What You Need to Know About the Newest Antidepressants
In addition to therapy, medication can be an invaluable treatment for clinical depression. It may alleviate symptoms and literally save lives. Which is why having an array of medications to choose from is vital.
Recently, in the U.S., three antidepressants were approved by the Food and Drug Administration (FDA) to treat depression: vilazodone (Viibryd) in 2011; levomilnacipran (Fetzima) in 2013; and vortioxetine (Trintellix; formerly called Brintellix, but renamed to avoid confusion with the blood-thinning medication Brilinta) in 2013.
In general, these medications are well-tolerated and effective. However, they’re no more effective than older antidepressants. But, again, having options is important. “[B]ecause individuals respond to antidepressants in ways that are often idiosyncratic with only about a third of patients remitting on the first antidepressant they try, it is positive to have a range of antidepressants to try,” said Jonathan E. Alpert, MD, PhD, chairman of the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center/Einstein College of Medicine.
All three medications—vilazodone, levomilnacipran and vortioxetine—tend to be the second or third line of treatment, Dr. Alpert said. That’s because currently they’re not available in generic form, which means they’re expensive. Below, you’ll find a brief summary of each medication, its potential benefits and possible side effects, along with what the prescribing process may look like.
Vilazodone is a selective serotonin reuptake inhibitor (SSRI) and a partial agonist of the 5HT1A receptor. “This direct receptor modulation activity further enhances serotonin transmission, and may contribute to the finding that vilazodone has fewer sexual side effects, weight gain, and sedation than many antidepressants,” said Randy Schrodt, MD, managing partner of Integrative Psychiatry, and a clinical associate professor at the Department of Psychiatry and Behavioral Sciences at the University of Louisville.
Research has found that vilazodone is effective in treating anxious depression when compared with placebo. Dr. Schrodt noted that it’s often used off-label for anxiety disorders and obsessive-compulsive disorder. However, most SSRIs and SNRIs also are effective in reducing anxiety, Alpert said. Also, “There are a paucity of head-to-head comparisons between vilazodone and other antidepressants for anxious depression.”
“Theoretically, vilazodone should be better with anxious patients,” said Michael Gitlin, MD, the director of the Adult Division and director of the Mood Disorders Clinic at the UCLA Neuropsychiatric Hospital. But he’s found that excessive stimulation is a common side effect. He told The Carlat Psychiatry Report that “vilazodone can be overly stimulating, which might not be something you want for a patient with comorbid anxiety.”
The most common side effects are nausea, vomiting and diarrhea, Schrodt said.