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Trintellix Tapering

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

Last Updated on July 26, 2022 by Carol Gillette

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

If Trintellix, classed as an atypical antidepressant, did not yield the desired results, you may be considering Trintellix tapering as the next step of your overall health plan.

The antidepressant Trintellix, FDA approved for MDD in adults6 is intended only as a prescription antidepressant when other antidepressants have not worked. Do not despair. Antidepressant medication may not have been what you really needed in the first place.

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As stated above, the antidepressant Trintellix is intended only as a prescription antidepressant when other antidepressants have not worked, rather than a first-line treatment choice.1 This would probably mean that a person taking Trintellix had tapered off another antidepressant medication before starting to take Trintellix. Perhaps this process went smoothly, or perhaps it did not go as easily as hoped. Tapering Trintellix, as is the case with many drugs, can be difficult without good planning and expert guidance. It is always advisable to be aware of FDA recommendations, information, and cautions regarding starting and stopping Trintellix or other prescription drug treatments.6

Two Most Common Reasons for Tapering Trintellix

reasons for Trintellix titration

In general, there are two main reasons people might consider tapering Trintellix or other types of medication. One is that the drug did not bring the relief that was hoped for. In the case of Trintellix in particular, the drug is FDA approved only for the treatment of MDD in adults, (major depressive disorder) and only when other drugs have not worked in prior treatment.5,6

However, sometimes the lines become blurred when it comes to selecting a particular drug or class of drugs for treatment and can result in “off label” prescribing. While the practice is not illegal, it is a little like experimenting outside the lines, outside the guidelines laid down and published in FDA and drug manufacturer literature. The results can be unpredictable. Unfortunately, desperately trying to quit one drug and switch to another is not as uncommon as one might think. According to research by Keks et al published in the Australian Prescriber, up to two-thirds of patients diagnosed with major depressive disorder fail to respond adequately to the first antidepressant, and are usually switched to a different one. Three-quarters of those whose prescription was switched also fail to achieve remission of symptoms on the second drug. The process can repeat many times.1,7

Another common reason for wanting to discontinue a drug is that the side effects became intolerable. Anyone in this predicament experiences the need for careful, conservative Trintellix titration. Intolerable side effects probably represent the most common reason a person may desire to get off Trintellix. It may be helpful, if you find yourself in this type of situation, to realize that many others have experienced similar problems. You are not alone.

In either circumstance, this scenario could have repeated multiple times, switching from drug to drug, trying to wean off Trintellix or another drug to avoid side effects such as nausea, headaches, diarrhea, sexual dysfunction, insomnia, or others. This is a potentially frustrating and sometimes scary difficulty to find oneself in. More information on Trintellix withdrawals and other side effects can be found below.

Trintellix Tapering Guidelines

Trintellix tapering guidelines include:
  • trintellix tapering guidelinesAlternative to Meds Center recommends inpatient treatment if possible, for tapering Trintellix. We have the capability and expertise that will make your experience comfortable and safe. However, we understand that inpatient care is not available to everyone. For the latter, it is imperative to seek medical guidance so you can travel the journey safely, guided by competent and sympathetic help.
  • To correctly configure reducing dosages, ask your doctor to prescribe the lowest dose pills available. Incremental adjustments may require cutting the pills. For Trintellix the pills are the 5 mg pink, a 10 mg off-white, 15 mg orange, and the largest, 20 mg brown (all are elliptical-shaped pills).8
  • For example, if you start your taper from 20mg and want to reduce very conservatively by 10% as a starting point, you could combine 1x15mg and cut 5mg in half for a total of about 17.5mg. Speak with your doctor who can help determine what adjustments are right for you.
  • Ensure enough time elapses between dose adjustments, to settle out at each new level. This will vary from person to person, but at least one or two weeks at each level would be a conservative approach.
  • Even using a very conservative timeline, withdrawals may emerge.11 Use the frequency and severity of symptoms to help determine whether the taper needs to slow down or is going along okay.8

Trintellix Withdrawals7-11

Symptoms that emerge during Trintellix withdrawal are similar to other antidepressants, and may occur after abrupt discontinuation as well as during more gradual titration, and are not necessarily dose-dependent, according to research by Siwek et al, published in Pharmaceuticals Journal in 2021.11

Discontinuation symptoms may include:
  • mania
  • psychosis including visual and audio hallucinations
  • impulsivity
  • increased suicidal thoughts
  • depersonalization, derealization — feeling one is outside the body and a sense that things around you are not real
  • paraesthesia — electrical zaps or shocks
  • dizziness
  • headache
  • insomnia, vivid dreams, nightmares, interrupted sleep
  • irritability, crying spells, sudden mood swings
  • visual perception changes
  • diarrhea
  • nausea, vomiting
  • confusion, inability to focus, memory impairment
  • anxiety
  • depression

Depression as a Diagnosed Mental Illness

trintellix taperingDepression is classified in the DSM (diagnostic manual) as a disease that has some or all of the following characteristics: depressed mood, thoughts about suicide or death, sadness, hopelessness, fatigue, loss of interest generally in life including loss of interest in sex, sleep disturbances such as insomnia or sleeping too much, increased or decreased appetite, significant weight loss when not dieting, prolonged irritability, anger, persisting unexplained aches and pains, anxiety, agitation, cognitive impairment sometimes called “brain fog,” inability to concentrate, think clearly or quickly, inability to make decisions, slowed body movements, and other unwanted conditions.

Amazingly, these, among others, are also known side effects of antidepressant drugs such as Trintellix.

So if taking a drug such as Trintellix did not provide relief for these types of symptoms, it might be time to consider how to get off Trintellix and try other approaches, as opposed to other drugs, to address the problem. Other approaches that don’t involve drugs at all, can be found below in this article.

Trintellix Titration With Inpatient Support

Alternative to Meds Center has helped many people to extricate themselves from such a tangle of methods of treatment that were not as effective as was needed. How to wean off Trintellix safely and gently is a subject that deserves attention to detail, and understanding what is going on when you taper off antidepressants. Our treatment plans are based on testing and the discovery and treatment of root causes. We do not believe that simply masking symptoms results in optimum treatment results. Trintellix titration (as with other medications) does not have to introduce further complications or harsh symptoms. We specialize in safely tapering Trintellix as well as other medications, with great success. More on our Trintellix cessation protocols can be found below.

Trintellix Side Effects

trintellix side effectsAccording to the drug manufacturer, the most commonly reported treatment-emergent side effects given as reasons for stopping Trintellix include nausea, constipation, headache, dizziness, constipation, and vomiting.10 Other more severe side effects that consumers and caregivers are advised to watch for while taking Trintellix include suicide attempts, increased suicidal thoughts, intentional self-harm, serotonin syndrome, violent behavior, akathisia, worsened depression, mania, psychotic symptoms such as hallucinations, hypomania, trouble sleeping, a drop in sodium blood levels, sexual dysfunction, dry mouth, and many others.2,5,9,10,11

These are much the same side effects for virtually all other antidepressants on the market. Such side effects can be difficult to manage and may make this type of treatment unworkable. It is possible that weaning off Trintellix can open the door to other, non-drug-based treatments, that may be more effective, and less intrusive in helping you reach your mental health goals.

Cautions Regarding Trintellix and Pregnancy

trintellix cautions pregnancyThe drug manufacturer indicates that if Trintellix is taken during the last trimester of pregnancy, the baby may be born with a condition known as PPHN, which means persistent pulmonary hypertension of the newborn, a persistent breathing difficulty.3 This may be another very good reason to consider Trintellix tapering for a woman who is planning to become pregnant, and who wants to avoid potential birth complications for the infant.

As John B. Warren states so succinctly in his article on “Antidepressants and the developing nervous system,” published in the British Journal of Clinical Pharmacology, “When a drug first comes to market, the assessment of the risk-to-benefit ratio is an educated guess” ~ John B Warren13

The truth is that few-to-no studies have been done on the effects of drugs and pregnancy and most that have been done were done on rats and rabbits, for ethical reasons. However, a 1996 study compared outcomes of various health factors in women who took fluoxetine during pregnancy vs those who did not and found significant differences in rates for premature delivery, admission to special-care nurseries, respiratory difficulty, and other neonatal problems.14 Because the information has to be collected and assessed “after the fact,” it can take years and decades, to come to dependable conclusions. A cautionary stance would be advised when it comes to the health of mother and child, especially concerning novel drugs such as Trintellix. There are non-drug-based remedies for depression that might be well considered before relying on pharmaceutical products which have no definitive history of testing for safety in pregnancy.4

Special Notes About the Name “Trintellix”

Trintellix is one in a group of relatively new antidepressant medications that have been on the market since 2013. Trintellix was first called Brintellix. However, a number of instances were reported where Brintellix was confused with another similar-sounding but entirely different drug, one that was used for anti-blood-clotting. In 2016 the drug manufacturer changed the name of Brintellix, the antidepressant, to Trintellix to avoid more instances of this confusion in the future.15

How to Wean Off Trintellix Safely

Alternative to Meds Center offers a Trintellix tapering program done gradually and comfortably over a two-month period of time. Longer programs can easily be arranged if desired. Clients are under the care of our licensed doctors, integrative psychiatrist, nursing staff, and clinicians who are all familiar with the intricacies of getting off Trintellix and other medications comfortably and safely.

natural trintellix tapering treatmentThe program features many components to support and soften Trintellix tapering. Some of these include lab testing for accumulations of neurotoxins, removal of these toxic substances through gentle cleansing methods, testing for and correcting vitamin and mineral deficiencies, low-temperature sauna, comforting mineral baths, IV + NAD treatments, refreshing foot baths, therapeutic massage, mild trainer-led exercise, yoga, meditation, nebulized glutathione treatments, bentonite clay packs, acupuncture, acupressure, colon hydrotherapy, and many other gentle therapies and procedures that are designed to significantly ease the Trintellix tapering process. With this level of attentive support, Trintellix titration can be surprisingly mild and easy to tolerate.

Counseling is also offered in many genres, such as CBT, and life coaching, that can help a person regain balance and renewed positive energy for life. Equine-assisted therapy and art therapy are also offered and are very popular with our clients.

We are always finding there is more to understand about how the CNS (central nervous system), hormones, the complexities of brain chemistry, the microbiome, and other important health matters all interconnect. Increasing understanding of such important information can greatly assist a person who is getting off Trintellix. That is why our programs include education components, as well as at-home tools and practical approaches to self-care, which are invaluable for clients as they leave the program.

Alternative to Meds Center provides a comprehensive series of educational modules. The in-class portions of the program aim to empower the client with practical and useful information about natural methods of neurochemistry and microbiome support, the role of nutrition in mental wellness, and many other important subjects useful in self-care. Tapering Trintellix does not have to be torturous or difficult. Using a number of blended holistic therapies, the body and CNS can be brought to a more healthy state, where symptoms can reduce and be completely eliminated. This is especially true when done in a truly caring and compassionate inpatient setting, with 24/7 staff on hand throughout the process.

Find Out More About Our Trintellix Tapering Programs

You or your loved one may benefit from the services we provide to address root causes of troubling symptoms such as depression, and thereby improve mental health naturally. Our programs are more than helping discontinue medication safely. We are all about achieving robust natural mental health without relying on pharmaceutical products. Please contact us at Alternative to Meds Center, to find out much more detailed information about how our Trintellix tapering programs at the center may be the help you or a loved one may have been searching for.

1. Trintellix – New Once Daily Antidepressant With a Unique Multi-Modal Mechanism of Action, Claimsecure Drug Review Vol XIV, Issue 1 [cited 2022 July 6]

2. Trintellix Medication Label Update, Takeda website 2018 May 2 [cited 2022 July 6]

3. Medication Guide Trintellix (vortioxetine) published by Takeda Pharmaceuticals America, approved by the US Food & Drug Administration [2017 Apr] [Internet] [cited 2022 July 6]

4. Medical News Today, “Trintellix: Side Effects, Dosage, Uses and More.” Reviewed 2019 Aug 31 [cited 2022 July 6]

5. Takeda News Release, “New Data Added to TRINTELLIX (vortioxetine) Labeling Demonstrated Superiority Over Escitaloprm in Improving SSRI-Induced Sexual Dysfunction in Patients with Major Depressive Disorder.” published 2018 Oct 22 [cited 2022 July 6]

6. FDA label Trintellix 2013 [cited 2021 Jun 10]

7. Keks N, Hope J, Keogh S. Switching and stopping antidepressantsAust Prescr. 2016;39(3):76-83. doi:10.18773/austprescr.2016.039 [cited 2022 July 6]

8. “Dosing & Administration Trintellix (vortioxetine) [online] [cited 2022 July 6]

9. Henssler J, Heinz A, Brandt L, Bschor T. Antidepressant Withdrawal and Rebound PhenomenaDtsch Arztebl Int. 2019;116(20):355-361. doi:10.3238/arztebl.2019.0355 [cited 2022 July 6]

10. Baldwin DS, Chrones L, Florea I, et al. The safety and tolerability of vortioxetine: Analysis of data from randomized placebo-controlled trials and open-label extension studies. J Psychopharmacol. 2016;30(3):242-252. doi:10.1177/0269881116628440 [cited 2022 July 6]

11. Siwek M, Chrobak AA, Gorostowicz A, Krupa AJ, Dudek D. Withdrawal Symptoms Following Discontinuation of Vortioxetine-Retrospective Chart Review. Pharmaceuticals (Basel). 2021;14(5):451. Published 2021 May 11. doi:10.3390/ph14050451 [cited 2021 Jun 10]

12. Nijenhuis CM, ter Horst PG, van Rein N, Wilffert B, de Jong-van den Berg LT. Disturbed development of the enteric nervous system after in utero exposure of selective serotonin re-uptake inhibitors and tricyclic antidepressants. Part 2: Testing the hypotheses. Br J Clin Pharmacol. 2012 Jan;73(1):126-34. doi: 10.1111/j.1365-2125.2011.04081.x. PMID: 21848990; PMCID: PMC3248262. [cited 2021 Jun 10]

13. Warren, J. “Antidepressants and the Developing Nervous System“, British Journal of Clinical Pharmacology 29 Steptember 2011 [cited 2021 Jun 10]

14. Chambers CD, Johnson KA, Dick LM, Felix RJ, Jones KL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996 Oct 3;335(14):1010-5. doi: 10.1056/NEJM199610033351402. PMID: 8793924.[cited 2021 Jun 10]

15. Eder K, “Brintellix Changed to Trintellix to Curb Brand Name Confusion with Brilinta.” Psychiatric Times, May 2, 2016 [cited 2021 Jun 10]

Originally Published Nov 2, 2019 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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