How does Trintellix (vortioxetine) compare to Vilazodone (vilazodone) and Trazodone (trazodone)?

From the Guidelines

Trintellix is likely a better option than vilazodone and trazodone due to its unique mechanism of action as a serotonin modulator and stimulator, which may result in fewer side effects, particularly less sexual dysfunction and cognitive impairment, as compared to traditional SSRIs like vilazodone and older sedating antidepressants like trazodone. When considering the treatment of depressive disorders, it's essential to evaluate the efficacy, safety, and tolerability of various antidepressants. According to a clinical practice guideline from the American College of Physicians 1, second-generation antidepressants, including venlafaxine, sertraline, and mirtazapine, have similar adverse events, but with some differences in the incidence of specific adverse events. Some key points to consider when comparing trintellix, vilazodone, and trazodone include:

• Mechanism of action: Trintellix works as a serotonin modulator and stimulator, while vilazodone combines SSRI action with partial 5-HT1A receptor agonist activity, and trazodone primarily affects serotonin and histamine receptors.
• Efficacy: All three medications are effective for treating major depressive disorder, but trintellix may have an advantage in terms of cognitive function improvement.
• Side effect profile: Trintellix and vilazodone may have a lower risk of sexual dysfunction compared to traditional SSRIs, while trazodone is often sedating and can cause somnolence.
• Cost: Trazodone is available as a generic and is generally more affordable than trintellix and vilazodone. It's crucial to weigh these factors and consider individual patient needs and preferences when selecting an antidepressant. Ultimately, the choice between trintellix, vilazodone, and trazodone should be based on symptom profile, tolerability concerns, and cost considerations.

From the Research

Comparison of Trintellix, Vilazodone, and Trazodone

• Trintellix (vortioxetine) is a novel antidepressant that combines inhibition of the serotonin transporter with modulation of multiple serotonin receptors, and has been shown to enhance cognitive performance in various animal models and clinical trials 2.
• Vilazodone is a selective serotonin reuptake inhibitor and 5-HT1A receptor partial agonist, which has been approved in the US for the treatment of major depressive disorder (MDD) in adults, and has been shown to be effective in reducing depressive symptoms with limited adverse effects on sexual function or bodyweight 3, 4.
• Trazodone is a 5-HT2A and 5-HT2C receptor antagonist and selective serotonin reuptake inhibitor, which has been FDA approved for use in the treatment of major depressive disorder, and has been used off label for numerous conditions including insomnia, anxiety, and substance abuse 5.

Efficacy and Tolerability

• Vortioxetine (Trintellix) has been shown to be effective in treating MDD, with significant improvements in cognitive function and depressive symptoms, and has been generally well tolerated with common adverse effects including nausea, constipation, and vomiting 2, 6.
• Vilazodone has been shown to be effective in treating MDD, with significant reductions in depressive symptoms and improved response rates, and has been generally well tolerated with common adverse effects including diarrhea, nausea, and headache 3, 4.
• Trazodone has been shown to be effective in treating MDD, with significant improvements in depressive symptoms, and has been generally well tolerated with common adverse effects including drowsiness, dizziness, and dry mouth 5.

Dosage and Administration

• The recommended therapeutic dose of vortioxetine (Trintellix) is 5-20 mg daily, with improvement in symptoms of depression noted at 2 weeks and full therapeutic effect observed at 4-6 weeks 2, 6.
• The recommended therapeutic dose of vilazodone is 20-40 mg daily, with improvement noted in depressive symptoms within 1 week of initiating therapy and increased remission rates noted at 6 weeks of therapy 3, 4.
• The maximum outpatient dose of trazodone should not exceed 400 mg per day in divided doses, with significant therapeutic response to trazodone noted by the end of the first week and the remainder of patients responding in 2-4 weeks of therapy 5.