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Viibryd and Brintellix might be better as adjuncts

Posted by SLS on June 14, 2015, at 11:40:31


In animal studies, blocking serotonin 5-HT7 receptors can produce or enhance an antidepressant effect when combined with other antidepressants, even when those antidepressants are given at subtherapeutic dosages. Viibryd (vilazodone) and Brintellix (vortioxitine) might be worth continuing, even when they don't produce a remission monotherapeutically. If these drugs are well-tolerated, one can leave them in place and add other drugs from various classes. This is nothing more than conjecture based upon some very recent data.

Other drugs that block 5-HT7 receptors are Abilify and Latuda, two antipsychotics. There is no question that Abilify has the ability of enhancing the antidepressant effects of other drugs. Latuda, despite being touted as a monotherapeutic agent to treat bipolar depression, has yet to prove itself in post-marketing, in my opinion. Risperidone is another antipsychotic with 5-HT7 antagonist properties. Before Abilify came along, some doctors found risperidone to be helpful as an adjunct when treating refractory depression.

It might be fruitful to consider Viibryd and Brintellix as being adjuncts or augmenters rather than primary antidepressant agents. I imagine that there are some people who respond well to these two drugs, but the drugs don't seem very robust.

It might be interesting to combine one of these drugs, both of which are potent serotonin reuptake inhibitors, with a tricyclic norepinephrine reuptake inhibitor. I am partial to nortriptyline or desipramine because they do not inhibit serotonin reuptake and have milder side effects. With nortriptyline, you also get some 5-HT2a antagonism. Of course, the 5-HT1a partial agonism of Brintellix and Viibryd might be important in an admixture of properties that yield improvements in depression and anxiety.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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