: According the inclusion and exclusion criteria,83 patients with first episode depression were included in our study.They were randomly divided into VOR group and Escitalopram Oxalate Tables(ES)group by random number table method.The demographic data and clinical baseline data of participants were analyzed via two-sample t test,chi-square test,and ANOVA.The Hamilton Depression Scale-17(HAM-D17)was performed to evaluate the severity of depression,which was analyzed by the mixed-effect models for repeated measures(MMRM).The Wsiconsin card sorting test(WSCT)and Wechsler Memory Scale(WMS)tests were used to assess cognitive function and the score changing from baseline at week 8 was analyzed using paired t test.The change from baseline of serum interleukin-6(IL-6)and c-reactive protein(CRP)concentrations were detected after 8 weeks,analyzing by MMRM.A P-value of less than 0.05 was considered statistically significant.Results: 1.Both VOR and ES significantly reduced the total score of HAM-D17,with no statistically significant difference between the two groups.2.VOR was significantly better than ES in improving WMS scale scores and several WSCT projects,while other WSCT items in VOR group were numerically better than that in ES group.3.There was no significant difference in IL-6 and CRP concentrations change between the two groups.After intervention,CRP concentration was significantly reduced in both group,while the reduction of IL-6 concentration exhibited in VOR group alone.Conclusions: VOR and ES had a significantly effect improving depressive symptoms,with no statistical difference.VOR improved the cognitive function of patients significantly better compared with ES.VOR and ES both decreased serum CRP level in patients with depression.Besides,VOR lowered serum IL-6 level significantly.There is a possible correlation between the improvement of cognitive function and the reduction of serum IL-6 concentration by VOR in clinical depression patients.