From the Guidelines
Trintellix (vortioxetine) can be taken alone as monotherapy for major depressive disorder, which is its FDA-approved use. Combining Trintellix with other antidepressants should be done cautiously and only under close medical supervision due to potential risks. When used as monotherapy, Trintellix is typically started at 10 mg once daily and may be increased to 20 mg daily based on response, or decreased to 5 mg if side effects occur.
- Combining Trintellix with other serotonergic medications (including SSRIs, SNRIs, or MAOIs) increases the risk of serotonin syndrome, a potentially life-threatening condition.
- This risk is particularly high with MAOIs, which should be avoided for at least 14 days before starting Trintellix, as recommended by guidelines such as those from the American College of Physicians 1.
- Trintellix works through multiple mechanisms including serotonin reuptake inhibition and modulation of serotonin receptors, which may provide benefits for both mood and cognitive symptoms of depression.
- Common side effects include nausea, vomiting, constipation, and sexual dysfunction.
- Any changes to antidepressant regimens should always be discussed with a healthcare provider who can evaluate individual risks and benefits, considering the latest evidence on comparative benefits and harms of different treatments for major depression 1.
From the FDA Drug Label
TRINTELLIX is indicated for the treatment of major depressive disorder (MDD) in adults (1,14). DOSAGE AND ADMINISTRATION The recommended starting dose is 10 mg administered orally once daily without regard to meals (2.1). WARNINGS AND PRECAUTIONS Serotonin Syndrome: Increased risk when coadministered with other serotonergic agents, but also when taken alone.
Trintellix (vortioxetine) can be taken alone for the treatment of major depressive disorder. However, it may also be taken with other medications, but the label warns of an increased risk of serotonin syndrome when coadministered with other serotonergic agents. The decision to take Trintellix with other antidepressants should be made with caution and under the guidance of a healthcare professional 2. Key considerations include:
- Monitoring for worsening and emergence of suicidal thoughts and behaviors
- Screening patients for bipolar disorder
- Risk of increased bleeding when coadministered with other medications that affect coagulation
- Potential for sexual dysfunction and other adverse reactions.
From the Research
Trintellix (Vortioxetine) Treatment Options
Trintellix (vortioxetine) can be taken alone or with other antidepressants for the treatment of major depressive disorder (MDD). The following points highlight its usage:
- Vortioxetine is approved in the EU and USA for the treatment of MDD in adults 3.
- It has a distinctive pharmacological profile, combining inhibition of the serotonin transporter with modulation of multiple serotonin receptors, and has been shown to enhance cognitive performance in various animal models and clinical trials 3, 4.
- Vortioxetine can be used as a monotherapy or as an adjunct to other antidepressants, and its effectiveness has been compared to other antidepressants in several studies 5, 6, 7.
Combination Therapy
Some studies suggest that vortioxetine can be used in combination with other antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-noradrenaline reuptake inhibitors (SNRIs), to improve treatment outcomes:
- A study found that patients with MDD who experienced a partial response to SSRI/SNRI monotherapy and were switched to vortioxetine treatment showed significant improvements in emotional blunting, depressive symptoms, and cognitive performance 6.
- Another study found that vortioxetine was effective in reducing symptoms of both depression and anxiety in patients with severe MDD comorbid with severe generalized anxiety disorder (GAD) 7.
Efficacy and Tolerability
Vortioxetine has been shown to be effective and well-tolerated in various studies:
- A study found that vortioxetine improved cognitive function, depressive symptoms, and overall functioning in patients with MDD, and its effects were largely independent of its effect on improving depressive symptoms 3.
- Another study found that vortioxetine was well-tolerated, with the most common adverse events being mild to moderate nausea and headaches 4.