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From Effexor to Trintillex


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I have had a long history with intermittent depression - episodes would seemingly appear out of nowhere, escalate to paralysing, tortuous levels and then dissipate within the course of 6-8 long months. I had about 6 of them between the ages of 23 and 40 - i probably had a few episodes of high level anxiety as a child that was also self limiting.  These episodes were all without medication, and all of them got progressively worse - i tended to try and exercise my way through them but that became exhausting - I had to take leaves of absences from jobs and NEVER told anyone what was going on in my head - except my long suffering husband.

Enter 2000, when i had my worst episode and found myself veering into oncoming cars on my way to collect my children from school, or thinking about climbing a local mountain and jumping (falling) off... i confided in a colleague ( i was in the medical field) and i was referred to a psychiatrist who commenced me on Effexor (with much kicking a screaming)  Lo and behold i got better! within 2-3 weeks! I thought it was a miracle, but then, once better I came off - and relapsed within 5 months, back on and rinse and repeat - about 11 times - each time, the period of wellness after being off decreased to 1 day.  My dr had been trying to convince me to stick to longterm (forever) treatment, but me being stubborn (and when i am well, there is no vestige of illness and it's hard to remember how bad it was) I kept trying to come off.  So, effexor was good to me for 17 years - the last year and a half, not so good - i felt like i had no joy - no excitement - life was just bleh - despite the fact that i have plenty in my life to be excited about.  

I started to discuss with my Dr about another drug - but i was always too scared to change - i was worried that my depression was only going to be treatable by Effexor.  I was worried about the transition - would i crash? would another drug work? if not, would effexor work again?  all of you with anxiety know these stupid thoughts.  

We decided on Trintillex - my life has been fairly chaotic with family issues over the last year, and i decided i couldn't wait until they settled before trying - because my ability to handle the family issues was being compromised by effexor's probable poop out anyway. Work wise - December/January looked clear. My psych dr was pretty conservative and wanted me to go from 112.5 to 75 for 3 weeks, then to 37.5 for 4 days and then stop and start trintillex.  She doesn't use it a lot because it is very expensive - my local GP has used it a bit and she said she starts people on 75 effexor and 5 brintellix, then 37.5 effexor and 10 brintellix and then off effexor after a week . She said it works a little differently to effexor, so i shouldn't have to worry about serotonin syndrome.  So that is what i did.

I was bat shit crazily worried that trintillex would give me nausea - but it didn't - in fact, i had ZERO side effects going on. I took my last 37.5mg effexor on January 1.  I went up to 20mg trintillex on Jan 3.  I may have had a little bit of itching each time i went up, which settled.  I also had to take a few grains of effexor on a couple of days because i felt those funny eye shift feelings.  

I don't think i am completely out of the woods - have had such a long love/hate relationship with effexor over the years - it has pulled me out of depression every time i have tried to go off - i knew it was time to try something else when i actually got depressed whilst on 150mg - that has never happened before, i felt it wasn't doing what it should.

What i really am hoping though, is that trintellix gives me back my b-b-bounce!  My motivation and excitement over the little things in life, my desire to travel and see people again.

So, after a long and perhaps boring read, i am cautiously optimistic. I started trintellix 5 mg on 20 Dec, went to 10mg on 27 December, stopped Effexor on jan 1 and went to 20mg trintellix on Jan 3 - so, it's only been 3 weeks - i still have a few weeks to consolidate. I will comeback and update :)

 

 

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Also consider that this may not be pure unipolar depression. What you describe sounds a lot like mood cycling. Specifically the timing of it all being a vicious cycle year over year. I have bipolar disorder with seasonal features. My mood episodes precipitate with the change in seasons, with Winter generally being more depressive, and Summer being more hypomanic and potential mixed episodes in the Fall and Spring.

If the same poop-out happens on Trintellix as it did on Effexor, you could always try another antidepressant, but with each additional antidepressant pooping out increases the likelihood that what you are experiencing isn't poop-out (antidepressant tachyphylaxis) but rather a mood swing or hypomanic switch. You start taking an antidepressant or increase the dose and you feel better for several days to weeks, typically a lot better. And then it just crashes. So what you may want to consider is a mood stabilizer to take with the Trintellix if it loses its luster. Generally speaking Trintellix can be very effective for treatment-resistant depression in some people where other proven treatments have failed, so having it poop out the same way as Effexor did would be a tad unusual but not unheard of.

Also keep in mind that if you feel too activated or agitated at the 20mg that dropping down to 15mg might be a good sweet spot. My pdoc and I generally don't increase my Trintellix to 20mg unless it's the deep of Winter and I'm extremely depressed. Otherwise, during the Winter I get by pretty well with 15mg and not too much in the way of side effects. I also didn't feel real nausea starting up but I did have dyspepsia. That's caused by the same thing that causes the itchy skin. Trintellix blocks 5HT3 which increases histamine release. This makes for itchy skin, but it also increases acid production in the stomach, which can lead to heartburn. This can be resolved with famotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac). I prefer famotidine personally, because my gdoc can write for a 40mg tablet once-a-day as a prescription and I can get it for much cheaper than OTC (which only comes in 20mg tablets taken up to twice a day)

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Thanks Bowri, I don't really think i have bipolar - i have never had any hint of hypomanic episodes.  I am also extremely stable when well - my cycles really have only ever been euthymic to depressed - not going over the normal level for me, which is not crazy busy.  I genuinely believe that Effexor (or maybe any drug would have done it) has made be more prone to be tripped into depression with little to no stimuli - the kindling phenomena.

I think 17 years of stability on one drug only is pretty good re 'poop out' statistically.

Anyway, i do agree that maybe i could drop to 15mg - but does that entail a 5 and a 10mg tablet? It is a more expensive drug - in australia 20mg is $82.00, 10mg was $65.00 (or around that)

My sleep is improved - I am not waking during the night, fall asleep within 10 minutes and have a good balance of light/deep and REM (according to my sleep ap on my watch) - I am generally getting around 7 - 7.5 hours unbroken sleep per night. I don't take any sleep aid. Effexor used to give me a really heavy feeling when i awoke and i would have trouble getting out of bed, not so with Trintillex. 

No constipation, and i think my long lost libido is returning!

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16 hours ago, surfer girl said:

Thanks Bowri, I don't really think i have bipolar - i have never had any hint of hypomanic episodes.  I am also extremely stable when well - my cycles really have only ever been euthymic to depressed - not going over the normal level for me, which is not crazy busy.  I genuinely believe that Effexor (or maybe any drug would have done it) has made be more prone to be tripped into depression with little to no stimuli - the kindling phenomena.

I think 17 years of stability on one drug only is pretty good re 'poop out' statistically.

I would agree with you. Typically with bipolar disorder, antidepressants "poop out" faster because they elevate your mood for a period of time and then you become depressed again, and oftentimes a patient will go through multiple antidepressants in a short period of time. Keep in mind though that most people experiencing hypomania don't realize that it's true hypomania. It took me several years before I was appropriately diagnosed. In fact more than 50% of bipolar disorder diagnoses start out as something else like unipolar depression. 

16 hours ago, surfer girl said:

Anyway, i do agree that maybe i could drop to 15mg - but does that entail a 5 and a 10mg tablet? It is a more expensive drug - in australia 20mg is $82.00, 10mg was $65.00 (or around that)

Unfortunately, it does entail a 5mg and a 10mg tablet. Takeda and Lundbeck got a 15mg tablet approved but never brought it to market unfortunately. They were too confident that 5mg, 10mg, and 20mg was sufficient but 20mg is too much for many people.

16 hours ago, surfer girl said:

My sleep is improved - I am not waking during the night, fall asleep within 10 minutes and have a good balance of light/deep and REM (according to my sleep ap on my watch) - I am generally getting around 7 - 7.5 hours unbroken sleep per night. I don't take any sleep aid. Effexor used to give me a really heavy feeling when i awoke and i would have trouble getting out of bed, not so with Trintillex. 

I remember reading a study that Trintellix improves sleep quality and reduces daytime sleepiness:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579402/

When directly compared to paroxetine (Paxil), vortioxetine had less of an impact on REM sleep structure most likely due to antagonism of 5HT3 receptors.

16 hours ago, surfer girl said:

No constipation, and i think my long lost libido is returning!

Lucky you. Trintellix can be weird because it can cause diarrhea OR constipation. Diarrhea can occur at any dose, but constipation tends to appear at the higher doses.

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Hey Bowri,

 i went to see my local doc yesterday and it is apparently available in 15mg here in Australia, but she recommended staying with 20 if i am tolerating it - particularly on the back of coming off long term 150mg effexor.... it's so confusing. I see my Pdoc next week, so will discuss it further there.   

How long do you normally notice dose changes?

 

 

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Ooooo luck you getting a 15mg tablet. Like I said I have to take a 5mg and a 10mg. There's records in the U.S. FDA database that a 15mg tablet was approved but then discontinued in the U.S. I don't think they ever brought it to market.

Trintellix has a half-life of 66 hours. If you multiply that by 5.5 you get the time it takes to reach peak plasma levels. That same time would be how long it would take for it to clear your system. This is 363 hours which is ~15 days. This means that levels are continuously rising after a dose increase (or falling after a decrease) for up to 2 weeks and there are still changes that occur in the brain after reaching a steady level. So if you wanted a hard date when you're going to ask yourself how you feel, it would be maybe about 21 days from the dose increase or decrease, whichever it may be.

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Hi all... I am wondering if a switch from paxil to trintillex would be a good move for me as I too have been in paxil 20 mg for 20+ years!  I am seriously the most depressed I have been in so long I can't remember feeling this bad!  

What do you think?  Aren't paxil and effexor similar?

Thanks!

Laney

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22 hours ago, Laney64 said:

Hi all... I am wondering if a switch from paxil to trintillex would be a good move for me as I too have been in paxil 20 mg for 20+ years!  I am seriously the most depressed I have been in so long I can't remember feeling this bad!  

What do you think?  Aren't paxil and effexor similar?

Thanks!

Laney

Paxil and Effexor are from different sub-classes. They both increase levels of serotonin in the synapse, but Effexor also increases levels of norepinephrine. Paxil has somewhat of an effect on the norepinephrine transporter as well, but that likely would only be experienced at higher doses. Paxil tends to be more calming, whereas Effexor tends to be more stimulating. Trintellix generally leans more towards stimulating as well in my experience, but it also has really improved my sleep in combination with Rexulti and Depakote.

Another big difference is that Paxil is proven in the treatment of anxious depression or anxiety disorders as a whole including panic disorder. Whereas Trintellix is paradoxical in that some people have new or worsening anxiety and others have their anxiety improve. Mine has improved but I've heard plenty of people say that Trintellix "rattled" them a little bit. In my experience though, Trintellix is a huge improvement over the other antidepressants I've tried.

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I guess it's too early to tell but the Trintellix is working?  Better than Effexor or same?

I'm asking cause my PDoc brought this drug up and I kind of said no because it was so new, I'm wary of newer drugs because there's not as much info out there about em...

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9 hours ago, BrianOCD said:

I guess it's too early to tell but the Trintellix is working?  Better than Effexor or same?

I'm asking cause my PDoc brought this drug up and I kind of said no because it was so new, I'm wary of newer drugs because there's not as much info out there about em...

Trintellix has a long half-life. So when it comes to the time it takes to start working, that isn't in its favor. It can take about 2 weeks for Trintellix to reach steady state once you reach a specific dose and park there. You can experience improvement as soon as the end of Week 1, but in my experience Trintellix continues improving things for a good 3 to even 4 weeks after you reach your target dose.

For me 5mg was like getting your toes wet. It was pretty activating, but not a WHOLE lot of antidepressant effect. At 10mg, I may have seen some improvement, but I shoved ahead to 15mg which is where I really started to notice a difference. I reserve 20mg for the deep of Winter because it's pretty strong at that dose.

Also, most people don't realize that it has a low but still notable affinity for the norepinephrine transporter. While on its own, this likely wouldn't be clinically noteworthy, Trintellix also increases norepinephrine output via 5HT3 antagonism which would enhance this NET inhibiting effect. This would make the 20mg dose somewhat comparable to some SNRIs in energizing effects.

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I am pretty sure Trintillex is working for me.  I  was on 20mg, but went down to 15mg as I wondered if it may have made me feel  little 'activated' - certainly no anxiety,  but a little 'keyed up'

So, it's been 11 days since i went down to 15mg.  It is silly for me to have doubts really because I feel well - my 'dependence' on effexor though was entrenched.  

So far, it is better than Effexor for me - no constipation, i wake up feeling refreshed, not groggy and I sleep better.  I thought initially that my libido was returning, but alas, that is not the case.  I have regained motivation and interest in things that had dropped off my radar.  I always had constipation, grogginess and no libido whilst on Effexor.  I was also very nauseous when i first started Effexor - interestingly, I had no nausea when I started Trintellix. 

When I first went on Effexor I was very unwell - so when it worked and i got better the change was miraculous.  I think there has been a very very gradual 'poop out'  The change since going on Trintellix has been subtle, but consistent. So, I really have no idea how quickly I might have responded had I actually been depressed when I began taking it.

I did try to change over to Pristiq once - but I had a really really bad reaction - it was very stimulating and made me so anxious and doom and gloom thoughts - weird!

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On 1/27/2019 at 1:45 AM, surfer girl said:

I am pretty sure Trintillex is working for me.  I  was on 20mg, but went down to 15mg as I wondered if it may have made me feel  little 'activated' - certainly no anxiety,  but a little 'keyed up'

Yeah I've heard that before from others and it's the same in my experience. I only take 20mg in the deep of Winter, other than that 15mg is usually my max.

On 1/27/2019 at 1:45 AM, surfer girl said:

So, it's been 11 days since i went down to 15mg.  It is silly for me to have doubts really because I feel well - my 'dependence' on effexor though was entrenched.  

So far, it is better than Effexor for me - no constipation, i wake up feeling refreshed, not groggy and I sleep better.  I thought initially that my libido was returning, but alas, that is not the case.  I have regained motivation and interest in things that had dropped off my radar.  I always had constipation, grogginess and no libido whilst on Effexor.  I was also very nauseous when i first started Effexor - interestingly, I had no nausea when I started Trintellix. 

The nausea is interesting. Some people get it from Trintellix and some don't. Some people just get an acidic stomach like I did which you can resolve with some Pepcid (famotidine). Trintellix isn't as bad for sexual dysfunction as other medications. In fact it faired better than citalopram, paroxetine, sertraline, and escitalopram in comparative trials. Enough that they were able to actually extend their patent protection. Give the lower 15mg dose some more time and your libido may return. Also keep in mind that even if your libido doesn't fully return, I find that if my partner "stimulates" me, I can usually get in the mood even if I wouldn't on my own spontaneously. They do say that if sexual dysfunction on Trintellix, it is usually for men and usually at the 20mg dose. Below that is usually less problematic.

On 1/27/2019 at 1:45 AM, surfer girl said:

When I first went on Effexor I was very unwell - so when it worked and i got better the change was miraculous.  I think there has been a very very gradual 'poop out'  The change since going on Trintellix has been subtle, but consistent. So, I really have no idea how quickly I might have responded had I actually been depressed when I began taking it.

I did try to change over to Pristiq once - but I had a really really bad reaction - it was very stimulating and made me so anxious and doom and gloom thoughts - weird!

Interesting that Pristiq didn't work for you where Effexor did. For some people, Pristiq works and Effexor doesn't, but for others, Effexor works and Pristiq doesn't. Depends on your body's metabolic speed.

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  • 2 weeks later...
12 hours ago, surfer girl said:

for the last 6 days i have been feeling more unwell - thoughts of doom/gloom back and anxiety - I bumped up from 15 to 20mg 4 days ago - I have another call booked in with my dr to discuss options - I am feeling a little bummed

Remember that it takes time for your body to adjust to dose increases and 20mg can be very stimulating. I would say to not completely give up on it until you've been at the 20mg for like a week or two. But it's also very possible you can't tolerate the higher dose. I don't usually go that high myself unless it's in the deep of Winter.

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13 hours ago, browri said:

Remember that it takes time for your body to adjust to dose increases and 20mg can be very stimulating. I would say to not completely give up on it until you've been at the 20mg for like a week or two. But it's also very possible you can't tolerate the higher dose. I don't usually go that high myself unless it's in the deep of Winter.

Thanks B, but i was on 20mg, but reduced back to 15mg on 16 Jan - so had been on 15mg for almost 3 weeks when I started to slip - i went up to the 20mg again 4 days ago.  

I am really hoping that the way I am feeling is not because of effexor withdrawal and Brintellix failure ( it is 5 weeks since my last effexor dose) - surely this would have shown up before now? My Dr suggested augmenting with Valdoxan (meltatonin modulating antidepressant) which i started last night.  I don't feel quite as bad today, but i did take 5mg diazepam to take the edge off this morning.

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10 hours ago, surfer girl said:

Thanks B, but i was on 20mg, but reduced back to 15mg on 16 Jan - so had been on 15mg for almost 3 weeks when I started to slip - i went up to the 20mg again 4 days ago.  

I am really hoping that the way I am feeling is not because of effexor withdrawal and Brintellix failure ( it is 5 weeks since my last effexor dose) - surely this would have shown up before now? My Dr suggested augmenting with Valdoxan (meltatonin modulating antidepressant) which i started last night.  I don't feel quite as bad today, but i did take 5mg diazepam to take the edge off this morning.

More than likely Effexor withdrawal would have shown up already, unfortunately. It's possible you just aren't compatible with Brintellix. However, the fact that Valdoxan gave you a lift might be worth sticking out. Even the two of them together because they operate differently.

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