What is the recommended tapering schedule for an adult patient with a history of major depressive disorder who is currently taking Trintellix (vortioxetine) 5mg?

Tapering Trintellix (Vortioxetine) 5mg

For a patient currently on Trintellix 5mg, the FDA label states that the medication can be discontinued abruptly, but for doses of 15mg/day or 20mg/day, it is recommended to reduce to 10mg/day for one week prior to full discontinuation—however, since you are already at 5mg (the lowest available dose), you can discontinue without tapering, though a cautious approach of taking 5mg every other day for 1-2 weeks before complete cessation may minimize any potential withdrawal symptoms. 1

FDA-Approved Discontinuation Guidance

• The official FDA label for Trintellix explicitly states that the medication "can be discontinued abruptly" 1
• The FDA recommends a one-week taper from 10mg to discontinuation only for patients on higher doses (15mg or 20mg daily), reducing first to 10mg for one week before complete cessation 1
• Since you are already at 5mg (the lowest commercially available dose), the FDA guidance does not require a formal taper 1

Practical Tapering Approach for 5mg

While the FDA permits abrupt discontinuation at 5mg, applying principles from antidepressant withdrawal research suggests a more conservative approach:

• Consider taking 5mg every other day for 1-2 weeks before complete cessation 2, 3
• Research on SSRIs demonstrates that alternate-day dosing at minimum therapeutic doses can increase withdrawal risk, but at sub-therapeutic doses (like 5mg vortioxetine), this strategy may be better tolerated 3
• The first dose reduction is critical—if you tolerate the every-other-day schedule well, proceed to complete discontinuation after 1-2 weeks 4

Monitoring for Withdrawal Symptoms

• Schedule follow-up within 1-2 weeks of initiating the taper to assess for withdrawal symptoms 5
• Monitor specifically for: nausea (the most common side effect of Trintellix), anxiety, irritability, insomnia, dizziness, and mood destabilization 1, 5
• Continue monitoring for 4-6 weeks after complete discontinuation, as some withdrawal effects can emerge or persist during this period 5, 2

Managing Withdrawal Symptoms If They Occur

• If significant withdrawal symptoms develop, return to daily 5mg dosing until symptoms resolve, then attempt a slower taper 5, 4
• Consider adjunctive medications for specific symptoms: trazodone 25-50mg for insomnia, or short-term symptomatic relief as needed 5, 6
• The taper rate must be determined by your tolerance, not a rigid schedule—pauses or slower progression are acceptable 6

Critical Considerations

• Vortioxetine has a relatively short half-life (approximately 66 hours), meaning withdrawal symptoms, if they occur, would typically emerge within 2-4 days of dose reduction 2
• Unlike benzodiazepines or higher-dose antidepressants, abrupt discontinuation of low-dose vortioxetine (5mg) is not life-threatening and does not carry seizure risk 5, 6
• Research suggests that only 8.9% of patients receive evidence of formal tapering when discontinuing antidepressants, indicating many patients tolerate direct cessation, though individual variation exists 4

Common Pitfalls to Avoid

• Do not extend the taper unnecessarily beyond 2-4 weeks at the 5mg dose, as prolonged tapering can become the focus of anxiety rather than preventing withdrawal 7
• Avoid substituting another antidepressant during the taper unless there is a clear clinical indication for ongoing treatment 8
• Do not mistake mild, transient withdrawal symptoms for relapse of depression—withdrawal symptoms typically resolve within days to weeks, while depression recurrence develops more gradually 5, 2