There is a very wide spectrum of conditions that go under the term “depression.” It can range from feelings of sadness or general anxiety without any specific emotional cause, through ‘situational’ depression, which usually has some direct cause, and all the way to major depression that has some biological cause.
Trintellix (vortioxetine) is a widely prescribed medication to treat people who are suffering from a more severe form of clinical depression known as Major Depressive Disorder (MDD). Brintellix, Trintellix, and Fonksera are all the same medication (vortioxetine) manufactured by Lundbeck.
Does depression have some physical cause, or is it purely emotional?
With the development of more and more accurate body scanning technologies, especially electroencephalography (EEG) and magnetic resonance imaging (MRI), there has been a sharp turn away from the older idea that depression is a purely emotional problem. Whereas in the past, it was being treated largely by psychologists and psychiatrists, there is now wide acceptance that there are multiple biological aspects that make it necessary for proper treatment of the whole body.
What is the main focus of research into the causes of clinical depression?
Research is now following two main paths:
Firstly, trying to identify any physical triggers or underlying conditions that can result in depression. Some of the most important of these are:
- Age: Older people carry a higher risk of depression. This is a two-edged sword, since it can be caused by changes in the body and exacerbated by other factors like living alone and no longer having family support.
- Side effects of medications: Many drugs, most significantly the widely prescribed corticosteroids, can increase the incidence of depression.
- Gender: On average, women are twice as likely as men to suffer depression. While there are as yet no clear links, there is evidence that the hormonal changes that women are subject to may play a role.
- Genetics: While no single gene has been identified as a carrier for any form of depression, there is strong evidence that people with a family history of developed depression are at elevated risk themselves. There are likely to be multiple different genes that exert small effects.
- Serious illness: Depression can develop as a direct result of a major illness, and can result from both biological and emotional triggers.
- Postpartum: According to one study, mood disorders affect approximately 10-15% of adult mothers yearly.
- Postmenopausal: In one study, 56.9% of the subjects displayed symptoms of depression.
- Substance abuse: About one in three of all people with substance abuse problems also develop major symptoms of depression.
In addition, there may also be transitional events where some outside environmental or sociological change served as an identifiable trigger, the most prevalent reported are:
- Social conflict: Depression may sometimes be triggered by personal conflicts or disputes with family members, colleagues or friends.
- Grief: After the loss of a loved one or even a pet, there is risk of depression.
- Social stress: Major life cycle changes, even positive ones like graduation or marriage, can lead to depression.
- Social isolation: One of the main effects of the coronavirus pandemic has been to throw people out of normal social contact, and there has been a marked uptick in the number of cases of people manifesting clinical depression over the past 18 months.
It’s essential to keep in mind that the syndrome of clinical depression is not subject to a simple diagnosis, and it requires supervision by a professional healthcare provider.
What are the characteristics of MDD?
Major Depressive Disorder is manifested in a combination of emotional, physical, and cognitive symptoms.
While everybody with a diagnosis of depression experiences either depressed mood or lowered levels of interest or pleasure in doing things, a list of specific symptoms of MDD includes:
- Lack of interest in activities
- Feelings of depression and hopelessness
- Trouble in falling and in staying asleep, or in sleeping too much
- Feeling a general lack of energy
- Poor appetite control, either in overeating or bulimia
- A lack of personal self-worth
- Difficulty in concentrating and making decisions
- Being observably slow in moving and speaking
- Suicidal thoughts
It is essential that anyone experiencing these symptoms in themselves, or observing them in another person, should seek professional help from a healthcare provider.
Is there a biological explanation for depression?
There are two main developments that have reinforced the current conviction that depression is in most cases at least partly controlled or caused by biological triggers.
Researchers have been studying images of the brains of people who have clinical depression and comparing them with those who do not have identified specific anatomical differences. In the main, a small part of the brain known as the hippocampus appears to be smaller in some people with a history of depression than in those who don’t show any signs.
Interestingly, the hippocampus is involved in some of the functions that mediate signal neurotransmission processes throughout the brain. One of the most important molecules involved in the process is serotonin, which works in the brain to allow the communications that connect the brain regions involved in processing emotions.
What happens in the brain that causes depression?
Research has shown that in neurotransmission, serotonin molecules that are not used up in the neurotransmission process by other nerve endings are reabsorbed by the same nerves that released them, in the process known as “reuptake.” This reduces the number of serotonin molecules available to carry signals and is probably one of the causes of depression.
Putting those facts together has led to an effective treatment for depression that boosts serotonin’s availability.
How does Trintellix work in the brain?
Selective serotonin reuptake inhibitors (SSRIs) like Trintellix work by inhibiting the reuptake of serotonin, an action that allows more free serotonin to be available for neurotransmission cycles.
The latest studies of the brain’s functions have also led to the belief that antidepressants like Trintellix can exert neurotrophic effects that will augment proliferation, differentiation, growth, and regeneration of nerve cells. In this way Trintellix works as a serotonin receptor modulator as well as a reuptake inhibitor.
How is Vortioxetine sold outside the USA?
Vortioxetine was previously trademarked as Brintellix in the United States, but the US FDA approved a name change to Trintellix in 2016. In Europe, the name was changed from Brintellix to Fonksera, so vortioxetine can be called Brintellix, Trintellix, and Fonksera, depending on where you are.
Are there any side-effects from Trintellix?
There are few significant reported side-effects, but if you experience any of the following, consult with your healthcare provider or pharmacist immediately:
- racing thoughts, decreased need for sleep, unusual risk-taking behavior, feelings of extreme happiness or sadness, being more talkative than usual;
- vision changes, eye pain, eye redness or swelling;
- easy bruising, unusual bleeding, coughing up blood
- confusion, memory problems, hallucinations, slurred speech, severe weakness, feeling unsteady.
As well, consult with your doctor at once if you notice any symptoms of serotonin syndrome, such as agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.
Mild side effects can be expected in the first two weeks as your body adapts to the medications. These may include mild to moderate nausea, which is more likely in women than men. Other common side-effects also include constipation and a dry mouth. Less commonly, patients may experience a bloated or full feeling, excess air or gas in the stomach, itching skin and unusual dreams.
Does Trintellix have any other uses?
Vortioxetine is prescribed only for the treatment of major depressive episodes in adults. In particular, it should not be given to children under the age of eighteen. Be sure to follow your prescribing doctor’s and pharmacist’s instructions. Do not alter the dosage without consulting first with them.
Does Trintellix conflict with other medication?
When your doctor prescribed Trintellix, he or she would have taken into account the known conflicts with any of your other regular medications. However, if you are self-medicating with non-prescribed supplements, then make sure to advise the doctor of this, and do not suddenly introduce new supplements without first discussing this. In particular, the widely available substances St. John’s wort and tryptophan (sometimes called L-tryptophan) are known to carry some potential risk for users of Trintellix, and you should either stop taking them, or discuss this with your healthcare provider or pharmacist.
How long must I wait for Trintellix to start working?
Like most other antidepressants, the benefits of Trintellix do not show up immediately. Usually, you will start to notice changes after two weeks, but it can sometimes take up to 4 weeks to feel the full benefits of the drug.
Does Trintellix make you gain or lose weight?
Nearly one in five of the participants in one study either gained or lost 7% of their original weight. In this, Trintellix has less of an effect on weight than other antidepressants. It is to be expected that weight changes will occur, and in part this may be a good sign, as this will be coming from the correction of some of the symptoms of MDD.