Brintellix/Vorioxetine

[LisaS]

Hey all,

After a few false starts on some meds and many years later, I've now been prescribed Vorioxetine. I'd love to hear if others had tried this and successes they have had. Please don't tell me horror stories! I usually have so many side effects so I started on 2.5mg 4 days ago. I plan to stay on this for 10-14 days and increase to 5mg. My side effect so far has been hideous nausea that lasts around 2 hrs after I take it. I've also been more anxious but I'm putting this down to my anxiety about taking meds and what may or may not happen.

Thanks all,

Lx

[panic_down_under]

My side effect so far has been hideous nausea that lasts around 2 hrs after I take it. I've also been more anxious but I'm putting this down to my anxiety about taking meds and what may or may not happen.

I suspect the nausea is being mostly driven by the anxiety, not the med, Lisa. Vortioxtine is absorbed only slowly with plasma levels taking 7-12 hours to peak. Ginger and/or vitamin B6 supplements often help.


(after recommending ginger for over 2 decades I recently had need of it myself to forestall seasickness and it worked great - I also discovered that it can trigger flushing for some minutes, not sure if it is a general side-effect, it isn't listed as one, or specific to the preparation I took, but something to be aware of)

[LisaS]

Thanks PDU.

I am pretty confident the nausea is the med - it appears around 30mins after I take it and last around 2 hours - to the point I'm feel ready to vomit. I know I have a variety of anxiety symptoms but nausea has never been on of them. It is also the no.1 side effect.

Just out of interest, my psych always uses these factsheets from the department of health when prescribing meds... https://www.choiceandmedication.org/wadoh/printable-leaflets/ and also the 'Handy Charts' when looking for suitable meds https://www.choiceandmedication.org/wadoh/printable-leaflets/handy-charts/

[LisaS]

Ugh. So this morning I have vomited. I forgot how horrible it is to vomit.

Do I keep going!? - I really am no good with meds ....

[panic_down_under]

Try taking something for the nausea 30-60 minutes before the AD to see whether that helps.

[LisaS]

Try taking something for the nausea 30-60 minutes before the AD to see whether that helps.

I took a kwells prior to the tablet and that really helped.

[panic_down_under]

I took a kwells prior to the tablet and that really helped.

Great! :) Just be extra careful if they makes you drowsy.

[LisaS]

Great! :) Just be extra careful if they makes you drowsy.

Yes! They make me so drowsy... I feel so lethargic!
Any other ideas!?

[panic_down_under]

Yes! They make me so drowsy... I feel so lethargic!
Any other ideas!?

Try ginger.

[LisaS]

Try ginger.

I took so much ginger it’s now making me feel nauseous just looking at it!! Haha! The nausea is better but it’s still there.
I did 2 weeks on 2.5mg and was feeling really good. Infact my psychiatrist said I should stay on 2.5, it was me that suggested the 5mg as I was keen to be therapeutic. She went on to draw me a bell curve and said you can’t cluster everyone in the same boat and 2.5 may work for you then 20mg may suit another.
So been on 5mg now and anxiety is peaking again.... Uni starts on Monday so this is partly due to this but pissed off im feeling such high anxiety again after 2 weeks of normality...

I can almost hear Pulisa saying I’m trying too hard....

[pulisa]

I promise I won't!:D

I think it sounds very promising that you have had a response from the brintellix and who knows whether the dose increase has caused more anxiety or whether it's anticipatory anxiety due to uni commitments or whether it would have happened anyway? Therapeutic doses are only therapeutic if they work for the individual..

Don't be pissed off by this because you've had 2 really good weeks and that's success! If you really feel that the 5mg is making you more anxious then you could go back to 2.5 and see if this makes a difference? It may do psychologically because you felt good on this dose previously? Even if it's the placebo effect it doesn't matter-what matters is your quality of life.

[LisaS]

I promise I won't!:D

Don't be pissed off by this because you've had 2 really good weeks and that's success! If you really feel that the 5mg is making you more anxious then you could go back to 2.5 and see if this makes a difference? It may do psychologically because you felt good on this dose previously? Even if it's the placebo effect it doesn't matter-what matters is your quality of life.

If I could hug you right now, I would 😃

[panic_down_under]

I took so much ginger it’s now making me feel nauseous just looking at it!! Haha! The nausea is better but it’s still there.

Try adding a vitamin B6 supplement. B6 is often prescribed for morning sickness.


I did 2 weeks on 2.5mg and was feeling really good. Infact my psychiatrist said I should stay on 2.5, it was me that suggested the 5mg as I was keen to be therapeutic. She went on to draw me a bell curve and said you can’t cluster everyone in the same boat and 2.5 may work for you then 20mg may suit another.

Although vorioxetine seems to boost hippocampal neurogenesis faster than some other ADs by accelerating maturation of existing immature cells, 2 weeks is unlikely to be long enough for the med to fully kick-in by that mechanism so the fact you were feeling good that quickly probably wasn't because of the med and likely says nothing about the effectiveness of that dose in the longer term.

That said, it is a fairly potent serotonin 5-HT3 receptor antagonist (blocker) and potent 5-HT3 antagonists such as ondansetron (Zofran) seem to have anti anxiety affects independent of hippocampal neurogenesis. At least that seemed to be the case based on early ondansetron drug trials. Unfortunately, the drug company decided to concentrate on selling it as an anti nausea med and there was little further research on this to tease out how it worked.


So been on 5mg now and anxiety is peaking again.... Uni starts on Monday so this is partly due to this but pissed off im feeling such high anxiety again after 2 weeks of normality...

Nevertheless I'd continue with the 5mg dose. The recommended vorioxetine starting and maintenance dose is 10mg, dropping back to 5mg post kick-in if it is working really well (or 20mg if it isn't), but doses below 5mg are not recommended. See, for example, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) vorioxetine data sheet (https://www.medicines.org.uk/emc/product/7121/smpc).

The rule of thumb is that about 80% of the serotonin transporter molecules need to be occupied (blocked) by an AD to sustain the antidepressant response, however, there is evidence that vorioxetine can be effective at as little as 50% and it takes around 5mg to achieve that (see the TGA data sheet (PDF (https://www.tga.gov.au/sites/default/files/auspar-vortioxetine-hydrobromide-140708-pi.pdf))).

With a little luck the anxiety spike will be shorter lived than it was at the beginning.

[pulisa]

Hope that Monday went as smoothly as possible at uni and that things are manageable for you, Lisa.

[LisaS]

Hope that Monday went as smoothly as possible at uni and that things are manageable for you, Lisa.

Bless you for remembering xx

It went well 😮 - I said to my husband that it was weird I wasn’t feeling more anxious - I was looking for it but I just had “normal” nerves.
Not sure what’s going on! I’ve been allowing all my physical symptoms on advice from Paul David and anxietyjoe and also went down to 2.5mg again. It’s either working or I’m getting out of my blips quicker.

Long may it continue. 🙏

[pulisa]

That's great news and what does it matter as to what actually is working....You're feeling better and more "normal" and if you can function better like this then carry on doing what you are doing. Maybe less is more for you re dosage? It certainly was for me. Personally I think that your thoughts and mindset are having a positive effect on how you are managing your anxiety and maybe the meds are not so significant anymore but it's early days and just see how you go..

Really pleased that life seems a little easier for you xx

[LisaS]

That's great news and what does it matter as to what actually is working....You're feeling better and more "normal" and if you can function better like this then carry on doing what you are doing. Maybe less is more for you re dosage? It certainly was for me. Personally I think that your thoughts and mindset are having a positive effect on how you are managing your anxiety and maybe the meds are not so significant anymore but it's early days and just see how you go..

Really pleased that life seems a little easier for you xx

Hmm... I've tried to hold off posting for a while to see if my blip will pass... it's been about 10 days of increase in anxiety - I'm managing and doing what I'm supposed to be doing but I feel like I'm just existing at the moment... I'm struggling to get to sleep and waking early...I do really think I need a good nights sleep and I think I'm just fed up of feeling like this whilst I've been doing all the right things. I feel like I deserve a break!
Still feeling nauseous so I'm taking Maxalon as well - just started 5mg...

Week 3 of uni and feeling pretty overwhelmed with the amount of work I have to do which is all very well but having 2 young kids can easily throw things off track pretty quick..

Anyway - sorry it's not better news but just hoping someone can give some words of wisdom and hope xx

[panic_down_under]

Still feeling nauseous so I'm taking Maxalon as well - just started 5mg...

Has this just been prescribed for you, Lisa? If so, does the doctor know you're on vorioxetine? The reason I'm asking is metoclopramide is a fairly potent serotonergic drug which could trigger serotonin syndrome when taken with a SSRI. If you're still on only 2.5mg vorioxetine the risk is likely small, but I'd be wary about increasing the dose of either without first discussing it thoroughly with your pharmacist.


I'm struggling to get to sleep and waking early...I do really think I need a good nights sleep

Then the antihistamine hydroxyzine (Vistaril) might be a better bet than metoclopramide as it may help with both insomnia and nausea. It is pretty good anxiolytic too.

[LisaS]

Hi PDU

My psych prescribed the maxalon but didn't mention anything about having a serotogenic effect? Is Vistaril something I can get OTC here in Aus? I'm not seeing my pscyh for another month so will phenergan do in the meantime to help with sleeping!?

Thanks,
Lisa

[panic_down_under]

My psych prescribed the maxalon but didn't mention anything about having a serotogenic effect?

I've done some more research and while there are several case reports of metoclopramide triggering SS and many warnings about it, the receptor data doesn't support the claims made. I've also finally managed to find a report (https://journals.lww.com/aacr/FullText/2016/07010/Patient_Safety_and_Methylene_Blue_Associated.1.asp x) by a couple of researchers who does know a great deal about SS and they seem to believe it isn't an issue, so I stand corrected. Unfortunately, most of the SS information decimated by the WHO, FDA, TGA, etc, and medical journals is wrong and finding the correct info can be difficult. Sorry for misleading you. :sad:


Is Vistaril something I can get OTC here in Aus? I'm not seeing my pscyh for another month so will phenergan do in the meantime to help with sleeping!?

No, hydroxyzine is a prescription med, though it seems to be missing from the PBS data base. Phenergan will likely do the trick, though I suggest you try it first on Friday evening to see how sedating it is just in case you have trouble getting up in the morning.

[Manxiety]

Hi Lisa,

I am really interested to hear how you get on with Vortioxetine. I have read some really good things when used for depression but results for panic are somewhat behind depression - as is always the case!
I want to go onto this med but having some difficulty. I am currently (and have been for several ears) taking Clomipramine which is incredibly good for panic but not great at all with regards to side effects..... My GP is reluctant to switch me as apparently in the UK it is only considered when two previous meds have not been successful and he says Clomipramine has been..... interestingly the side effects don't interest my GP!

Good luck and let us know how you get on with it :-)

[panic_down_under]

I am currently (and have been for several ears) taking Clomipramine which is incredibly good for panic but not great at all with regards to side effects.

Which side-effects are making life difficult for you?