What is the difference between Cipralex (escitalopram) and Trintellix (vortioxetine)?

From the Guidelines

Cipralex (escitalopram) and Trintellix (vortioxetine) are both effective antidepressants, but the choice between them should be based on individual patient factors, including symptom profile, previous medication response, side effect concerns, and cost considerations, as there is no strong evidence to suggest one is more effective than the other in terms of morbidity, mortality, and quality of life 1.

Key Differences

• Mechanism of action: Cipralex is a selective serotonin reuptake inhibitor (SSRI), while Trintellix is a multimodal antidepressant that also modulates serotonin receptors.
• Side effect profiles: Cipralex commonly causes sexual dysfunction, drowsiness, and weight gain, while Trintellix more frequently causes nausea but may have fewer sexual side effects.
• Dosing: Cipralex is typically prescribed at 10-20mg once daily, while Trintellix ranges from 5-20mg once daily.
• Cost: Cipralex is generally less expensive as it's available as a generic (escitalopram), whereas Trintellix remains under patent protection.

Clinical Considerations

• The American College of Physicians recommends selecting second-generation antidepressants based on adverse effect profiles, cost, and patient preferences 1.
• Clinicians should assess 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.
• Treatment should be modified 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.

Patient Factors

• Symptom profile: Trintellix may have advantages for cognitive symptoms of depression.
• Previous medication response: Patients who have not responded to SSRIs like Cipralex may benefit from trying Trintellix.
• Side effect concerns: Patients who are concerned about sexual side effects may prefer Trintellix.
• Cost considerations: Patients who are sensitive to cost may prefer Cipralex due to its availability as a generic.

From the FDA Drug Label

The effect of TRINTELLIX on TESD induced by prior SSRI treatment in MDD patients whose depressive symptoms were adequately treated was evaluated in an eight-week, randomized, double-blind, active-controlled (escitalopram), flexible-dose study (Study 11) Patients taking citalopram, sertraline, or paroxetine for at least eight weeks duration and who were experiencing sexual dysfunction attributed to their SSRI treatment were switched to TRINTELLIX (n=217) or escitalopram (n=207).

The main difference between Cipralex (escitalopram) and Trintellix (vortioxetine) is that vortioxetine has been shown to have a lower incidence of treatment-emergent sexual dysfunction (TESD) compared to escitalopram in patients with major depressive disorder (MDD) who were switched from another SSRI due to sexual dysfunction. This suggests that vortioxetine may be a better option for patients who experience sexual side effects with SSRIs like escitalopram 2.

From the Research

Mechanism of Action

• Cipralex (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) that works by increasing the levels of serotonin in the brain 3.
• Trintellix (vortioxetine) is a multimodal antidepressant that targets multiple serotonin receptors, including 5-HT1A, 5-HT1B, 5-HT1D, 5-HT3, and 5-HT7, as well as the serotonin transporter (5-HTT) 4, 5, 6.

Efficacy

• Both escitalopram and vortioxetine have been shown to be effective in the treatment of major depressive disorder (MDD) 3, 5, 7, 6.
• Vortioxetine has been found to have a positive impact on cognitive symptoms in depressed patients, including improvements in executive function, attention, processing speed, learning, and memory 5, 6.
• Escitalopram has been shown to be at least as effective as other SSRIs, as well as venlafaxine, bupropion, and duloxetine, in the treatment of depression and anxiety 3.

Safety and Tolerability

• Both escitalopram and vortioxetine are generally well-tolerated, with common adverse events including nausea, sexual dysfunction, constipation, and vomiting 4, 3, 7.
• Escitalopram has been found to have a relatively fast onset of action and minimal clinically relevant interactions with other drugs 3.
• Vortioxetine has been found to have a satisfactory tolerability profile, with most adverse events being mild or moderate 7, 6.

Comparison

• A randomized controlled study found that both vortioxetine and escitalopram improved mental status and cognitive functions in patients with MDD, with no significant difference between the two groups 7.
• Another study found that vortioxetine had a unique mechanism of action and a positive impact on cognitive symptoms, offering a new therapeutic option for patients with MDD 6.