P.0669 Differential response to three antidepressants in patients with major depressive episode who suffered Covid-19-related trauma

Introduction. The Covid 19 has probably altered the epidemiology of mental disorders worldwide, with their incidence which is likely to have increased during the pandemic [1,2]. It is possible that it has impacted response to drug treatment in psychiatric conditions, resulting in differential hospitalisation rates. Hence, we compared the responses to three different antidepressant drugs in outpatients with a major depressive episode (MDE) in the course of Major Depressive Disorder (MDD) and Bipolar Disorder (BD) during two time periods, i.e., prior to suffering Covid-19-related trauma and after suffering such trauma. Methods. We conducted an observational study on outpatients with MDE during their course of MDD (N=58) or BD (N=84)who were clinically stabilised for at least 6 months and treated with antidepressants, antipsychotics or mood stabilisers according to recent treatment guidelines [3,4]. Outpatients, of whom we had baseline assessments of Montgomery-Asberg Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (Ham-A), were recruited at the time they suffered Covid-19-related traumas, defined as developing Covid-19 infection or witnessing Covid-19 infection in a close person, death of a loved one, domestic violence, or job loss. Fifty patients were being treated with 15 mg/day oral vortioxetine, 46 with 450 mg/day oral extended-release trazodone (ERT), and 46 with 150 mg/day oral sertraline. We compared their scores on the MADRS, Ham-A, and WHOQOL-2.0-BREF drug-wise and gender-wise. We used Student's t test for continuous variables and the chi2 test 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). There was a main effect of time for MADRS scores (F(1.000,130.000)=147.292, p<0.001, eta2=0.531; from 13.75 +/- 4.60 to 20.38 +/- 7.06) and Ham-A scores (F(1.000,130.000)=100.260, p<0.001, eta2=0.435; from 13.41+/-7.14 to 20.61+/-7.99) and an interaction effect, i.e., a Time x Treatment effect (F(2.000,130.000)=10.376, p<0.001, eta2=0.138) for MADRS and (F(2.000,130.000)=6.836, p=0.002, eta2=0.095) for Ham-A, with a lower impairment for the vortioxetine group (from 14.20+/-3.60 to 17.26+/-5.44) than sertraline (from 13.56+/-4.29 to 22.44+/-6.59) and trazodone (from 13.57+/-5.85 to 21.68+/-7.06) for MADRS and for Ham-A (vortioxetine from 13.96+/-6.26 to 17.78+/-7.09 better than sertraline, from 13.79 +/-8.36 to 22.77+/-7.62 and trazodone, from 12.39+/-6.69 to 21.48+/-8.55) from the pre-Covid-19 to the post-Covid-19-related trauma period. Improved QoL from the Covid-19-related trauma period to 1 month post-trauma was shown for trazodone (from 62.16+/-15.44 to 67.90+/-13.74), but not vortioxetine (from 61.56+/-13.89 to 63.50+/-15.60) or sertraline (from 63.89+/-13.37 to 62.08+/-15.10). 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. We found all drugs to improve depression and anxiety scores with vortioxetine showing a small advantage over the others in patients with and MDE during the course of MDD or BD. Trazodone improved QoL faster than other drugs. No differences between vortioxetine, sertraline and trazodone were found as concerns the need for hospitalisation. No conflict of interestCopyright © 2021