Brand & Generic Names; Drug Classes
|US brand name: Brintellix|
|Generic name: vortioxetine|
|Primary drug class: Antidepressants|
|Additional drug class(es): Miscellaneous Antidepressants|
Approved & Off-Label Uses (Indications)
Brintellix’s US FDA Approved Treatment(s)
Major depressive disorder (MDD) Approved 30 September 2013.
Brintellix is one of very few meds approved as a both short-term (acute) and long-term (maintenance, continuation, chronic) treatment of MDD. It’s the only crazy med I know of that hit the market approved for both, regardless of the condition it was treating.
Uses Approved Overseas but not in the US
In Australia Brintellix is also approved to treat the combination of MDD with high levels of anxiety.
Off-Label Uses of Brintellix
- Improving cognitive function in depressed adults
- Generalized Anxiety Disorder (GAD) . In four studies Brintellix failed three times and passed once, so don’t expect to see it approved to treat anxiety.
- I haven’t found any references for this, but because of its AP-like properties and little-to-no discontinuation symptoms, I’d like to see how 5 mg a day of Brintellix would work to wean people off of Paxil or Effexor who aren’t able to otherwise stop.
When & If Brintellix Will Work
Brintellix’s Usual Onset of Action (when it starts working)
You should feel something within a week. By week 2 you’ll know for sure if it’s going to work or not.
Likelihood of Working
Decent. Based on the few reports from the field I could find, and the amazing amount of clinical trial data Lundbeck and Takeda released, Brintellix is less effective than Cymbalta. But they had the balls to put it up against a real, modern, widely-prescribed med, and not just a placebo. They also put Brintellix head-to-head against Valdoxan (agomelatine) in a clinical trial, an AD with a completely different way of working. Brintellix both worked better and sucked less.
If you experience insomnia or somnolence (excessive fatigue and/or daytime tiredness) that doesn’t go away after a week, you’re either taking too much, or the likelihood of Brintellix working has dropped significantly.
If you had good results with an SSRI, but experienced brain fog or other cognitive issues that wouldn’t go away, Brintellix might be just the med you’re looking for.
Taking and Discontinuing
How to Take Brintellix
Lundbeck and Takeda recommend:
The recommended starting dose is 10 mg administered orally once daily without regard to meals. Dosage should then be increased to 20 mg/day, as tolerated, because higher doses demonstrated better treatment effects in trials conducted in the United States. The efficacy and safety of doses above 20 mg/day have not been evaluated in controlled clinical trials. A dose decrease down to 5 mg/day may be considered for patients who do not tolerate higher doses. --the Brintellix PI sheet
First and foremost, unless you have a cast-iron stomach like I have1: TAKE WITH FOOD!!! Because of the way Brintellix works and current reports from the field, the time of day you take it seems to matter less than almost any other AD, so many doctors are recommending “with your largest meal.”
As for how much to take, as always we suggest starting with as low of a dosage as you think you need. They make 5 mg tablets for a reason2, and it’s a lot easier to start at 5 mg and go up to 10 mg than to start at 10 mg, go down to 5 mg, then later go up to 10 mg. However, Brintellix at 2.5 and 5 mg a day vs. placebo or Cymbalta failed 3 out of 4 of their clinical trials, so there’s also a reason why they say to start you at 10 mg a day. 5 mg a day will work for a lot of people, but the odds are you’ll need more. The things you and your doctor need to discuss are your history with medications and how depressed you are.
You’ll need to adjust your dosage if you’re taking a medication than affects CYP2D6 (see drug-drug interactions) or are a poor CYP2D6 metabolizers (see pharmacokinetics). The PI sheet repeatedly tells doctors to adjust the dosage, by cutting it in half, if you’re taking a CYP2D6 inhibitor like Paxil, Prozac, or Wellbutrin - especially the first two - and that the maximum dosage for poor CYP2D6 metabolizers is 10 mg.
How to Stop Taking Brintellix (discontinuation / withdrawal)
2.3 Discontinuing Treatment Although BRINTELLIX can be abruptly discontinued, in placebo-controlled trials patients experienced transient adverse reactions such as headache and muscle tension following abrupt discontinuation of BRINTELLIX 15 mg/day or 20 mg/day. To avoid these adverse reactions, it is recommended that the dose be decreased to 10 mg/day for one week before full discontinuation of BRINTELLIX 15 mg/day or 20 mg/day. --the Brintellix PI sheet
Oh hell no. For companies that were doing so much right (unprecedented transparency with clinical trial data, and digging really deep into pharmacology before it was released, e.g.) how could they fuck up so badly with “Sure, just stop taking your 20 mg a day.” before how you’re supposed to do it? I don’t care how mild the discontinuation symptoms were in the clinical trials, it’s irresponsible to write it that way! You don’t want to stop taking any med suddenly unless your life or long-term health depends on it; preferably when qualified medical professional tells you to do so. Like when you’re having a nasty allergic reaction to it.3 Are they not aware that consumers read PI sheets? Or that there are idiot doctors out there?
At 10mg a day you should be able to just stop taking Brintellix, especially since it has such a long half-life and works like an antipsychotic in a lot of ways. But if you’ve gone through SSRI/SNRI discontinuation hell before, you’ll probably want to step down to 5 mg a day before stopping completely. Most people shouldn’t have an issue with discontinuing at 10 mg a day.