As women transition into the menopause, they experience a constellation of symptoms including vasomotor symptoms (hot flashes and night sweats), sleep disruption, problems with sexual functioning, and cognitive impairment.  Women may also be more vulnerable to depression and anxiety during the menopausal transition.   A recent study from the Center for Women’s Mental Health looks at the effectiveness of vortioxetine (sold in the US as Trintellix) for the treatment of major depression and other menopause-related symptoms.  

In this study, perimenopausal or early postmenopausal women with with major depressive disorder (MDD, N = 27) received 8 weeks of open-label treatment with vortioxetine. The Montgomery-Åsberg Depression Rating Scale (MADRS) was used to assess depressive symptoms.  Other assessments included the Greene Climacteric Scale (GCS), Menopause-Specific Quality of Life Questionnaire (MEN-QOL), Beck Anxiety Inventory (BAI), Cognitive and Physical Functioning Questionnaire (CPFQ), Digit Symbol Substitution Test (DSST), and Cogstate testing.

Of the 27 women, 24 (88.8%) were evaluated (with one or more visits), and 21 (77.8%) completed the study.  One participant discontinued because of side effects. 

The mean MADRS score decreased significantly from 31.3 (standard deviation [SD] = 5.5) at baseline to 8.1 (SD = 7.8) after 8 weeks of treatment  (P = .0001).  Depression scores improved (50% or greater reduction in MADRS scores) in 75% of the women, and 70.8% of the women experienced remission of their depressive symptoms (final MADRS ? 10).  In addition, the frequency and severity of hot flashes improved significantly.  Participants’ ratings of menopausal symptoms (GCS, MEN-QOL), anxiety (BAI), and cognitive symptoms (CPFQ, DSST) also improved.  Cogstate test scores did not improve.  

One of the challenges in treating peri- and postmenopausal symptoms is that this population often presents with a broad array of symptoms, as described above, and choosing a single medication that addresses multiple symptoms can be difficult, if not impossible.  This study suggests that vortioxetine improves depression and anxiety, while at the same time improving vasomotor symptoms and, at least according to several scales, cognitive symptoms.  

Previous studies have demonstrated that the serotonergic antidepressants — SSRIs and SNRIs — are effective antidepressants in peri- and postmenopausal women and are also effective for the treatment of vasomotor symptoms.  Vortioxetine also works by blocking serotonin reuptake; however, vortioxetine is pharmacologically distinct in that it also acts through direct modulation of various serotonin receptors.  In this study and in others, vortioxetine has been associated with improvements in cognitive functioning independent of depressive symptoms, a factor which might make this antidepressant attractive to women who also report cognitive changes in the setting of the menopausal transition.

Ruta Nonacs, MD PhD

Freeman MP, Cheng LJ, Moustafa D, Davies A, Sosinsky AZ, Wang B, Petrillo LF, Hogan C, Cohen LS.    Vortioxetine for major depressive disorder, vasomotor, and cognitive symptoms associated with the menopausal transition.  Ann Clin Psychiatry. 2017 Nov;29(4):249-257.

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