From the Guidelines
Vortioxetine is recommended over SNRIs for patients with depression-related cognitive dysfunction due to its potential cognitive benefits and favorable side effect profile, as evidenced by recent studies 1.
Mechanism and Efficacy
Vortioxetine works through multiple serotonergic mechanisms, which may offer advantages in terms of cognitive benefits alongside mood improvement. In contrast, SNRIs, such as duloxetine, venlafaxine, and desvenlafaxine, work by inhibiting the reuptake of both serotonin and norepinephrine, making them potentially more effective for patients with concurrent pain conditions due to their dual neurotransmitter action.
Side Effect Profiles
The side effect profiles of vortioxetine and SNRIs differ notably. Vortioxetine causes less sexual dysfunction and weight gain than many antidepressants but has higher rates of nausea. On the other hand, SNRIs can cause increased blood pressure, sweating, and potentially more difficult discontinuation symptoms.
Treatment Choice
Treatment choice should be individualized based on symptom profile, comorbidities, prior medication response, and tolerability concerns. Cost may also be a factor, as vortioxetine is newer and typically more expensive than many SNRIs, which are available as generics.
Key Considerations
- Vortioxetine typically starts at 10mg daily and can be increased to 20mg if needed.
- Common SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq).
- Recent studies, such as the one published in 2016 1, provide evidence for the efficacy and safety of vortioxetine and SNRIs in the treatment of major depressive disorder.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Comparison of Vortioxetine and SNRIs
- Vortioxetine is a novel antidepressant that has been compared to SNRIs in several studies 2, 3, 4, 5, 6.
- In terms of efficacy, vortioxetine has been shown to be similar to SNRIs such as duloxetine and venlafaxine 3.
- Vortioxetine has also been compared to SNRIs in terms of tolerability, with some studies suggesting that it may have a more favorable side effect profile 3, 4.
- A study published in 2016 found that vortioxetine was 5.1 times more likely to be associated with response than discontinuation due to an adverse event when compared to placebo, which is similar to the likelihood to be helped or harmed for SNRIs such as duloxetine and venlafaxine 3.
Mechanism of Action
- Vortioxetine has a unique mechanism of action that involves the inhibition of the serotonin transporter, as well as the modulation of several serotonin receptors, including the 5-HT3, 5-HT7, and 5-HT1A receptors 2, 6.
- SNRIs, on the other hand, work by inhibiting the reuptake of both serotonin and norepinephrine 6.
- The differences in mechanism of action between vortioxetine and SNRIs may contribute to differences in their efficacy and tolerability profiles 2, 6.
Clinical Trials
- Several clinical trials have compared the efficacy and tolerability of vortioxetine to SNRIs, including duloxetine and venlafaxine 3, 4.
- These trials have generally found that vortioxetine is similar to SNRIs in terms of efficacy, but may have a more favorable side effect profile 3, 4.
- A study published in 2017 found that switching to vortioxetine from an SNRI such as sertraline or venlafaxine was associated with significant improvements in depressive symptoms and cognitive function 4.