Vortioxetine Vs SSRIs: Exploring Differences and Benefits. A Better Choice in Depression Treatment?
HTML-код
- Опубликовано: 7 июл 2024
- If you've been searching for a comprehensive guide to understanding the differences between Vortioxetine and SSRIs, this video will be invaluable.
00:00 What is the mechanism of action of Vortioxetine? (Trintellix, Brintellix)
2:04 The role of 5HT1A, 5HT3 and 5HT7 receptors in the treatment of depression with Vortioxetine?
4:43 What are the benefits and side effects of Vortioxetine?
In this detailed video, Dr Sanil Rege takes you on a fascinating journey into the world of Vortioxetine, also known as Trintellix and Brintellix. Vortioxetine is a multi-modal agent that's redefining the landscape of depression management.
Vortioxetine, a multi-modal agent, increases levels of neurotransmitters, including serotonin, dopamine, noradrenaline, acetylcholine, and histamine.
This unique action offers not only benefits in depression treatment but also potential advantages in addressing pain and cognitive enhancement.
Discover the specific properties of Vortioxetine that set it apart, such as its 5HT1A receptor effects that accelerate desensitisation, leading to quicker action. Moreover, its interactions with the 5HT3, 5HT7, 5HT1B, and 5HT1D receptors provide additional pro-cognitive effects, mood enhancement, and sleep-promoting qualities.
In this comprehensive analysis, we delve into Vortioxetine's advantages, which include its minimal impact on emotional blunting and low incidence of sexual dysfunction. We address common side effects, such as nausea, and offer practical strategies to manage them effectively.
While Vortioxetine's long half-life offers convenience, we emphasise the importance of understanding its implications when transitioning to other medications. We also highlight the significance of cautious use when combining Vortioxetine with other serotonergic agents to avoid potential risks of serotonin syndrome.
Knowledge is power, especially in the realm of psychiatric treatment. Let this enlightening video empower you to make informed decisions in your practice. Hit the play button now and embark on an insightful exploration of Vortioxetine Vs SSRIs and the benefits they offer for depression.
Please remember that this video does not replace professional medical advice. Always consult with a healthcare professional for accurate information.
#Vortioxetine #Trintellix #Brintellix #Antidepressant #DepressionTreatment #MultiModalAgent #Neurotransmitters #MechanismOfAction #SSRIs #PsychiatricAdvancements #MentalHealth #Cognition #PainReduction #SleepPromotion #ProCognitiveEffects #EmotionalBlunting #SerotoninSyndrome #HealthcareProfessional #Psychiatry #MedicalScience #Neuroscience #Psychology #DepressionManagement #MoodEnhancement #ScienceExplained #MedicationInsights
🔵 Watch now to gain a comprehensive understanding of Vortioxetine's unique mechanisms and its potential in depression treatment.
🔵 Like, share, and subscribe for more enlightening content on mental health and psychiatry.
🔵 Join the discussion in the comments section below and share your insights and experiences with Vortioxetine.
🔵 Stay informed and keep learning with Dr Sanil Rege - subscribe to our channel for more informative videos on psychiatric advancements.
Related Resource:
Vortioxetine - Mechanism of Action and Clinical Application: psychscenehub.com/psychinsigh...
🎓RESOURCES BY PSYCH SCENE:
🌐The Academy by Psych Scene: PSYCHIATRY EDUCATION REDEFINED
academy.psychscene.com/
Revolutionary psychiatry learning.
🌐Psych Scene Hub: PSYCHIATRY TEXTBOOK OF THE FUTURE
psychscenehub.com/
The Hub is devoted to making you a better mental health professional. Our team of academic and clinical experts bring you powerful summaries, videos and interviews in psychiatry and neurosciences.
🌐Psych Interview Online: REAL WORLD SKILLS FOR REAL WORLD SUCCESS
www.psychinterview.com/
The Psych Interview online courses offer high-quality training to help you improve your psychiatric interview skills through self-study. They are suitable for Psychiatrists, Psychiatry trainees, Mental health practitioners, Nurses and General Practitioners.
🌐Psych Scene Online: THE ONLINE COURSES TO HELP YOU SUCCEED
ranzcpexams.psychscene.com/
Learn at your own pace with the RANZCP Written Exam prep online courses, psychotherapy online courses and CEQ podcasts brought to you by the Psychiatry Training Experts.
🌐Psych Scene: THE PSYCHIATRY TRAINING EXPERTS
psychscene.com/
Psych Scene offers specialised training and professional development for Psychiatry Trainees, Psychiatrists, General Practitioners and Mental Health Practitioners. Here you can find our upcoming live courses.
--
📱SOCIALS
Subscribe for weekly videos on Psychiatry and Neuroscience:
Facebook: / psychscenehub
Instagram : / psychiatry.excellence
-
👋 LET’S CONNECT!
Follow Sanil Rege on LinkedIn: / sanilrege
Great video. Thanks for the brilliant content. I'm impressed by your ability to write legibly as a doctor and also in reverse!
Really simplified this topic in very informative manner, keep it up good work 💯
Thanks for your feedback. 🙏🏼
Wow. Really informative
Thank you so much sir for simplifying it. Stay blessed ❤
You are welcome
Thank you greatly, this is a great help to know. Thank you
Glad it was helpful!
Thank you, very clear and informative. I just started taking this medication. Subscribed.
Thank you for your feedback.
How did it go?
@@jrman413 I stopped taking it within two-three weeks and started meditating seriously every day instead (to improve impulse control and concentration) and taking my therapy more seriously.
Why did I stop taking it so early? I sensed emotional numbness/flatness and sexual dysfunction after 3-4 days and got flashbacks from how I experienced flouxetine/prozac.
However, this medication might work for others and the eventual flatness effect might be a good place to be for a while for some.
And such a psychopharmacology nerd and no matter what I do and how much I study, I can never seem to wrap my head around the way that full or partial agonists work at different receptors, but I so so appreciate the way you broke it down!! I feel like i understand so much more!
Trintellix and Abilify has been a total God-Combo for me!
That's good to know.
Excellent ! to hear that this combo is working for you 👍 May I ask what is your current dose of Trintellix ?
Great video
Thanks for your feedback 🙏🏼
Excellent. Fascinating drug!
Also I am going to contact you clinic to see if you can take me on as a patient, you seem very knowledgeable, I’m currently in Brisbane with a psychiatrist from Ramsay care and have not had much luck .
Thank you so much !
You're welcome!
Love from India ❤️🕉️❤️
Really Nice content
Thank you 🙏🏼
I want to know more about clinical depression .
Can you make a special video about it .
Please see this video - Clinical Symptoms and Treatment of Severe Depression - Melancholic and Psychotic Depression
ruclips.net/video/_Lfj7mXxUe0/видео.html . We also have the video on the descent into despair that provides another perspective.
Nice video
@PsychiatrySimplified
1 second ago
Thanks for your feedback 🙏🏼
Amazing videos: i am a mental health researcher and your videos are great. Just a quick one how do you compare Vortioxetine with Agomelatine
We have a couple of videos on Agomelatine. Different mechanism - ‘ Milder ‘ in a way Agomelatine is and won’t be able to address moderate to severe depression on its own - Vortioxetine at 15-20 mg becomes broad spectrum which Agomelatine doesn’t. Thanks for feedback
Thanks for the video. This med didn’t help me and ultimately I’m having a hard time getting off of it due to akathesia, etc. Giving it plenty of time with a hyperbolic taper and doctor support. Time to go inside and resolve the root causes of my struggles.
Sorry to hear
Great vid Sanil. Can you explain one thing please for me. How does desensitising the 5HT1A autoreceptor lead to more serotonin release compared with how much the receptor was sending out before the medication? Wouldn’t the receptor just return to where it was before, by compensating or learning to tolerate the medication? Or do serotonergic antidepressants push the 5HT1A Auto receptor so far that it can’t compensate, thus leading to an overall increased serotonin release?
The 5HT1A receptor is a feedback (negative ) so it regulates the release of serotonin 5HT from the presynaptic neuron depending on the amount of extracellular synaptic serotonin. Too much and it will act as a brake ; too little and it will act to release. It depends on endogenous serotonin. We covered this more in SSRI mechanism video on this channel. Here when the 5HT1A receptor is desensitized (i.e not antagonised ) then the break is released.
Oh and also i have been prescribed tritico 50 mg. for bedtime and vortioxetine 10 mg for morning.Is this combination good?
Dear Doctor , your videos are very interesting. I am on Nexito 20mg for a small episode of insomnia triggered by gastritis ( due to lots of partying in december 2022). I also have a history of health anxiety.
At the same time , I love to enjoy evenings with a small drink with friends and a good meal. But this new condition has created a great fear in me towards liquor.
1) Will I have a relapse again due to a small drink?
2) Will the current condition worsen into a psychosis or Schiz even while I am taking medication?
These are the burning questions I have! I teach and am 28 years old.
Sorry to hear. I can't answer those questions because it requires an assessment. Would recommend consider a psychologist as this can help with strategies to combat the health anxiety. And it's important to address the insomnia if present. Wish you well.
@jonharry totally agree!
I am on Agomelatine and my psychiatrist prescribed Vortioxetine as an additional drug to take in the morning. Let's see how it goes.
Wish you well
how re u on agomelatine i was so blunted on agomelatine like on ssri and no sexual function i started off label Valproate and i hope it will stabilize me
@@danielkanka495 I was blunted for the first 3 weeks or so, then it went away.
I'd be very curious to hear your thoughts on a drug with this many different mechanisms of action. It seems radically different from the drugs that have come before us which have one or maybe two different moas. Do you think that this broad approach offers inherent advantages over simpler antidepressants. And in your clinical experience what kind of results have you seen with vortioxetine to date? I've observed that there seems to be a lot of skepticism about this drug among psychiatrists.
I think as with all agents its the targeted use that is most beneficial I.e linking the diagnostic formulation to psychopharmacology. It has lower SERT so not as good as SSRI in anxiety but also does not lead to emotional bunting as a result. It is more ‘activating’ hence better for mod - severe ends of depression than SSRI. It has a good tolerability profile. Also specifically can be used for cognition. In practice in the presence of mixed features or severe depression often a single agent doesn't help. Here an agent might be prescribed but the mixed features or other factors ( sleep apnea) aren't addressed. The medication needs help - in this case the medication is still working but there are other factors preventing it from working. Maximising that gives a better outcome. In summary it is a good agent ; milder compared to TCA, but stronger than agomelatine & SSRI. Hope this helps
I use to be on vortioxetine for a while and it didn’t work for me. It made me feel anxious and depressed it was very poor although it was easy enough to stop, withdrawals weren’t evident. It makes me suspicious that all those other effects at 5ht receptors even play much role in depression. As an example mirtazapine also hits various 5ht receptors and this didn’t help my depression either. So I am dubious that blocking these 5ht receptors does what it’s cracked up to do
Fantastically informative video as always!, I am hoping to change from Sertraline (14 yrs 100mg!) to Vortioxetine, can you advise on the best way to transition between them?
I can't specifically advise but in general.
1. Sertraline half life approx 26-32 hrs - lets say 30 hrs •30*5 = 150 hrs 95% is washed out = around 7 days almost all of sertraline will be out. Margin of safety say 10 days.
2. Vortioxetine does not have significant SERT blockade ( 50% less than SSRI) so risk of serotonin syndrome with combination is low.
3. Withdrawal syndromes are most prominent when lower doses are reduced e.g 25 mg to 0 - but if vortioxetine is present it will reduce this ( due to mild SERT blockade)
Based on the above principles one can formulate a plan with their doctor. Switch should always be done under medical supervision. Wish you well.
Do a video on PSSD
Here you go 👉ruclips.net/video/345gEKz6kLQ/видео.html
I'm guessing that the GABA inhibition might explain in part why many patients (including me) find that Trintellix is a very effective antidepressant, but neutral or even bad as an anxioltic. Imagine the noradrenaline and dopamine effects are an additional boost for depression - but raising NE and glutamate don't sound to me like anxiety friendly MoAs. Nice overview!
Many have reported Trintellix being helpful for their anxiety. It’s always a wonder why certain antidepressants work for some for some things but for other quite the opposite. I’m going on week 2 at 10 mg and I was prescribed to me off label for anxiety. Hope I am one of the ones it helps
@@NorthCountry84I wouldn’t say many. Meta analysis shows Trintellix to be lower than pretty much all other psychotropic in effect size for anxiety, including buspirone which has largely not been used anymore due to better drugs for anxiety. That says a lot. Especially since the drug trials were done by the people making it, so they had a vested interest in getting it approved for anxiety but that didn’t work. It doesn’t mean it can’t help, and it may show reduction in severe anxiety, but most people unfortunately would probably benefit from something else for anxiety which sucks since Trintellix otherwise has a great side effect profile and less sexual dysfunction.
Exactly! hence why Ketamine infusions have had decent success and a large advancement towards treating depression since 2000. It suppresses excessive glutamate via NMDA antagonism and other downstream effects
I know it hasn't been approved for anxiety, and I can see why. Correct me if I am wrong, but if it inhibits Gaba, then anxiety would increase. Benzos work on the Gaba A receptor, giving you that sense of relief from anxiety.
It doesn't work for anxiety predominant conditions because it's action on the SERT is 50% lower than SSRIs. SSRIs reduce anxiety because of their action at the GABA receptor on 5HT2A receptor. Vortioxetine effect is much lower in increasing serotonin in the cleft to do this. Further vortioxetine is more activating - greater increase of NA, DA / which helps in treating the mod to severe forms of depression but can increase anxiety in some
Helped my anxiety which I use it for🤷🏽♂️
@@alexanderfernandez2863- Do you find that it help with increasing your Dopamine levels making you fell happier?
@@PsychiatrySimplifiedHi Doc, Thank you for clarifying this! I have severe anxiety & depression & I was considering taking this medication but I’m confused because I’ve come across some articles online that say that it helps with anxiety & you are saying that doesn’t help with anxiety.. but I would go with your information since you’ve explained it why!!
@@intermilan6202 i was prescribed vortioxetine a few days back , my anxiety is at an all time high and my resting heart rate goes above 130 most of the times, my heart rate has not crossed above 120 in the last 3 days of starting it... will have to give it time to know how it affects you.. go for it,, you miss all the shots you dont take.. best of luck
Sir i stop my 2mg trifluoperazine cold Turkey, luckily i don't feel any withdrawal yet, why is that?
Can i replace it from Amitriptyline for anti anxiety and sleep?
Question, I was taking Kratom for a while over a year and decided to try prozac so i wouldn't have to rely on Kratom. But after about a month, the effects of kratom completely disappeared, no matter the dosage. So im assuming the prozac was letting out too much of the receptor u mentioned above, causing a break. I've been off the prozac for over a year and the only time ive felt the effects of Kratom was when I was taking stimulant medication for a while. So how can I fix this if at all possible? Hope you can shoot me a reply. Thank you for the great vids btw!
Hi Dr Rege , currently on vortioxtine for anxiety it’s helping more than sert.. I had switched over from sertaline which did nothing at 200mg except for make me sick and give me jaw tension . Why is buspar not available in Australia ?
Buspar is available only under special access: it’s good that Vortioxetine is helping. There are several existing medications in Australia that can address Sx without need for Buspar. If sertraline did that - likely mixed state may be present (arousal plus or minus agitation). Consider ruling out mixed state with your doctor. See video on this on channel.
I could not walk down the street it was terrible with the sert the. They added lithium cause I was feeling very low. They have ruled out mixed states I have health anxiety which is muscle tension in neck and shoulder and i can’t relax ? Will you help if I were to contact your office and organise a referral.
This is information that is extremely difficult to find elsewhere, fantastic video thank you.
Given that it inhibits GABA, is this contraindicated for people with GAD type neuroses with resultant depression?
Not contraindicated but not as effective for GAD predominant. It can be effective if depression plus secondary anxiety. Anxiety can be treated by addressing the amygdala end of the equation - SSRIs , BZDs , Pregabalin etc OR by enhancing PFC inhibition of amygdala ‘firing’ e.g Agomelatine , SNRIs
@@PsychiatrySimplified thanks, I am trying to develop a strategy for treatment of GAD without the SSRI sexual dysfunction and blunting issues.
I cover the algorithm and evidence based treatments - psychscenehub.com/psychinsights/generalised-anxiety-disorder-diagnosis-and-management-2/
Hi Doctor, u delivered a very good explanation about the drug. I have few doubts regarding the pharmacological use,
* Can this be used to treat ADHD ?
* Does it stimulate the brain ?
* Whats the best time to take medicine - Morning or Night ?
Thanks in advance sir.
1. It can improve cognition so in mild cases benefits may be seen
2. Stimulate is a vague word ? So not sure what that means. It has activating effects if that’s what you mean
3. Usually 30 mins after food in the evening to prevent nausea but not too late at night as can affect sleep / some individuals prefer taking it in the morning.
What are your doubts or questions ?
Can the histamine in vortioxetine cause migraines?
Could you go into why reducing REM sleep is good for sleep? From what i understand REM sleep is necessary for memory reconsolidation, brain development and emotional processing. As always love your content!
I’ll be doing a video on SSRI and REM sleep rebound . But essentially some reduction / suppression is good ( via Serotonergic inhibition of amygdala noradrenergic neurons ) - but too much is not good. REM is essential in synaptic plasticity. So in PtSD where NA activity is significant - it may help but in normal REM sleep this may not be helpful. Hope this helps
I guess deep is important for memory and meaning of REM sleep is not well known. But my knowledge might be outdated since havent read this stuff for quite some time. Vortioxetine sounds so good that even healthy people might want to take it and elder people without depression, just for cognitive benefits and better sleep, which are probably connected to each other.
@@bogse here is a the article on neuropsychiatry of sleep. REM sleep is needed for establishing synaptic plasticity and for ensuring adequate emotional tone the following day. It is also responsible for creativity. Non rem sleep is essential for glymphatic system to work - the system removes the toxins r.g amyloid and is 85% active in N3 phase of deep sleep. psychscenehub.com/psychinsights/neurobiology-sleep/
en.wikipedia.org/wiki/Vortioxetine
5-HT3 antagonism appears to have a better effect on REM sleep compared to SSRI's. However what concerns me is that SSRIs and 5-HT1A receptor agonists often produce nausea as a side effect, whereas 5-HT3 receptor antagonists like ondansetron are antiemetics and have been found to be effective in treating SSRI-induced nausea. It was thought that the 5-HT3 receptor antagonism of vortioxetine would reduce the incidence of nausea relative to SSRIs. However, clinical trials found significant and dose-dependent rates of nausea with vortioxetine that appeared to be comparable to those found with the SNRI duloxetine 😒
Thanks Dr.Rege for putting your efforts for these educational video. For 18yr old, prozac was working for 2 yrs but not anymore.(Lexapro was tried for 2 weeks when started med but stopped becoz of agitation) Cant increase Prozac as per Genesight report. Dr suggesting to start on SNRI - effexor. But worried if its right move as learned this med is hard with withdrawal symptoms. How we can compare effexor with wellbutrin? Will wellbutrin would be options? Feeling of down mood and emptiness are the main symptoms. Appreciate your time and understand your inputs are only suggestions. Thank you
I have some headache .Is it a side effevt and will it go away?
I had remission due to combo of cymbalta and mitrazapine for four years + successful CBT. In the last 2 months i relapsed despite my circumstances getting better. My dr said it is medication tolerance. Does that happen in practice? He perscribed brintillex 10mg and told me it will give a boost. Also i get worse on dopamine reuptake or high doses of remeron and cymbalta due to their norepinoherine. I get worse on cafeiine and stimulants. Does vortexitine cause such stimulating effects?
Sorry to hear. While I can’t comment specifically for you : vortioxetine is less activating that duloxetine at higher doses. In general loss of medication effect or activation can indicate an underlying arousal state - poor sleep, racing thoughts, irritability etc - mixed features should be ruled out as if arousal is present treating that helps improve the overall picture. Ps not medical advice. Please see video on mixed features and melancholic depression. Ultimately it depends on the clinical symptoms for which the meds are prescribed. Wish you well
@@PsychiatrySimplified thanks for the reply sir. I live abroad and in 6 september will see my home town psych. I didn't have a hypomania and mania before but when doctor raised my cymbalta to 90mg and remeron to 45mg, my depression went worse. Very suicidal and depressed as hell, melancholic, anxiety to roof. Same thing happened when tried MAOI. Now after 4 years remission on CBT + remeron 30mg + cymbalta 60mg, They added for me trintillix, after week on 5mg, melamcholic depression went away, i became just anxious and mild moderate depression, once i upped it for 10mg in the last 3 days, I am depressed again severely, suicidal thoughts, anxiety, cant eat or do any small activity like eat. I returned back now to 5mg..do you think patients who get worse on high avtivating antidepressants may have hidden bipolarity?
Do you have any information about Bupropion? It's been withdrawn in the UK and Europe pending investigation for nitrosamine deposits. But it's not been withdrawn in the USA. I can't find out anything from GSK. Thanks.
Information as in summary? Here. Still available in Australia & US as of now psychscenehub.com/psychinsights/bupropion-mechanism-of-action-psychopharmacology-clinical-application/
@@PsychiatrySimplified Thank you, that's a good summary. What I can't find out is how long the investigation into *nitrosamine impurities* (either from manufacture or storage) is going to take. Very importantly, why Bupropion is still available in the US and Australia. How is that possible if a drug is suspected of carcinogenic properties in another territory? Either it is or it isn't. GSK just send out cut & paste responses. Any ideas how I can find out something? It's the only antidepressant I can tolerate. Literally tried everything else. Really struggling without it. Thanks.
I have been prescribed this nedici e for moderate mixed general anxiety diaorder and postpartum depeession.Is it auitable ,because i want to take care for my baby.Is it ok for regulating sleep?I already took two pills from 5 mg and to knock on wood ,i dont have side effects.
Please discuss this with your doctor. In the context of postpartum depression it would be inappropriate for me to provide any comments - your doctor would have individualised your treatment and any side effects should be discussed with your doctor. Wish you and your family well.
is vortioxetine good for patients with multiple sclerosis? GREAT VIDEO!!
Depends on what is being targeted. If it’s depression, cognition then yes it can help.
@@PsychiatrySimplified that's exactly what i would use it for...just went out and bought it at 10mg. thank you
Please seek medical advice and consider supervision. Especially as side effects of nausea can occur . Usually this is prevented by starting at a low dose of 5 mg half hr after food in early evening and then increasing the dose. If persists there are other options. Ps not medical advice Wish you well .
It did nothing for me but there was severe withdrawal symptoms after tapering off. I switched my doc. & he prescribed paroxetine cr . It brought wonders but unable to taper it off due to withdrawal issues .
Was this predominantly for anxiety?
@@PsychiatrySimplified my problem was mainly related to anxiety and a bit of ocd symptoms. Vortioxetine didn't worked but paroxetine worked quite well on 25 mg cr dose. The only problem is that when I try to taper it my anxiety returns and I am forced to go back to my usual dose . Don't know how to tackle it .
As you know that, I am suffering from schizoaffective disorder, OCD.
I have used all SSRI's, but nothing tolerable/ ineffective.
Will vortioxetine be a good medicine for OCD without exacerbating psychosis/ schizophrenia?
I’ve also got OCD and have been on vortioxetine in the past. It didn’t benefit me and there was no benefit for anything. Maybe that’s why it doesn’t seem to be used as often as many other antidepressants. Of course, my experience is also that OCD is very difficult to treat and SSRI’s don’t offer much benefit either, it’s a tricky condition to treat
@@cultfiction3865 Have your tried fluvoxamine (Luvox) for OCD?
I am a student and my psychiatrist prescribed me vortioxetine for irritation and mood swings. Initially, I experienced high concentration in studies. But after one month of 5mg dosage my concentration level seems to diminish. Why is it so? What should i do?
Please discuss this with your doctor however the dose is low. Usually doses range between 10-20 mg. Wish you well.
Great video, but what are your sources for the information that these raises serotonin, and dopamine levels?
All references here 👉psychscenehub.com/psychinsights/vortioxetine-mechanism-of-action-2/
@@PsychiatrySimplified so 8 week trials. Are there any long term trials of a year or more with follow-ups?
@@SuperCody888 www.tandfonline.com/doi/full/10.1080/03007995.2023.2178082#:~:text=In%20the%20long%2Dterm%2C%20maintenance,61%25%20at%20one%20year20
@@SuperCody888 pubmed.ncbi.nlm.nih.gov/28693903/
Excellent video
Thank you
On the other hand. The music is too loud
Thanks for the feedback 🙏🏼
Thank you for your video. I have very important question about this medication. I was diagnosed with hypothyroidism and hashimoto's in July 2024.
I have taken Trintellix since 2024 June. My thyroid blood tests have been not that great so far. My tsh is high and T3 barely works at all, so it is low. My current thyroid medication teva levothyroxine is 100microg.
Is it possible that Trintellix is affecting my thyroid function and absorption of levothyroxine or it shouldn't usually affect at all?
Very unlikely. Best to discuss this with the endocrinologist / doctor though. Were the thyroid tests significantly better pre trintellix ?
Thanks for quick respond.
My tsh was in June 2022 around 2,4(0,5-4) and after a year when diagnosed 7,04. Latest test showed 4,1. The next renewed depression was last November. Levothyroxine dose lift helped. Mild latent depression still rears its head from time to time. Can you tell how Lamictal affects thyroid function? It is considered as the next option.
Lamotrigine had no significant effect on thyroid hormone levels. The TSH may be independent of medications. But your doctors are in the best position to opine.
Good video. Isn't gaba inhibition bad for anxiety? 😮
It can be if there is underlying significant activation already - GABA inhibition is needed to increase dopamine for example - this is why some antidepressants activate. It all depends on baseline tone
Hi Doctor
Thanks very much for your informative video. I have just started yesterday going from 5mg to 10mg on my doctor 's advice..
Anxiety is my main problem. Is there any chance that vortiioxetine could increase the anxiety as if l am thinking more clearly l could be thinking more anxiously.
Have tried Lexapro but made me demotivated and hungry.
Doctor l live in Ireland and l wonder is this the best medication for me at the moment. I suppose I have to give it a chance. Any encouragement from you if you had a chance l would reallty appreciate.
Should a higher dose improve my sleep. Does sleep improve with the higher dose.
Thanks so much for your assistance and any advice.
Vortioxetine reduces REM sleep and promotes NREM sleep which is a good thing. If sleep or anxiety worsens it’s important to let the doctor know as usually it means a mixed state should be ruled out - e.g vivid dreams , nightmares, racing thoughts etc. Vortioxetine is an effective antidepressant. We have a done a video on mixed state.
Hi, I came by to watch a video to better understand this medication. Like you, I was on Lexapro and HATED it, I fell into a horrible depression, all I wanted to do was eat and sleep. I gained weight which I hate, because I have worked so hard on losing weight to gain it back so easily. I was told to start Trintellix but after my experience with Lexapro I am so scared! How have you been feeling with this medication and how is your sleep?
@@PsychiatrySimplified thanks so much Doctor for your useful and considered opinion. I really appreciate it. 🌻🌻
@@mimiii444 Hi Mimi oh l know that feeling oh so well of being nervous over a new medication. I would say try Trintellix. Give it a chance. First impressions for me are somewhat positive as l feel a bit less anxiety. Start slow on 5mg and then like me now go up to 10mg. That is the therapeutic dose l have been told by my doctor. My sleep is a bit better and am less anxious on waking compared to last week say. Am quietly hoping and praying for the best with this medication. Hoping for no weight gain as l am just like you Mimi and want to keep weight off. Keep me posted if you like. Sending 🌻🌻
Much better role: Histone deacetylase inhibitors, butyrate and propionate and spermidine.
All the serotonin in the world doesn't mean jack when the neurons express too little BDNF to facilitate growth of mitochondria and to power adenylyl cyclase for cAMP to open calcium channels.
The ion channels do the thinking, the information propagation in the brain.
Once these fail, you integrate less information, and fear ensures as your reward estimations fall.
Thanks for your comment. Vortioxetine increases BDNF - also, most antidepressants bind to the TRKB receptor with the downstream effect of increasing BDNF. This agent actually does not act via increasing serotonin predominantly. BDNF is one aspect - there are multiple other aspects that play a part. also 5HT receptors are part of the G protein receptor superfamily that allows the receptor to modulate the activity of different effector systems, such as ion channels, phospholipase C and adenylyl cyclase. 5HT3 is a ligand-gated channel. .
Does it help with the PSSD problem?
It can treat SSRI indices sexual dysfunction but PSSD there is no significant evidence. Bupropion has benefits mentioned in PSSD
is there any interaction between Votioxetine & L-theanine?
While we can't provide specific advice - “Our study suggests that chronic (8-week) l-theanine administration is safe and has multiple beneficial effects on depressive symptoms, anxiety, sleep disturbance and cognitive impairments in patients with MDD. However, since this is an open-label study, placebo-controlled studies are required to consolidate the effects.” it is, however, best to ask the prescriber and pharmacist as they will individualise the advice. Ps not advice
is it best to take at night or morning? will be starting next week
Half hr after food usually early evening ( not too close to bed time) to avoid nausea but this can vary . . It should not affect sleep.
Dr sahb maine escitalopram oxalate 10 mg khayi thi 14 days tak fir sideeffect dekhke fauran withdraw kardi uske baad se kabhi nhin khayi.
Jab maine dawa khayi 18 years ka tha
Abhi 9 months ho gyh aur penile numbness feel hoti hai aur low libido and inability to reach orgasm kya yeh puri taranh recover ho jaaega apney aap?
Dr., would this med be helpful for ADHD?
There is some evidence of vortioxetine being beneficial in improving cognition. However in the context of ADHD - evidence based treatments are recommended. There is a proof of concept study and there is a trial ongoing to evaluate this. We have just released a video on other agents that may be beneficial if stimulants are not indicated. Clonidine and guanfacine - ruclips.net/video/IwRJugnSHSc/видео.html
Sir how to get rid of side effects. I'm having nausea, and stomach issues at 10mg dose. It's almost 6 weeks but side effects not improving. Somedays no side effects somedays too much.
In general - half hr after food in the evening ( not too late ) several hrs before bed time . 2. If not resolving short term ondansetron 4-8 mg for two weeks . 3. Antihistamine short term for two weeks also can help. Ps not medical advice
@@PsychiatrySimplified thanks a lot sir. Sir I'm having too much side effects.... ( Nausea, stomach issues, urinary issues and fever from last 4, 5 days, Can't sleep at night even after taking lithium 400mg and Clonazepam 1.5mg at night and Seroquel xr 50 in the morning with trintellix. But my psychiatrist wants me to continue it. I meet him 2 days ago and again gonna see him next week.
Yes please follow the psychiatrist advice and carry out lithium level. But this could also be unrelated to medication - perhaps a viral infection etc - but it’s important to discuss with your doctor which you have done. Ps not advice
It is mentioned online that it causes internal bleeding. Is it true ?
Vortioxetine has a lower risk. SSRIs and SNRIs reduce platelet aggregation and hence can be associated with this risk which is more common in the elderly and if on anticoagulants etc . Vortioxetine has a lower SERT affinity so theoretically a lower risk. But as in all cases if risk factors present it’s helpful to monitor
Why not just put a stimulant in than use vortioxetine? they wash out by night time if not dosed too high. Is there harm in using stimulant vs things with serotonin action if there is depression with cognitive issues?
Respected Professor,
Can vortioxetine treat sensory OCD without exacerbating Schizophrenia/Psychosis? Please reply I shall be very grateful to you
It is not indicated for depression. It does not have significant evidence for OCD but may be able to address it if part of a depressive syndrome . If antipsychotic is present for psychosis then it is unlikely to worsen the psychosis
Thank you sir❤
How effective is it for ANXIETY?
It isnt as effective for anxiety on its own ; there is evidence for depression with anxiety. It's mechanism moves away from SSRI - hence does not have the amygdala suppressing action as an SSRI - therefore not equivalent benefits in anxiety - but this same property reduces emotional blunting which vortioxetine does not do ( or reduced risk) . Vortioxetine is more activating as a mechanism
@@PsychiatrySimplified Still, it has some SERT and 5HT1A activity, so should offer some relief. Right?
@@Slazerable yes it should and in some it can. At lower doses 5-10 mg. Not medical advice
Can you explain how increasing histamine is a good thing?
Histamine promotes wakefulness . Histamine does not only modulate the immune response and inflammation, but also acts as a neurotransmitter in the mammalian brain. The histaminergic system plays a significant role in the maintenance of wakefulness, appetite regulation, cognition and arousal.
@@PsychiatrySimplified Thanks! So if we're not encountering an antigen/allergen, but the response is activated, how does that affect the immune system?
The immune system is involved in response to any ‘stress’ pain, infection, allergen, physical injury , psychological stress ( including positive stress )
Can it help with neuropathic pain?
It has evidence for it 👉pubmed.ncbi.nlm.nih.gov/34497709/
this is now Trintellix? looks like it has had many other names
All the reuptake inhibitor antidepressants have about the same efficacy rate including this one. There are minute differences, but really insignificant. Their mechanisms are too similar and have shown limited benefit over another. So pick from the hat and then keep picking.
This is a medication that does not mediate its action through reuptake inhibition. The SERT inhibition is up to 50% less than SSRIs - it’s action is mediated by many other neurotransmitters - and that’s seen in clinical practice in terms of addresing melancholic depression , cognition etc.
It definitely causes sexual dysfunction, especially at higher doses.
Thanks for sharing. Yes I can see that can be a possibility
how can i switch from desvenlafaxine to vortioxetine.. taking desven for 11 yrs
There is no single formula. This is best done under medical supervision and advice. It's not necessarily challenging. Generally it is a cross taper. Stopping desvenlafaxine too quickly can result in significant withdrawals for some
@@PsychiatrySimplified i'm under medical supervision.. but my doctor is too optimistic and i'm the one who suffer...
Sorry to hear. Best to follow advice and inform if any side effects . Wish you well
@@PsychiatrySimplified thanks...i'm a walking side effect..
Can it be combined with an SSRI
Recommendations are not to due to risk of serotonin syndrome. There is a study of Vortioxetine add on to SSRI - Vortioxetine has 50% lower SERT affinity which means there is a reduced risk but such combinations should be done under expert care
Does vortioxetine cause weight gain or weight loss?
It doesn't have a significant effect either way - though does not mean either can't happen.
Can anyone explain why GABA-inhibition is good? isnt GABA all the good stuff that we want making us feel calm, safe etc. So inhibiting GABA would do the opposite and sound terrible??
GABA is an inhibitory neurotransmitter and widely present on other neurons ( serotonin, dopamine , noradrenaline) . While gaba is good in terms of arousal reduction an optimal balance occurs with adequate excitation and inhibition. So e.g NA & DA release is under a GABA control - if this was inhibited too much that results in cogntive and motor slowing. GABA inhibition at 5HT3 improves neurotransmitters in the PFC improving cognition . Hope this helps
Ok thanks, so PFC is prefrontal cortex I assume. I was just wondering that if Vortioxetine enhances sleep but at the same time inhibits GABA it sounds, weird, since I associate GABA for relaxation and sleep but I guess this is not so simple.@@PsychiatrySimplified
I took Vortioxetine 5mg and it gives me severe digestive problem that lasted for 3 months even after the medication, and extreme fatigue, but I guess everyone is different
GI issues is the main side effect. Usually low doses can do that but activating effects come in at higher doses. To combat nausea - administer in evening, after food. For some the first two weeks or so may need anti nausea agent or antacid cover. If still an issue probably not the best tolerability profile for you. Ps not advice
Please korean sub🙏🙏🙏🙏🙏
Does it treat anxiety? GAD?
Limited efficacy for anxiety.
I'm diagnosed with ADHD recently , I'm single / 30 yrs old male. Sir can I use this medicine along with Bupropion and Modafinil together at same time in morning ?
Will there be any drug interaction or harmful side effects when combined all together?
Thanks in advance sir.
Best done under supervision . Activation is the main side effect so one should monitor closely
WHO CAN AFFORD THIS ?
In AUS - 60 AUD / Month
Vortioxetine is no ED side effect is it true?
Lower incidence
Before I'm taking sertraline it's good for my panic disorder but I notice it's ruins to my sexlife it's so hard get orgasm, So I'm went back to my Pysch tell about that, he gave me a prescription Brintellix , every I take I feel Nausea that is normal it will gone?
Nausea is a very common side effect - it should reduce in 2 weeks . Taking it in the evening half hr after food usually keeps nausea away. This however varies.
Sir my dumb psychiatrist suggest me to stop my meds cold Turkey, and yet you still suggest me to talk to my psychiatrist
Sorry but it's important that one discusses the issues with the prescriber or get a second opinion from another provider. Any advice here can be detrimental and not appropriate for the individual. It is general in nature
@@PsychiatrySimplified sir my psychiatrist turned out to have misdiagnosed me this whole time, and i have already taken this stelazine due to misdiagnosis , ending up i have tardive dystonia and tardive dyskinesia because of misdiagnosis. They misdiagnosed me with schizophrenia paranoid, my actual illness is social phobia
Isn't it crazy?
Brings on the worst headaches ever, feels like being hit by a bus. Not for me.
Thanks for sharing.
One of the greatest harms caused to humanity by the international drug mafia is Brintellix, which contains the active ingredient vortioxetine. Advertising Brintellix is also a despicable act
Why?
why?
@@jocs8824 It disrupts the brain's 6 receptors and cuts people off from life.
Why? Please explain! It's important!
@@langueundlife3667 Antidepressants disrupt two receptors in the brain. Brintellix causes insomnia by disrupting 6 receptors in the brain. And it causes many diseases.
It does nothing for anxiety and to be honest is pretty useless.
It’s not useless. It is a very effective medication when used for the right targets. It doesn’t have much evidence for anxiety
@@PsychiatrySimplified Can give you Glaucoma
You mean it does nothing for YOU.
I’ve always felt like all this medication does is give me insomnia
@@latisha334 rule out mixed states. See the video. The medication should be matched to patient symptom profile.