How Viibryd (Vilazodone) Works: The Science
Viibryd (Vilazodone): A Novel Antidepressant for Major Depressive Disorder
What it is
Viibryd (vilazodone) is a prescription medication that belongs to a class of drugs called serotonin modulators1. It is used to treat major depressive disorder (MDD), a condition characterized by persistent and severe low mood, loss of interest, and impaired functioning 2. Viibryd is taken orally once a day, usually with food 1.
History
Viibryd was developed by Merck KGaA, a German pharmaceutical company, under the code name EMD-68843 3. It was first tested in clinical trials in 2001, and showed promising results for the treatment of depression 3. In 2004, Merck KGaA licensed the drug to Clinical Data, Inc., a US biotechnology company, for further development and commercialization 3. In 2011, Viibryd was approved by the US Food and Drug Administration (FDA) as the first serotonin modulator for MDD1. In 2018, Viibryd was also approved by Health Canada for the same indication 4.
Mechanism of Action
Viibryd is considered both a selective serotonin reuptake inhibitor (SSRI) and a serotonin (5-HT1A) receptor partial agonist 1. Serotonin is a neurotransmitter that regulates mood, emotion, cognition, and other brain functions 5. SSRIs work by blocking the reabsorption of serotonin into nerve cells, thus increasing its availability in the brain 5. Serotonin receptor partial agonists work by stimulating certain types of serotonin receptors, which may enhance or modulate the effects of serotonin 5. The exact way that Viibryd works to treat depression is not fully understood, but it is thought to involve both mechanisms of action 1.
Evidence for use
1. In these trials, Viibryd was compared to placebo (a dummy pill) or other antidepressants over a period of 8 to 10 weeks. The primary outcome measure was the change in the Hamilton Depression Rating Scale (HAM-D), a tool that assesses the severity of depressive symptoms. The results showed that Viibryd was significantly more effective than placebo in reducing HAM-D scores in five out of seven trials. In two trials, Viibryd also showed comparable efficacy to Lexapro (escitalopram), another SSRI antidepressant.
Dosing
The recommended starting dose of Viibryd is 10 mg once daily for 7 days, followed by 20 mg once daily for 7 days, then increased to 40 mg once daily as the target dose1. The dose may be adjusted by the doctor based on the patient’s response and tolerance. The maximum dose of Viibryd is 40 mg per day. Viibryd should be taken with food to improve its absorption and reduce nausea1.
Side Effects/ Adverse reactions / Contradictions
Like all medications, Viibryd may cause side effects in some people. The most common side effects of Viibryd are nausea, diarrhea, vomiting, dizziness, trouble sleeping, decreased sexual interest or ability, and dry mouth 1 . These side effects are usually mild and tend to improve over time. However, some side effects may be serious and require medical attention. These include:
- Increased risk of suicidal thoughts or actions in children, adolescents, and young adults up to age 24. This risk is higher during the first few months of treatment or when the dose is changed. Patients and their caregivers should monitor for any changes in mood or behavior and report them to the doctor immediately 1 .
- Serotonin syndrome, a potentially life-threatening condition caused by too much serotonin in the body. This can occur when Viibryd is taken with other medications that affect serotonin levels, such as other antidepressants, migraine medications, opioid painkillers, herbal supplements, or illicit drugs. Symptoms of serotonin syndrome include agitation, confusion, hallucinations, fast heartbeat, high blood pressure, fever, sweating, tremors, muscle stiffness or twitching, nausea, vomiting, diarrhea, or loss of consciousness. Seek emergency medical help if you experience any of these symptoms while taking Viibryd1 .
- Bleeding problems, especially when Viibryd is taken with other medications that increase the risk of bleeding, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), blood thinners, or other antidepressants. Viibryd may affect the ability of the blood to clot, which can lead to easy bruising, bleeding gums, nosebleeds, heavy menstrual bleeding, or more serious bleeding events. Tell your doctor if you have any bleeding problems or if you notice any unusual bleeding while taking Viibryd 1 .
- Mania or hypomania, a condition characterized by abnormally elevated mood, energy, activity, or impulsivity. This can occur in people who have bipolar disorder (a mood disorder that involves alternating episodes of depression and mania) or who are at risk of developing it. Viibryd may trigger or worsen manic episodes in some people. Tell your doctor if you have a history of bipolar disorder or if you experience any signs of mania while taking Viibryd, such as racing thoughts, excessive talking, decreased need for sleep, reckless behavior, or extreme irritability 1 .
- Pancreatitis, a condition that causes inflammation of the pancreas, an organ that produces digestive enzymes and hormones. This can occur in rare cases when taking Viibryd. Symptoms of pancreatitis include severe abdominal pain, nausea, vomiting, fever, or jaundice (yellowing of the skin or eyes). Stop taking Viibryd and seek medical help if you develop any of these symptoms 1 .
- Syndrome of inappropriate antidiuretic hormone secretion (SIADH), a condition that causes the body to retain too much water and lower the level of sodium in the blood. This can occur in rare cases when taking Viibryd. Symptoms of SIADH include headache, confusion, weakness, muscle cramps, seizures, or coma. Tell your doctor if you have any of these symptoms while taking Viibryd 1 .
Viibryd is not suitable for everyone and may be contraindicated in some people. Do not take Viibryd if you:
- Are allergic to vilazodone or any of the ingredients in the medication 1.
- Have taken a monoamine oxidase inhibitor (MAOI) antidepressant in the past 14 days or plan to take one in the next 14 days. This can cause a dangerous drug interaction with Viibryd. MAOIs include isocarboxazid, linezolid, phenelzine, tranylcypromine, and others 1.
- Have taken methylene blue injection in the past 14 days or plan to take it in the next 14 days. This can also cause a dangerous drug interaction with Viibryd1 .
Before taking Viibryd, tell your doctor if you:
- Have liver or kidney problems1 .
- Have a bleeding or blood clotting disorder1 .
- Have narrow-angle glaucoma1 .
- Have seizures or epilepsy1 .
- Have sexual problems1 .
- Have a history of drug abuse or addiction1 .
- Have a history of suicidal thoughts or actions1 .
- Drink alcohol1 .
- Are pregnant, planning to become pregnant, or breastfeeding1 .
Also tell your doctor about all the medications, supplements, and herbal products that you are taking or plan to take, as some of them may interact with Viibryd and affect its effectiveness or safety.
Positives or Pros
Viibryd has some advantages over other antidepressants that may make it a better choice for some people. These include:
- Novel mechanism of action. Viibryd is the first antidepressant that combines SSRI and serotonin receptor partial agonist properties. This may offer a more comprehensive and balanced modulation of serotonin signaling in the brain than other antidepressants that only target one aspect of serotonin function.
- Less emotional blunting. Some antidepressants may cause emotional blunting, which is a reduced ability to experience positive and negative emotions. This can affect the quality of life and satisfaction with treatment for some people with depression. Viibryd may cause less emotional blunting than typical SSRIs and SNRIs due to its dual action on serotonin receptors.
- Less sexual dysfunction. Some antidepressants may cause sexual dysfunction, which is a decreased interest or ability to engage in sexual activity. This can affect the self-esteem and relationships of some people with depression. Viibryd may cause less sexual dysfunction than typical SSRIs and SNRIs due to its partial agonist effect on 5-HT1A receptors, which may counteract the inhibitory effect of increased serotonin levels on sexual function.
Negatives or Cons
Viibryd also has some disadvantages or limitations that may make it a less suitable option for some people. These include:
- High cost. Viibryd is a relatively new and patented drug, which means it is more expensive than older and generic antidepressants. The average retail price of Viibryd is about $400 per month, compared to about $10 per month for generic SSRIs. Although some insurance plans may cover part of the cost, many patients may still face high out-of-pocket expenses or copayments for Viibryd.
- Nausea. Viibryd is associated with a high rate of nausea, which is the most common reason for discontinuation of the drug. About 30% of patients who take Viibryd experience nausea, compared to about 10% of those who take placebo. Nausea usually occurs during the first few weeks of treatment and tends to decrease over time, but it can still be bothersome and interfere with adherence to the medication regimen. Taking Viibryd with food may help reduce nausea, but it may not eliminate it completely.
- Drug interactions. Viibryd can interact with many other medications that affect the levels or actions of serotonin or other neurotransmitters in the brain. These include other antidepressants, antipsychotics, mood stabilizers, anti-anxiety drugs, painkillers, migraine medications, herbal supplements, and illicit drugs. Some of these interactions can be dangerous and cause serious side effects such as serotonin syndrome or bleeding problems. Therefore, patients who take Viibryd should inform their doctor about all the medications they are taking or plan to take, and follow their doctor’s instructions carefully.
Conclusion
Viibryd is a novel antidepressant that has been shown to be effective for the treatment of major depressive disorder in adults. It has a unique mechanism of action that involves both inhibiting the reuptake of serotonin and stimulating certain serotonin receptors in the brain. It may have some benefits over other antidepressants in terms of causing less emotional blunting and sexual dysfunction. However, it also has some drawbacks such as high cost, nausea, and drug interactions. Therefore, the decision to use Viibryd should be based on a careful evaluation of the individual patient’s needs, preferences, and medical history, as well as a discussion with their doctor about the potential risks and benefits of the medication.
Sources:
- Viibryd (vilazodone) Prescribing Information. Forest Pharmaceuticals, Inc. Revised 01/2020.
- Major Depressive Disorder: Symptoms, Causes, and Treatment. WebMD. Updated 09/17/2019.
- Vilazodone: A Review in Major Depressive Disorder. Drugs. 2015;75(4):403-413.
- Viibryd (vilazodone) Product Monograph. Allergan Inc. Revised 07/31/2018.
- Vilazodone: A New Treatment Option for Major Depressive Disorder. The Mental Health Clinician. 2012;2(1):15-19.
- Sexual Dysfunction Associated With Antidepressant Treatment. Current Psychiatry Reports. 2019;21(11):106.
- Viibryd Prices, Coupons & Savings Tips. GoodRx. Accessed 08/23/2023.
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The Surprising Alternative for Depression: Atomoxetine Uncovered
What is Atomoxetine?
Atomoxetine is a non-stimulant medication that is primarily used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents, and adults. It is a selective norepinephrine reuptake inhibitor (SNRI), which means it works by increasing the levels of norepinephrine, a neurotransmitter involved in regulating attention, impulsivity, and hyperactivity.
While atomoxetine is currently approved by the U.S. Food and Drug Administration (FDA) for the treatment of ADHD, it is also being studied as a potential treatment option for Major Depressive Disorder (MDD). Research has shown that atomoxetine may have antidepressant effects, which could make it a valuable addition to the existing treatment options for MDD.
History of Atomoxetine
Atomoxetine, marketed under the brand name Strattera, was developed by Eli Lilly and Company in the late 1990s. Originally approved by the U.S. Food and Drug Administration (FDA) in 2002, atomoxetine was initially intended for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children, adolescents, and adults.
While atomoxetine was primarily developed as a non-stimulant alternative to traditional ADHD medications like methylphenidate and amphetamines, its unique mechanism of action also showed promise in treating other conditions. In 2008, the FDA approved the use of atomoxetine for the treatment of binge-eating disorder in adults, making it the first medication specifically approved for this condition.
Over the years, researchers have explored the potential of atomoxetine in various other psychiatric and neurological disorders, including major depressive disorder (MDD), anxiety disorders, and substance use disorders. However, the FDA has not yet approved atomoxetine for the treatment of MDD, although it has been studied extensively in this area.
Mechanism of Action
Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that works by blocking the reuptake of norepinephrine (noradrenaline) in the brain. Norepinephrine is a neurotransmitter that plays a crucial role in regulating mood, attention, and arousal.
The primary mechanism of action of atomoxetine involves inhibiting the presynaptic norepinephrine transporter (NET), which is responsible for reuptaking norepinephrine from the synaptic cleft back into the presynaptic neuron. By blocking this transporter, atomoxetine increases the availability of norepinephrine in the synaptic cleft, allowing it to bind to and activate postsynaptic norepinephrine receptors for a more extended period.
Norepinephrine is involved in various brain circuits and pathways, including the prefrontal cortex, which is responsible for executive functions such as attention, working memory, and cognitive control. By increasing norepinephrine levels in the prefrontal cortex, atomoxetine can improve these cognitive functions, which may contribute to its therapeutic effects in conditions like attention deficit hyperactivity disorder (ADHD) and major depressive disorder (MDD).
Additionally, norepinephrine plays a role in regulating mood and emotional processing through its interactions with other neurotransmitter systems, such as serotonin and dopamine. The increased availability of norepinephrine in the brain may also contribute to the antidepressant effects of atomoxetine by modulating these neurotransmitter systems and their associated neural circuits.
It's important to note that while atomoxetine primarily targets the norepinephrine system, it may also have indirect effects on other neurotransmitters and brain regions, contributing to its overall therapeutic effects.
Evidence for Use in Atomoxetine in Major Depressive Disorder
Atomoxetine has been studied in several clinical trials for its efficacy in treating major depressive disorder (MDD). The evidence suggests that atomoxetine may be an effective treatment option for adults with MDD, particularly in cases where traditional antidepressants have failed or are not well-tolerated.
In a randomized, double-blind, placebo-controlled study published in the Journal of Clinical Psychiatry, atomoxetine demonstrated significant improvement in depressive symptoms compared to placebo. The study involved 520 adults with MDD who were randomized to receive either atomoxetine or placebo for 10 weeks. The primary outcome measure was the change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to endpoint.
The results showed that atomoxetine was significantly more effective than placebo in reducing depressive symptoms, with a mean reduction in MADRS scores of 11.6 points for atomoxetine compared to 8.3 points for placebo (p < 0.001). Additionally, a higher proportion of patients receiving atomoxetine achieved remission (defined as a MADRS score ≤ 10) compared to those receiving placebo (28.6% vs. 17.3%, respectively; p < 0.001).
Another randomized, double-blind, placebo-controlled study published in the Journal of Affective Disorders evaluated the efficacy and safety of atomoxetine in adults with MDD who had an inadequate response to selective serotonin reuptake inhibitors (SSRIs). The study included 195 patients who were randomized to receive either atomoxetine or placebo as an adjunctive treatment to their existing SSRI therapy.
The results showed that adjunctive atomoxetine was significantly more effective than placebo in reducing depressive symptoms, as measured by the Hamilton Depression Rating Scale (HAM-D) and the Clinical Global Impressions-Severity (CGI-S) scale. The response rates (defined as a ≥ 50% reduction in HAM-D score) were 47.5% for atomoxetine and 31.3% for placebo (p = 0.018), and the remission rates (defined as a HAM-D score ≤ 7) were 28.8% for atomoxetine and 16.7% for placebo (p = 0.039).
These clinical trials provide evidence that atomoxetine may be an effective treatment option for adults with MDD, both as a monotherapy and as an adjunctive treatment to SSRIs. However, it is important to note that the studies were sponsored by the manufacturer of atomoxetine, which may introduce potential bias. Further independent research is needed to confirm these findings and to better understand the role of atomoxetine in the treatment of MDD.
Benefits vs Other Antidepressants
Atomoxetine offers some unique advantages compared to more commonly prescribed antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Unlike these medications that primarily target serotonin and norepinephrine, atomoxetine works by selectively inhibiting the reuptake of norepinephrine, a neurotransmitter involved in regulating mood, attention, and energy levels.
One key benefit of atomoxetine is its relatively favorable side effect profile. It is generally associated with fewer sexual side effects, such as decreased libido or difficulty achieving orgasm, which are common with SSRIs and SNRIs. Additionally, atomoxetine is less likely to cause weight gain, a common issue with many antidepressants.
In terms of efficacy, several studies have demonstrated that atomoxetine is effective in treating major depressive disorder (MDD), with response rates comparable to those of SSRIs and SNRIs. However, atomoxetine may have a slower onset of action, with some patients requiring several weeks to experience the full therapeutic effects.
Another advantage of atomoxetine is its lower risk of drug interactions compared to many other antidepressants. It does not significantly inhibit or induce the cytochrome P450 enzyme system, which is responsible for metabolizing many medications, reducing the potential for adverse drug interactions.
While atomoxetine is generally well-tolerated, it does have some unique side effects, such as increased blood pressure and heart rate, which may be a concern for patients with cardiovascular conditions. Additionally, atomoxetine may cause insomnia or other sleep disturbances in some individuals.
Overall, atomoxetine offers a valuable alternative for patients who have not responded well to or cannot tolerate other antidepressants, particularly those with concerns about sexual side effects or weight gain. Its unique mechanism of action and favorable side effect profile make it a viable option for treating MDD.
Dosing of Atomoxetine for MDD
Atomoxetine is typically started at a low dose and gradually increased to minimize side effects. The recommended starting dose for adults with MDD is 40 mg once daily. The dose can be increased in increments of 20 mg at weekly intervals, depending on the patient's response and tolerability.
The maximum recommended dose for MDD is 120 mg once daily. However, some patients may benefit from a lower dose of 80-100 mg per day.
For patients with hepatic impairment, the recommended starting dose is 40 mg every other day, which can be gradually increased based on tolerability and clinical response.
In the elderly population, a lower starting dose of 20-40 mg once daily is recommended, with slower dose titration due to potential age-related changes in drug clearance and increased sensitivity to adverse effects.
It is important to note that atomoxetine should be taken consistently, either in the morning or evening, and should not be taken with a high-fat meal, as it may decrease the absorption of the medication.
Side Effects and Adverse Reactions
Atomoxetine is generally well-tolerated, but like any medication, it can cause side effects. Some of the most common side effects associated with atomoxetine include:
- Decreased appetite
- Nausea or vomiting
- Dizziness
- Dry mouth
- Constipation
- Insomnia
- Fatigue
- Increased heart rate or blood pressure
While these side effects are typically mild and may subside with continued use, it's essential to inform your healthcare provider if they become persistent or severe.
In some cases, atomoxetine can cause more serious adverse reactions, including:
- Liver injury: Atomoxetine has been linked to rare cases of severe liver injury. Your healthcare provider will likely monitor your liver function through blood tests, especially during the first few months of treatment.
- Suicidal thoughts or behaviors: As with other antidepressants, atomoxetine carries a warning about the increased risk of suicidal thoughts or behaviors, particularly in children, adolescents, and young adults. It's crucial to monitor for any changes in mood, behavior, or thoughts of self-harm.
- Priapism: Atomoxetine has been associated with rare cases of prolonged and painful erections in males. If this occurs, seek immediate medical attention.
- Serious cardiovascular events: Atomoxetine can increase heart rate and blood pressure, which may increase the risk of serious cardiovascular events, such as stroke or heart attack, especially in patients with pre-existing cardiovascular conditions.
When discontinuing atomoxetine, it's essential to taper off the medication gradually under medical supervision to avoid discontinuation symptoms, such as:
- Increased anxiety
- Agitation
- Insomnia
- Fatigue
- Dizziness
- Nausea or vomiting
If you experience any concerning side effects or adverse reactions while taking atomoxetine, contact your healthcare provider immediately. They may need to adjust your dosage or consider alternative treatment options.
Contraindications and Precautions
Atomoxetine should not be used in patients with severe cardiovascular disorders, including uncontrolled hypertension, symptomatic coronary artery disease, or congestive heart failure. It is also contraindicated in patients with narrow-angle glaucoma or a history of hypersensitivity to atomoxetine or any of its components.
Atomoxetine should be used with caution in patients with the following conditions:
- Hypertension: Atomoxetine can increase blood pressure, so it should be used cautiously in patients with pre-existing hypertension or those at risk for developing hypertension.
- Tachycardia: Atomoxetine can increase heart rate, so it should be used cautiously in patients with pre-existing tachycardia or other cardiac arrhythmias.
- Liver disease: Atomoxetine is primarily metabolized by the liver, so it should be used cautiously in patients with hepatic impairment.
- Renal disease: Atomoxetine is eliminated through the kidneys, so it should be used cautiously in patients with renal impairment.
- Angle-closure glaucoma: Atomoxetine should be used cautiously in patients with angle-closure glaucoma or a history of glaucoma, as it can increase intraocular pressure.
Atomoxetine should be used cautiously in combination with other medications that can increase blood pressure, heart rate, or the risk of QT prolongation, such as monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and certain antipsychotics. It should also be used cautiously with medications that are metabolized by the cytochrome P450 2D6 enzyme system, as atomoxetine can inhibit this enzyme and increase the risk of adverse effects from these medications.
Positives and Advantages
Improved Concentration and Cognitive Function: One of the key advantages of atomoxetine is its ability to improve concentration, focus, and cognitive function. This can be particularly beneficial for individuals with Major Depressive Disorder (MDD) who often struggle with attention and executive functioning deficits.
- Weight Neutrality: Unlike many other antidepressant medications, atomoxetine is generally considered weight-neutral, meaning it does not typically cause significant weight gain or weight loss. This can be an important consideration for individuals who are concerned about the metabolic side effects of certain antidepressants.
- Safety in Overdose: Atomoxetine has a relatively low risk of severe adverse effects in cases of overdose compared to some other antidepressants. This can provide reassurance for individuals who may be at risk for intentional or unintentional overdose.
- Minimal Sedation: Atomoxetine is less likely to cause sedation or drowsiness compared to many other antidepressants, which can be advantageous for individuals who need to remain alert and productive during the day.
Potential Neuroprotective Effects: Some research suggests that atomoxetine may have neuroprotective properties, meaning it could help protect brain cells from damage or degeneration. This could be beneficial for individuals with MDD, as the condition has been associated with structural and functional changes in the brain.
Negatives and Disadvantages
Despite the potential benefits of atomoxetine for the treatment of major depressive disorder (MDD), there are several negatives and disadvantages associated with its use that should be considered:
- Delayed Onset of Action: One of the primary drawbacks of atomoxetine is its delayed onset of action. Unlike many other antidepressants, which can start showing effects within a few weeks, atomoxetine may take several weeks or even months to achieve its full therapeutic effect. This delayed response can be frustrating for patients seeking relief from their depressive symptoms.
- Cost and Availability: Atomoxetine is generally more expensive than many other antidepressant medications, which can be a significant barrier for some patients, especially those without adequate insurance coverage or financial resources. Additionally, atomoxetine may not be readily available in all regions or countries, limiting access for some patients.
- Need for Monitoring: Atomoxetine requires regular monitoring of vital signs, such as blood pressure and heart rate, particularly during the initial treatment phase and when dosage adjustments are made. This added monitoring can be inconvenient for patients and may increase the overall cost of treatment.
- Potential for Abuse and Dependence: Although the risk is relatively low, there is a potential for abuse and dependence with atomoxetine, particularly in individuals with a history of substance abuse or addiction. Careful monitoring and management are necessary to minimize this risk.
- Interactions with Other Medications: Atomoxetine can interact with certain medications, including some antidepressants, antipsychotics, and medications used to treat cardiovascular conditions. These interactions can potentially reduce the effectiveness of atomoxetine or increase the risk of adverse effects.
- Limited Long-Term Data: While atomoxetine has been studied extensively in the short-term, there is limited data on its long-term safety and efficacy in the treatment of MDD. This lack of long-term data can be a concern for patients requiring extended treatment.
It is essential for patients and healthcare providers to carefully weigh the potential negatives and disadvantages of atomoxetine against its potential benefits in the treatment of MDD. Open communication and regular monitoring can help mitigate some of these drawbacks and ensure safe and effective use of the medication.
Conclusion
Atomoxetine represents a unique approach to treating major depressive disorder by targeting the norepinephrine system rather than the more commonly targeted serotonin and dopamine systems. While the evidence supporting its efficacy is somewhat mixed compared to traditional antidepressants, it may offer benefits for certain patients, particularly those with comorbid ADHD or anxiety disorders.
Key advantages of atomoxetine include a lack of sexual side effects, low risk of weight gain, and a different mechanism of action that could prove useful for treatment-resistant depression. However, its potential for cardiovascular side effects, risk of liver injury, and relatively high cost may limit its widespread use.
As a non-controlled substance with low abuse potential, atomoxetine could also be a valuable option for patients with substance use disorders. Ongoing research is still needed to better define its place in therapy relative to other antidepressant medications and to identify potential subgroups of patients most likely to benefit.
Overall, while not a first-line treatment, atomoxetine represents a reasonable alternative or adjunctive option for managing major depression, particularly in patients who have not responded to or cannot tolerate traditional antidepressants. Its unique pharmacology warrants further study to optimize its clinical utility in this challenging psychiatric condition.
Atomoxetine, developed for ADHD, may ease depression symptoms. Discover its non-stimulant benefits, evidence, dosing, pros, cons, and side effects.
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