March 22, 2023

In this video, we compare escitalopram or Lexapro with vortioxetine or Trintellix.

Welcome back in today’s video we’re going to be talking about escitalopram or lexapro and comparing it to vortioxetine or trintellix and this is in response to one of our viewers who asked us to make a video specifically about this topic if you would like us to make a video for you drop it down in the comment section below and that video will be coming your way

So in this comparison we’re going to specifically look at how these two medications work what they’re used for their common side effects some considerations to think about and my final thoughts so without further ado here we go so first of all let’s talk about how these two medications work so with vortioxetine this is a multimodal antidepressant and now both

Of these medications are antidepressants but since vortioxetine has many actions on various serotonin receptor sites and transport systems it’s going to lead to increases in not only serotonin but also norepinephrine dopamine glutamate acetylcholine and histamine and this is why bordeoxetine boasts pro-cognitive effects escetalopram on the other hand is a pure

Ssri it goes in there and targets that serotonin transport system and will just specifically increase serotonin levels and so what are these medications used for lexapro or escitalopram was fda approved in 2002 for the treatment of major depressive disorder in ages 12 and older and generalized anxiety disorder vortioxetine or trintellix on the other hand was

Fda approved in 2013 for the treatment of major depressive disorder in adults now vortioxetine can be used off label to treat generalized anxiety disorder and also used adjunctively or with other antidepressants to specifically target those cognitive symptoms of depression it’s also commonly used in geriatric depression because geriatric depression will commonly

Have those cognitive symptoms that come with depression like poor memory poor concentration now lexapro acetalopram also has off-label uses that include panic disorder post-traumatic stress disorder social anxiety disorder and pre-menstrual dysphoric disorder therapeutic doses of both lexapro or escitalopram and bordioxetine and trintellix are 10 to 20 milligrams

Now when we’re looking at the common side effects with fortioxatene you’ll have nausea diarrhea dry mouth and dizziness and then with escitalopram or lexapro you’ll have headaches nausea sombulence or insomnia and dry mouth now when it comes to the side effects remember that both of these medications are typically well tolerated and these side effects if you’re

Going to experience them will typically disappear once your body adjusts to the medication in about one to two weeks so if you’re experiencing any of these side effects hang in there and they will typically go away within that adjustment period now many of you are concerned about weight gain and i get it but both of these medications are considered weight neutral

However the way that some of these medications can increase your weight is by increasing your cravings for food and increasing your appetite so to minimize that like i always say you want to make sure that you only keep low calorie snacks and foods on hand so that when those cravings come about you’ll be reaching for lower calorie options like fruits and vegetables

And therefore not so much impact on the weight now when it comes to sexual dysfunction there are reports of sexual dysfunction for both of these medications just like there are for many of the antidepressants out there with escitalopram you’ve got two to twelve percent of males reporting this and about three percent of females with forty oxatine according to the

Fda label reports in males were 16 to 29 and females were 22 to 34 and these numbers sound very high and what i found interesting is that in the male group 14 of the placebo group also reported sexual dysfunction in the female group 20 percent of the placebo arm also reported sexual dysfunction so for some reason this group of patients maybe it was perhaps it

Was psychological but the placebo arm and the medication arm both had reported high rates of sexual dysfunction however i do not see this in practice and in researching this a little bit further i found an article from 2015 that was a comparison study comparing both escitalopram and vordioxetine for antidepressant-induced sexual dysfunction so these patients

Were on other antidepressants that caused sexual dysfunction and then they were switched to either escitalopram or vortioxetine and in that study vordioxatine was superior in treating that antidepressant sexual dysfunction which is what i see in practice if i have somebody that has sexual dysfunction with another antidepressant and i switch them to vordioxatine

It typically is resolved now some considerations here with both of these medications like all of the antidepressants there are rare and dangerous side effects to these medications that i cover in this video so if you haven’t seen that video yet go ahead and check it out it’s a thorough review of the first line treatments for major depressive disorder and also

With drug interactions with these two medications keep in mind that they are antidepressants and when they’re acting on serotonin that there’s a risk for bleeding and you increase that risk when you add non-steroidal anti-inflammatories like ibuprofen and or other blood thinners that risk of bleeding will be increased also there’s a risk of serotonin syndrome

And that risk is increased when you take other medications that can increase serotonin so watch this video if you haven’t already so that you can get a good understanding of serotonin syndrome and which medications are the most likely to put you at risk for serotonin syndrome now with drug interactions with escitalopram specifically there really aren’t many drug

Interactions here because escitalopram is not an inhibitor or inducer of any of the cyp enzymes and it’s metabolized by two different pathways it’s metabolized by the cyp3a4 and the cyp2c19 and because it has these two different pathways even if it’s paired with an inhibitor or an inducer of that pathway it has been shown to not have much of effect on the

Metabolism of that medication when you’re looking at vortioxetine vortioxetine is primarily metabolized by the cyp2d6 and so if you’re taking any medications that are strong inhibitors or inducers of that enzyme substrate then you are going to be at risk for some drug interactions and may need to increase or decrease the dose of vortioxetine now it’s important

That with either of these medications despite the risks here you always want to make sure that you’re putting your medications into a drug interaction checker and looking to see what the risks are with the medications that you’re taking and making sure that the medications that you’re taking are safe to take together also make sure that you are letting all of your

Providers know all the medications that you’re taking including over the counter medications and so to wrap this up my final thoughts on bordeotine or trintellix and escitalopram and lexapro are this so both of these medications have a lot of efficacy and proof that they work they’re both great at treating depression and even anxiety and both tend to be very well

Tolerated however in a 2016 study that indirectly compared many antidepressants including vortioxetine and escitalopram vortioxetine was actually the most tolerated medication over escitalopram and a lot of these other antidepressants and that was noted by a decreased or very significantly low dropout rate due to adverse effects vortioxetine is also superior in

Treating patients who have those cognitive symptoms of depression who have decreased concentration and poor memory due to depression bordioxane is going to be superior in treating those patients with that specific symptom now in my opinion escitalopram is superior in treating generalized anxiety disorder and other anxiety disorders like panic disorder when compared

To vortioxetine and vortioxetine seems to be superior in treating depression with an underlying mix of anxiety when depression dominates and anxiety is underlying symptom vordioxatine tends to be superior in treating that type of depression and this is just something i see in my clinical practice however the big disadvantage of vortioxetine is right now is that

It is not generic it is still branded under the name trintellix and so therefore it’s very expensive it’s like 400 to 500 and that’s with like coupons so if you have insurance right now insurances are typically covering vortioxetine if you’ve failed another antidepressant first then you can go ahead with 40 oxygen and they should or most insurances should cover

It without any cost now if you don’t have insurance there is a patient assistance program that can help you to get that cost down significantly and i’ll make sure to link that patient assistance program down in the description and you can go ahead and go on that site click on where the application is so that way you can go ahead apply and hopefully get a discount

If you feel that vortioxetine or trintellix would be a good choice for you however keep in mind that when you’re choosing which medication is going to be right for you it’s going to be different for everybody there are many factors and variables here that determine whether or not a medication is going to work for you this video just goes over the generalized

Information that’s out there about these two medications and comparing that so the best medication for you is going to be the medication that you can tolerate and that treats your target symptoms so there’s my review on vortioxeteen or trintellix and escitalopram or lexapro do you have anything to add to this video have you taken trintellix or lexapro in the

Past and want to share your experience go ahead and put that down in the comment section below because we learn from sharing each other’s experiences and as always i thank you for watching i wish you well on your mental health care journey and i’ll look forward to seeing you all next week

Transcribed from video
Escitalopram vs Vortioxetine: A comparison of two antidepressants By Levelheaded Mind