Vortioxetine: A New Antidepressant Choice in the United States

Christoph U. Correll, MD


October 02, 2013

In This Article

A New Multimodal Antidepressant

On September 30, 2013, a new antidepressant, vortioxetine (Brintellix™), produced and comarketed by Lundbeck and Takeda, was approved by the US Food and Drug Administration. The recommended starting dose is 10 mg orally once daily, taken at any time. The dose should then be increased to 20 mg/day, as tolerated, with consideration being given to lowering the dose to 5 mg/day for patients who do not tolerate higher doses. When a new medication is approved, several questions arise for clinicians: How does this medication differ from existing agents that are available to treat the same condition? What is the efficacy and tolerability signature of this new drug? Will certain patients or patient groups benefit most from this new treatment option? In essence, will this medication be an advance, and when and for whom should I prescribe it? These questions are particularly relevant for the treatment of depression because many antidepressant agents targeting monoamine receptors are already available, many of which are generic.

Despite the already wide availability of antidepressants, there is a need for new treatment options. Depression is among the most common psychiatric conditions, treatment response is heterogeneous, and a considerable number of patients benefit only partially from currently available treatments.[1]

The discovery of the tricyclic antidepressants and the monoamine oxidase inhibitors was followed by the development and approval of several new agents. These include selective serotonin-reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), and medications such as bupropion, mirtazapine, and certain second-generation antipsychotics that stimulate or block different monoamine receptors. Furthermore, in Europe, agomelatine, a melatonin receptor agonist, has been approved.[2] Several drugs with potentially novel mechanisms of action have been tested, most of which have failed.[3,4] A notable exception is the current focus on ketamine and ketamine-like N-methyl-D-aspartate receptor (NMDA) antagonists, which seem to hold promise.[5] Thus, antidepressants with novel and/or multimodal mechanisms of action are needed.


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