Jump to content
CrazyBoards.org

Wonderful.Cheese

Trintellix and Bipolar depression/interactions/good fit?

Recommended Posts

So it appears as though we qualify for patient assistance for trintellix. I am severely depressed and could really use something. I was hoping to try an AD but EVERYTHING under the sun interacts with SEROQUEL and ABILIFY AND INVEGA it appears. But hey, free trintellix is good. It doesn't seem to interact poorly with any of my AAP's or other meds. Is it worth trying to help the following? Or will it be a let down? If you guys think it's worth a shot I'll call and ask about it. That's saying a lot (phone anxiety and I NEVER ask for help, but everyone is pressuring me to do so).

Currently: 

I'm in bad shape depressed, my mood is so low/suicidal at times, feel very negative about everything

Can't get out of bed

Don't want to (or can't) be around people

Skipping everything I normally do like: Group therapy, spending time with my mom, doing crafts, exercising, etc.

Just laying around all day, low energy

Crazy worry about my husband's health and feeling insanely guilty that I caused him to have cancer years ago

Not showering or cooking or cleaning if at all really

Share this post


Link to post
Share on other sites
Posted (edited)
17 hours ago, CeremonyNewOrder said:

It did nothing for me good or bad but of course your experience could be different

Thanks for your reply and sharing your experience. I'm hoping this med might do something for me but it could be a let down too like it was for you. I did put a call in but no call back. I got her voicemail. That was very hard for me to do. And now it's the weekend. Dang.

So I still don't know for sure if I even get to try this one for sure or not yet or any AD for that matter. 

It's hard to wait when you feel so so so unbelievably low. 

Edited by Wonderful.Cheese
  • Like 1

Share this post


Link to post
Share on other sites

Way to go Cheese for calling!

I hope something is done as I know you are suffering! I've never tried that particular AD but if you do try it, I hope it works!

Share this post


Link to post
Share on other sites
4 hours ago, Butterflykisses said:

Way to go Cheese for calling!

I hope something is done as I know you are suffering! I've never tried that particular AD but if you do try it, I hope it works!

Thank you butterfly!  I appreciate your kindness!

2 hours ago, looking for answers said:

i really liked trintellix, someone else on here did too, i believe @browri  obv YMMV

Thanks! That's good to know! I appreciate that!

  • Like 1

Share this post


Link to post
Share on other sites

Hey @Wonderful.Cheese

Sorry to hear you're in a tough place right now. With the symptoms you mentioned, Trintellix COULD work. However, it doesn't work for everyone. One thing I must stress is that you have to give it time. Some of its pharmacological actions do shorten the time to effect but that's negated by the fact that it has a super-long half-life of 66 hours. So it can take up to 2 weeks for it to reach steady blood levels, and you need to give it a good 1-2 weeks beyond that once you've gotten to a dose to decide if it's REALLY working for you. Clinical trials said it started separating from placebo at week 2. But the recommended dosage is 10mg for a week then immediately go right to 20mg. In retrospect, I'm glad we took it slowly so I could really get an idea of how each dose impacted me.

Trintellix can be tricky with anxiety. Some people say it makes their anxiety worse, and some people say it improves their anxiety or doesn't really affect it at all. I think it has helped mine, but I also feel that Rexulti is carrying most of the weight there at the moment. A study was done that seems to indicate pre-treatment functioning could be indicative of how it will work for someone's anxiety. Someone who is already productive and frequently occupied like pursuing a degree might get more anxiolytic efficacy from Trintellix:

https://www.psychiatryadvisor.com/anxiety/vortioxetine-generalized-anxiety-disorder-tx-pre-treatment-functioning/article/737747/

However, all-in-all Trintellix in my experience has been stimulating. It doesn't start to have any sort of calming effect until you get to maybe 10mg. Again everyone is different, I just remember feeling a bit hyper in the beginning when I started on 5mg, which I did for several weeks. The hyper feeling went away after 3-5 days. Then maybe 3 more days of stimulation when we increased it to 10mg, but I didn't notice it (as much) when we went to 15mg or 20mg. Some people do say that Trintellix makes them feel tired during the day, but my experience has been the opposite. YMMV.

My hypomania and mixed states can be problematic, so we tread carefully with Trintellix. We also are working on a seasonal rhythm for dosages so that I go higher on Rexulti and lower on Trintellix in the Spring/Summer (10mg vortioxetine / 1mg brexpiprazole) and then reverse for Fall/Winter (20mg vortioxetine / 0.5mg brexpiprazole). Keeping in mind of course that I'm also taking Depakote as a baseline mood stabilizer. Because Trintellix can be stimulating, be mindful of any new mania/hypomania. Didn't give me a problem. The hyper feeling didn't really feel like mania, but I was mildly irritable. Nothing I couldn't handle, though.

One thing I can say is that Trintellix has been better for anhedonia than any other antidepressant I've taken.....except Wellbutrin, which definitely takes the cake in that department pretty much by default. I will also note that higher doses of Trintellix mean I need to go down on Vyvanse. There's definitely some dopamine effect from Trintellix, because I've done dose increases and experienced the dopamine "tics" like facial twitches. Decreasing Vyvanse always resolves the issue, and I find with higher doses of Trintellix, I don't need as much Vyvanse and I might feel over-stimulated. Despite the stimulation though, it didn't interfere with my sleep at all. Probably improved it actually.

Sexual dysfunction is somewhat less on Trintellix but it's definitely still there at the higher doses (15-20mg). Similar to Viibryd, not as good as Wellbutrin, but definitely better than Prozac, Lexapro, and Zoloft.

I would actually recommend anyone try Trintellix. It's either going to be your wonder drug or it just won't do anything. Kinda weird but it works for me. Again YMMV lol

  • Like 1

Share this post


Link to post
Share on other sites

@browri

Thanks so much for all the information!

I guess that is one thing that stinks about AD's: they take a long time to kick in. I will be patient. 

Oh my goodness I hope it doesn't make my anxiety worse. I don't think I could bear that. But at the same time I'm so lethargic something a little more stimulating might be ok for me. 

Mania could be a potential problem for me as well. Something to keep an eye on for sure. 

I am on Nuvigil. I wonder if I will need to decrease the dose of that or if it is different from a stimulant med. I guess we will see.

This is all IF I even get to try trintellix or another AD. I wonder what my pdoc's nurse will say. And who the covering pdoc is. 

Share this post


Link to post
Share on other sites
23 hours ago, Wonderful.Cheese said:

@browri

Thanks so much for all the information!

No problem! That's why we're on this board, right? ;)

23 hours ago, Wonderful.Cheese said:

I guess that is one thing that stinks about AD's: they take a long time to kick in. I will be patient. 

This is true, but Trintellix will definitely start working faster than something like Prozac. In my mind the 5mg is kind of a useless starter dose. It made me feel hyper for a few days. Then that went away and I didn't really feel anything. I didn't really feel less depressed. No improvement in anxiety or cognition. At 5mg, it really just doesn't do as much. Once I got to 10mg, I felt the same few days of stimulation again but after it went away I started to notice some subtle changes that I couldn't put my finger on. By 15mg I knew it was doing something and was seeing true improvement. However, it wasn't until 1-3 weeks on 20mg that I fully felt better. Ultimately I ended up coming back down to 10mg for the Spring/Summer, but I will likely go back up to 15mg and then 20mg in August or September as we drop down the Rexulti.

23 hours ago, Wonderful.Cheese said:

Oh my goodness I hope it doesn't make my anxiety worse. I don't think I could bear that. But at the same time I'm so lethargic something a little more stimulating might be ok for me. 

Go into it assuming it will do nothing for your anxiety. I can't seem to make heads or tails of people's reports on this. It seems like 50% report it does nothing for their anxiety or depression, 25% say it makes their anxiety worse and 25% say it's a miracle drug. It's so very strange. However, they did just do a comparative meta-analysis of both efficacy and tolerability of antidepressant drugs:

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

"In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants (range of ORs 1·19–1·96), whereas fluoxetine, fluvoxamine, reboxetine, and trazodone were the least efficacious drugs (0·51–0·84)."

"For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were more tolerable than other antidepressants (range of ORs 0·43–0·77), whereas amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine had the highest dropout rates (1·30–2·32)."

So if you look carefully, the only two drugs that are both the best tolerated and the most efficacious were actually either Lexapro or Trintellix. So I would think that would be reason enough to try it despite your anxiety, because there is a fair chance it will help.

23 hours ago, Wonderful.Cheese said:

Mania could be a potential problem for me as well. Something to keep an eye on for sure.

Yeah definitely keep an eye on it, but like I said it's probably going to feel like 3-5 days of "hyperactivity" almost akin to akathisia in a way. You might be a tad irritable or snappy. I adjusted though just fine and the Rexulti has helped to mellow me out as well. You have enough dopamine blockade in your regimen already to keep that from happening. Just good to be mindful.

23 hours ago, Wonderful.Cheese said:

I am on Nuvigil. I wonder if I will need to decrease the dose of that or if it is different from a stimulant med. I guess we will see.

Actually I believe @spyker takes Trintellix with either Provigil or Nuvigil and swears by the combo. I feel the exact same way about the combo of Trintellix and Vyvanse. Because Trintellix manually activates the 5HT1A receptor and blocks the 5HT3 receptor it can cause a strong downstream release of dopamine that most antidepressants don't usually cause. More typical of an SSRI is to increase serotonin to a level that effectively inhibits dopamine release due to overactivation of serotonin receptors. So because Trintellix has demonstrated to cause downstream release of dopamine (in addition to norepinephrine, acetylcholine, and histamine, as well as serotonin), you typically don't need as much of another medication that does the same thing like Vyvanse, which causes release of serotonin, norepinephrine, and dopamine into the synapse with the order of strongest effect being dopamine > norepinephrine > serotonin.

When I feel over-stimulated, I usually get tics in my face. Twitches in my nose, eyes, and mouth. Not like the jerky or chewing movements caused by antipsychotics, but just general dopamine-overstimulation. I can decrease either Trintellix or Vyvanse and it solves the issue. Although I generally choose to decrease the Vyvanse if that issue presents itself.

23 hours ago, Wonderful.Cheese said:

This is all IF I even get to try trintellix or another AD. I wonder what my pdoc's nurse will say. And who the covering pdoc is. 

Most pdocs are intrigued enough with Trintellix because of how it works that they will let you try it, but they're VERY, very hesitant on dosing. Like I said, the prescribing information says start on 10mg for 1 week, then go right to 20mg. Based on my experience that would be a positively LUDICROUS activation period for the patient, and I'm really glad I took 5mg for a few weeks, then 10mg for a few, then 15mg for a few, before going to 20mg. That way I could understand how each dose affected me. And each dose was slightly different.

Out of curiosity @Wonderful.Cheese, is the list of meds in your signature up-to-date? I know you and your pdoc were making a lot of changes to try and streamline the cocktail and didn't know if there was anything in that list that you aren't taking anymore.

Be well! :)

Share this post


Link to post
Share on other sites

@browri thanks again. That was very helpful and I appreciate it a lot. My med list is current, yes. The streamline attempt blew up in my face and I was put on my old cocktail unfortunately. I'm still pretty upset about that.

 

Share this post


Link to post
Share on other sites

To update here too, just in case....

 

I just got a call from my pdoc's nurse and I'm crushed. She yet again didn't consult with any Dr covering for my pdoc (who is out of the office until June). She just does what she thinks or wants. She knows she can walk all over people/me and get away with it. She is a wanna be Dr. 

She basically told me to wait it out. Sure...I hope I don't hurt myself in the meantime. Or further ruin relationships from isolating/irritability/negativity/depressed mood. I told husband I'm done with group therapies and just everything. I don't enjoy anything. I was so proud of myself for reaching out and calling my care team. But that only made things worse. :(

She said, talk to my case manager or tdoc (also out of office until May 4) about "coping skills". I suppose she thinks I don't use therapy enough.

She also said, since I had a med change in March, it's too soon to have another one. I kind of stopped listening after that. :(

  • Sad 1

Share this post


Link to post
Share on other sites

There is no problem as regards me with modafinil 200mg and trintelix 10 mg. It works nice 2 months now.

Share this post


Link to post
Share on other sites

I might be a little late but I have just started trintellix. I' in day 5 I think at 5mg. I also take 15mg ability.  

 

Too soon to really know if it' doing anything. Nothing negative from it. I was expecting the usual start up ssri effects like nausea! 

 

Share this post


Link to post
Share on other sites
24 minutes ago, Eilatan said:

I might be a little late but I have just started trintellix. I' in day 5 I think at 5mg. I also take 15mg ability.  

 

Too soon to really know if it' doing anything. Nothing negative from it. I was expecting the usual start up ssri effects like nausea! 

 

Yeah the nausea is common. It will either go away or it won't. Just gotta wait it out and see.

Share this post


Link to post
Share on other sites

Modafinil because i need dopamine release. It works like a booster on Trintellix But I say it again, i speak for my person only. Maybe someone else would feel anxious with that combo.

Share this post


Link to post
Share on other sites

I'm feeling insanely hungry and agitated on Trinellix and i'm only on 5MG. Has anyone else had this experience. 

Share this post


Link to post
Share on other sites

Don't recall feeling more hungry. Kinda suppressed my appetite really. However I can say from my own experience that your agitation is not surprising. I can also say from my own experience that it went away after a few days. How long have you been on it?

Share this post


Link to post
Share on other sites

It’s been about 3 week now and about one week on the 5mg. I started off at 2.5 mg for two weeks since I’m so sensitive to these meds .

Share this post


Link to post
Share on other sites

Thought I'd update here. I think my current combo of 15mg aripiprazole/abilify and 5mg brintillix is working really well. I am either on the beginning of a natural lull in my depression, hypomania or its JUST WORKING yay.......

Share this post


Link to post
Share on other sites
18 hours ago, Ethansmom said:

It’s been about 3 week now and about one week on the 5mg. I started off at 2.5 mg for two weeks since I’m so sensitive to these meds .

Do you recall experiencing any agitation when you started at 2.5mg? I would say it's safe to expect it to go away. I was reading some articles about why this happens, and I think it has something to do with the 5HT1B partial agonism and 5HT1D antagonism. Those receptors have been implicated in anger, but they have also been implicated in cognition when tested against scopolamine. Once those receptors desensitize, it should ease up. You may experience it again going to 10mg. But the 15mg and 20mg jumps are much smoother in my opinion.

15 hours ago, Eilatan said:

Thought I'd update here. I think my current combo of 15mg aripiprazole/abilify and 5mg brintillix is working really well. I am either on the beginning of a natural lull in my depression, hypomania or its JUST WORKING yay.......

I believe @dtac was prescribed 5mg Trintellix as an augment to his 2mg Rexulti and enjoys it so far. Doctor's are clearly starting to get curious about this medication, and I'm observing cautious use of low doses in combination with high dose mood stabilizer to help treat bipolar depression off-label.

In order for an SSRI to work, it needs upwards of 85% occupancy at the serotonin transporter. Trintellix at 5mg is only 45% and at 10mg is about 55%. However, in trials, those doses did still produce a considerable antidepressant effect compared to other pure SSRIs at 45-55% SERT occupancy. The 10mg dose separated from placebo after 10-14 days. This means that there really is a lot more that Trintellix is doing to produce that antidepressant effect, and that makes doctor's curious. I don't mind being a lab rat. ;)

Keep an eye out for the possibility of hypomania though. Abilify has a balance of 60% activating / 40% blocking at the dopamine receptors and Trintellix causes more dopamine release because of 5HT1A agonism and 5HT3 antagonism. This might "turn you up" a bit.

Share this post


Link to post
Share on other sites

Very interesting eilatan. What are your thoughts on changing to clominiprine? I suffer for severe anxiety, obsessive thought and panic attacks 

Share this post


Link to post
Share on other sites
8 hours ago, browri said:

Do you recall experiencing any agitation when you started at 2.5mg? I would say it's safe to expect it to go away. I was reading some articles about why this happens, and I think it has something to do with the 5HT1B partial agonism and 5HT1D antagonism. Those receptors have been implicated in anger, but they have also been implicated in cognition when tested against scopolamine. Once those receptors desensitize, it should ease up. You may experience it again going to 10mg. But the 15mg and 20mg jumps are much smoother in my opinion.

I believe @dtac was prescribed 5mg Trintellix as an augment to his 2mg Rexulti and enjoys it so far. Doctor's are clearly starting to get curious about this medication, and I'm observing cautious use of low doses in combination with high dose mood stabilizer to help treat bipolar depression off-label.

In order for an SSRI to work, it needs upwards of 85% occupancy at the serotonin transporter. Trintellix at 5mg is only 45% and at 10mg is about 55%. However, in trials, those doses did still produce a considerable antidepressant effect compared to other pure SSRIs at 45-55% SERT occupancy. The 10mg dose separated from placebo after 10-14 days. This means that there really is a lot more that Trintellix is doing to produce that antidepressant effect, and that makes doctor's curious. I don't mind being a lab rat. ;)

Keep an eye out for the possibility of hypomania though. Abilify has a balance of 60% activating / 40% blocking at the dopamine receptors and Trintellix causes more dopamine release because of 5HT1A agonism and 5HT3 antagonism. This might "turn you up" a bit.

Hi browri 

Thank you for replying. Yes my pharmacy has to order it in as it'''s not very well known. They are quite interested to see if it works well too. I think it does. I'm still cautious but optimistic.... I am doing a few slightly reckless things. Like err ordering stimulants online and getting my address wrong.  I'm  such an idiot. 150 dollars down the drain......

Share this post


Link to post
Share on other sites
7 hours ago, Ethansmom said:

Very interesting eilatan. What are your thoughts on changing to clominiprine? I suffer for severe anxiety, obsessive thought and panic attacks 

I' not sure what clominipeine is!!! I' pretty sure I'm not taking it though. Are you on it?? My thinking is you're wanting to reply to @browri as they seem to know a lot about all these things. 

I'm sorry you'e having anxiety etc. I too have lived with it to a severe degree. 

 

 

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now


×