Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, sleep disturbances, fatigue, and frequently comorbid psychiatric conditions such as depression and anxiety. Its multifactorial nature, involving neurobiological, psychological, and social dimensions, complicates treatment and underscores the importance of targeted interventions. Among pharmacological options, antidepressants play a central role. Duloxetine, a serotonin–norepinephrine reuptake inhibitor (SNRI), has been widely studied and is considered adequate in FM due to its dual modulation of serotonergic and noradrenergic pathways, which are critical in both mood regulation and pain perception. Vortioxetine, on the other hand, is a newer multimodal antidepressant that combines serotonin transporter inhibition with receptor-level modulation and has been associated with potential benefits in mood and cognitive symptoms. However, data on vortioxetine in FM remains scarce. This study aimed to prospectively examine the sociodemographic and psychiatric characteristics of FM patients with comorbid depressive disorders, and to evaluate whether vortioxetine can be considered as preferable to duloxetine in this population. By following patients for six months and applying a comprehensive battery of psychiatric and cognitive assessment tools, the study sought to clarify the comparative effectiveness of these two agents on depression, anxiety, somatic amplification, distress tolerance, and subjective cognitive complaints.

The study included 100 patients diagnosed with FM and comorbid depressive disorder who attended the psychiatric outpatient clinic between February and June 2024. Diagnosis of FM was confirmed in collaboration with the physical therapy and rehabilitation clinic. Eligible participants were adults between 18 and 65 years of age who were literate and capable of providing informed consent. Exclusion criteria included psychotic disorders, bipolar disorder, dementia, intellectual disability, or unwillingness to continue follow-up. Patients were assigned to one of two groups: Group D received duloxetine at a mean daily dose of 60 mg, while Group V received vortioxetine at a mean daily dose of 15 mg. Only monotherapy cases were included, and patients were followed for six months. Assessments were conducted at baseline and the end of the treatment period. The following validated instruments were administered: (1) Beck Depression Inventory (BDI) to assess depressive symptoms; (2) Beck Anxiety Inventory (BAI) to evaluate the severity of anxiety symptoms; (3) Toronto Alexithymia Scale (TAS) to measure difficulties in emotional awareness and expression; (4) British Columbia Cognitive Complaints Inventory (BC-CCI) to capture subjective cognitive difficulties; (5) Somatosensory Amplification Scale (SSAS) to assess tendency to exaggerate bodily sensations; (6) Discomfort Intolerance Scale (DIS), including DIS-Int and DIS-Avoid subscales, to measure capacity for tolerating or avoiding distressing bodily sensations. Sociodemographic data, including age, gender, marital status, education, and occupation, were collected. Statistical analyses included Student's t-tests, Mann-Whitney U tests, chi-squared tests, and correlation analyses, with significance set at P < 0.05.

The study sample comprised 68 females and 32 males, with an overall mean age of approximately 43 years. The two groups were broadly comparable in sociodemographic characteristics, except for educational background, which differed significantly ( P = 0.005). Regarding depression, patients in the vortioxetine group displayed significantly lower baseline and post-treatment BDI scores compared to those in the duloxetine group. However, the degree of reduction in BDI scores was greater with duloxetine ( P < 0.001), indicating stronger antidepressant efficacy. For anxiety, baseline BAI scores did not differ significantly between groups. Post-treatment, duloxetine patients had significantly lower anxiety scores, and the reduction in BAI from baseline was greater in this group ( P = 0.003). Interestingly, vortioxetine patients had higher post-treatment anxiety scores, suggesting less pronounced anxiolytic effects. When examining distress tolerance, vortioxetine patients exhibited lower DIS scores both before and after treatment. Nevertheless, duloxetine was associated with a more substantial decline in DIS scores, suggesting greater improvement in tolerating distressing sensations ( P = 0.024). Concerning somatic amplification, duloxetine significantly reduced SSAS scores, consistent with its known efficacy in alleviating somatic symptoms in FM. By contrast, vortioxetine patients paradoxically showed increased SSAS scores after treatment, raising questions about its role in addressing somatization. For cognitive complaints, both groups demonstrated improvements in BC-CCI scores, with no statistically significant differences between duloxetine and vortioxetine. This suggests that both agents may positively impact subjective cognitive functioning in FM patients. Finally, alexithymia scores were elevated in both groups compared to healthy controls reported in the literature, but no significant difference was observed between treatment groups. This highlights the emotional processing difficulties often present in FM, irrespective of pharmacological treatment.

This prospective study provides comparative insights into the effectiveness of duloxetine and vortioxetine in patients with FM and comorbid depression. Duloxetine demonstrated greater efficacy in reducing depressive and anxiety symptoms and somatic amplification, confirming its central role in FM management. Vortioxetine, while less effective in these domains, showed potential benefits in distress tolerance and cognitive complaints, suggesting that it may still be a therapeutic option for selected patients, particularly when SNRI treatment is contraindicated or poorly tolerated. Overall, the findings reinforce the importance of tailoring antidepressant therapy to the clinical profile of FM patients, with duloxetine remaining the more reliable first-line option. Vortioxetine may be considered as an alternative agent, but further large-scale and long-term studies are required to establish its role more definitively.

La fibromyalgie (FM) est souvent associée à des troubles dépressifs et anxieux, mais les données comparatives réelles sur les choix d’antidépresseurs restent Activé par Editorial Manager® et ProduXion Manager® depuis Aries Systems Corporation limitées. Nous avons comparé les résultats psychiatriques sur 6 mois sous duloxétine (DLX) et sous vortioxétine (VTX) chez des patients dépressifs atteints de FM.

Dans cette cohorte prospective et observationnelle (février-juin 2024), 100 patients ambulatoires atteints de FM et de troubles dépressifs selon le DSM-5 ont reçu une monothérapie choisie par le clinicien avec DLX (moyenne de 60 mg/jour) ou VTX (moyenne de 15 mg/jour). Les échelles ont été administrées au début de l’étude et après 6 mois : inventaire de dépression de Beck (BDI), inventaire d’anxiété de Beck (BAI), échelle d’alexithymie de Toronto (TAS-20), inventaire des plaintes cognitives de Colombie-Britannique (BC-CCI), échelle d’amplification somatosensorielle (SSAS) et échelle d’intolérance à l’inconfort (DIS ; sous-échelles DIS-Int, DIS-Avoid). Les différences entre les groupes ont été évaluées à l’aide du χ ² , du t/Mann–Whitney U ; les changements au sein des groupes et les différences entre les groupes en termes de changement (Δ) ont été examinés en conséquence. Alpha = 0,05.

Les groupes étaient comparables en termes d’âge/sexe ; le niveau d’éducation différait (niveau d’éducation élémentaire plus élevé dans le groupe VTX ; niveau d’éducation secondaire plus élevé dans le groupe DLX, p = 0,005). Au départ, le VTX présentait un BDI et un DIS inférieurs à ceux du DLX (BDI p < 0,001 ; DIS p = 0,007). Au bout de 6 mois, le VTX présentait un BDI ( p = 0,032) et un DIS ( p = 0,035) inférieurs, mais un BAI ( p < 0,001) supérieur à ceux du DLX. Il est important de noter que l’amélioration au fil du temps a favorisé le DLX : les réductions ΔBDI et ΔBAI étaient plus importantes avec le DLX qu’avec le VTX ( p < 0,001 et p = 0,003, respectivement). Pour le DIS, le changement était plus faible avec le VTX ( p = 0,024), ce qui correspond à son DIS absolu plus faible aux deux moments. Le SSAS a divergé : il a augmenté sous VTX (Δ négatif ; p < 0,001) mais a diminué sous DLX (Δ positif ; p < 0,001), tous les contrastes SSAS entre les groupes étant significatifs ( p = 0,001 au départ ; p < 0,001 après traitement ; Δ p < 0,001). Le BC-CCI n’a montré aucune différence entre les groupes (post p = 0,056 ; Δ p = 0,506). Le TAS-20 ne différait pas au départ ( p = 0,424). Les catégories de gravité reflétaient ces tendances : au départ, le BDI sévère était plus fréquent dans le groupe DLX (70 % contre 36 %, p = 0,001) ; le BAI normal post-traitement était plus fréquent dans le groupe DLX (94 % contre 74 %, p = 0,011). Les analyses de corrélation ont confirmé les liens attendus (par exemple, BDI↔BAI avant et après le traitement ; DIS↔SSAS).

Dans la FM dépressive, les deux agents ont été associés à une amélioration symptomatique, mais la duloxétine a entraîné une réduction plus importante de la dépression et de l’anxiété et une réduction de l’amplification somatosensorielle, tandis que la vortioxétine a été associée à des niveaux absolus d’intolérance à l’inconfort plus faible à tous les moments, mais à des changements plus faibles dans l’ensemble. L’attribution non aléatoire et les déséquilibres de base doivent être confirmés dans des essais randomisés ; néanmoins, les résultats peuvent guider la sélection individualisée (DLX lorsque le soulagement affectif est prioritaire ; VTX lorsque l’intolérance à l’inconfort ou les considérations de tolérance prédominent).