Vortioxetine is a new drug for the treatment of depression. It is jointly developed by Lundbeck of Denmark and Takeda of Japan. It was approved by the U.S. Food and Drug Administration (FDA) on September 30, 2013. Its trade name is Brintellix, which is used for the treatment of severe depression (MDD).
What are the categories of antidepressants?
See the following for different types of depression drugs:
● SSRIs (selective serotonin reuptake inhibitors) - generally, it is the initial medication for patients with depression. It is often effective, safe, and has fewer side effects, including citalopram (trade name: Celexa), fluoxetine (trade name: Prozac), and sertraline (trade name: Zoloft).
● SNRIs (serotonin and norepinephrine reuptake inhibitors) – act in a manner similar to SSRIs, but with other effects. When SSRIs are not effective enough, doctors may recommend SNRIs. SNRIs include duloxetine (trade name: Cymbalta) and venlafaxine (trade name: Cymbalta) and desvenlafaxine (trade name: Pristiq). SNRIs can increase hypertension. If there is hypertension, you should tell the doctor.
● atypical antidepressants – including bupropion (trade name: Wellbutrin) and mirtazapine (trade name: Remeron), generally do not cause sex-related side effects, so those who have such side effects when using other antidepressants can use these drugs. Bupropion does not cause weight gain. It is especially beneficial for people who lack energy, but it can cause tension. Mirtazapine can increase appetite and cause weight gain, so doctors sometimes give it to patients with low appetite.
● serotonin modulators – including trazodone, trazodone (trade name: Viibryd), and vortex (trade name: Trintlix). Trazodone can improve sleep, so it is sometimes used in patients with sleep difficulties. Trazodone is easy to causes nausea, vomiting, and diarrhea.
● TCAS (tricyclic and tetracyclic antidepressants) – less than SSRIs, SNRIs, and atypical antidepressants. Because of its many side effects, such as constipation and sleepiness, it can also disturb the heart rhythm and cause other serious problems, and also cause falls, confusion, and memory problems for elderly patients. However, TCAS is still helpful for some patients with depression, especially those who do not improve after treatment with SSRIs, SNRIs, or atypical antidepressants. TCAS includes norepinephrine (trade name: Pamelor) and desipramine (trade name: Norpramin).
● MAOIs (monoamine oxidase inhibitor) – MAOIs have many side effects, and it must avoid taking some food and drugs when used, so it is not used much, but it is still helpful for patients with depression who have other problems or have not improved after other drug treatment. MAOIs include isocarboxazid (trade name: Marplan), moclobemide (trade name: matrix), phenyl-ethyl hydrazine (trade name: Nardil), Gilan (trade name: Emsam patch) and anti phenyl cyclopropylamine (trade name: Parnate). If you need to follow a special diet, the medical staff will list safe foods.
The attached table lists the common names and U.S. trade names of some antidepressants, as well as the possible side effects of each drug. The choice of medication depends on your health, the other medications you use, and the side effects you can tolerate.
According to the long-term and short-term clinical studies before FDA approval, the advantages of the vortex are:
1. Good tolerability and few side effects.
This is also one of the reasons why I am willing to try Wotexetine. When I transferred from venlafaxine to escitalopram, I once wrote: the tolerance of Laishipram is stronger than that of Lennox. I think the side effects of escitalopram are much lower than venlafaxine, which also cultivated my good impression of Lingbei. I buried the subconsciousness that Lingbei has fewer side effects.
The biggest side effect reported by vortioxetine is in the intestines and stomach (digestive tract), which may cause nausea and other symptoms, but it will gradually stabilize after a period of time, and the side effects will disappear.
2. little drug withdrawal reaction.
Both traditional SSRIs and SNRIs need to be reduced step by step to achieve the reduction of drug withdrawal after the state are stable. If not handled properly, the sudden stop will bring more uncomfortable side effects of drug withdrawal. Although not recommended, vortex claims that it can be stopped suddenly.
3. the anti-depression effect is good, especially for the elderly.
The experimental data show that. Votes affect about 5-10% of primary care patients and up to 15% of the elderly.
4. it can relieve some symptoms of anxiety disorder.
The randomized blind study in 2017 evaluated the efficacy of vortioxetine in GAD subjects who are working and/or receiving education. Conclusion: vortioxetine has a greater beneficial effect on anxiety symptoms, function, and quality of life of GAD patients. It is working with GAD researchers and/or receiving education.
5. improve cognition
In August 2015, Lingbei and Takeda submitted a supplementary new drug application to FDA to add the efficacy data of vortioxetine on some cognitive functions of major depressive disorder (MDD) to the label. Earlier, in Europe, Brinellix obtained the support of CHMP (Committee for medicinal products for human use) under EMA and was approved to be the first antidepressant drug in the EU to improve the cognitive function of patients with depression.
The application materials submitted are mainly based on the data of focus and connect tests. The period of the two randomized studies was 8 weeks. The two studies used the digit symbol substitution test to evaluate the subjects' executive ability, processing speed, and attention. The study showed that a vortex could improve the cognitive performance of adult patients with major depression compared with a placebo.
6. mainly through liver metabolism
The peak plasma concentration at 7 to 11 hours, with a half-life of 66 hours, is metabolized through the liver CYP450 enzyme system, mainly CYP2D6, and others include CYP3A4, CYP3A5, CYP2C9, and CYP2C19; Not affected by renal function.