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Is Trintellix Good for Major Depression? Trintellix Pros and Cons

This entry was posted in Antidepressant and tagged on by .
Medically Reviewed Fact Checked

Last Updated on April 20, 2022 by Diane Ridaeus

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Trintellix: Pros and Cons

Trintellix: Pros and Cons

If your health care provider has prescribed Trintellix to alleviate your severe depression symptoms, it is important to weigh the pros and cons of using this medication.1 Trintellix is one of the innumerable SSRI medications marketed by 45 different pharmaceutical drug companies around the world. Antidepressants have seen a significant global decline in sales and researchers report that side effects of SSRI medications, in general, are the main reason for the hampered market growth of these medications.2


  • There was no difference between Trintellix and any other antidepressants in adverse events leading to stopping therapy except where the dosage was high, i.e., 20mg vs 5mg. 1
  • Trintellix can be prescribed in an outpatient setting.
  • Insurance providers may reimburse some of the costs of medication, reducing the price from $423 for a 30 day supply to approximately $350. or less, depending on your coverage.17,18
  • The serious adverse events vs placebo reported for Trintellix resulted in the Canadian Drug Expert Committee not recommending a price premium for the drug, making it more affordable than some other antidepressants.17


  • Trintellix poses a risk of increased suicidal thoughts in users under the age of 25 as well as risk for serotonin syndrome not limited to any age groups.4,5,26,27
  • Taking Trintellix during pregnancy can result in withdrawals in the newborn.5
  • Trintellix can increase your risk for bleeding issues, hyponatremia (low sodium) especially in the elderly, and emerging mania or hypomania in all age groups.5,27
  • Using Trintellix or any antidepressant medication can cause both psychological dependence and physical withdrawals requiring careful tapering, indicating physical dependence has developed.5,6,7
For most people, experiencing loneliness or sadness is a normal reaction to dealing with life struggles or losses. Unfortunately, sometimes those struggles fail to resolve themselves and become overwhelming. They may produce psychological and physical symptoms that interfere with handling daily activities and enjoying life. According to the DSM V, if these conditions persist for more than two weeks, you could be diagnosed with MDD or major depressive disorder.8 Mental health care providers at Alternative to Meds Center are trained in natural, drug-free therapies that can avoid the adverse effects of medication while effectively improving symptoms of depression and helping people develop the coping skills they need to enjoy life.

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Alternative to Meds has more than 15 years of experience as an antidepressant withdrawal help authority. Using holistic therapies and Environmental Medicine, we have published evidence demonstrating the wonderful success of the majority of our clients in beating not only their dependence on medication but beating their depression symptoms as well.
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What Is Depression?

Depression is one of the most prevalent mental health disorders in the United States. Research such as that of Hasler, published in The Official Journal of the World Psychiatric Association, indicates that depression results from a combination of psychological, biological, environmental, and genetic factors rather than a singular source.28 Depression can occur in people of any age but commonly occurs during adulthood.

Depression can be an observed response to a traumatic event, life change, or extreme stress. However, depression also presents itself where no such stress or life event has occurred. Laboratory testing and other clinical assessment tools can help pinpoint root causes that may otherwise be overlooked. Sometimes medication prescribed for physical ailments causes the onset of depression. Depressive symptoms can also co-occur with illnesses, such as diabetes, heart disease, cancer, or Parkinson’s disease. Having a family history of depression or other mental health disorders may also put you at higher risk for depression. There are many genetic markers such as the CYP2C19 variant that could play a role. These and other factors can be discovered in lab testing and may be mitigated with certain supplements and correction of diet.4,9,19

Major depressive disorder is more commonly known as clinical depression. It causes severe symptoms that impact how you think, feel, and your ability to handle your daily life. Major depressive disorder makes things like working, spending time with family and friends, eating, or sleeping feel almost impossible.

Symptoms of Depression

If you experience more than five of the following symptoms along with low-level mood and energy for more than two weeks, you could be diagnosed with major depression.8

The number of symptoms and the severity of the issues will vary from person to person.

    • Lack of energy and excessive fatigue
    • Difficulty making decisions, inability to concentrate, or memory issues
    • Ongoing feelings of worthlessness, helplessness, or guilt
    • Extreme irritability or restlessness
    • Feelings of hopelessness and overriding pessimism
    • Changes in appetite, weight loss, or weight gain
    • Changes in sleep habits—either sleeping too much or insomnia issues
    • Persistent feelings of emptiness and sadness, or ongoing anxiety
    • Loss of interest in pleasurable activities, including sex
    • Unexplained headaches, cramps, aches and pains, or digestive issues that do not resolve themselves with treatment
    • Increasing fixation on death, suicidal thoughts, or attempted suicide

Your doctor will ask when your symptoms began, how long you have been experiencing them, the severity of the symptoms, whether depression or other mental health issues run in your family, and if you have any history of drug or alcohol abuse. They will also likely ask if you have had prior bouts of depression, how long they lasted, and what type of treatment you used to address your depression. Unfortunately, no other questions or investigative work will typically be done prior to prescribing an antidepressant such as Trintellix.

Three Therapies for Depression

The earlier you begin treatment for depression, the more effective your outcome will be. Even in the most severe cases, there are treatments that can alleviate your symptoms. Depression is typically treated with psychotherapy, medications, or a combination of the two. Today, in addition to the typical psychotherapy-medication path, more emphasis is on behavioral therapies in conjunction with alternative medicine treatments and environmental therapy. The following are just a few of the treatments in use to alleviate symptoms associated with major depression.

1. Psychological Treatment

Psychological TreatmentPsychological treatments, also known as talk therapy, are a critical factor in successfully treating major depressive disorder. Psychological therapy focuses on teaching you strategies to better deal with negative thinking patterns, establish better coping skills, and relieve unresolved trauma. Various types of therapy fall under the umbrella of psychological treatment, and psychotherapy can be experienced in different formats. Depending on your needs, treatment may involve more than one format. Standard psychotherapy formats include individual therapy, group therapy, couples therapy, and family therapy.

There are several types of psychological treatments available.

The ones that have shown the most success in treating depression are:

  • Cognitive therapy. This short-term goal-focused therapy concentrates on the ways our thought patterns impact our emotional states. Cognitive therapy helps you identify and change negative thinking patterns or cognitive distortions. Mindfulness-based cognitive group therapy uses mindfulness meditation practices to make you more aware of your thought patterns and help you focus on the present moment.
  • Cognitive-behavioral therapy (CBT). This short-term therapy is one of the most effective psychological therapy options for treating depression. CBT effectiveness is based on the understanding that the way we think and act affects the way we feel. CBT focuses on identifying distorted thoughts or beliefs that cause negative feelings or actions. It does not consider unconscious issues from your past. Therapists work with you to identify the thought patterns and behaviors contributing to your depression, change negative or irrational thought patterns, and modify behaviors.
  • Interpersonal therapy (IPT). This is also a more limited therapy addressing past and present interpersonal interactions to determine how interpersonal conflict and lack of social support impact depression. Therapy may look at conflict resolution techniques in relationships with family, partners, or coworkers.
  • Psychoanalytic therapy. This type of psychological treatment is an internally focused treatment that works on the assumption that your current depressive disorder is connected to unconscious unresolved childhood issues. This long-term therapy can build self-awareness by helping you understand how feelings and emotions from the past contribute to your present-day situation.

2. Behavioral Treatment for Depression

Behavioral TreatmentBehavioral therapy differs from cognitive therapy in that it focuses on changing behaviors rather than thought patterns. This type of therapy helps you identify and participate in activities that will enhance your positive feelings and overall well-being. Behavioral therapy enables you to identify unhealthy or self-destructive behaviors that may contribute to your depression and replace them with more positive ones.

A central component in behavior therapy is behavioral activation. When you are suffering from depression, you are more likely to avoid participating in activities you enjoy. This results in increasing isolation, higher anxiety levels, and a worsening of your mood, compounding your depression. Behavioral activation helps you identify specific pleasurable activities and set goals to incorporate them into your daily life. Learning this coping strategy can increase your chances of successfully reducing your depression symptoms.

The different types of behavior therapy include behavioral and cognitive play therapy, system desensitization, and aversion therapy, among others.

3. Environmental Treatment

Environmental TreatmentEnvironmental therapy treatment focuses on the impact that a patient’s physical environment has on their physical and mental health. Environmental factors can be your workplace environment, your home, food, air, or water. Bijlsma & Cohen are two of many clinical experts who have researched the association between toxic exposure and deteriorating health conditions.25 Environmental medicine is based on the belief that allergic and toxic substances produce subtle reactions in the body that accumulate over time, causing illness or disease and behavioral and mental disturbances. Practitioners focus on identifying and removing environmental issues that may cause illness and reducing exposure to toxins. The next step is detoxifying and cleansing the body of all toxic substances and integrating practices that support holistic recovery and healing.

Another form of environmental therapy, or eco-therapy, involves getting back to nature. Eco-therapy practitioners believe that modern society’s focus on technology and its alienation from nature cause much of our depression and anxiety. Since the Industrial Revolution began, our focus has become increasingly removed from the outdoors. There are proven psychological benefits from just getting outside and enjoying nature. Researchers such as Ulrich, Summers, and Vivian among others have found that walking outside in nature every day can be as effective as antidepressant medication for mild-to-moderate depression, and effective as a recovery tool applicable to times of stress, social upheaval, and even during or after a pandemic has ravaged through an entire population.22,23,24


Antidepressant medications are often the first-line treatment 11 given after a diagnosis of MDD despite the commonly overlooked criteria “C” in the DSM V that requires establishing that the depressive state is not attributable to physiological effects of some substance or medical condition. Nonetheless, antidepressants are the most common treatment for depression. There has been debate about efficacy in general with antidepressants. In published clinical trials out of Germany10 approximately 20-40% of people taking a placebo reported feeling better. An additional 20% of those participating in the trials reported improvements with actual antidepressant medication. It is not uncommon to have to try several antidepressants to find one that has manageable side effects and helps with your symptoms. Because of the risk of withdrawals, never abruptly stop taking your medication. A doctor will need to help you safely decrease your dosage, which may mean gradually titrating down to well below the minimum prescribed doses, i.e., well below 5 mg.7

How Trintellix (Vortioxetine) Works to Treat Depression

The FDA, drug researchers, and drugmakers all admit the precise action of how antidepressants work is unknown.4,12 There has been much research done to clarify the mechanisms of action and how these relate to mental illness, but so far nothing definitive has been established beyond some quite detailed theories and hypotheses, all as yet unproven according to published research in The Lancet.11

1. What Is Trintellix (Vortioxetine)?

Trintellix is a doctor-prescribed SSRI-type antidepressant medication used in treating major depressive disorder in adults as young as age 18 and up.4,26,27 Trintellix was designed to influence the serotonin neurotransmitter, and possibly other areas of neurochemistry. Decades of research as reported by Sangkuhl et al in The Journal of Pharmacogenetics and Genomics have not discovered any definitive explanation of how SSRI medications work.12

2. What Type of Antidepressant Is Trintellix?

Trintellix is classed as an SSRI antidepressant, which means selective serotonin reuptake inhibitor.

3. Does Trintellix Help With Major Depressive Order?

Kirsch et al did a massive review of all the clinical trials researching SSRI efficacy for the treatment of MDD that had been submitted to the FDA prior to drug approval. The evidence of the efficacy of antidepressants compared to placebo was poor, meaning the results resulted in less than what could be considered clinically significant.14

4. Is Trintellix a Mood Stabilizer?

A mood stabilizer is a drug used to treat bipolar disorders. Trintellix is not a mood stabilizer, is not approved to treat bipolar, and is not in the same category as drugs such as lithium.15

Side Effects of Using Trintellix to Treat Depression

The FDA has reported and stated on the package insert that Trintellix is associated with a number of adverse side effects, some of which require cessation of the drug or reducing the dosage by half for patient safety.4 As stated above, these are not dissimilar to the adverse effects of other antidepressants.

The most common are:

  • Decreased sex drive
  • Heartburn
  • Gas and constipation
  • Dry mouth
  • Blurred vision
  • Spinning sensation
  • Change in taste sensations
  • Nausea and vomiting

More severe side effects that require a call to your doctor are:

  • Coordination issues
  • Agitation
  • Muscle twitching
  • Increased thirst
  • Breathing issues
  • Vomiting blood
  • Seizures
  • Black stools

Trintellix can cause many serious side effects, including suicidal thoughts, serotonin syndrome, mania, hypomania, increased bleeding, vision problems, discontinuation syndrome, and low salt levels. Be sure to keep up with your regular health care appointments.

What to Do If Your Antidepressant Stops Working

Antidepressant Stops Working

According to the Journal of Advances in Psychopharmacology, author Penn advises that since there is little to no evidence available to assess the efficacy of SSRIs, they are generally considered “working” if a person can tolerate the side effects.15

If you feel your antidepressant medication is no longer working, or you are dissatisfied with the side effects of your current medicines, talk to your doctor. It may be helpful to contact a nutritional psychiatrist20 or other holistic practitioners familiar with alternative treatments for depression. It is of extra importance for your safety to have the proper support when changing medications or adjusting dosages.21 If your medication no longer works, there may be better alternatives. Contact Alternative to Meds for more information on treatments that can help with your depression besides Trintellix.

1. Clinical Review Report: Vortioxetine Hydrobromide (Trintellix): (Lundbeck Canada Inc.): Indication: The treatment of major depressive disorder in adults [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Nov. Executive Summary. Available from: [cited 2021 Jun 21]

2. Antidepressants-Global-Market-Report-2021-COVID-19-Implications-And-Growth-To-2030.html [cited 2021 Jun 21]

3. Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997 Jun;50(6):683-91. doi: 10.1016/s0895-4356(97)00049-8. PMID: 9250266. [cited 2021 Jun 21]

4. FDA label Trintellix (vortioxetine) tablets. Approval 2013 [cited 2021 Jun 21]

5. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndromeOchsner J. 2013;13(4):533-540. [cited 2021 Jun 21]

6. Fujii K, Suzuki T, Mimura M, Uchida H. Psychological dependence on antidepressants in patients with panic disorder: a cross-sectional study. Int Clin Psychopharmacol. 2017 Jan;32(1):36-40. doi: 10.1097/YIC.0000000000000143. PMID: 27496597. [cited 2021 Jun 21]

7. Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019 Jun;6(6):538-546. doi: 10.1016/S2215-0366(19)30032-X. Epub 2019 Mar 5. PMID: 30850328. [cited 2021 Jun 21]

8. Bains N, Abdijadid S. Major Depressive Disorder. [Updated 2021 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: [cited 2021 Jun 21]

9. Sim SC, Risinger C, Dahl ML, Aklillu E, Christensen M, Bertilsson L, Ingelman-Sundberg M. A common novel CYP2C19 gene variant causes ultrarapid drug metabolism relevant for the drug response to proton pump inhibitors and antidepressants. Clin Pharmacol Ther. 2006 Jan;79(1):103-13. doi: 10.1016/j.clpt.2005.10.002. PMID: 16413245. [cited 2021 Jun 21]

10. [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. Available from:  [cited 2021 Jun 21]

11. Harmer CJ, Duman RS, Cowen PJ. How do antidepressants work? New perspectives for refining future treatment approachesLancet Psychiatry. 2017;4(5):409-418. doi:10.1016/S2215-0366(17)30015-9 [cited 2021 Jun 21]

12. Sangkuhl K, Klein TE, Altman RB. Selective serotonin reuptake inhibitors pathway. Pharmacogenet Genomics. 2009;19(11):907-909. doi:10.1097/FPC.0b013e32833132cb [cited 2021 Jun 21]

13. D’Agostino A, English CD, Rey JA. Vortioxetine (brintellix): a new serotonergic antidepressant. P T. 2015;40(1):36-40. [cited 2021 Jun 21]

14. Kirsch I, Deacon BJ, Huedo-Medina TB, Scoboria A, Moore TJ, Johnson BT. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med. 2008 Feb;5(2):e45. doi: 10.1371/journal.pmed.0050045. PMID: 18303940; PMCID: PMC2253608.[cited 2021 Jun 21]

15. Nath M, Gupta V. Mood Stabilizers. [Updated 2021 Apr 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: [cited 2021 Jun 21]

16. Penn E, Tracy DK. The drugs don’t work? antidepressants and the current and future pharmacological management of depressionTher Adv Psychopharmacol. 2012;2(5):179-188. doi:10.1177/2045125312445469 [cited 2021 Jun 21]

17. CADTH Canadian Drug Expert Committee Recommendation: Vortioxetine (Trintellix — Lundbeck Canada Inc.): Indication: For the treatment of major depressive disorder in adults [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Feb. Available from: [cited 2021 Jun 21

18. Manufacturer Takeda Pharmaceuticals, “Cost of Trintellix” [online] [cited 2021 Jun 21]

19. Davey Smith G. Use of genetic markers and gene-diet interactions for interrogating population-level causal influences of diet on healthGenes Nutr. 2011;6(1):27-43. doi:10.1007/s12263-010-0181-y [cited 2021 Jun 21]

20. Adan RAH, van der Beek EM, Buitelaar JK, Cryan JF, Hebebrand J, Higgs S, Schellekens H, Dickson SL. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019 Dec;29(12):1321-1332. doi: 10.1016/j.euroneuro.2019.10.011. Epub 2019 Nov 14. PMID: 31735529. [cited 2021 Jun 21]

21. Keks N, Hope J, Keogh S. Switching and stopping antidepressantsAust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039 [cited 2021 Jun 21]

22. Summers JK, Vivian DN. Ecotherapy – A Forgotten Ecosystem Service: A Review. Front Psychol. 2018;9:1389. Published 2018 Aug 3. doi:10.3389/fpsyg.2018.01389 [cited 2021 Jun 21]

23. Ulrich, Roger S. “Visual landscapes and psychological well‐being.” Landscape research 4.1 (1979): 17-23. [cited 2021 Jun 21]

24. Chaudhury P, Banerjee D. “Recovering With Nature”: A Review of Ecotherapy and Implications for the COVID-19 Pandemic. Front Public Health. 2020 Dec 10;8:604440. doi: 10.3389/fpubh.2020.604440. PMID: 33363096; PMCID: PMC7758313. [cited 2021 Jun 21]

25. Bijlsma N, Cohen MM. Expert clinician’s perspectives on environmental medicine and toxicant assessment in clinical practice. Environ Health Prev Med. 2018 May 16;23(1):19. doi: 10.1186/s12199-018-0709-0. PMID: 29769039; PMCID: PMC5956903. [cited 2021 Jun 21]

26. Lundbeck Safety Information “Trintellix” [online] [cited 2021 Jun 21]

27. Drug manufacturer Trintellix Dosing – Important Safety Recommendations [cited 2021 Jun 21]

28. Hasler G. Pathophysiology of depression: do we have any solid evidence of interest to clinicians?World Psychiatry. 2010;9(3):155-161. doi:10.1002/j.2051-5545.2010.tb00298.x [cited 2021 Jun 21]

Originally Published Jun 20, 2021 by Lyle Murphy

This content has been reviewed and approved by a licensed physician.

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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