Medication guide

Vortioxetine (Trintellix)

What is vortioxetine?

Vortioxetine is known as Trintellix in the United States and Japan (トリンテリックス on Japanese packaging), and Brintellix in the UK and Europe; it's all the same medicine. It's one of the newer antidepressants, working on serotonin in several ways at once (a "multimodal" design). It's taken once a day.

How is it different from other antidepressants?

One of the newer options in Japan: its mechanism goes beyond the classic SSRI design
Studied for the "brain fog" of depression: research has looked specifically at concentration and thinking, not just mood
Few hard restrictions: it has one of the shortest rule-out lists among antidepressants
One of the gentler antidepressants to come off: it leaves the body slowly

What is it used for in Japan?

Depression.

How does it help?

By adjusting serotonin signalling in several ways at once, it eases low mood over time. The full effect often takes a few weeks. If you don't feel better right away, that's normal; keep taking it as prescribed.

What should I tell my doctor before starting?

Vortioxetine suits most people, but a few situations rule it out entirely; your doctor will choose something else if any of these apply:

A past allergic reaction to vortioxetine
Taking, or recently stopping, an MAO inhibitor (a medicine for depression or Parkinson's); these can't overlap

And tell your doctor first if any of these apply; these usually just need adjustments or a closer eye:

Certain other antidepressants such as paroxetine, or the heart medicine quinidine (they can raise vortioxetine's level, so the dose is kept lower)
Epilepsy medicines like carbamazepine or phenytoin, or the antibiotic rifampicin (they can lower its level)
Other antidepressants, tramadol (a painkiller), migraine triptans, or lithium
Blood thinners, or regular painkillers like ibuprofen
A history of seizures, bipolar disorder, or glaucoma
Past suicidal thoughts, or strong impulsivity: the label asks for closer monitoring
Being older
St John's Wort supplements
Pregnant, planning to be, or breastfeeding (see the section below)

How do I take it, and what if I miss a dose?

Vortioxetine is taken once a day, at any time that suits you, with or without food.

If you miss a dose: take it when you remember, unless the next dose is close; in that case just skip. Never take a double dose to catch up
Early on: nausea can appear when you start, and it often eases as your body adjusts. Some effects can continue, so tell your doctor if they do
Agitation: if you notice unusual agitation or feeling wired, contact your doctor promptly
Alcohol: avoid it while taking vortioxetine; the Japanese label advises against drinking

What side effects should I expect?

Many are mild and ease as your body adjusts, and many can be eased with a counter-medicine (for nausea, for example). Not everyone gets them; the rough figures below just give a sense of how common each one is.

Nausea: the most common one (around 10% or more); it often eases as your body adjusts, and if it bothers you, tell your doctor, as a counter-medicine can help
Vomiting
Drowsiness
Headache
Dizziness
Trouble sleeping
Constipation or diarrhea
Itching or rash
Tiredness
Feeling more anxious or restless at first

If anything is bothering you, tell your doctor; there's often a way to adjust. And if you ever feel worse instead of better, tell us straight away; it's easily managed, and that's what we're here for.

Will I become dependent? How do I stop safely?

No; vortioxetine isn't addictive, and it's one of the gentler antidepressants to come off. There's no craving and no urge to take more. It leaves the body slowly, so stopping tends to cause fewer problems than with some antidepressants, though symptoms such as dizziness, headache, nausea, or anxiety have been reported after a sudden stop. So the same rule applies: never stop suddenly on your own. Changes are planned with your doctor, and many people continue for some months after they feel better before coming off together.

Can I drive while taking it?

Yes, with care, especially at the start. Drowsiness or dizziness can occur in some people, so see how it affects you before driving, particularly when starting or changing the dose, and don't drive if you notice them. The Japanese label asks for caution here, not a ban.

What about pregnancy and breastfeeding?

Tell your doctor early; this is decided case by case. As a newer medicine, vortioxetine has less accumulated pregnancy data than older antidepressants, so the plan is individual: sometimes continuing, sometimes switching to an option with a longer record, with any change made gradually with your doctor. Never stop on your own on learning you're pregnant. Our guides to medication in pregnancy and medication while breastfeeding cover the details.