Understanding Speed of Processing in MDD: Insights on DSST Data and a Treatment Option

Paid content from Takeda Pharmaceuticals

Please click for Full Prescribing Information

Hello, I’m Dr. Leslie Citrome, Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, New York. In this second video which is sponsored content from Takeda Pharmaceuticals, I’ll provide insights on an aspect of cognitive function that may be impaired by MDD —specifically something that we call speed of processing.¹ Speed of processing refers to the pace with which one can accurately process information or the time needed to complete a mental task.²

As a practicing psychiatrist, I’ve spent a lot of time delving into the complexities of treating MDD. Through my experience with patients, I’ve discussed several different treatment options, including Trintellix^®, also known as vortioxetine, a prescription medication indicated to treat MDD in adults. Trintellix is available as 5 mg, 10 mg, and 20 mg tablets.³

TRINTELLIX has a Boxed Warning for suicidal thoughts and behaviors.³ Antidepressants increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients in short-term studies. Closely monitor all antidepressant-treated patients for clinical worsening, and for emergence of suicidal thoughts and behaviors. TRINTELLIX is not approved for use in pediatric patients.

Please listen for additional Important Safety Information later in this video, and see the Full Prescribing Information by clicking on the link in the transcript below this video.

Trintellix monotherapy was shown to reduce the overall symptoms of MDD across 6 short-term clinical studies, which was measured by the total score of the Hamilton Depression 24-item Rating Scale or the Montgomery-Asberg Depression Rating Scale.³ Those six clinical studies were randomized, double-blind, and placebo-controlled, over a 6- to 8-week duration. Patients were given a once-daily dosage of Trintellix, ranging from 5 mg to 20 mg.

The most common adverse reactions with an incidence of 5% or more and at least twice the rate of placebo in the 6- to 8-week studies were nausea, constipation, and vomiting.

In addition to the efficacy demonstrated in the six, short-term studies, Trintellix has been shown to improve speed of processing as measured by the Digit Symbol Substitution Test, or DSST in patients with MDD.³

The DSST is a neuropsychological test that most specifically measures processing speed, which is an aspect of cognitive function that may be impaired in MDD.³ Although the DSST is simple to use, it is not generally employed in my routine clinical practice. However, I believe it is useful in clinical research in order to objectively measure this important component of cognitive functioning.

Trintellix's speed of processing data draw from two 8-week studies, numbered Study 7 and Study 8 in the product label. Both studies were randomized, double-blind, placebo-controlled, and assessed the effect of Trintellix on the number of correct responses on the DSST in patients aged 18-65 being treated for acute MDD.^3,4,5 Patients in the Trintellix arm in Study 7 received Trintellix 10 mg/day or 20 mg/day, while patients in Study 8 received a flexible dose of Trintellix 10 mg or 20 mg daily. Study 7 randomized adult patients meeting the diagnostic criteria for recurrent MDD and Study 8 randomized adult patients meeting the diagnostic criteria for recurrent MDD and reporting subjective difficulty concentrating or slow thinking. Neither study included patients whose MDD was in remission, yet still continued to experience difficulty concentrating or slow thinking.³

Trintellix doses were statistically superior to placebo in improvement in the number of correct responses on the DSST, with observed P values less than 0.001 and 0.05 for Study 7 and Study 8, respectively.^3,4,5,6 However, the effects observed on DSST may reflect a general improvement in depression.³ Trintellix is the only antidepressant that has data on speed of processing during the treatment of MDD in its U.S. Prescribing Information.⁶ Comparative studies have not been conducted to demonstrate a therapeutic advantage for Trintellix over other antidepressants on the DSST.³

Common adverse events, or AEs, as defined by an incidence greater than or equal to 5% for Trintellix in Study 7 were nausea and headache.⁴

Common AEs with an incidence greater than or equal to 5% for Trintellix in Study 8 were nausea, headache, and diarrhea.⁵

In one study two serious AEs were reported in the Trintellix group, and in the other study, one patient taking Trintellix attempted suicide.^4,5

Trintellix is contraindicated to patients with hypersensitivity to vortioxetine or any component of the Trintellix formulation.³ Hypersensitivity reactions including anaphylaxis, angioedema, and urticaria have been reported in patients treated with Trintellix. Additionally, do not use Monoamine Oxidase Inhibitors or MAOIs intended to treat psychiatric disorders with Trintellix or within 21 days of stopping treatment with Trintellix, due to an increased risk of serotonin syndrome. Do not use Trintellix within 14 days of stopping an MAOI intended to treat psychiatric disorders, and do not start Trintellix in a patient being treated with MAOIs such as linezolid or intravenous methylene blue due to an increased risk of serotonin syndrome.³

Remember, speed of processing is an aspect of cognitive function that may be impacted in patients with MDD.

I encourage you to visit www.TrintellixHCP.com for more expert insights. The site also includes information about how your eligible patients can enroll in the Trintellix Savings Program.

Thank you for tuning in to this Expert Perspective series. We hope you find this information helpful as you continue to support the advancement of MDD care for your patients. Please continue listening for additional Important Safety Information, and click the link beneath this video for the Full Prescribing Information.

¹ American Psychiatric Association. Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th edition (DSM-5®). Arlington, VA: American Psychiatric Association; 2013:155-188.
² Costa SL, Genova HM, DeLuca J, Chiaravalloti ND. Mult Scler. 2017;23(6):772-789.
³ TRINTELLIX (vortioxetine) prescribing information. Takeda Pharmaceuticals. 2023.
⁴ McIntyre RS, Lophaven S, Olsen CK. Int J Neuropsychopharmacol. 2014;17(10):1557-1567.
⁵ Mahableshwarkar AR, Zajecka J, Jacobson W, Chen Y, Keefe RSE. Neuropsychopharmacology. 2015;40(8):2025-2037.
⁶ Data on file. Takeda Pharmaceuticals.