Vortioxetine (Trintellix): A Patient’s Guide
Introduction:
Vortioxetine, marketed under the brand name Trintellix, is an antidepressant that has shown efficacy in treating major depressive disorder (MDD) among other mental health conditions. This handout provides detailed information about the medication, including patient benefits, dosing guidelines, and potential side effects.
Efficacy: What Percentage of Patients Benefit?
Clinical trials have demonstrated that vortioxetine significantly improves depressive symptoms compared to placebo. Response rates (improvement of symptoms by 50% or more) were 57.0% and 61.6% for vortioxetine at different doses, compared to 32.3% for placebo. Remission rates (no significant signs of depression) were also higher with vortioxetine, reaching up to 38.4% compared to 19.0% for placebo.
Efficacy Compared to Pristiq (Desvenlafaxine):
Pristiq (desvenlafaxine) is a powerful antidepressant with a favorable side effect profile. The VIVRE study is a pivotal piece of research that compares the effectiveness of vortioxetine, a multimodal antidepressant, against desvenlafaxine, a serotonin-norepinephrine reuptake inhibitor (SNRI), in improving symptoms and functional outcomes in patients with MDD. Conducted across multiple countries and involving over 600 participants, this study is particularly relevant for its focus on those who have not fully responded to initial SSRI therapy—a common challenge in clinical practice.
Key findings from the study reveal that vortioxetine was not only non-inferior but showed a numerical advantage over desvenlafaxine in reducing depressive symptoms as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). More importantly, vortioxetine-treated patients exhibited significantly higher rates of symptomatic and functional remission. This includes improvements in daily and social functioning and greater satisfaction with medication, which are critical for holistic treatment outcomes.
Dosing Guidelines:
Vortioxetine is typically started at 10 mg once daily for adults. Depending on the patient's response and tolerability, the dose may be adjusted. The maximum recommended dose is 20 mg per day. For patients aged 65 and older, a lower starting dose of 5 mg may be considered due to increased sensitivity to the medication.
Optimal Timing for Medication:
Vortioxetine can be taken with or without food, usually once daily in the morning. This helps maintain consistent blood levels of the medication throughout the day.
Potential Side Effects:
Common side effects include nausea, which is generally mild to moderate and often subsides within the first two weeks. Other possible side effects are diarrhea, dry mouth, and headaches. It is important for patients to report any severe or persistent side effects to their healthcare provider.
Potential Contraindications:
Vortioxetine should not be used in conjunction with monoamine oxidase inhibitors (MAOIs) or other drugs that significantly increase serotonin levels due to the risk of serotonin syndrome. Please read this blog for more on serotonin syndrome. It is also contraindicated in patients with known hypersensitivity to the drug.
Any antidepressant used in patients under the age of 25 carries a black box warning for a low risk for increased suicidal ideation.
FDA Approval Information:
Vortioxetine was approved by the FDA for the treatment of major depressive disorder. It is recognized for its dual mechanism as a serotonin reuptake inhibitor and serotonin receptor modulator.
Off-Label Benefits Supported by Research:
While primarily approved for MDD, vortioxetine has also been studied for its potential benefits in treating anxiety disorders, though it is not officially approved for these conditions. Research indicates potential efficacy, but more studies are needed to fully establish these benefits.
Citations:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296590/
https://www.nottsapc.nhs.uk/media/o3llekpi/vortioxetine_info_sheet_.pdf
https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/vortioxetine-trintellix/
https://www.healthlinkbc.ca/medications/vortioxetine-oral
https://medlineplus.gov/druginfo/meds/a614003.html
https://www.psychiatrist.com/jcp/vortioxetine-versus-desvenlafaxine-patients-major-depressive-disorder-partial-response-ssri-therapy-results-vivre-study/
