What to Know About Trintellix (Vortioxetine)

Trintellix (Vortioxetine) is an antidepressant medication used in the treatment of major depressive disorder in adults. While its exact mechanism of action is unknown, it is suggested that the drug works by blocking serotonin reuptake.

Overview

The drug differs from other types of selective serotonin reuptake inhibitors (SSRIs) because it also works to modulate different serotonin receptors. It is believed that Trintellix works by increasing the levels of serotonin in the brain.

It is usually recommended in cases where people have not seen improvement in their symptoms after trying two other types of antidepressants. The medication is available in oral tablet form. It is available in 5mg, 10mg, 15mg, and 20mg immediate-release tablets.

Vortioxetine is currently available under the brand name Trintellix. The drug was previously marketed under the brand name Brintellix until the name was changed in 2016. There are no generic forms currently available.

Uses

Trintellix was approved for medical use in the United States in 2013. It is used to treat major depressive disorder. Research suggests that it is as effective as other antidepressants. 

Off-Label Uses

Doctors sometimes prescribe vortioxetine off-label to treat anxiety. However, research suggests that the medication is no more effective than a placebo at treating generalized anxiety disorder.

While Trintellix is not FDA-approved for children, doctors do sometimes prescribe it to children off-label. Because of the increased risk of suicide and suicidal thoughts, children on antidepressants should be monitored closely.

Before Taking

Before you start Trintellix, always tell your doctor about any other medications or supplements that you are taking in order to avoid possible drug interactions. 

Precautions and Contraindications

Vortioxetine has the potential to interact with other medications that also act on serotonergic pathways. When taken with other drugs that act upon serotonin receptors, there is an increased risk for serotonin syndrome. 

Symptoms of serotonin syndrome can include confusion, rapid heartbeat, high blood pressure, diarrhea, tremors, and anxiety. The syndrome can be dangerous so you should contact your doctor immediately if you suspect you are showing signs.

When taking Trintellix, people should avoid also taking:

• Antipsychotic medications
• Fentanyl
• Lithium
• Meperidine
• Methylene blue
• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Tramadol
• Tricyclic antidepressants (TCAs)
• Triptans

People taking vortioxetine should also avoid taking over-the-counter medications that include dextromethorphan (a common cough suppressant) or St. John's wort (an herbal supplement sometimes used to relieve depression).

Dosage

Trintellix and other brands of vortioxetine are usually prescribed starting at a dose of 10 milligrams (mg) per day, which can then be increased up to 20mg per day. In cases where people cannot tolerate higher doses, doctors may start out by prescribing a 5mg per day dose, according to the manufacturer. 

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

How to Take

Always follow your doctor's dosage instructions. Take your medication at the same time each day. If you miss a dose, take your medication as soon as you remember it. However, if it is close to the time that you would normally take your next dose, simply take your dose at the normal time.

Side Effects

As with any prescription medication, vortioxetine use has been associated with certain undesirable side effects. Among the side effects that were most commonly seen during clinical trials were:

• Nausea
• Constipation
• Vomiting
• Sexual dysfunction
• Dizziness
• Diarrhea

This is not a complete list of all the possible side effects of this medication. You should speak with your doctor or pharmacist if you need a complete list of potential side effects.

Warnings and Interactions

Although the following complications occur only rarely, you should seek immediate medical care if they do occur. It is possible that these side effects can do serious harm to your health. In some cases, they can even be fatal if they are not attended to in a timely manner.

• Increased bleeding: Potential signs of increased bleeding might be gums that bleed more easily or abnormal bruising. People who take blood thinners or non-steroidal anti-inflammatory medications (NSAIDs) are at the greatest risk.
• Low sodium in the blood: Symptoms might include such things as a headache; weakness; confusion; and problems with thinking, concentration or memory.
• Mania or hypomania: Symptoms may include greatly increased energy, difficulty sleeping, racing thoughts, impulsive behavior, grandiose thinking, elevated mood, irritability, and talking more and faster than usual.
• Serotonin syndrome: Symptoms may include shivering, diarrhea, confusion, extreme muscle tightness, fever, and seizures.
• Suicidal thoughts or feelings: When a new antidepressant is started or a change in dosage is made, there is a greater risk for symptoms such as suicidal thoughts or actions, worsening depression, impulsivity, aggression, anxiety, irritability, agitation, restlessness, or problems sleeping.
• Visual problems: Symptoms to be aware of include eye pain, changes in vision, and swelling or redness in or around the eye.

The drug carries an FDA warning on the box that it may increase the risk of suicidal thoughts and actions in children and young adults.

In general, most people who use vortioxetine will have only minor side effects which will become less as they adjust to the medication. However, if you experience side effects that are particularly disruptive and they don't seem to be getting better, it is a good idea to speak with your doctor. 

Some of the possible options that your doctor may use to help you include: giving you strategies for lessening your side effects, giving you medications to counteract your side effects, or changing you to a new medication with fewer side effects.

Although your first impulse may be to stop taking your medication when you experience side effects, it is important that you speak with your physician first for advice. If you stop taking your medication, it is possible that your depression symptoms could return or worsen.

In addition, when you stop an antidepressant too abruptly, you may find yourself experiencing some very unpleasant flu-like symptoms called discontinuation syndrome. These symptoms can be minimized, or avoided altogether, by following your doctor's instructions to either taper off gradually or switch to a different medication.