What is the recommended tapering schedule for an adult patient with a history of depression or mood disorder when weaning off Brintellix (vortioxetine) 15 mg?

Weaning Off Brintellix (Vortioxetine) 15 mg

Brintellix 15 mg can be discontinued abruptly without a formal taper, but reducing to 10 mg daily for one week before complete cessation is recommended to minimize potential discontinuation symptoms. 1

FDA-Approved Discontinuation Protocol

The FDA label for vortioxetine provides clear guidance that distinguishes it from many other antidepressants:

• Vortioxetine can be discontinued abruptly without medical risk 1
• For doses of 15 mg/day or 20 mg/day: reduce to 10 mg/day for one week prior to full discontinuation if possible 1
• This one-week step-down is a recommendation for patient comfort, not a medical necessity 1

Why Vortioxetine Differs from Other Antidepressants

Vortioxetine has a unique multimodal mechanism targeting multiple serotonin receptors (5-HT1A, 5-HT1B, 5-HT1D, 5-HT3, 5-HT7) and the serotonin transporter, which may contribute to its more favorable discontinuation profile compared to traditional SSRIs 2. The FDA explicitly states abrupt discontinuation is acceptable, unlike most SSRIs where this approach is discouraged 1.

Practical Tapering Approach

Standard taper (recommended):

• Week 1: Reduce from 15 mg to 10 mg daily 1
• Week 2: Discontinue completely 1

If withdrawal symptoms emerge during the standard taper:

• Extend the 10 mg phase to 2-4 weeks before discontinuation 3
• Monitor weekly for discontinuation symptoms during tapering 3
• If severe symptoms occur, pause at current dose until symptoms resolve, then resume slower taper 3

Monitoring for Discontinuation Symptoms

Watch for these potential withdrawal symptoms during and after discontinuation:

• Neurological: Dizziness, headache, paresthesias 4, 5
• Psychiatric: Anxiety, irritability, mood changes, insomnia 4, 5
• Physical: Nausea, fatigue, flu-like symptoms 4, 5
• Timeline: Symptoms typically emerge within 1-7 days of dose reduction and may last 1-3 weeks 4, 6

Schedule follow-up within 1-2 weeks after complete discontinuation to assess for withdrawal symptoms or return of depressive symptoms 3.

Distinguishing Withdrawal from Depression Relapse

Critical pitfall: Withdrawal symptoms can mimic depression relapse, leading to unnecessary medication reinitiation 4, 6.

Withdrawal symptoms typically:

• Appear within days of dose reduction 4
• Include physical symptoms (dizziness, electric shock sensations) not typical of depression 4, 5
• Improve within 2-3 weeks without treatment 4

Depression relapse typically:

• Develops gradually over weeks to months 6
• Lacks prominent physical symptoms 6
• Requires treatment intervention 6

Adjunctive Support During Discontinuation

Consider these supportive measures if withdrawal symptoms are problematic:

• Trazodone 25-50 mg at bedtime for insomnia 3
• Gabapentin 100-300 mg three times daily for anxiety and sleep disturbances 3
• Clonidine 0.1 mg twice daily to attenuate adrenergic symptoms (anxiety, restlessness) 3

When to Consider Slower Tapering

Extend the taper beyond the standard one-week protocol if the patient:

• Has been on vortioxetine for more than 2 years 4, 6
• Has history of severe withdrawal from previous antidepressant discontinuation 4
• Develops moderate to severe symptoms during the standard taper 3
• Has significant anxiety about discontinuation 5

For these patients, consider 10% dose reductions monthly rather than the standard one-week taper 3, 4.

Important Caveats

• The goal is successful discontinuation, not speed - taking 2-3 months is acceptable if needed for tolerability 3
• Do not confuse brief withdrawal symptoms with treatment failure - resist immediate medication reinitiation unless symptoms persist beyond 3 weeks 4, 6
• Ensure depression is in sustained remission before attempting discontinuation - patients should be symptom-free for at least 4-9 months 7
• Consider psychological support during discontinuation, particularly for patients with recurrent depression 6