Trintellix for Depression: Things to Know

There are many medications available to treat depression and other mental health disorders. If you have severe depression symptoms, your healthcare provider may have recommended a medication called Trintellix. Please continue reading to learn more about this antidepressant medication used to treat major depressive disorder (MDD), the more severe form of this mental health condition, which can cause severe symptoms that can drastically reduce the quality of life.

What kind of drug is Trintellix?

Trintellix is the brand name for the generic drug vortioxetine. Vortioxetine belongs to a drug class called atypical antidepressants or miscellaneous antidepressants. Because vortioxetine affects the serotonin levels in the brain, vortioxetine is classified as a serotonin modulator. Serotonin modulators or serotonergic agents work by increasing the amount of serotonin, a natural chemical in the brain that helps in regulating mood. Notably, the levels of serotonin and other brain chemicals may be unbalanced in the brains of those who have depression and other mental health conditions.

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The exact mechanism of action of Trintellix is unknown. However, Trintellix is similar to a selective serotonin reuptake inhibitor (SSRI) because they increase the levels of serotonin in the brain by blocking serotonin reuptake. Therefore, more serotonin is available in the central nervous system (CNS). What’s unique about Trintellix is that it also affects other serotonin receptors, but it is unclear if this contributes to the antidepressant effect of vortioxetine.

Examples of other antidepressants that are selective serotonin reuptake inhibitors include sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), and fluoxetine (Prozac).

Trintellix was previously marketed as Brintellix prior to June 2016. This name change was due to the confusion between Brintellix and Brillinta (ticagrelor), a blood thinner

How effective is Trintellix for depression?

Trintellix is effective in treating depression. Studies have shown that after taking this medication for 8 weeks, 61% of patients report at least 50% improvement in their depressive symptoms, and 35% of patients reported complete remission of their symptoms of depression.

It is worth noting that psychological treatment for the symptoms of depression requires a holistic approach consisting of both medications and psychoanalytic therapy or “talk therapy.”

A typical psychotherapy-medication path consists of a drug such as Trintellix combined with effective psychological therapy options such as talk therapy, cognitive behavioral therapy (CBT), cognitive play therapy, aversion therapy, interpersonal therapy, group therapy, family therapy, and environmental therapy.

Cognitive therapy helps in changing thought patterns and improving behavioral and mental disturbances. Other behavioral therapies can help to resolve unconscious unresolved childhood issues that are the root cause of clinical depression.

In some cases, clinicians would first use cognitive therapy in people with mild to moderate depression or those with situational depression, such as those dealing with grief, loss, or major life events. Depending on their response, adding an antidepressant in addition to psychological therapy may be necessary.

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In addition to Trintellix, SSRIs and SNRIs are proven to be effective in treating depression while being generally well-tolerated by most people. However, the incorporation of cognitive therapy along with antidepressant medication as part of a holistic approach is essential for long-term treatment success because psychological therapy focuses on teaching coping mechanisms.

Does Trintellix have a calming effect?

Trintellix may have a calming effect on some people. Trintellix is only approved for treating depression. However, it has been used off-label to treat generalized anxiety disorder (GAD). One study found that 55% of patients who took Trintellix for 8 weeks had a decrease in their anxiety symptoms by at least half.

Keep in mind that Trintellix is not an FDA-approved drug for generalized anxiety disorder (GAD). It is only approved for major depressive disorder. Talk to your doctor if you have anxiety along with depression. Your doctor will help you to determine if Trintellix, other antidepressants, or a different class of medication would be the best choice for your mental health issues.

What are the side effects of Trintellix?

Common side effects of Trintellix include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation. Other side effects can include dizziness, dry mouth, strange or unusual dreams, and sexual dysfunction in men and women, including decreased libido and erectile dysfunction. Tell your doctor if these side effects are severe or persist after about a week.

It is important to know that Trintellix has a boxed warning for the increased risk of suicidal thoughts and behaviors in children and young adults. Boxed warnings (formerly Black Box Warnings) are the highest safety-related warnings for medications assigned by the U.S. Food and Drug Administration (FDA).

More serious side effects include:

• Allergic reaction with skin rash, hives, itching
• Swelling of the face, eyes, lips, tongue, or throat
• Difficulty breathing or swallowing
• Hoarseness
• Fever, fast or irregular heartbeat, sweating, confusion, severe muscle aches or stiffness or twitching, hallucinations, agitation, poor coordination, nausea, vomiting, diarrhea
• Nosebleeds
• Memory problems
• Difficulty concentrating
• Headache
• Weakness
• Unsteadiness
• Confusion
• Hallucinations
• Seizures
• Fainting
• Loss of consciousness or coma

Call your doctor immediately or seek emergency medical care if you develop any of these serious side effects.

Which is better – Wellbutrin or Trintellix?

Both Wellbutrin (bupropion) and Trintellix (vortioxetine) are atypical antidepressants that can help improve depression symptoms. Each person’s response to antidepressant medication is different. One drug may work better for you than the other.

Some things to keep in mind when choosing between Wellbutrin vs Trintellix are:

• Wellbutrin (bupropion) is not recommended for people with a seizure disorder or an eating disorder such as anorexia or bulimia.
• Trintellix (vortioxetine) can increase the risk of bleeding, especially if you are taking other medications that also increase bleeding risk.

Which is better – Zoloft or Trintellix?

Zoloft (sertraline) belongs to a group called selective serotonin reuptake inhibitors (SSRIs). Trintellix (vortioxetine) is a serotonin modulator. Both medications are used to treat depression. One may work better for you than the other. Your doctor will help you choose the best treatment for your symptoms based on your response and tolerability of side effects.

Studies have evaluated the relative efficacy of Trintellix (vortioxetine) compared to other antidepressants in people with major depressive disorder who had an inadequate response to a selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI). People who were switched to Trintellix (vortioxetine) had higher remission rates compared to other therapies.

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Some things to keep in mind when choosing between Zoloft vs Trintellix include:

• Zoloft is available in a lower-cost generic version. Trintellix is a brand name-only drug. With Trintellix being a newer medication, prior authorization may be required in some cases, and out-of-pocket costs can be higher with Trintellix.
• Zoloft comes in the form of tablets and oral solutions. Trintellix comes in tablet form only.
• Zoloft is approved to treat not only major depressive disorder but also social anxiety disorder, panic disorder, premenstrual dysphoric disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. It also is used off-label to treat generalized anxiety disorder, hot flashes associated with menopause, and premature ejaculation. Trintellix is approved to treat major depressive disorder only.

What are the risks of taking Trintellix to treat depression?

Some of the risks of taking Trintellix include the following:

Serotonin syndrome

This is a serious and life-threatening drug reaction that can occur due to a buildup of serotonin in the body. Seek emergency medical care if you develop signs and symptoms such as agitation, hallucinations, fast heartbeat, changes in blood pressure, dizziness, sweating, flushing, fever, tremors, muscle rigidity or twitching, incoordination, seizures, nausea, vomiting, or diarrhea.

Increased risk of bleeding

Taking Trintellix can increase the risk of bleeding, especially if you are taking other medications, such as nonsteroidal anti-inflammatory drugs (aspirin) or anticoagulants (warfarin).

Activation of mania/hypomania

Patients with bipolar disorder can present with depression symptoms. Taking Trintellix can trigger an episode of mania or hypomania in such individuals. All patients should be screened for bipolar disorder before starting Trintellix to treat depression.

Angle-closure glaucoma

People with untreated narrow angles in their eyes can develop angle-closure glaucoma after treatment with antidepressants such as Trintellix. Seek emergency medical care if you develop sudden severe eye pain on one side, rainbow halos surrounding bright lights, blurred vision, headache, nausea, and vomiting.

Hyponatremia

Low sodium levels can occur in association with SIADH (syndrome of inappropriate antidiuretic hormone secretion) after starting Trintellix treatment. Get immediate medical help if you have symptoms such as nausea, vomiting, headache, confusion, drowsiness, fatigue, restlessness, muscle weakness, and muscle cramps.

Drug interactions

Trintellix can interact with other medications and cause serious adverse effects. For example, concurrent use of monoamine oxidase inhibitors (MAOIs) and Trintellix can lead to an increased risk of serotonin syndrome. You should not use Trintellix if you have used an MAO inhibitor within the past 14 days. You should wait 21 days to start taking an MAO inhibitor after the last dose of Trintellix.

Give your doctor a complete list of your medications, including prescription drugs, over-the-counter medicines, dietary supplements, and herbal products, before starting Trintellix. Also, tell your doctor if you have a history of drug or alcohol abuse.

Increased risk of suicidal thinking and behavior

Antidepressants have been linked to an increased risk of suicidality (thoughts or behaviors of harming yourself). This risk is especially high in children and young adults on antidepressants. Family members should closely monitor a person taking Trintellix for any unusual changes in mood or behavior.

Important things to know about Trintellix

• The usual starting dose of Trintellix is 10 mg by mouth once a day. The maintenance dose is 5 to 20 mg by mouth once per day. The maximum daily dose is 20 mg.
• Tell your doctor if you have severe side effects. Do not discontinue the medicine suddenly. Your doctor will instruct you on how to gradually reduce the Trintellix dose before stopping the medication to avoid withdrawal symptoms.
• You can take Trintellix with or without food.
• This medication is not approved for use in pediatric patients.
• Use of Trintellix in the third trimester of pregnancy can increase the risk of pulmonary hypertension and withdrawal symptoms in the newborn baby.
• Behavioral therapy is also important to long-term treatment success and supports holistic recovery. Psychological treatments work by modifying negative thinking patterns. Talk to your doctor or pharmacist about different resources for cognitive therapy or other behavioral treatment.

References:

1. https://medlineplus.gov/druginfo/meds/a614003.html
2. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a5b68e2-14d0-419d-9ec6-1ca97145e838
3. https://pubmed.ncbi.nlm.nih.gov/35499104/
4. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/atypical-antidepressants/art-20048208
5. https://pubmed.ncbi.nlm.nih.gov/26637048/

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