How long does Trintellix take to work?

In this article:

• What to expect when taking Trintellix
• What to avoid while taking Trintellix
• When to see a doctor when taking Trintellix
• Trentellix vs. alternatives

In this article

• What to expect when taking Trintellix
• What to avoid while taking Trintellix
• When to see a doctor when taking Trintellix
• Trentellix vs. alternatives

Trintellix (vortioxetine) is a brand-name prescription medication that’s approved by the Food and Drug Administration (FDA) to treat major depressive disorder (MDD). It is also sometimes prescribed off-label for anxiety disorder. Vortioxetine, the active ingredient in Trintellix, helps improve levels of serotonin, a neurotransmitter (chemical messenger) that significantly impacts mood, emotional regulation, and appetite. 

Anyone taking this drug for the first time might wonder: How long does it take Trintellix to work? Experts say patients may experience symptom improvement in as little as two weeks, but it can take four to six weeks for the drug to reach its full effect. It’s important to alert your prescribing healthcare professional if depression or anxiety symptoms have not started to improve after a month.

What to expect when taking Trintellix

Antidepressants like Trintellix take time to stabilize in the body so they can influence the activity of neurotransmitters in the brain.

Trintellix is classified as an atypical antidepressant, but it has a similar timeline to other antidepressants, per Sid Khurana, MD, a board-certified psychiatrist and medical director of outpatient services at Nevada Mental Health in Las Vegas. Dr. Khurana says Trintellix starts working two to four weeks after starting it.

The first 24 hours

“[Trintellix] is absorbed into the bloodstream within about seven to 11 hours,” says Christina M. Madison, Pharm.D., founder of The Public Health Pharmacist. “It has a half-life of 66 hours, which means it lasts in the body for a long time once it reaches a steady state.” 

Effects of Trintellix, whether positive or negative, generally will not develop during the first 24 hours. However, symptoms that develop within hours of dosing could indicate an allergic reaction to the drug. 

Signs of an allergic reaction to Trintellix may include:

• Hives
• Facial or throat swelling
• Wheezing, difficulty breathing
• Feeling lightheaded
• Vomiting
• Shock

This type of drug allergic reaction is considered a medical emergency, so seek emergency medical attention if symptoms develop after taking Trintellix (or any new drug).

The first week or two

Sleep, energy, and appetite may improve within the first week or two of taking Trintellix, according to the National Alliance on Mental Illness. Mood and emotional regulation will likely take a couple more weeks.

Unfortunately, patients may also experience common side effects in the first week or two. “Side effects like nausea, vomiting, and constipation often develop soon after starting treatment and many times resolve in a few weeks,” Dr. Khurana says. 

The first month

Symptoms of depression and anxiety should gradually improve during the first month of Trintellix. “It often takes around four to six weeks of consistent use at an effective dose for Trintellix to reach its full effectiveness,” says Jodie Pepin, Pharm.D., clinical pharmacy program director at Harbor Health. 

Of course, side effects can also develop or worsen. Some people taking Trintellix continue experiencing nausea after the first two weeks, according to the manufacturer of Trintellix, Takeda Pharmaceuticals Inc. Dr. Khurana says sexual problems, such as ejaculation or erection difficulties in men and decreased sex drive or orgasm difficulties in women, may also develop and persist.

RELATED: Does Trintellix cause sexual side effects?

After the first month

Patients may need to wait up to six weeks to experience the full benefits of Trintellix. If symptoms of depression and anxiety have not improved after six weeks, the dosage may need to be adjusted. 

Allergic reactions usually appear quickly. However, in rare cases, it is also possible to develop signs of an allergic reaction weeks after starting this medication. Reports of skin reactions from vortioxetine, the active ingredient in Trintellix, include excessive itchiness, swelling, bruising, and red dots on the legs that develop three weeks to three months after starting Trintellix. 

“The side effects from this medication could be prolonged because of the long half-life of the medication,” Dr. Madison explains. “Always talk to your healthcare prescriber first before discontinuing, as it may require a tapered reduction in the dose before you completely discontinue the therapy.”

What to avoid while taking Trintellix

When prescribing an antidepressant, healthcare providers take into account each patient’s medical conditions, medical history, other prescriptions, and whether the person is breastfeeding or pregnant (or plans to become pregnant). This antidepressant should be avoided if a person has:

• Had an allergic reaction to vortioxetine
• Taken a monoamine oxidase inhibitor (MAOI) in the last 14 days
• Been diagnosed with bipolar disorder

Anyone taking this drug for the first time should review this list of prescription drugs and supplements to avoid mixing with Trintellix:

• MAOIs – Taking an MAOI antidepressant with Trintellix increases the risk of serotonin syndrome. Trintillex should only be taken after at least 14 days have passed since the last MAOI dose.
• Other serotonergic drugs or supplements – Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and the herbal supplement St. John’s wort all affect serotonin levels. Antipsychotics, anticonvulsants, opioids (e.g. tramadol or fentanyl), lithium, and triptans may also impact serotonin. Mixing any of these (among other drugs that affect serotonin levels) with Trintellix can cause serotonin imbalance and raise the risk of serotonin syndrome. 
• Blood thinners – Mixing Trintellix with anticoagulants like warfarin may increase a person’s risk of bleeding. Nonsteroidal anti-inflammatory drugs (NSAIDs) also thin blood, so they should be used with caution, and only if approved by the healthcare provider.
• Strong CYP2D6 inhibitors – Drugs such as bupropion, fluoxetine, paroxetine, and quinidine may cause an unintended boost of Trintellix in the bloodstream, which could increase the risk of side effects.
• Strong CYP inducers – Rifampin, carbamazepine, and phenytoin may cause an unintended decrease of Trintellix in the bloodstream.

When to see a doctor when taking Trintellix

Trintellix has a boxed warning (the most serious warning required by the FDA) because it is linked to an increased risk of suicidal thoughts and behavior in young adults ages 24 and younger. Patients of any age who experience mood or behavior changes or suicidal thoughts while taking Trintellix should seek urgent medical advice. 

Other worrisome Trintellix side effects that warrant calling a healthcare provider right away or getting immediate medical attention include:

• Signs of angle-closure glaucoma, such as eye pain, redness, swelling, or changes in vision
• Signs of serotonin syndrome, which include: 
  • Nausea
  • Sweating
  • Mood changes
  • Irritability 
  • Dizziness
  • Tingling or tremors
  • Confusion
  • Headache
  • Tiredness or trouble sleeping
  • Hypomania (euphoria, excitability)
  • Tinnitus (ringing in the ears)
  • Seizures
• Low sodium levels, which are indicated by:
  • Headache
  • Trouble concentrating
  • Confusion
  • Weakness

Serious side effects that require urgent medical attention include:

• Hallucinations
• Fainting 
• Seizures

It’s also important to monitor changes in mood, as Trintellix may worsen rather than improve symptoms of mental illness. 

“This medication—like many other antidepressants—can cause activation and agitation or make them hypomanic or manic,” Dr. Khurana says. “In some cases, it can make anxiety worse. For some cases, often the plan is to either stop the medicine or start a mood stabilizer.”

Trentellix vs. alternatives

Dr. Khurana says Trintellix works at a similar speed compared to its alternatives. Most antidepressants don’t reach their maximum efficacy until four weeks after starting them. But like Trintellix, many antidepressants start to kick in and offer partial symptom relief in the first two weeks.

RELATED: Trintellix vs. Zoloft: Differences, similarities, and which is better for you