Should I restart Trintellix (vortioxetine) or try a different antidepressant, such as a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI)?

From the Guidelines

You should consult with your healthcare provider promptly to discuss your options, as stopping or changing antidepressants without medical supervision can lead to withdrawal symptoms or worsening depression. Given your experience with Trintellix and your current symptoms, it's essential to have a personalized medical evaluation to determine the best course of action. Antidepressant selection depends on many factors, including your specific symptoms, previous treatment outcomes, potential drug interactions, and individual tolerability 1. Trintellix works differently than traditional SSRIs and SNRIs, as it has additional receptor activities beyond serotonin reuptake inhibition. If you previously had partial benefit from Trintellix but experienced side effects, your doctor might consider adjusting the dosage. Alternatively, if you had minimal response or intolerable side effects, trying a different medication class might be appropriate. Some studies have reported that about 63% of patients receiving second-generation antidepressants experience at least one adverse effect during treatment, with common side effects including diarrhea, dizziness, dry mouth, fatigue, headache, sexual dysfunction, sweating, tremor, and weight gain 1. Additionally, SNRIs can have adverse effects such as diaphoresis, dry mouth, abdominal discomfort, nausea, vomiting, diarrhea, dizziness, headache, tremor, insomnia, somnolence, decreased appetite, and weight loss, as well as potentially serious adverse effects like suicidal thinking and behavior, behavioral activation/agitation, hypomania, mania, sexual dysfunction, seizures, abnormal bleeding, and serotonin syndrome 1. It's crucial to weigh the benefits and harms of different treatment options and consider factors like your medical history, previous medication responses, and current health status to make an informed decision about your treatment. Some key points to consider when discussing your options with your healthcare provider include:

• Your specific symptoms and how they've changed since stopping Trintellix
• Your previous experience with Trintellix, including any benefits or side effects you experienced
• Potential drug interactions with other medications you're taking
• Your individual tolerability of different medications and their side effects
• The potential benefits and harms of different treatment options, including SSRIs, SNRIs, and other antidepressants.

From the Research

Considering Restarting Trintellix or Trying a Different Antidepressant

• The decision to restart Trintellix (vortioxetine) or try a different antidepressant, such as a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI), depends on various factors, including the patient's medical history, current symptoms, and previous response to treatment 2, 3.
• Vortioxetine has been shown to be effective in treating major depressive disorder (MDD), with a unique mechanism of action that differentiates it from other antidepressants, such as SSRIs and SNRIs 2, 3.
• Studies have demonstrated that vortioxetine has procognitive effects, improving cognitive function in adults with MDD, and may be beneficial in overcoming sexual dysfunction associated with other antidepressant agents 2, 4.
• The pharmacokinetics of vortioxetine are linear and dose-proportional, with a mean terminal half-life of approximately 66 hours, and steady-state plasma concentrations are generally achieved within 2 weeks of dosing 5.
• Adjunctive vortioxetine may be useful and well-tolerated in stage I treatment-resistant depression, with significant reductions in depressive symptoms and improvement in response and remission rates 6.

Potential Benefits and Drawbacks of Restarting Trintellix

• Restarting Trintellix may be beneficial for patients who previously responded to the medication and are experiencing a recurrence of depressive symptoms 2, 3.
• However, it is essential to consider the potential drawbacks, including the risk of side effects, such as nausea, vomiting, and constipation, and the possibility of developing tolerance or resistance to the medication 5, 3.
• Additionally, the cost and availability of Trintellix may be a concern for some patients, and alternative treatment options may be necessary 3.

Alternative Treatment Options

• SSRI or SNRI antidepressants may be considered as alternative treatment options for patients who do not respond to or cannot tolerate Trintellix 3, 6.
• However, these medications may have different side effect profiles and mechanisms of action, and patients should be closely monitored for efficacy and tolerability 5, 4.
• Other treatment options, such as psychotherapy or lifestyle modifications, may also be considered in conjunction with or instead of medication 2, 6.