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Brintellix/Vortioxetine


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7 hours ago, the maze runner said:

My Dr. just added Vortioxetine to my regiment. I take Clozapine 150mg and Concerta 36mg with it.

 

What are the effects I can look forward to and when does the onset of action begin.

 

TIA

I started vortioxetine (it is called Trintellix here) in early October, so I've been on it almost 2 months....I started out at 5mg, now I'm at 10mg.

I haven't really felt any improvement so far, but next month I'm hoping my doc will increase the dose (max recommended dose is 20mg)......Although, according to what I read, Trintellix can take up to 6-8 weeks to fully kick in....So I'm not giving up on it yet, and I have room to go up in dosage also.

The only side effect I have had with it is some mild nausea, which goes away if I eat something when I take it...I can't predict what sides you will get from it, but most possible side effects are GI in nature, from what I understand:      https://www.medicalnewstoday.com/articles/326083.php#side-effects

Edited by CrazyRedhead
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14 hours ago, CrazyRedhead said:

I started vortioxetine (it is called Trintellix here) in early October, so I've been on it almost 2 months....I started out at 5mg, now I'm at 10mg.

I haven't really felt any improvement so far, but next month I'm hoping my doc will increase the dose (max recommended dose is 20mg)......Although, according to what I read, Trintellix can take up to 6-8 weeks to fully kick in....So I'm not giving up on it yet, and I have room to go up in dosage also.

The only side effect I have had with it is some mild nausea, which goes away if I eat something when I take it...I can't predict what sides you will get from it, but most possible side effects are GI in nature, from what I understand:      https://www.medicalnewstoday.com/articles/326083.php#side-effects

Cool. I also noticed the nausea and with me too it goes away if I eat something.I am on a bunch of stuff so it's really hard to tell what is from what.

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On 11/28/2019 at 3:24 PM, ~nestling~ said:

That's good to know - I didn't know that!

yep, most numbers put ~80% of your serotonin supply in your gut, which is why diarrhea and/or constipation can be so prevalent with serotonergic antidepressants.

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On 11/26/2019 at 1:36 AM, the maze runner said:

My Dr. just added Vortioxetine to my regiment. I take Clozapine 150mg and Concerta 36mg with it.

 

What are the effects I can look forward to and when does the onset of action begin.

 

TIA

I find with Trintellix that I can dial back my stimulant dose because of how activating it can be. I usually take 40mg of Vyvanse (lisdexamfetamine), but at 20mg of Trintellix I often go down to 30mg on my Vyvanse, which I plan on doing at my next pdoc appt. I only say this because you are taking Concerta. You may find you want to back down on it if you increase Trintellix to 15mg or 20mg.

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On 12/4/2019 at 3:57 AM, the maze runner said:

that's an interesting point @browri. At first my doc had refused to prescribe Brintellix with methylphenidate. Then he revised his thought and did prescribe it. I find it is quite an effective combo. I'm still on 10mg though.

Yeah you likely won't have any issues with 10mg vortioxetine and 36mg methylphenidate, it would be when you get to 15mg or 20mg of vortioxetine that you may actually start to feel over-stimulated. Trintellix is an interesting antidepressant because it does manage to cause quite a bit of downstream dopamine release that is similar to the effect of stimulants. anything that is a serotonin reuptake inhibitor will increase serotonin in the synapse and cause activation of central 5HT1 receptors, which will cause a downstream release of dopamine. After receptor sensitivity changes take effect, SSRIs typically actually SUPPRESS dopamine signaling. It is most notable that when this long-term/chronic dopamine suppression was tested between vortioxetine and other antidepressants, vortioxetine was shown to cause LESS dopamine inhibition in the long-run than other antidepressants. This may explain why vortioxetine is better for symptoms like anhedonia where other antidepressants fail.

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  • 4 weeks later...

I tried it when it first came out and it pretty much acted like a straight SSRI to me.....in that after about a month all hell broke loose. Crazy anxiety, ruminating thoughts, just terrible. I had the same reaction when I tried lexapro way back in the day. I just don't do well with SSRI's. A genetic test years later with a big red flag to stay away from SSRI's confirmed this. I've generally done okay with SNRI's(cymbalta, nortriptyline) and Remeron.

It's classified as a "Serotonin Modulator" but I find this to be just marketing bullshit. It's an SSRI that does some extra agonism/antagonism on certain serotonin receptors.

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On 12/27/2019 at 10:28 AM, quiet storm said:

I tried it when it first came out and it pretty much acted like a straight SSRI to me.....in that after about a month all hell broke loose. Crazy anxiety, ruminating thoughts, just terrible.

Yeah some people can power through that with Trintellix and some just aren't compatible. I know @mikl_pls had similar difficulty with Trintellix. It even happens to me too. Everything starts to get really fast/rapid but it all eventually calms down like the roar of a crowd that slowly fades away. I usually have that kind of trouble only with the 20mg and 5mg doses oddly enough. When starting Trintellix, the 5mg is pretty activating to me. I was snappy and irritable and it didn't really help my mood at all other than motivate me a bit. Then I increased to 10mg after several weeks, and then to 15mg after several more weeks. And it wasn't until after 2 weeks on 15mg that I started to really feel better.

In the Fall/Winter though, we do increase it to 20mg and everything tends to get worse before it gets better. Even still, I can actually still FEEL. I don't feel blunted.

Quote

I had the same reaction when I tried lexapro way back in the day. I just don't do well with SSRI's. A genetic test years later with a big red flag to stay away from SSRI's confirmed this. I've generally done okay with SNRI's(cymbalta, nortriptyline) and Remeron.

Do you remember what on the genetic test was flagged specifically? Some tests will examine the gene that encodes the serotonin transporter and determine if you already have reduced SERT expression. If so, they generally contraindicate all SSRIs, SNRIs, pretty much anything that has serotonin reuptake inhibitor activity, but that would have included Cymbalta and nortriptyline because they are both SRIs.

On the other hand, the test may have flagged that you are a CYP2D6 poor metabolizer, which would make you incompatible with most of the SSRIs, but not Cymbalta or Luvox, both of which are metabolized by CYP1A2. Remeron is metabolized partially by CYP2D6 but is also metabolized by CYP1A2 and CYP3A4, so that would have been a safe bet. Still though, the fact that SNRIs worked for you but not SSRIs doesn't really point a finger at the serotonin reuptake inhibition but rather at some sort of metabolic interaction. I think @mikl_pls can back me up on that.

Quote

It's classified as a "Serotonin Modulator" but I find this to be just marketing bullshit. It's an SSRI that does some extra agonism/antagonism on certain serotonin receptors.

Maybe it is all press, but it does still make a difference for some people. Those actions have already been pitted against active comparators and vortioxetine is definitely superior at increasing serotonin levels throughout the body and maintaining higher neurotransmitter signaling among serotonin, norepinephrine, dopamine, histamine, and glutamate, and acetylcholine despite the body's propensity to compensate by desensitizing to this signaling. Also consider that receptor agonism/antagonism is why tricyclics work better for some people than SSRIs or SNRIs or why Remeron works where nothing else does. Those options do rely upon receptor modulation as well to achieve both their more potent clinical effects.....and their side effects.

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  • 2 weeks later...

When I took vortioxetine I found it activating like others have said and I also found it was not good for my bipolar disorder and threw me into hypomania. I didn't get irritable or become irritated like I did on wellbutrin or have crazy amounts of energy like I did on Prozac. Because of my anxiety disorders, I tens to stick to the sedating ADs instead of the activating ones. Is there a more sedating SSRI or AD that is as wonderful for anxiety disorders other than Paxil?

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On 1/12/2020 at 11:59 AM, mmaryland said:

When I took vortioxetine I found it activating like others have said and I also found it was not good for my bipolar disorder and threw me into hypomania. I didn't get irritable or become irritated like I did on wellbutrin or have crazy amounts of energy like I did on Prozac. Because of my anxiety disorders, I tens to stick to the sedating ADs instead of the activating ones. Is there a more sedating SSRI or AD that is as wonderful for anxiety disorders other than Paxil?

Other than Paxil, your best choices are Celexa and Lexapro (citalopram & escitalopram), although Lexapro is preferable and more effective for most. Interestingly enough, we have coined this class of supposedly SELECTIVE serotonin reuptake inhibitors meaning they supposedly only do that or that's how they exert their effect. However, Lexapro (escitalopram) is the MOST selective of the SSRIs in that other than the serotonin transporter (SERT), it doesn't bind to much else. Paxil (paroxetine) on the other hand as a "SSRI" is also a mild norepinephrine reuptake inhibitor, anticholinergic, and anti-alpha-adrenergic. Even Prozac (fluoxetine) is not selective. It also dramatically increases norepinephrine and dopamine signaling by blocking the 5HT2C receptor and also having some mild norepinephrine reuptake inhibition. This could be why it's stimulating for some at higher doses.

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  • 2 months later...
On ‎12‎/‎29‎/‎2019 at 9:19 AM, browri said:

Yeah some people can power through that with Trintellix and some just aren't compatible. I know @mikl_pls had similar difficulty with Trintellix. It even happens to me too. Everything starts to get really fast/rapid but it all eventually calms down like the roar of a crowd that slowly fades away. I usually have that kind of trouble only with the 20mg and 5mg doses oddly enough. When starting Trintellix, the 5mg is pretty activating to me. I was snappy and irritable and it didn't really help my mood at all other than motivate me a bit. Then I increased to 10mg after several weeks, and then to 15mg after several more weeks. And it wasn't until after 2 weeks on 15mg that I started to really feel better.

In the Fall/Winter though, we do increase it to 20mg and everything tends to get worse before it gets better. Even still, I can actually still FEEL. I don't feel blunted.

Do you remember what on the genetic test was flagged specifically? Some tests will examine the gene that encodes the serotonin transporter and determine if you already have reduced SERT expression. If so, they generally contraindicate all SSRIs, SNRIs, pretty much anything that has serotonin reuptake inhibitor activity, but that would have included Cymbalta and nortriptyline because they are both SRIs.

On the other hand, the test may have flagged that you are a CYP2D6 poor metabolizer, which would make you incompatible with most of the SSRIs, but not Cymbalta or Luvox, both of which are metabolized by CYP1A2. Remeron is metabolized partially by CYP2D6 but is also metabolized by CYP1A2 and CYP3A4, so that would have been a safe bet. Still though, the fact that SNRIs worked for you but not SSRIs doesn't really point a finger at the serotonin reuptake inhibition but rather at some sort of metabolic interaction. I think @mikl_pls can back me up on that.

Maybe it is all press, but it does still make a difference for some people. Those actions have already been pitted against active comparators and vortioxetine is definitely superior at increasing serotonin levels throughout the body and maintaining higher neurotransmitter signaling among serotonin, norepinephrine, dopamine, histamine, and glutamate, and acetylcholine despite the body's propensity to compensate by desensitizing to this signaling. Also consider that receptor agonism/antagonism is why tricyclics work better for some people than SSRIs or SNRIs or why Remeron works where nothing else does. Those options do rely upon receptor modulation as well to achieve both their more potent clinical effects.....and their side effects.

Hey sorry for the super delayed response. I'll just attach a snippet of the report that says I should stay away from SSRI's:

Capture.thumb.PNG.923f256450d4c93410d2feeabd822721.PNG

I'm a normal metabolizer for the CYP2D6 as well as the others you mentioned. I am an intermediate for CYP2C19. Your explanation does make sense but I just know that SNRI's and Remeron have been okay for me. I'll never touch an SSRI again.

 

 

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2 hours ago, quiet storm said:

Hey sorry for the super delayed response. I'll just attach a snippet of the report that says I should stay away from SSRI's:

Capture.thumb.PNG.923f256450d4c93410d2feeabd822721.PNG

I'm a normal metabolizer for the CYP2D6 as well as the others you mentioned. I am an intermediate for CYP2C19. Your explanation does make sense but I just know that SNRI's and Remeron have been okay for me. I'll never touch an SSRI again.

It's all good. The result that you posted seems to make sense. It indicates a SNP that is homozygous for the short allele of the SERT. The more short repeats you have, the less serotonin transporter you supposedly have. And because you have less of the transporter, less serotonin is cleared from the synapse into pre-synaptic neurons to be metabolized. Therefore, lower SERT usually means higher levels of serotonin.

When someone has multiple short repeats for SERT and they take a serotonin reuptake inhibitor, it causes excessive inhibition of the transporter that your brain can't balance out. Typically these are the people who get agitated when starting an antidepressant or experience insomnia or anxiety. No that doesn't necessarily mean bipolar disorder. It just means you don't tolerate antidepressants well.

USUALLY, I would say that if you can't tolerate SSRIs then SNRIs won't be much better despite what the report says. However, I imagine that inhibiting norepinephrine reuptake would desensitize the adrenergic system an MIGHT calm some of the serotonin activation in the long-run.

This does also indicate why Remeron worked so well. It's a serotonin antagonist. With the results above as they are, this would actually be a really good thing to do. Particularly when combined with an SNRI.

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On 3/17/2020 at 5:30 PM, browri said:

It's all good. The result that you posted seems to make sense. It indicates a SNP that is homozygous for the short allele of the SERT. The more short repeats you have, the less serotonin transporter you supposedly have. And because you have less of the transporter, less serotonin is cleared from the synapse into pre-synaptic neurons to be metabolized. Therefore, lower SERT usually means higher levels of serotonin.

When someone has multiple short repeats for SERT and they take a serotonin reuptake inhibitor, it causes excessive inhibition of the transporter that your brain can't balance out. Typically these are the people who get agitated when starting an antidepressant or experience insomnia or anxiety. No that doesn't necessarily mean bipolar disorder. It just means you don't tolerate antidepressants well.

USUALLY, I would say that if you can't tolerate SSRIs then SNRIs won't be much better despite what the report says. However, I imagine that inhibiting norepinephrine reuptake would desensitize the adrenergic system an MIGHT calm some of the serotonin activation in the long-run.

This does also indicate why Remeron worked so well. It's a serotonin antagonist. With the results above as they are, this would actually be a really good thing to do. Particularly when combined with an SNRI.

Thanks for the explanation. I love remeron. It's too bad that it can cause such bad weight gain and sedation. I've never really had an issue with the weight gain at all and the sedation does get better with time. Those two probably scare people off without even wanting to try it or just don't get give it a fair shot. It's somewhat understandable as that day after the first dose is pretty terrible sedation wise and really the first couple of weeks can be difficult but I wish people would stick with it more.

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18 hours ago, quiet storm said:

I love remeron. It's too bad that it can cause such bad weight gain and sedation. I've never really had an issue with the weight gain at all and the sedation does get better with time. Those two probably scare people off without even wanting to try it or just don't get give it a fair shot.

Yeah I've heard that weight gain on mirtazapine can be blown out of proportion. Some don't gain weight. Some do but only gain a few pounds in the beginning and it plateaus.

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