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 newest antidepressants, working on serotonin in several ways at once (a "multimodal" design). It's taken once a day, and many people find it gentle to be on day to day.

How is it different from other antidepressants?

• One of the newest options in Japan, with a mechanism that 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 of any antidepressant
• Gentler to come off than many antidepressants, thanks to its long, smooth action

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 and helps thinking feel clearer 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
• 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
• The first days to weeks are when nausea is most likely; taking it with food helps, and it usually fades
• Rarely, the early weeks bring unusual agitation or feeling wired. If that happens, contact your doctor promptly

What side effects should I expect?

Most are mild and settle within the first week or two 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); taking it with food helps, and it usually fades within days to a couple of weeks
• Drowsiness
• Headache
• Dizziness
• Constipation or diarrhea
• Itching or rash
• Feeling a bit more anxious or restless at first; this usually passes as the medicine starts working

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. Its long, smooth action means stopping tends to be less eventful than with many antidepressants, though 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.

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. Never stop on your own on learning you're pregnant. Our guides to medication in pregnancy and medication while breastfeeding cover the details.