Switching from Sertraline to Vortioxetine (Trintellix)
When switching from sertraline to vortioxetine, perform a direct switch by starting vortioxetine 10 mg daily while discontinuing sertraline, as both medications can be safely co-administered during the transition without requiring a washout period. 1, 2
Recommended Switching Protocol
Direct Switch Method (Preferred)
- Start vortioxetine 10 mg once daily on the same day you discontinue sertraline 1, 2
- After 1 week, increase vortioxetine to 20 mg daily if tolerated and clinically indicated 1, 2
- The majority of patients (65-71%) ultimately receive the 20 mg dose for optimal efficacy 1
- No washout period is required between sertraline and vortioxetine, as they can be safely co-administered 2
Rationale for Direct Switching
This approach is supported by FDA-approved clinical trial data demonstrating that patients can be directly switched from SSRIs (including sertraline) to vortioxetine without safety concerns. 1 In the pivotal switching study, patients taking sertraline, citalopram, or paroxetine were directly switched to vortioxetine starting at 10 mg, increased to 20 mg at Week 1, with flexible dosing thereafter 1. This direct switch maintained antidepressant efficacy while improving treatment-emergent sexual dysfunction 1, 2.
Monitoring During the Switch
Week 1-2 Assessment
- Monitor for early response indicators: patients with at least 20% symptom reduction by week 2 are 6 times more likely to achieve response or remission 3
- Assess for common adverse events including nausea (most common), headache, dizziness, vomiting, and diarrhea 4
- Evaluate for any withdrawal symptoms from sertraline discontinuation, though direct switching minimizes this risk 5
Weeks 2-8 Optimization
- Continue treatment for at least 8 weeks to adequately assess response, as approximately 50% of responses and two-thirds of remissions occur after 6 weeks 3, 4
- If inadequate response at 8 weeks on vortioxetine 10 mg, increase to 20 mg 1
- Monitor sexual function improvement using validated measures if sexual dysfunction was present on sertraline 1, 4
Expected Outcomes
Efficacy Maintenance
- Both vortioxetine and escitalopram maintained antidepressant efficacy after switching from SSRIs, with 47% of patients achieving remission (MADRS ≤10) at week 8 4
- Vortioxetine demonstrates similar efficacy to other antidepressants with a number needed to treat (NNT) of 9 for response versus placebo 6
Sexual Function Improvement
- Vortioxetine produced a 2.2-point greater improvement in sexual function compared to escitalopram when switching from SSRIs 1
- 50% of patients reported no emotional blunting after 8 weeks of vortioxetine treatment 4
- Greater improvements were seen in patients ≤45 years, women, those with 1-3 prior depressive episodes, and those on prior SSRI therapy >1 year 2
Tolerability Profile
- Vortioxetine has superior tolerability compared to most antidepressants, with a number needed to harm (NNH) of 43 for discontinuation due to adverse events versus placebo 6
- The likelihood to be helped versus harmed ratio is 5.1, meaning vortioxetine is 5.1 times more likely to produce response than cause discontinuation due to adverse events 6
Critical Considerations
Contraindications and Drug Interactions
- Do not combine vortioxetine with monoamine oxidase inhibitors (MAOIs); contraindicated due to serotonin syndrome risk 7
- Sertraline has minimal effects on cytochrome P450 metabolism compared to other SSRIs, making the switch to vortioxetine straightforward without significant drug interaction concerns 7
Avoiding Common Pitfalls
- Do not use conservative tapering strategies with prolonged washout periods unless clinically necessary, as this creates treatment gaps and increases relapse risk 5
- Avoid starting vortioxetine at subtherapeutic doses below 10 mg for extended periods, as this delays optimal response 1
- Do not prematurely discontinue treatment before 8-12 weeks, as many responses occur after 6 weeks 3, 4