Trintellix (vortioxetine) for anxiety and depression: What to know

Trintellix (vortioxetine) for anxiety and depression: What to know

Reviewed by:
Divya Khosla, MD
Staff Psychiatrist
at Talkiatry
March 26, 2024
In this article

When it comes to finding the right treatment there are many different options out there. It’s normal to have concerns when trying new medication, and knowing what will work and how effective it might be. One medication that’s used to treat anxiety and depression is Trintellix, the brand name for vortioxetine.  

If your doctor has already prescribed you Trintellix for depression or anxiety, or you’re curious to know what to expect if you begin to take it, this article can help. We’ll cover details about how Trintellix works, why you might be prescribed it, its effects on people with anxiety and depression, potential side effects, and more.  


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What is Trintellix, and how does it work?

Trintellix (originally called Brintellix) was approved in the US in 2013 for treating depression. While most antidepressants belong to one of 4 main categories (SSRIs, SNRIs, MAOIs, and TCAs) based on how they work in the brain, there are a few that don't fit into those categories, especially newer drugs like Trintellix. These are sometimes called "atypical antidepressants," but despite the name, they're actually fairly common, and effective. In clinical trials, Trintellix has been medically proven to help with symptoms of depression.  

It’s also been referred to as a multimodal antidepressant because it works in multiple ways on the brain, instead of just one. It mainly works by increasing the levels of serotonin in your brain. Serotonin is a chemical known as a neurotransmitter, and its levels can affect your mood, sleep and more. Antidepressants like Trintellix can increase your levels of circulating serotonin and improve your symptoms of depression by preventing the brain from reabsorbing serotonin (like SSRIs do). What makes Trintellix an atypical antidepressant is how it also directly affects serotonin receptors, increasing the brain’s sensitivity to the serotonin it already has. Also unlike SSRIs, Trintellix doesn’t just affect serotonin. It can affect noradrenaline, dopamine, acetylcholine and histamine. While the mechanism of action isn’t completely understood, the effect is: Patients taking Trintellix notice an improvement in their depression symptoms.  

What is Trintellix used for?

Trintellix is FDA-approved to treat the symptoms of major depressive disorder (MDD), which may include persistent feelings of sadness, low energy and fatigue, loss of interest, and suicidal thoughts.  

To learn more about symptoms of depression, check out: What does depression feel like.  

Trintellix is also prescribed by some doctors to help manage symptoms of anxiety, including generalized anxiety disorder (GAD). Trintellix is not FDA approved to treat anxiety but in some clinical trials, it has been shown to improve symptoms This is called an “off-label” use, meaning the medication has been prescribed for something other than its approved purpose, usually based on scientific studies. Off-label uses can sound scary, but they are safe and often effective.

For example, in clinical trials Trintellix has been shown potentially to improve symptoms in patients with depression accompanied by anxiety, as well as in treating anxiety on its own, especially severe GAD, so some health care providers will offer it as an option.  

More studies are needed for Trintellix’s effects on anxiety to be fully established, but your doctor might recommend it as a good choice for your treatment, especially if you have had trouble tolerating other anxiety medications.  

Trintellix dosage

Trintellix only comes in a few different dosages, so finding the right dose for you might be simpler than other antidepressants, which can have a wider variety of options. Finding the right dose of any new medication takes time, so be patient. Your doctor will help you figure out which is the right one for you.  

It’s common for doctors to start you at a dose of 10mg a day, and then increase it until you reach the final dosage based on their recommendations. The maximum dosage is 20mg a day and it’s usually adjusted in 5mg increments.

If your body’s not responding well to Trintellix or you want to stop it, make sure to chat with your doctor about that, too. When you stop medication suddenly, it’s possible to experience withdrawal symptoms (antidepressant discontinuation syndrome) including a return of your depression symptoms, but your doctor will help you minimize this risk. One way that’s usually done is by steadily decreasing your dosage before you stop the medication completely.  

What to do if you miss a dose

When you’re starting a new medication, you might miss a dose. When it comes to dosing, it’s also important to note the half-life of a medication. The half-life is how long it takes for half the amount of the drug to leave your system. Trintellix has a half-life on the longer side at 66 hours, which means forgetting to take it once shouldn’t have much effect. If you happen to forget to take Trintellix or have any questions about your medication, it’s always safest to reach out to your doctor to clarify what to do and when to take your next dose.

How long does it take for Trintellix to work?

If you’re taking Trintellix for depression or anxiety, and it’s a good fit for you, you may start to see improvement in your symptoms as early as two weeks, and you’ll feel the full effects and maximum benefit of a particular dose in about a month. Remember, treatment can take time so it’s important to stick with your medication and take it consistently. It can be helpful to jot down how you’re feeling, too, and track your symptoms to see when Trintellix starts to have an effect.

Doctors typically recommend staying on an antidepressant for at least six months to a year after achieving an improvement in symptoms. Deciding to stop is an individual decision, and if you’re feeling better and decide to stop sooner, it’s important to talk to your doctor so they can develop a taper plan to help you stop the medication safely.

To learn more about stopping medication, check out Going back on antidepressants after stopping

What are the common side effects of Trintellix?  

Like most antidepressants, a variety of side effects might crop up if you start taking Trintellix. It’s normal to feel a little nervous when reading about side effects, but don’t worry. Many of them are low-impact and a number of them subside or improve with time. When prescribing you Trintellix your doctor will let you know ahead of time what you can expect and help you minimize any discomfort you might feel from taking medication.

The most common side effects of Trintellix are related to the digestive system, and they include:    

  • Nausea  
  • Constipation
  • Vomiting
  • Sexual dysfunction, including lowered sex drive and difficulty reaching orgasm

Less common and more rare but serious side effects include:  

  • Weight gain  
  • Sedation
  • Seizures
  • Increased suicidal thoughts
  • Manic episodes (hypomania)
  • Low sodium levels (hyponatremia)
  • Serotonin syndrome, if also taking other medications that increase serotonin levels

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Other considerations

There are a few other instances when Trintellix might not be right for you, and your doctor will ask you about your health history and medical conditions to make sure it’s safe for you to take before prescribing it to you. Here are a few of them:

  • MAOIs, SSRIs, SNRIs, and tryptophan: Using Trintellix alongside prescription drugs like these can increase the risk of serotonin syndrome, a rare but potentially dangerous interaction.  
  • Triptans: You may experience weakness, hyperreflexia, and incoordination if you take Trintellix with migraine medications.
  • Tramadol: There is an increased risk of seizure when taking this opioid with Trintellix.
  • Existing eye problems: Trintellix might cause a rare side effect called angle-closure glaucoma. If you experience eye pain, swelling, or loss of vision, let your doctor know right away.
  • Medications with blood-thinning effects like warfarin, aspirin, and NSAIDs (including over-the-counter drugs like ibuprofen and naproxen): Trintellix can potentially cause an increased risk of bleeding, when taken with these. Make sure to let your doctor know if you regularly take any of them regularly.

Is Trintellix a good choice for depression and anxiety?

If you're struggling with depression or anxiety, Trintellix can offer some relief. Research has shown that Trintellix is effective in treating depression. In fact, it outperformed the placebo in improving patients’ depression symptoms and preventing them from returning. It also potentially has fewer side effects than some other antidepressants, which can be helpful if you have struggled with side effects in the past.  

That said, only a mental health expert, like a psychiatrist, will know if it’s the right choice for you. They can give you a diagnosis, if you don’t have one, and then work with you on a treatment plan with proper medication.

Talkiatry is a national psychiatry practice that provides in-network mental health services. To get matched with a psychiatrist, fill out this free online assessment to schedule your first virtual visit within a few days.  

FAQs

Here are more answers to your questions related to Trintellix.

Is Trintellix an SSRI?

Although Trintellix works by affecting the amount of serotonin in the brain, it’s not technically an SSRI (selective serotonin reuptake inhibitor), which includes medications like Paxil (paroxetine) and Zoloft (sertraline). It’s also sometimes called an SMS (serotonin modulator and stimulator) as well as a miscellaneous antidepressant. In addition to suppressing serotonin reuptake in the brain, it also acts on a number of other receptors and neurotransmitters. It’s this multimodal effect which can make it an effective treatment for depression as well as anxiety.  

How much does Trintellix cost?

As of 2024, the cost of Trintellix is $489.67 for a 30-day prescription. Your health insurance, combined with a savings card from the manufacturer, can help bring that cost down to as little as $10.  

What's the difference between Trintellix and Viibryd?

Viibryd (vilazodone) is a drug that has been FDA-approved to treat depression and is prescribed off-label for anxiety, just like Trintellix. Both medications are also classed as a serotonin modulator, and is a multimodal alternative to SSRIs and SNRIs. In clinical trials, it has not been shown to have any advantages over other antidepressants.  

Unlike Trintellix, Viibryd is available as a low-cost generic. If the cost of Trintellix is prohibitive for you, Viibryd may be a good alternative that works in a similar way on the brain.  

Does Trintellix cause weight gain or sexual side effects?

Weight gain is not a typical side effect of Trintellix, but some incidences of it have been reported. Sexual side effects may possibly occur but will likely improve with time. Additionally, a 2015 study showed that Trintellix resulted in significantly better sexual functioning and fewer sexual side effects compared to Lexapro (escitalopram).  

To learn more, check out: Can antidepressants cause weight loss?

Can I take Trintellix while breastfeeding?  

Trintellix levels in breast milk have been shown to be low. You do not necessarily need to stop taking Trintellix if you plan to start breastfeeding, but make sure to let your doctor know you plan to take Trintellix while breastfeeding so that they can give the most accurate and individual medical advice. It's important to discuss risks, benefits, potential side effects, and alternative treatment options with your healthcare professional prior to making any medication changes.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Dr. Divya Khosla, MD, is a board certified Adult Psychiatrist and board eligible Child and Adolescent Psychiatrist. She received her undergraduate degree from Case Western Reserve University in Cleveland, Ohio, and her medical degree from Ross University, completing all of her clinicals in Maryland, D.C., and NYC. She completed her adult psychiatry residency at The Ohio State University in Columbus, Ohio. Then she returned to the east coast, where she completed her child and adolescent psychiatry fellowship at Nassau University Medical Center in East Meadow, New York.

Dr. Khosla has participated in a variety of innovative academic clinical research, and has presented research at annual national meetings of the American Psychiatric Association. Her robust clinical experience with varying demographics at different clinical sites around the country has allowed her to treat patients in an evidence-based way, tailoring treatment to an individual’s specific needs.

Although Dr. Khosla’s practice focuses on medication management, she also implements supportive therapy and motivational interviewing in sessions to allow for a more comprehensive approach to treatment. Her clinical interests include depression, bipolar disorder, anxiety disorders, post-traumatic stress disorder, panic disorder, and ADHD.

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