From the Guidelines
The recommended treatment regimen for major depressive disorder using Trintellix (vortioxetine) typically begins with a starting dose of 10 mg once daily, taken orally with or without food. The dose may be increased to 20 mg daily based on individual patient response, or decreased to 5 mg daily if higher doses are not tolerated. Trintellix usually takes 2-4 weeks to show initial therapeutic effects, with full benefits potentially requiring 6-8 weeks of consistent use. Treatment should continue for at least 6 months after symptom resolution to prevent relapse, with many patients requiring longer maintenance therapy. Trintellix works as a multimodal antidepressant that modulates serotonin activity through reuptake inhibition and receptor activity at multiple serotonin receptor subtypes. Common side effects include nausea, vomiting, constipation, and sexual dysfunction. Patients should be monitored for worsening depression, suicidal thoughts (especially in the first few weeks), and potential serotonin syndrome if combined with other serotonergic medications. Abrupt discontinuation should be avoided; instead, the medication should be tapered gradually under medical supervision to minimize withdrawal symptoms, as recommended by the American College of Physicians 1.
Some key points to consider when treating patients with Trintellix include:
- Monitoring patient status, therapeutic response, and adverse effects of antidepressant therapy on a regular basis beginning within 1 to 2 weeks of initiation of therapy 1.
- Modifying treatment if the patient does not have an adequate response to pharmacotherapy within 6 to 8 weeks of the initiation of therapy for major depressive disorder 1.
- Continuing treatment for 4 to 9 months after a satisfactory response in patients with a first episode of major depressive disorder, and considering longer durations for patients with multiple episodes of depression 1.
Overall, Trintellix can be an effective treatment option for major depressive disorder, but it is essential to carefully monitor patients and adjust treatment as needed to minimize adverse effects and optimize therapeutic outcomes.
From the FDA Drug Label
The recommended starting dose is 10 mg administered orally once daily without regard to meals (2.1). The dose should then be increased to 20 mg/day, as tolerated (2. 1). Consider 5 mg/day for patients who do not tolerate higher doses (2.1).
The recommended treatment regimen for major depressive disorder using Trintellix (vortioxetine) is to start with a dose of 10 mg/day and increase to 20 mg/day as tolerated. For patients who cannot tolerate higher doses, a dose of 5 mg/day should be considered 2.
From the Research
Recommended Treatment Regimen for Major Depressive Disorder using Trintellix (Vortioxetine)
- The recommended starting dose of vortioxetine is 10 mg administered orally once daily without the need for food 3.
- The dose can be adjusted between 5 and 20 mg, with a forced up-titration to 20 mg/day after 1 week in some cases 4.
- Long-term treatment with vortioxetine has been shown to be safe and well-tolerated, with the most common adverse events being nausea and headache 5.
- Vortioxetine has been found to be effective in reducing symptoms of depression and anxiety, as well as improving overall functioning and health-related quality of life 4, 6.
Efficacy of Vortioxetine in Treating Major Depressive Disorder
- Vortioxetine has been shown to be more effective than placebo in achieving response and remission in patients with major depressive disorder 7.
- Compared to serotonin noradrenaline reuptake inhibitors (SNRIs), vortioxetine has been found to have better tolerability but no significant difference in response or remission 7.
- Vortioxetine has also been found to have no significant difference in response or remission compared to selective serotonin reuptake inhibitors (SSRIs) 7.
Dosing and Titration
- The dose of vortioxetine can be adjusted based on the patient's response and tolerability, with a maximum dose of 20 mg/day 3, 4.
- A study found that increasing the dose of vortioxetine to 20 mg/day early in the course of therapy was well-tolerated and effective in reducing symptoms of depression and anxiety 4.
- Another study found that vortioxetine 5,10, and 20 mg significantly reduced the risk of relapse compared to placebo in patients with remitted major depressive disorder 6.