Switching from Trintellix 20mg to Zoloft: Dosage Recommendation
When switching from vortioxetine (Trintellix) 20mg to sertraline (Zoloft), start with 50mg daily of sertraline, not 100mg, as there is no established dose equivalency between these medications and immediate switching at higher doses increases the risk of adverse effects.
Understanding the Medication Switch
No Direct Dose Equivalency Exists
- Vortioxetine and sertraline have fundamentally different mechanisms of action, making direct dose conversion impossible 1
- Vortioxetine is a multimodal antidepressant with antagonist activity at 5-HT3, 5-HT1D, and 5-HT7 receptors, agonist activity at 5-HT1A receptors, and partial agonist activity at 5-HT1B receptors, while sertraline is a selective serotonin reuptake inhibitor 1
- The maximum therapeutic dose of vortioxetine is 20mg daily, which you were taking, representing the upper end of the dosing range 1
Recommended Switching Strategy
Initial Sertraline Dosing:
- Start sertraline at 50mg daily when switching from vortioxetine 20mg 2
- Immediate switching without tapering is generally well-tolerated when moving between serotonergic antidepressants 3
- The therapeutic range for sertraline at steady-state is approximately 12-17 ng/mL at 50mg daily, increasing to 19-18 ng/mL at 100mg daily 2
Titration Schedule:
- If 50mg is well-tolerated after 1-2 weeks but insufficient for symptom control, increase to 100mg daily 2
- Further increases to 150mg or 200mg can be made at 1-2 week intervals if needed, with maximum dose of 200mg daily 2
- Monitor for treatment-emergent adverse events, particularly nausea, headache, diarrhea, and insomnia during the first 2 weeks 3
Why 100mg May Be Too High Initially
Tolerability Concerns
- Patients switching from SSRIs to other antidepressants at equivalent therapeutic doses showed significantly lower discontinuation rates (4.5%) compared to those initiating at full doses (17.9%) 3
- Starting at a lower dose reduces the risk of nausea, which occurs in over 10% of patients initiating serotonergic antidepressants 3
Efficacy Timeline
- Sertraline requires 4-8 weeks for full therapeutic effect regardless of starting dose 2
- Starting lower and titrating up does not delay ultimate response if adjustments are made appropriately 2
Monitoring During the Switch
Week 1-2:
- Assess for discontinuation symptoms from vortioxetine (though minimal expected with immediate switch) 3
- Monitor for common sertraline side effects: nausea, headache, diarrhea, insomnia 3
Week 2-4:
- Evaluate depressive symptom response using standardized scales 4
- If inadequate response at 50mg and good tolerability, increase to 100mg 2
Week 4-8:
- Continue dose optimization up to 200mg maximum if needed 2
- Full therapeutic assessment should occur by week 8 2
Important Caveats
- Both medications showed comparable efficacy in treating major depressive disorder in comparative trials, with vortioxetine showing particular benefit for emotional blunting 5, 6
- If you experienced good response to vortioxetine 20mg but are switching due to cost or availability rather than lack of efficacy, discuss with your prescriber whether continuing vortioxetine might be preferable 5
- Sertraline may cause more gastrointestinal side effects initially compared to vortioxetine 7