Brand Name for Vortioxetine
The brand name for vortioxetine is Trintellix (formerly marketed as Brintellix in some regions). 1, 2
FDA-Approved Indication
- Vortioxetine (Trintellix) is indicated for the treatment of major depressive disorder (MDD) in adults. 1
Dosing and Administration
The recommended starting dose is 10 mg orally once daily without regard to meals, with subsequent increase to 20 mg/day as tolerated. 1
- For patients who do not tolerate higher doses, consider 5 mg/day 1
- Maximum recommended dose is 10 mg/day in known CYP2D6 poor metabolizers 1
- Trintellix can be discontinued abruptly, though doses of 15-20 mg/day should ideally be reduced to 10 mg/day for one week prior to full discontinuation 1
Treatment Approach Based on Guidelines
Clinicians should select between either cognitive behavioral therapy (CBT) or second-generation antidepressants (including vortioxetine) after discussing treatment effects, adverse effect profiles, cost, accessibility, and patient preferences. 3
Key Decision Points:
- CBT and second-generation antidepressants show similar efficacy for MDD 3
- CBT may have lower relapse rates compared to antidepressants 3
- CBT has fewer adverse effects than pharmacotherapy 3
- Where CBT is accessible, it should be strongly considered as an alternative to medication 3
Unique Properties of Vortioxetine
Vortioxetine has a multimodal mechanism of action, functioning as a serotonin transporter inhibitor with activity at multiple 5-HT receptors (5-HT3, 5-HT1A, 5-HT7). 4, 5
Procognitive Effects:
- Vortioxetine demonstrates procognitive effects that appear independent of its antidepressant action 5, 2
- It is the first antidepressant shown to efficiently augment cognitive function in adults with severe depression, irrespective of effects on mood 5
- These cognitive benefits may provide advantages over other antidepressants in patients with prominent cognitive symptoms 5
Efficacy Evidence
Vortioxetine is more effective than placebo for response (RR 1.35), remission (RR 1.32), and reduction in depressive symptoms. 6
- Against duloxetine specifically, vortioxetine may be slightly less effective for response rates (RR 0.86) and symptom reduction 6
- No significant difference in efficacy compared to venlafaxine 6
- Vortioxetine shows comparable efficacy to SNRIs as a class 6
Tolerability and Adverse Effects
The most common adverse effects are nausea and vomiting, which are generally mild to moderate and increase with higher doses. 1, 5, 7
Key Safety Considerations:
- More patients discontinue vortioxetine than placebo due to adverse effects (RR 1.41), but fewer discontinue due to inefficacy (RR 0.56) 6
- Vortioxetine causes fewer adverse effects overall compared to duloxetine (RR 0.90) 6
- Sexual dysfunction occurs at the highest dosage, but vortioxetine may actually improve previous treatment-emergent sexual dysfunction better than escitalopram 2
- Headaches are common but mostly transient 5
Black Box Warning:
- Increased risk of suicidal thinking and behavior in pediatric and young adult patients—close monitoring required for worsening and emergence of suicidal thoughts 1
- Vortioxetine is not approved for pediatric use 1
Contraindications and Drug Interactions
Vortioxetine is contraindicated with MAOIs: 1
- Do not use MAOIs within 21 days of stopping vortioxetine
- Do not start vortioxetine within 14 days of stopping an MAOI
- Contraindicated with linezolid or IV methylene blue 1
Dose Adjustments for Drug Interactions:
- Reduce vortioxetine dose by half when coadministered with strong CYP2D6 inhibitors 1
- Consider dose increase (up to 3 times original dose maximum) when coadministered with strong CYP inducers for more than 14 days 1
Additional Warnings
- Serotonin syndrome risk, especially with concomitant serotonergic agents—discontinue immediately if occurs 1
- Increased bleeding risk with NSAIDs, aspirin, antiplatelet drugs, or anticoagulants 1
- Screen for bipolar disorder before initiating (risk of mania/hypomania activation) 1
- Monitor for hyponatremia/SIADH 1
- Risk of angle-closure glaucoma in patients with untreated anatomically narrow angles 1
Similar Medications
Vilazodone is the most mechanistically similar alternative to vortioxetine, combining SSRI action with 5-HT1A receptor partial agonism. 8