Vortioxetine (Trintellix): What to Know Before You Talk With a Prescriber

What vortioxetine is

Vortioxetine is a prescription antidepressant that comes as a tablet. Its brand name in the United States is Trintellix. MedlinePlus places it in a group of medicines called serotonin modulators, which sets it a little apart from the better known SSRI family, even though it also acts on serotonin.

If you are reading about it because someone mentioned it, or because you already take it, this page sums up what the FDA label and MedlinePlus say. It is general information, not advice about your own treatment. You can see other medicines on our list of medicines.

What it is approved for

The current FDA label lists a single approved use: the treatment of major depressive disorder (MDD) in adults. It is not approved for children or teens.

This page describes only the label's approved use. If you have heard of it being used for something else, that is a good question for your prescriber.

How it is thought to work

According to the label, the way vortioxetine helps depression is not fully understood. It is thought to be related to boosting serotonin activity in the brain by blocking serotonin reuptake. It also acts directly on some serotonin receptors, blocking one type and activating another, but the label says the contribution of those extra actions has not been established.

What taking it can be like

MedlinePlus says vortioxetine can be taken with or without food, at around the same time each day, and that it may take several weeks or longer to feel the full benefit. The National Institute of Mental Health (NIMH) notes that medicines affect people in different ways, and that finding the one that works best with the fewest side effects may take several tries. Short notes on mood, sleep and side effects can make follow-up visits easier.

MedlinePlus also says vortioxetine may affect judgment, thinking and movement, so do not drive or use machinery until you know how it affects you. It advises talking with your doctor about alcohol, which can make side effects worse.

Other medicines can matter too. The label says some, such as bupropion, fluoxetine, paroxetine, rifampin, carbamazepine and phenytoin, can change how much vortioxetine is in your body, so your prescriber may need to adjust your treatment. Share a full list, including St. John's wort and tryptophan, which MedlinePlus says may interact.

Boxed warning and who should not take it

Vortioxetine carries a boxed warning about suicidal thoughts and behaviors. Antidepressants increased this risk in children, teens and young adults in short-term studies. Anyone taking an antidepressant should be closely watched for worsening depression and new suicidal thoughts. MedlinePlus says the risk may be more likely in the first few months and when a dose is increased, and to call your doctor right away about new or worse depression, panic attacks, severe restlessness, agitation or trouble sleeping.

If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Locascio Wellness does not provide emergency services. You can also see our crisis resources.

The label says vortioxetine must not be used by people allergic to it or its ingredients. Reported reactions include anaphylaxis, swelling and hives. It also must not be used with an MAOI for psychiatric conditions, or within 21 days after stopping vortioxetine, or within 14 days after stopping such an MAOI. Starting it during treatment with linezolid or intravenous methylene blue is also ruled out, because of the risk of serotonin syndrome.

Side effects and other warnings

The most common side effects in the label are nausea, constipation and vomiting. MedlinePlus also lists unusual dreams. Sexual side effects can occur in men and women, and the label notes they may go unreported unless someone asks, so please raise them.

MedlinePlus says not to stop vortioxetine without talking to your doctor. In trials, some people who stopped suddenly at higher doses had temporary headache and muscle tension, and the label recommends a gradual reduction whenever possible. Other possible effects after stopping serotonin antidepressants include nausea, dizziness, irritability and electric shock sensations.

Tell your prescriber if you are pregnant, plan to become pregnant or are breastfeeding. Serious risks named in the label include:

• Serotonin syndrome, which can happen alone or with other serotonin medicines. MedlinePlus lists fever, sweating, confusion, fast heartbeat, muscle stiffness or twitching and agitation.
• Bleeding, with more risk alongside aspirin, NSAIDs, warfarin or other blood thinners.
• Mania or hypomania, which is why the label says to screen for a personal or family history of bipolar disorder.
• Angle-closure glaucoma in people with narrow eye angles. MedlinePlus says eye pain, vision changes or eye swelling need a call to your doctor or emergency care right away.
• Low sodium, with more risk in older adults and people on diuretics: headache, confusion, weakness or unsteadiness.

Can it be managed online in Pennsylvania and New York

The label does not require vortioxetine to be given in a clinic. A secure video visit can cover your history, your other medicines and how you are feeling over time, though a physical exam or lab test would need to be arranged locally if one is needed.

A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO), treats depression by secure video for people physically located in Pennsylvania or New York during each visit. Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help. Read about online depression treatment, psychiatry in Pennsylvania or psychiatry in New York, or send us a medication question.

Our therapists do not prescribe. They offer depression therapy by video in Pennsylvania, West Virginia, Arizona, Colorado and Florida, but not New York, so New York readers can get psychiatry here but not therapy here. Reaching out about depression is an ordinary and hopeful step, and many people find more than one path forward.