Vortioxetine - Safer Than Typical SSRIs?

Peat Party

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I haven't seen this drug discussed much on this forum, other than briefly in one thread, so i thought i should create thread around it. It's relatively new, which might be the reason why there's not much discussion about it.

I wonder if anyone might have any experience with it, and also how it is in regards to safety compared to "conventional" SSRIs? The wikipedia page states that there's been incidences of sexual dysfunction with it. Might that suggest it has some effect on raising Serotonin? Vortioxetine is classified as a Serotonin Modulator and Simulator and does seem to have some inhibition on SERT. But it's also an antagonist at some 5-HT receptors.

I have tried Mirtazapine so far, previously at 30mg, now 15mg. Could the dose be too low? I've heard from a Psychiatrist i've seen, doses as high as 90mg was common. Mirtazapine has not been as effective at reducing depressive symptoms as Vortioxetine, in my experience. Mirtazapine also has weight gain as a side effect, which might not always be desired.
 

mujuro

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I tried it. The insomnia was otherwordly. Not even quetiapine could put me out.
 
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Peat Party

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I tried it. The insomnia was otherwordly. Not even quetiapine could put me out.

No other positive or negative effects? What dose, and for how long did you take it? I'm at 10mg currently and have been taking it for about two weeks. If i could i would rather not use any anti-depressant at all, but i need to get a handle on the depression somehow.
 

mujuro

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I took 10mg and I didn't take it for long since sleep is integral to my mental health. It would have been less than a week. I just remember being excessively stimulated. It felt very tense and uncomfortable, like the stress response from coffee.
 
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Peat Party

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I took 10mg and I didn't take it for long since sleep is integral to my mental health. It would have been less than a week. I just remember being excessively stimulated. It felt very tense and uncomfortable, like the stress response from coffee.

I see, doesn't sound too pleasant. I agree about sleep, it's crucial for overall well being. I remember experiencing, what you describe as excessive stimulation and insomnia, when i was on Bupropion a few years ago. Didn't take it for very long either.
 

DaveFoster

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Vortioxetine still has serotonergic effects (on the gut I believe); nausea and insomnia are common sides, along with sexual dysfunction. Mirtazapine or a tricyclic would be a better option, generally, but ensuring good thyroid function is necessary.

15 mg is the "ideal dosage" for anxiety; 30 mg - 60 mg would be more appropriate for severe depression.
 
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Peat Party

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Vortioxetine still has serotonergic effects (on the gut I believe); nausea and insomnia are common sides, along with sexual dysfunction. Mirtazapine or a tricyclic would be a better option, generally, but ensuring good thyroid function is necessary.

15 mg is the "ideal dosage" for anxiety; 30 mg - 60 mg would be more appropriate for severe depression.

Do you happen to know of any other tricyclic antidepressants that you'd recommend? The only other tricyclic i've tried, is Clomipramine. Don't know if it's safe long term though.

Maybe it's just a matter of dose in regards to effectiveness of Mirtazapine. Still experienced quite severe anxiety and panic attacks on 30mg. In any case, it has contributed to quite a weight gain, so don't think it's an option to try a higher dose at the moment. Currently trying to get off it, might start taking it in the future again if necessary.

Doing a bunch of different things to optimize metabolism/thyroid and fix fatty liver. Kuinone, Lapodin, Niacinamide, Coffee, Pansterone, Epsom Salt Baths, Oxidal, Fruits, Cheese, Milk & Liver are some of the things... Recently started tracking temps/pulse throughout the day. I tried T3/T4 briefly (a month or so) this autumn/winter, but didn't notice much effect then, this was also when i experienced the severe anxiety and panic attacks i mentioned earlier.
 

DaveFoster

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Do you happen to know of any other tricyclic antidepressants that you'd recommend? The only other tricyclic i've tried, is Clomipramine. Don't know if it's safe long term though.

Maybe it's just a matter of dose in regards to effectiveness of Mirtazapine. Still experienced quite severe anxiety and panic attacks on 30mg. In any case, it has contributed to quite a weight gain, so don't think it's an option to try a higher dose at the moment. Currently trying to get off it, might start taking it in the future again if necessary.

Doing a bunch of different things to optimize metabolism/thyroid and fix fatty liver. Kuinone, Lapodin, Niacinamide, Coffee, Pansterone, Epsom Salt Baths, Oxidal, Fruits, Cheese, Milk & Liver are some of the things... Recently started tracking temps/pulse throughout the day. I tried T3/T4 briefly (a month or so) this autumn/winter, but didn't notice much effect then, this was also when i experienced the severe anxiety and panic attacks i mentioned earlier.
I seem to have missed the notification of your reply, my apologies.

I knew a person who has taken clomipramine; he liked it. I believe it works on oxytocin, but maybe most antidepressants do so.

Activated charcoal (1-3 TBSP per day) taken away from meals can help significantly with anxiety. It might be a good idea to take 1 or 2 TBSP before bed for a week or so consecutively with a complete elimination of starch and minimization of fiber. Niacinamide and progesterone work somewhat for anxiety.

Tricyclics tend to be dangerous acutely, but amitryptyline is relatively safe. Nortryptyline may be more safe, but I haven't looked into it extensively. Progesterone can work fairly well for depression, and a combination of coffee and mirtazapine works exceedingly well. One can take mirtazapine to keep regular stress levels down, and then use caffeine, progesterone, cyproheptadine, pregnenolone, and DHEA to keep things moving away from depression.

Someone on the forum has had good results from Lapodin and Pansterone. Methylene blue helps others; it's contraindicated with mirtazapine, but I know of a person who has taken methylene blue with mirtazapine without any major side effects. Mirtazapine has a far lesser risk of serotonin syndrome than the SSRI class, as it's an atypical tetracyclic and derived from mianserin, which also has some beneficial effects in depression.

You could also try increasing the mirtazapine dose, as doses > 30 mg tend to yield a lesser degree of weight gain, and provide more stimulation. Some find 30 mg still appropriate for managing anxiety.
 
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DaveFoster

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Just to update this, I found 45 mg of mirtazapine to have a positive effect on both anxiety and depression despite claims of doses greater than 30 mg having stimulating effects.
 

bionicheart

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I haven't seen this drug discussed much on this forum, other than briefly in one thread, so i thought i should create thread around it. It's relatively new, which might be the reason why there's not much discussion about it.

I wonder if anyone might have any experience with it, and also how it is in regards to safety compared to "conventional" SSRIs? The wikipedia page states that there's been incidences of sexual dysfunction with it. Might that suggest it has some effect on raising Serotonin? Vortioxetine is classified as a Serotonin Modulator and Simulator and does seem to have some inhibition on SERT. But it's also an antagonist at some 5-HT receptors.

I have tried Mirtazapine so far, previously at 30mg, now 15mg. Could the dose be too low? I've heard from a Psychiatrist i've seen, doses as high as 90mg was common. Mirtazapine has not been as effective at reducing depressive symptoms as Vortioxetine, in my experience. Mirtazapine also has weight gain as a side effect, which might not always be desired.
How did you feel on Vortioxetine? How long did you take it? My doctor just gave this to me after being on mirtazapine. Mirtaz worked great for a while but I felt it finally felt like I had more aggression and irritable, then those "brain zaps."
I want to try Vortioxetine, it's just a very new drug and in it's own class, so there's not much to research, therefore I'm hesitant
 

PeskyPeater

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Effect of vortioxetine vs. escitalopram on plasma BDNF and platelet serotonin in depressed patients - PubMed

Abstract​

Escitalopram and vortioxetine are efficacious antidepressants. They directly target serotonin (5-HT) system, but vortioxetine mechanism of action is distinct from the one of selective serotonin reuptake inhibitors (SSRIs). Treatment with SSRIs decrease platelet 5-HT concentration and increase peripheral brain-derived neurotrophic factor (BDNF) levels. Since vortioxetine has a multimodal mechanism of action, it is expected to have a greater effect on circulatory BDNF concentration, compared to conventional antidepressants. This longitudinal study aimed to explore and compare the effects of 4-weeks of treatment with vortioxetine and escitalopram on plasma BDNF and platelet 5-HT concentration in patients with major depressive disorder (MDD). The results revealed that vortioxetine significantly increased plasma BDNF concentration (p = .018) and significantly decreased platelet 5-HT concentration (p < .001). Treatment with escitalopram significantly decreased platelet 5-HT concentration (p < .001), but it did not affect plasma BDNF concentration (p = .379). Response to vortioxetine was not predicted by baseline plasma BDNF or platelet 5-HT concentration, but response to escitalopram was predicted by baseline platelet 5-HT concentration. These effects might be due to vortioxetine unique mechanism of action, but the clinical implications are unclear. It remains to be determined whether this finding extends during long-term vortioxetine treatment, and which, if any, clinical effects emerge from BDNF increase.
 

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