How does 100mg of Zoloft (sertraline) compare to 20mg of Trintellix (vortioxetine) in terms of patient response rates?

Sertraline 100mg vs Vortioxetine 20mg: Response Rates Comparison

Based on available evidence, sertraline 100mg and vortioxetine 20mg demonstrate comparable response rates for major depressive disorder, with neither showing clear superiority in terms of patient response. However, the evidence base is limited by the absence of direct head-to-head trials comparing these specific doses.

Evidence from Guidelines

The American College of Physicians guidelines consistently demonstrate that second-generation antidepressants, including sertraline, do not significantly differ in efficacy, effectiveness, or quality of life outcomes 1. These comprehensive reviews found:

• Response rates across second-generation antidepressants are similar, with approximately 38% of patients not achieving treatment response during 6-12 weeks of treatment and 54% not achieving remission 1
• Meta-analyses showed no statistically significant differences between SSRIs or between SSRIs and other second-generation antidepressants 1
• When differences were found, effect sizes were small and likely not clinically significant 1

Specific Evidence for Each Medication

Sertraline 100mg

Sertraline demonstrates dose-dependent therapeutic response, with efficacy increasing with dosage 2. The meta-analysis of sertraline trials showed:

• Pooled mean difference in HAM-D total score of -2.34 (95% CI -2.93 to -1.76) compared to placebo 2
• Response rates improve with higher doses, though adverse effects also increase above 150mg 2
• Sertraline showed particular efficacy in patients with melancholia and psychomotor agitation 1

Vortioxetine 20mg

Vortioxetine's efficacy profile shows:

• Recommended dose range of 5-20mg/day for major depressive disorder 3
• More effective than placebo in MDD, though direct comparison to duloxetine showed smaller efficacy but lower risk of adverse effects 3
• Number needed to treat (NNT) of 9 (95% CI 7-11) for response versus placebo 4

Comparative Analysis

An indirect comparison study provides the most relevant data for this question 4:

• Vortioxetine NNT: 9 (95% CI 7-11) for response versus placebo 4
• Sertraline NNT: 6 (95% CI 4-13) for response versus placebo 4
• Vortioxetine showed superior tolerability with NNH of 43 (28-91) for discontinuation due to adverse events versus sertraline's NNH of 7 (5-12) 4
• Likelihood to be helped or harmed (LHH) was 5.1 for vortioxetine versus 1.2 for sertraline, indicating vortioxetine is more likely to produce response than cause discontinuation 4

Clinical Interpretation

While sertraline may have a slightly lower NNT (suggesting marginally better efficacy), vortioxetine demonstrates substantially better tolerability 4. The wide confidence intervals for sertraline (4-13) versus vortioxetine (7-11) suggest considerable overlap in efficacy 4.

Important Caveats

• No direct head-to-head trials exist comparing these specific doses, limiting definitive conclusions 1
• All comparisons are indirect, derived from separate placebo-controlled trials with potentially different patient populations 4
• Individual patient factors such as comorbid anxiety, insomnia, or prior treatment failures may influence relative effectiveness 1

Practical Recommendation

Choose based on tolerability profile rather than efficacy alone, as response rates appear comparable but discontinuation rates differ substantially 4. Vortioxetine may be preferable when tolerability is a primary concern, while sertraline remains a reasonable first-line option given its established track record and lower cost 1.