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Vortioxetine (Trintellix, Brintellix) Posts

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5 hours ago, gandolfication said:

Ug.  But congratulations on dodging the harassment bullet....seems to be going around a lot these days with men in positions of power.  I've never seen the appeal.

Hope you find a new doctor soon.

Thank you. I’m patiently optimistic. 

I did dodge the bullet but he tried. From the stories I read, he tried the same tactics with me but I shut down right away. I barely spoke to him or even looked at him from then on and only continued to see him for my refills.  

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14 minutes ago, Ceebee said:

Many years ago, I tried to harm myself. I was on Paxil at the time and was trying to quit. I wasn’t aware that I was having severe withdrawals so you can imagine my mental state. Anyways, I ended up in the hospital and they changed my medication on me to Wellbutrin without asking. I was manic. I wanted to crawl out of my skin. I think that memory alone has turned me off of taking it. I doubt I’ve given it a fair chance.  

Since the trintellix didn’t work for me,  my doctor gave me a script for Cymbalta. I’m so tired of trying new stuff. I had a full script of Wellbutrin in the house that I hadn’t taken so I decided to give it another go to stabilize me instead of the Cymbalta. It’s been a couple of days and I’ve only experienced a slight increase in anxiety. I get tired a few hours after taking it and just want to sleep.  I have absolutely no appetite and I could stand to lose a few lbs so that’s ok haha  

As for the Vyvanse, I didn’t really experience any side effects from it. Or maybe I just didn’t notice any. I was only on 40mg. I didn’t really have trouble sleeping at night because I was on the go all day and able to do things that by the end of the day, I was exhausted.  

Vyvanse sounds like exactly what I need to get out of this stall I'm in.

I feel you on the merry-go-round of "Try this, try that, try the kitchen sink!" On one of my last pdoc visits, she actually told me to experiment on my own with combinations and doses of the prescriptions. It's obvious she's at a loss for what to prescribe me anymore, so she's phoning it in and telling me to do whatever the hell I want. Problem is, being my own doctor has never worked out in the past, lol. 

Your last pdoc was a sick b*stard. Don't worry, though...the boys in lockup know what he's there for, and he's getting it ten times worse than he ever gave it.

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Vyvanse has pretty much changed my whole baseline. I've been taking Focalin now for the past few weeks to see if methylphenidate products would be worth a try but now that I'm taking Depakote I don't find that Focalin does a good job of powering through the sedation I'm feeling. Decided to take Vyvanse today and remembered why I liked it so much. I'll be asking my pdoc to go back to it at my next appt.

@carter_burn1 I can definitely speak to what you're feeling. Part of the whole reason I feel depressed is that I can't actually get ENGAGED in any meaningful tasks and I'm easily distracted by negative thoughts that I just stew over. Everything seems like such an effort that I can't muster up. I have no interest in anything. But with Vyvanse I have task reward on my side. Feeling good about completing tasks is a critical part of feeling better and I'm just not able to do that without Vyvanse. Things just seem like less of a chore all the time. My thoughts are also more collected. With Focalin I can sometimes get really hyper-focused to the point of not even realizing that someone is talking to me. Vyvanse makes me more socially active as well. I also firmly believe Vyvanse enhances my antidepressant response.

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@browri

That's exactly what I'm looking for. Sometimes I can't even force myself out of bed to mow the lawn or wash clothes, stuff that doesn't even take an hour. It just seems like it would take too much effort. And then I get more depressed because my depression is preventing me from getting my sh*t done. Simple tasks make me feel tired to the point of being unwell. A seven hour shift doing menial bullsh*t at work makes me feel like I ran a marathon and then had a five round fight. It would be funny if it weren't so damn exhausting. So taking a pill that would give me the energy, drive, and focus to do what I need to do sounds like a fantasy...the same way I felt about antidepressants when I first started trying them out. I had so much hope and optimism that things were finally going to change...then letdown after letdown, to the point where I don't even want to try another AD, because one of these days the letdown is gonna be too much and they're gonna find me swinging from the rafters. But maybe I've just been trying to medicate the symptom and not the problem...maybe the problem is this lack of energy and drive. Either way, it's worth a shot, and I will be pestering my pdoc to give it to me, lol. Thanks for sharing your experience!

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@carter_burn1

Keep in mind though that the feeling of motivation that you get when you start taking Vyvanse does go away as you adjust to taking it daily. Your definition of motivation changes when you take stimulants.....as well as your definition of tired lol. When I don't take Vyvanse, if I'm not motivated to do something, I just don't do it and then I stew in myself because I'm not doing anything meaningful with my day. When I take Vyvanse and I'm not motivated, most of the time I can bring myself to do it anyway. But trust me, there does come a point after taking the same dose for a while when that "pizazz" dulls a little bit.

Also be careful with pressing your pdoc too much for stimulants. That can be seen as drug-seeking behavior and could end up becoming a note in your record.

It's somewhat inevitable as well for people with bipolar disorder even if they are well-controlled to experience some hypomania when first starting Vyvanse. Make sure that you take it easy on the dose. For me, I find that 30mg is not quite enough and 40mg sometimes feels like a bit much but I'm finding I tolerate the 40mg more now that I'm taking Depakote. Ask yourself when you're thinking about asking for a dose increase if you're chasing motivation or hypomania or if it's because you're actually having issues with your attention to detail and ability to initiate and complete tasks. It's not about the motivation to do things, it's about the ability to be more task-oriented, complete tasks in fewer sittings, ability to remain engaged in what you know you need to do, and overall executive functioning.

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@browri

Not real worried about my pdoc thinking I'm seeking drugs to "have fun" or "get high." She's been throwing benzos at me for well over a year, and I keep shutting it down. We're both disappointed in how little I've responded to the plethora of ADs I've tried, so I have a feeling she'll be fine with trying something different. I'm not planning on pestering her about it, just bringing it up and seeing what she thinks. 

Thanks for the info!

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Wow, am I glad that I stumbled upon this thread.  About 18 months ago I added Wellbutrin 300 to my Effexor.  Then about a year ago I switched the Effexor out for Trintellix.  And I think that the "fogginess" that I've been fighting for 10+ years has gotten worse.  I thought that it was just me, or maybe diet or exercise.  

I wish I could find a good path to go down.  I feel like Wellbutrin alone may aggravate my anxiety.  My depression is not "sad" depression but more "locked in neutral" depression.  (AKA dysthymia AKA atypical depression.)  

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Trintellix and Wellbutrin are generally contraindicated because Wellbutrin increases the Trintellix blood level. If you are taking 300mg of Wellbutrin, it would be advisable to not go above 10mg without extra care.

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Just starting Trintellix.  Currently on Wellbutrin 300 and tapering off.  

I hope this works.  I really liked the Wellbutrin, but we hit a bunch of gloomy days and I just went downhill fast.  Missed most of work this week.

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Just now, tamsynx said:

Just starting Trintellix.  Currently on Wellbutrin 300 and tapering off.  

I hope this works.  I really liked the Wellbutrin, but we hit a bunch of gloomy days and I just went downhill fast.  Missed most of work this week.

Hope it works for you, @tamsynx! Be careful though with the Trintellix/Wellbutrin mix. Wellbutrin inhibits CYP2D6 which is one of the primary metabolic pathways for Trintellix. This would greatly increase the Trintellix blood levels. You would have to cut the Trintellix dose by half which would mean the highest it would be safe to go on either together would be Trintellix 10mg / Wellbutrin 150mg.

Another thing to keep in mind that the initial effects of Trintellix can be activating and agitating. For me it would last about 3-5 days after starting it or increasing the dose. Because you're taking it with Wellbutrin which inhibits the metabolism of Trintellix and is also activating itself, the effect may be compounded. Based on my experience with Trintellix and Wellbutrin, if it were me and my pdoc approved, this is how I would titrate it:

Week 1: Trintellix 5mg, Wellbutrin 150mg

Week 2: Trintellix 5-10mg depending on tolerance of activating/agitation and eliminating Wellbutrin depending on severity of withdrawal, if any. Eliminating the Wellbutrin may also ease the startup effects of Trintellix, to be considered.

Week 3: Trintellix 15mg, at this point, definitely no Wellbutrin

Week 4: Trintellix 20mg

Then you really should be on the 20mg for a good 2-3 weeks before you make a final determination on whether or not you're going to stick with it or switch to something else.

Trintellix has a really long half-life which means it not only takes a while to build in your system, but because you are not already on a serotonin reuptake inhibitor it will take time for receptors to desensitize. Trintellix's other activities in the brain do speed up this process, but in my experience Trintellix took almost as long as Prozac to see the full positive effects after getting to the right dose.

I also cannot emphasize more that my experience has taught me the studies were correct when it comes to dosing. Before you really give up on Trintellix you need to try as hard as possible to get to the 20mg dose and stay there for a few weeks before you give up on it. The activation and agitation to me almost felt like restlessness, but this was only really pronounced when I started on 5mg and after I went up to 10mg. 15mg and 20mg were easier to adjust to.

At 5mg and 10mg it felt like a placebo. It would stimulate you for a few days and then nothing. It wasn't until 15mg that I felt like it might be doing something for my depression but I wasn't sure I wanted to keep it until I was on 20mg for 2 weeks. I'm telling you it's really long, no matter what Takeda said about it working in as fast as two weeks. You have to take 10mg for a week and then move to 20mg right away at week 2 for it to actually work that fast, but the activation period was rough enough that titrating that fast wasn't possible for me anyway.

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Thanks @browri!

I'm on Wellbutrin XL 300 mg.  I'm supposed to start taking it every other day and start on 5 mg  Trintellix for 1 week, then go up to 10 mg for 21 days, then see the doc again.

But now I'm worried the Wellbutrin might get out of my system before the Trintellix kicks in.  I hate changing meds.

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4 minutes ago, tamsynx said:

Thanks @browri!

I'm on Wellbutrin XL 300 mg.  I'm supposed to start taking it every other day and start on 5 mg  Trintellix for 1 week, then go up to 10 mg for 21 days, then see the doc again.

But now I'm worried the Wellbutrin might get out of my system before the Trintellix kicks in.  I hate changing meds.

Don't worry too much about it yet. Just try it out and see how you feel. Interesting that they suggested taking 300mg every other day instead of giving you 150mg, but they may be doing something to try and ease the withdrawal.

As for Trintellix kicking in, the dosing schedule suggested makes sense to me. Not sure you'll want to stay at 10mg for 21 days, but you never know. We all react to things differently. I've read a lot of horror stories about Rexulti but I'm on Day 2 and it seems pretty great to me lol.

Don't hesitate to ask to go up though. I was on each dose for several weeks and 20mg was really the winner.

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I still haven't started the Trintellix yet.  I'm emailing back and forth with my doc.  I also use Sumatriptan for migraines.  She said to take half of one the day I use Sumatriptan and half the next day.  So I'd need to wait a day to take the half Trintellix and the Sumatriptan.  Argh!

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12 hours ago, tamsynx said:

I still haven't started the Trintellix yet.  I'm emailing back and forth with my doc.  I also use Sumatriptan for migraines.  She said to take half of one the day I use Sumatriptan and half the next day.  So I'd need to wait a day to take the half Trintellix and the Sumatriptan.  Argh!

Your doctor is likely worried about the combination of sumatriptan/vortioxetine causing serotonin syndrome, which is possible. Would be smart to do as your doctor asks, but good luck splitting those Trintellix tablets. They're shaped like eggs. No idea how pdocs think we're going to split those.

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Hm.  Good point.  I'll see if I can get some half doses for those days.

Just started the process of weaning Wellbutrin and starting 5 mg Trintelllix.  So far, mostly okay.  Really nauseous the first day.  And sleepy in the afternoon.  We'll see if it continues.

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I am highly treatment-resistant. No other SSRI has ever worked for me. The only drug that's ever worked for me was Effexor but it pooped out. It's very discouraging. I was very close to getting ECT, but I'm giving this a shot first. I was on 5 mg for a little less than a month and just started 10 mg a few days ago. I'm eager to get up to 20 mg, but I have to wait another month until my next appointment.

If this works, it will be a miracle. If that happens, I'll be back to share my experience - especially for others who, like me, are fairly treatment-resistant. If this works, it think it will be due to its relatively novel method(s) of action. 

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I've been on Trintellix for over a year now. My insurance is changing, and I'll have to go through a re-approval process to get coverage for it. I'm not sure how well it is really working for me. On 20 mg dose. I'll talk to my doctor, but I'm thinking maybe phase off of this for a while and continue work with my therapist to get me through the rough patches. 

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I started Trintellix about a month ago. I started on 10mg and per my request, my doctor upped it to 20. I've noticed an increase in nausea, sometimes severe, since the increase, but I'm afraid this is the only med that does anything at all for me. (The resulting nausea led to me throwing up for about ten minutes straight a week ago. It was brutal.) I don't really know what to do. I have also experienced problems with the pre-auth insurance nonsense. Also, my dr gave me a card that is supposed to make it cost "no more than" $10 per month for one year. It's been $80 per month at my local pharmacy with my insurance, and since my insurance is through a mail-in pharmacy that does not offer an 'opt-out' option, it will be $165 for a 90-day supply if I decide to get it filled again. It could be worse, but it's still frustrating, especially with my monopolizing insurance/pharmacy. This will be my most expensive prescription.

That said, it might be worth it. It's not a tremendous improvement, but I have noticed less severe depressing thoughts of various stripes; automatic, spiraling, etc. I'm hoping I can stay on this long-term, I just don't know about the nausea.

Edited to ask for advice: Has anyone dealt with relatively frequent and occasionally severe nausea on Trintellix? What worked/didn't work for you? I've been alternating Zofran and Pepto and I don't think either of those is a permanent solution. I'm really hoping it goes away since I just went up to 20 around 2 weeks ago, but I'm not optimistic about that.

Edited by poetic_fail
forgot to ask question

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On 12/1/2017 at 4:03 PM, standup said:

I am highly treatment-resistant. No other SSRI has ever worked for me. The only drug that's ever worked for me was Effexor but it pooped out. It's very discouraging. I was very close to getting ECT, but I'm giving this a shot first. I was on 5 mg for a little less than a month and just started 10 mg a few days ago. I'm eager to get up to 20 mg, but I have to wait another month until my next appointment.

If this works, it will be a miracle. If that happens, I'll be back to share my experience - especially for others who, like me, are fairly treatment-resistant. If this works, it think it will be due to its relatively novel method(s) of action. 

Hey standup, I'm the same way. I've been on almost all of the older drugs and quite a few of the newer ones, too, and I too have considered ECT. (I had childhood epilepsy though, so I'm not sure if it's safe for me. Plus, I'd need a driver for all the treatments, so it seems really inconvenient.)

I'm interested to know if you went up to 20mg and if so, how that worked for you. Have you experienced any side effects?

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@poetic_fail The Trintellix savings card was actually in the news recently. I think someone took Takeda to court over the fine print of the savings program, which didn't define a maximum savings benefit anywhere. It only said pay no more than $10/30-day or $30/90-day, even though there was in fact a maximum benefit.

The terms have been updated as follows:

For a 30-day, you are responsible for the first $10 of your insurance copay, then the savings card will pay $100, and then you are responsible for the difference, which in your case appears to be $70. Therefore, I would assume that your insurance copay is $180/30-day.

For a 90-day, you are responsible for the first $30, then the savings card will pay $300, and then you are responsible for the difference.

As for the nausea, it is something I noticed a bit in the beginning although it was more like dyspepsia which I managed with famotidine and Tums but it always went away within a week or two after a dose increase. I never vomited from it though. Some people have said they have less nausea if they take it on an empty stomach and some say they have less when they take it with food. What's even weirder is that Trintellix is a 5HT3 antagonist just like Zofran, which should actually REDUCE nausea. So it's been perplexing to the psychiatric community as to why it CAUSES so much nausea. However, the hypothesis is that it is most likely coming from the 5HT1A agonism, which is one of the reasons why Viibryd can have some considerable nausea as well.

In my opinion, it is worth getting to 15mg or 20mg and staying there for at least 3 weeks before you decide if you want to give up on it. Trintellix has a 66 hour half-life which means it takes up to 15 days to reach steady state after starting or changing the dose. I had been on the 5mg and 10mg doses for several weeks and once I adjusted to them, I didn't really feel that significantly different. It wasn't until I got to 15mg that I felt like it was actually doing something, but after 3 weeks at 20mg, I realized it was going to be a staple med for me. That being said, I have since established that 20mg and 15mg are more "winter doses" and I dial back the dose going into the spring/summer in favor of increasing my AAP (Rexulti at time of this writing).

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@browri Thanks for that info. I called my insurance and they told me regardless of a coupon, my copay will be $165 for 90 days, so I wonder if that's correct. That's the standard "non-preferred" price for a name brand medication. (I think it's bs that it is "non-preferred" when there's no alternative to it. It's not like I'm choosing to buy the name brand, I'm just attempting to choose to not be as depressed as I was.)

I will stay on it for as long as I can. I'm hoping the nausea peaked last week with the vomiting, although it has occurred multiple times this week without vomiting. I think I've been on the 20mg for 2 weeks. 

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39 minutes ago, poetic_fail said:

Hey standup, I'm the same way. I've been on almost all of the older drugs and quite a few of the newer ones, too, and I too have considered ECT. (I had childhood epilepsy though, so I'm not sure if it's safe for me. Plus, I'd need a driver for all the treatments, so it seems really inconvenient.)

I'm interested to know if you went up to 20mg and if so, how that worked for you. Have you experienced any side effects?

I did go up to 20 mg and it didn't work for me. But not only did it not work for me, I didn't even get the side effects. I never got any nausea. This makes me wonder if my body even metabolizes these drugs in the first place.

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19 minutes ago, poetic_fail said:

@browri Thanks for that info. I called my insurance and they told me regardless of a coupon, my copay will be $165 for 90 days, so I wonder if that's correct. That's the standard "non-preferred" price for a name brand medication. (I think it's bs that it is "non-preferred" when there's no alternative to it. It's not like I'm choosing to buy the name brand, I'm just attempting to choose to not be as depressed as I was.)

I will stay on it for as long as I can. I'm hoping the nausea peaked last week with the vomiting, although it has occurred multiple times this week without vomiting. I think I've been on the 20mg for 2 weeks. 

I see. So Trintellix is considered a non-preferred brand or top-tier drug on your prescription formulary. And you don't have the option of filling 90-days at a retail pharmacy (no "opt-out", which is total BS). That says to me though that filling 30-days with the Takeda coupon at a retail pharmacy will end up costing you $240 versus mailing it in and not using the Takeda card at all. Your mail-order pharmacy won't accept savings cards? Mine won't either except for specialty medications, which is also TOTAL BS!!

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I'm still having a lot of nausea on the 20mg dose of Trintellix. I don't remember if I had it on the 10mg but I just bought a refill of the 20, so I hope I don't have to go back down. I now take Zofran (dissolvable 8mg) at least once a day, as needed, which is usually when I feel this weird constriction in my throat and my saliva seems to turn sour (is that weird?). The only way I know I need it at that point is that's what happened the first time I threw up. I took Zofran about 10 minutes ago and I'm still burping and feeling like I may lose this battle. I have GERD and gastritis, too, (which have caused nausea in the past but my gastritis has been mostly controlled for the past two years) so I don't know if that's contributing to this.

I'll repeat my initial comment: has anyone won this battle? If so, what worked? 

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On 5/2/2018 at 2:55 PM, poetic_fail said:

I'm still having a lot of nausea on the 20mg dose of Trintellix. I don't remember if I had it on the 10mg but I just bought a refill of the 20, so I hope I don't have to go back down. I now take Zofran (dissolvable 8mg) at least once a day, as needed, which is usually when I feel this weird constriction in my throat and my saliva seems to turn sour (is that weird?). The only way I know I need it at that point is that's what happened the first time I threw up. I took Zofran about 10 minutes ago and I'm still burping and feeling like I may lose this battle. I have GERD and gastritis, too, (which have caused nausea in the past but my gastritis has been mostly controlled for the past two years) so I don't know if that's contributing to this.

I'll repeat my initial comment: has anyone won this battle? If so, what worked? 

I actually experienced exactly what you described. But in my case the nausea was secondary to the "acidic stomach". The name of the side effect that you're looking for is "dyspepsia". It is also a side effect of Trintellix but less talked about relative to the nausea side effect because the nausea is more common. For me the dyspepsia (i.e. agitated and acidic stomach) did go away after a time. And it was important to me as well because I also had a chronic acid reflux problem going into Trintellix that did get slightly worse as a result, but it did ease up and it's back to "as good as it used to be", which isn't really saying much tbh.

If you get to 20mg. Give it 2 weeks before you give up on it. You'll know by the end of the 2 weeks if the side effects have eased up at all. But you really do have to stick it out pretty long because of the long half-life and thus long time to steady-state.

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