Trintellix (Vortioxetine) - Better Than Current Antidepressants?

---

Antidepressants are medications that are used to treat various mental health conditions, such as depression, anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder. Antidepressants work by affecting the levels of certain chemicals in the brain, such as serotonin, norepinephrine, and dopamine, that are involved in mood regulation. Antidepressants can help improve the symptoms and quality of life of many people who suffer from these conditions. However, antidepressants also have some potential drawbacks, such as side effects, interactions with other drugs, and the risk of developing a condition called antidepressant discontinuation syndrome (ADS) if they are stopped abruptly or tapered too quickly. In this article, we will explain what ADS is, what causes it, what symptoms it can cause, how it can be prevented and treated, and what to do if you or someone you know experiences it.

What is antidepressant discontinuation syndrome?

Antidepressant discontinuation syndrome (ADS) is a condition that can occur following the interruption, reduction, or discontinuation of antidepressant medication after its continuous use for at least a month. ADS is sometimes also called antidepressant withdrawal syndrome or antidepressant cessation syndrome. ADS is not a sign of addiction or dependence on antidepressants, but rather a physiological reaction to the sudden change in the brain chemistry caused by stopping or reducing the medication.

ADS can occur with any type of antidepressant, including selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs). However, some antidepressants are more likely to cause ADS than others, depending on their half-life (the time it takes for half of the drug to be eliminated from the body), their potency (the amount of drug needed to produce an effect), and their specificity (the degree to which they affect only certain neurotransmitters). Generally, antidepressants with a shorter half-life, higher potency, and lower specificity are more likely to cause ADS than those with a longer half-life, lower potency, and higher specificity. For example, paroxetine (Paxil) and venlafaxine (Effexor) have a higher risk of causing ADS than fluoxetine (Prozac) or citalopram (Celexa).

ADS can occur within hours or days of stopping or reducing the antidepressant dose, depending on the half-life of the drug. The symptoms usually last for a few days to a few weeks, but in some cases they can persist for months or even years. The severity and duration of the symptoms depend on several factors, such as the type and dose of the antidepressant, the length of time it was taken, the speed and method of discontinuation, the individual's genetic makeup and metabolism, and the presence of other medical or psychiatric conditions.

What are the symptoms of antidepressant discontinuation syndrome?

The symptoms of antidepressant discontinuation syndrome (ADS) can vary from person to person and from drug to drug. However, some common symptoms include:

- Flu-like symptoms: such as headache, nausea, vomiting, diarrhea, muscle pain, chills, sweating
- Neurological symptoms: such as dizziness, vertigo, balance problems
- Sensory symptoms: such as tingling sensations ("pins and needles"), electric shock-like sensations ("brain zaps"), visual disturbances
- Psychological symptoms: such as anxiety, irritability, mood swings, insomnia, nightmares, depersonalization (feeling detached from oneself), derealization (feeling that the world is unreal), confusion, memory loss, difficulty concentrating, reduced interest or pleasure in activities
- Return of depression or anxiety symptoms: such as low mood, hopelessness, guilt, worthlessness, suicidal thoughts or actions, excessive worry, panic attacks, phobias

The symptoms usually start within hours or days of stopping or reducing the antidepressant dose, and last for a few days to a few weeks. However, in some cases they can persist for months or even years. The severity and duration of the symptoms depend on several factors, such as the type and dose of the antidepressant, the length of time it was taken, the speed and method of discontinuation, the individual's genetic makeup and metabolism, and the presence of other medical or psychiatric conditions. 

How to prevent and treat antidepressant discontinuation syndrome?

The best way to prevent ADS is to avoid stopping or reducing the antidepressant dose abruptly or without consulting a doctor. If a person needs or wants to discontinue an antidepressant, they should follow these steps:

- Talk to their doctor about the reasons, benefits, and risks of discontinuing the antidepressant, and discuss alternative treatment options if needed.
- Plan a gradual and individualized tapering schedule with their doctor, depending on the type and dose of the antidepressant, the length of time it was taken, and the person's response to the medication. The tapering process may take from several weeks to several months, depending on the situation. Generally, the longer the person has been taking the antidepressant, the slower the tapering should be.
- Monitor their symptoms and mood during the tapering process, and report any changes or difficulties to their doctor. The doctor may adjust the tapering schedule or prescribe another medication to help ease the transition or manage any withdrawal symptoms.
- Seek support from family, friends, or mental health professionals during the discontinuation process, especially if they experience emotional distress or suicidal thoughts. They may also benefit from psychotherapy, self-help groups, or online resources that can provide information and guidance on coping with ADS.

If a person experiences ADS despite following a tapering schedule, they should not panic or resume their previous dose without consulting their doctor. Instead, they should:

- Contact their doctor as soon as possible and inform them of their symptoms. The doctor may advise them to reinstate a lower dose of the antidepressant or switch to another medication with a longer half-life (such as fluoxetine) that can be tapered more easily.
- Take over-the-counter medications or supplements that may help with some of the physical symptoms of ADS, such as painkillers for headache or muscle pain, antihistamines for nausea or itching, or melatonin for insomnia. However, they should check with their doctor before taking any new medications or supplements, as some of them may interact with their antidepressant or worsen their symptoms.
- Practice self-care strategies that can help with some of the psychological symptoms of ADS, such as relaxation techniques for anxiety, mindfulness exercises for depersonalization or derealization, cognitive behavioral therapy for negative thoughts, or distraction activities for boredom or irritability.
- Seek emergency medical attention if they experience severe or life-threatening symptoms of ADS, such as seizures, hallucinations, delirium, mania, or suicidal behavior.

Conclusion

Antidepressants are effective and safe medications that can help many people with mental health conditions. However, they can also cause a condition called antidepressant discontinuation syndrome (ADS) if they are stopped abruptly or tapered too quickly. ADS can cause various physical and psychological symptoms that can be distressing and impairing. ADS can be prevented and treated by following a gradual and individualized tapering schedule under the guidance of a doctor, monitoring one's symptoms and mood during the discontinuation process, seeking support from others during the transition period, and taking medications or practicing self-care strategies to manage any withdrawal symptoms. ADS is not a sign of addiction or weakness, but a normal physiological reaction to a sudden change in brain chemistry. With proper planning and care, people can successfully discontinue their antidepressants without experiencing significant discomfort or complications.

Sources:
(1) Discontinuing antidepressant medications in adults - UpToDate. https://www.uptodate.com/contents/discontinuing-antidepressant-medications-in-adults.
(2) Antidepressant Discontinuation Syndrome | AAFP. https://www.aafp.org/pubs/afp/issues/2006/0801/p449.html.
(3) Going Off Antidepressants - Harvard Health Publishing - Harvard Health. https://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants.
(4) Coming off antidepressants: Timeline and symptoms - Medical News Today. https://www.medicalnewstoday.com/articles/how-long-after-stopping-antidepressants-before-i-feel-normal-again.
(5) Antidepressant discontinuation syndrome - Wikipedia. https://en.wikipedia.org/wiki/Antidepressant_discontinuation_syndrome.