Trintellix vs Viibryd

Trintellix (vortioxetine) and Viibryd (vilazodone) are selective serotonin reuptake inhibitor (SSRI) antidepressants. Both medicines are prescription drugs approved by the United States Food and Drug Administration (FDA) to treat major depressive disorder in adults only. Let’s take a look at the similarities and differences between them.

What is Viibryd?

Viibryd is the brand name of an FDA (Food and Drug Administration) approved antidepressant medication for adults containing the active ingredient vilazodone. Viibryd is classed as a selective serotonin reuptake inhibitor (SSRI) and a partial serotonin 5-HT1A receptor agonist.

It is thought to work by correcting the imbalance of serotonin, a neurotransmitter in your brain. Low levels of serotonin may be linked to symptoms of depression. Due to Viibryd’s ability to activate 5-HT1A receptors, it can also decrease blood pressure and increase calm behavior and have other effects.

Viibryd is used to treat:

• Major Depressive Disorder (MDD)
• Obsessive-Compulsive Disorder (OCD) prescribed off-label
• Generalized Anxiety Disorder prescribed off-label

What is Trintellix?

Trintellix is a brand name antidepressant originally called Brintellix prescribed to adults to treat:

• Major depressive disorder (MDD)
• Obsessive-Compulsive Disorder (OCD) prescribed off-label
• Generalized Anxiety Disorder prescribed off-label

It’s a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). If you have MDD, your doctor may prescribe Trintellix to you, in addition to recommending other treatments. Trintellix works by increasing levels of a natural substance that regulates your brain activity called serotonin. This can reduce the severity of depressive episodes and help keep them at bay. You take Trintellix as an oral tablet that you swallow.

Trintellix & Viibryd mechanism of action

The active ingredient in Trintellix is called vortioxetine. The active ingredient in Viibryd is called vilazodone. Both these drugs are a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). When you swallow a Trintellix or Viibryd tablet, it releases vortioxetine or vilazodone into your bloodstream. Vortioxetine or vilazodone is then carried in your blood to your brain, where it slows down how quickly your brain cells reabsorb a substance called serotonin.

Serotonin is a neurotransmitter that helps regulate your brain function, particularly areas of your brain involved in mood, learning, and memory. Your brain cells reabsorb excess serotonin, but vortioxetine and vilazodone slow down how quickly this happens, causing serotonin levels to rise. This can rebalance your serotonin levels. Research has shown this can help to reduce the symptoms of depression.

Your body uses serotonin in many different ways: to regulate mood, control bowel movements, control nausea, and regulate sleeping and waking, and is also involved in blood clotting, bone health, and mental health. This neurotransmitter plays an important role in the body.

Trintellix dosage

Trintellix is available in three different strength immediate-release, film-coated tablets:

• 5 mg
• 10 mg
• 20 mg

Your doctor will advise you on your dosing regime. Triltellix can be taken with or without food. Each individual will be different and the dose will change from person to person. Some patients may begin with the 5 mg dose, others may take the higher dose. Always follow your doctor’s instructions and seek medical advice if you are unsure about dosing. The medication guide for Trintellix will be provided by your pharmacist before you start taking Trintellix.

Never stop your medication abruptly without consulting your doctor as withdrawal symptoms are possible. In clinical trials, some patients experienced discontinuation symptoms such as headache, muscle tension, mood swings, sudden outbursts of anger, dizziness, and a runny nose. This may occur in the first week of sudden discontinuation of Trintellix 15 mg daily or 20 mg daily.

Viibryd dosage

Viibryd is available in three different strengths of film-coated tablets:

• 10 mg
• 20 mg
• 40 mg

Start with an initial dosage of 10 mg once daily for 7 days, followed by 20 mg once daily. The dose may be increased up to 40 mg once daily after a minimum of 7 days between dosage increases. Viibryd is to be taken with food. Taking Viibryd on an empty stomach could result in the drug not working as well. The drug absorbs better when taken with food. Your doctor will advise you on your dosing regime. Each individual will be different and the dose will change from person to person.

Trintellix and Viibryd common side effects

The most commonly observed adverse side effects with Trintellix are:

• Constipation
• Itching

The most commonly seen adverse  side effects of Viibryd are:

• Joint pain
• Headaches

Common side effects observed with both Trintellix and Viibryd are:

• Nausea (feeling sick)
• Vomiting (being sick)
• Dry mouth
• Weight gain
• Weight loss
• Sexual side effects

Sometimes, Trintellix and Viibryd can cause more serious side effects. These include:

• Severe allergic reactions to the medication
• An increased risk of suicidal thoughts and suicide, particularly in young adults
• Serotonin syndrome – a potentially life-threatening condition caused by high levels of serotonin
• An increased risk of bruising and bleeding, especially if taken with medications that can reduce blood clotting, like blood thinners, aspirin, or NSAIDs like ibuprofen
• An increased risk of developing eye problems, including eye pain, swelling, and changes in vision
• An increased risk of hypomania (manic episodes)
• Hyponatremia – low sodium levels in your blood that can cause serious health problems and death

To minimize drug interactions and worsening of possible side effects you must inform your health care professional of other medical conditions you are taking prescription drugs to treat, over-the-counter medications such as cough suppressant dextromethorphan, or supplements such as St. John’s Wort. If you are breastfeeding and taking Trintellix, talk with your doctor about the potential risks and benefits. This article is not medical advice therefore always speak to your doctor about your health conditions.

You are encouraged to report the negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Trintellix and Viibryd drug interactions

Trintellix and Viibryd can interact with other medications, including:

• Monoamine oxidase inhibitors (MAOI) medications such as linezolid, methylene blue, isocarboxazid, phenelzine, and tranylcypromine. Their use must be separated by 14-21 days, depending on the individual treatment plan
• Strong CYP inducers, such as Dilantin (phenytoin) Rifadin or Rimactane (rifampin), Tegretol, or Epitol (carbamazepine). Your doctor may increase your dose of Trintellix or Viibryd. Based on clinical response, consider increasing the dosage over 1 to 2 weeks in patients taking strong CYP3A4 inducers for greater than 14 days
• Tricyclic antidepressants such as lithium
• Any selective serotonin reuptake inhibitor (SSRI) antidepressant such as sertraline (Zoloft), citalopram (Celexa), paroxetine, fluoxetine, and escitalopram (Lexapro)
• Any serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant such as duloxetine and venlafaxine (Effexor)
• Any other medications taken to treat major depressive disorder
• Any other medications that can affect your serotonin levels
• Buspirone, taken most often to treat anxiety disorders
• Any antipsychotic medications
• Opioid painkillers, like tramadol or fentanyl
• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen
• Triptans used for migraines
• Aspirin
• Warfarin, an anticoagulant (blood thinner) taken to reduce the risk of blood clots
• A herbal supplement called St. John’s Wort

Drug interactions with Viibryd only

• Strong CYP2D6 inhibitors such as Cardioquin (quinidine), and bupropion (Wellbutrin). Your doctor may decrease your dose of Viibryd. The dose should not exceed 20 mg once daily with the concomitant use of a strong CYP3A4 inhibitor
• Benzodiazepines such as alprazolam, clonazepam and diazepam
• Cardiac glycosides such as digoxin

Trintellix and Viibryd warnings & precautions

Antidepressants can increase the risk of suicidal thoughts and suicide in children and young adults, particularly during the first few months of treatment. Trintellix and Viibryd are not for use in children, but young adults taking them should be monitored for signs of sudden changes in behavior, mood, thoughts, or feelings. Seek urgent medical attention if you, or someone you care for, feels they are at risk of suicide.

Don’t take Trintellix or Viibryd if you:

• Are allergic to the active ingredient vortioxetine or vilazodone or any of the other ingredients in Trintellix or Viibryd
• Are currently taking a monoamine oxidase inhibitor (MAOI) antidepressant or have taken one in the last 14 days
• Are under 18 years of age

Talk to your doctor before taking Trintellix or Viibryd if you:

• Have bipolar disorder or mania. It is important to screen patients for a personal or family history prior to initiating treatment
• Have any liver problems
• Have a personal or family history of angle-closure glaucoma
• Have or have ever had seizures/convulsions
• Have or have ever had any problems with bleeding
• Have low salt (sodium) levels in your blood
• Regularly drink alcohol
• Are pregnant or are planning to become pregnant
• Are breastfeeding or are planning to breastfeed

Suicidal thoughts and worsening mental health

Like other serotonergic antidepressants, Trintellix and Viibryd carry a boxed warning due to the risk for suicidal thoughts and actions. In studies, Trintellix and Viibryd were shown to increase suicidal thoughts and actions in children, adolescents, and young adults (up to 24 years old). Trintellix is not approved for use in pediatric patients.

The FDA requires all antidepressant-treated patients to be monitored for clinical worsening and the emergence of suicidal thoughts or behaviors. It is very important that family members monitor their loved one’s behavior closely and any change in mood which might indicate an emerging problem should immediately trigger concern about stopping medication therapy.

A boxed warning is the strongest warning that the FDA requires. These warnings alert doctors and patients about drug effects that may be dangerous.

Serotonin syndrome

Serotonin syndrome occurs when serotonin levels in the body are dangerously high. This can happen when Trintellix or Viibryd are taken alone or with other antidepressants such as sertraline, citalopram, paroxetine, fluoxetine, and escitalopram, attention deficit hyperactivity disorder (ADHD) drugs, St. John’s wort, and others.

Symptoms of serotonin syndrome can include:

• High blood pressure
• Confusion
• Increased heartbeat
• Agitation
• Muscle rigidity
• Diarrhea

Symptoms of serotonin syndrome can be severe and sometimes even life-threatening. If you experience any of the above symptoms while taking Trintellix or Viibryd then please stop immediately.

Weight gain

Trintellix did not significantly impact weight in short-term studies and during a 6-month phase of a long-term study of patients who responded to Trintellix when compared to patients taking a sugar pill. Some reports of weight gain have been received since product approval.

Sexual dysfunction

Like other serotonergic antidepressants, Trintellix and Viibryd may cause sexual side effects during treatment. In clinical trials for Viibryd, up to 4% of people taking Viibryd reported sexual side effects compared to 1% of people who took a placebo.

In 6 to 8-week clinical studies with Trintellix the overall incidence in sexual dysfunction was as follows: in male patients the overall incidence was 3%, 4%, 4%, 5% in Trintellix 5mg/day, 10 mg/day, 15 mg/day, 20 mg/day, respectively, compared to 2% in placebo. In female patients, the overall incidence was <1%, 1%, <2%, 2% in Trintellix 5 mg/day, 10 mg/day, 15 mg/day, 20 mg/day, respectively, compared to <1% in placebo. These results were from voluntary reports of sexual side effects of antidepressants which are known to be underreported in part because patients may be reluctant to discuss them.

Male sexual dysfunction symptoms include:

• Ejaculation delay or failure
• Decreased libido
• Erectile dysfunction symptoms may be seen

Female sexual dysfunction symptoms:

• Decreased libido
• Delayed orgasm
• Absence of orgasm

Talk to your healthcare provider if you develop any changes in your sexual function or if you have any questions or concerns about sexual problems during treatment. Other alternatives are available.

Serious bleeding

When Trintellix or Viibryd are used with other medications that increase the risk of bleeding such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or warfarin there is a serious bleeding risk. Nose bleeds, bleeding in the stomach, or bleeding in the brain have the potential to occur.

Symptoms of serious bleeding can include:

• Uncontrollable bleeding
• Urine turning red, pink, or brown
• Tarry stools red or black in color
• Coughing up blood
• Vomit that looks like coffee grounds

You should be informed about the risk of bleeding associated with using Viibryd and antiplatelet agents or anticoagulants together. For patients taking warfarin, carefully monitor coagulation levels when initiating, titrating, or discontinuing Trintellix or Viibryd.

Low sodium levels

Certain people and people older than 65 years of age, or those taking a diuretic medication, are more likely to have this side effect. Trintellix and Viibryd can cause low sodium levels.

Symptoms of low sodium can include:

• Trouble concentrating
• Headache
• Confusion
• Weakness

Pregnancy and Trintellix and Viibryd

Your doctor may weigh the risks and benefits when prescribing Trintellix and Viibryd during pregnancy. Using Trintellix or Viibryd during the third trimester of pregnancy can increase the risk for persistent high blood pressure in the pulmonary artery and withdrawal in the newborn.

If you are pregnant or plan on becoming pregnant, it is best to speak with your healthcare provider before starting a medication.

Breastfeeding

Talk to your healthcare provider if you are breastfeeding or planning to breastfeed. It is unknown if this drug passes into breast milk.

Can you mix Trintellix and alcohol?

Trintellix’s and Viibryd’s prescribing information does not list alcohol as a contraindication or warning but is strongly discouraged by healthcare professionals. Trintellix and Viibryd can worsen the effects of alcohol, while alcohol can worsen the side effects of Trintellix and Viibryd. When you have depression, you have an increased risk of developing a substance use disorder. Therefore mixing antidepressants with alcohol can lead to alcohol abuse, increasing the potential to become alcohol dependent. If you drink and develop an addiction to alcohol, it will become more difficult for you to control your symptoms of depression and get your alcohol consumption under control. You may need more frequent and long-term treatment if you have both an alcohol use disorder and depression.

The combination of alcohol and antidepressants can be very challenging if someone is drinking, binge drinking, heavy drinking, or has an alcohol use disorder prior to taking antidepressants. Furthermore, if someone decides to stop taking drugs for depression and starts drinking alcohol for symptom management instead, they can worsen their symptoms of depression, in some cases leading to suicidal thoughts.

What are the different types of antidepressants? Are Trintellix and Viibryd the same?

There are several classes of antidepressants:

Selective serotonin reuptake inhibitors (SSRIs)

Trintellix and Viibryd both act like SSRI antidepressant prescription drugs. SSRIs are the most widely prescribed type of antidepressant altering serotonin levels. They are usually prescribed over other antidepressants, as they tend to cause fewer side effects.

Examples of SSRIs:

• Prozac (fluoxetine) is probably the best-known SSRI
• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Luvox (fluvoxamine)

Atypical antidepressants

Trintellix and Viibryd act like SSRIs, they also work in other ways on serotonin receptors, which are not completely understood. Viibryd is officially categorized as an SSRI and a 5-HT1A partial agonist. Trintellix is classed as an SSRI and acts as an antagonist, agonist, and partial agonist of multiple serotonin receptors. Due to their activity, they are also known as atypical antidepressants.

Atypical antidepressants don’t fit into other classes of antidepressants, but target different neurotransmitters such as dopamine to change the brain chemistry and regulate mood.

Examples of Atypical antidepressants:

• Wellbutrin (bupropion)
• Remeron (mirtazapine)
• Desyrel (trazodone)
• Viibryd (vilazodone)
• Trintellix (vortioxetine)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

SNRIs are similar to SSRIs. They were designed to be a more effective antidepressant than SSRIs but it seems that some people respond better to SSRIs, while others respond better to SNRIs. SNRI antidepressants work on altering serotonin and norepinephrine neurotransmitters.

Examples of SNRIs:

• Cymbalta (duloxetine)
• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)

Tricyclic antidepressants (TCAs)

TCAs are the traditional type of antidepressant. They are no longer usually recommended as the first treatment for depression because they can be more dangerous if an overdose is taken. They also cause more unpleasant side effects than SSRIs and SNRIs.

TCAs respond better to severe depression and can be used for other mental health conditions, such as OCD and bipolar disorder. Amitriptyline can also be used to treat chronic pain.

Examples of TCAs:

• Elavil (amitriptyline)
• Anafranil (clomipramine)
• Tofranil (imipramine)
• Pamelor (nortriptyline)
• Norpramin (desipramine)

Monoamine oxidase inhibitors (MAOIs)

MAOIs are an older type of antidepressant that is rarely used nowadays. They can cause potentially serious side effects so should be prescribed with caution.

Examples of MAOIs:

• Parnate (tranylcypromine)
• Nardil (phenelzine)
• Marplan (isocarboxazid)