Can I take Effexor and Trintellix together?

This blog post will aim to answer whether the prescription drugs Effexor and Trintellix can be taken together or not. It will also explain what the two drugs are, how they can be used, their side effects and so on. Several experimental studies will be used to illustrate the facts.

Can I take Effexor and Trintellix together? 

Yes, you can take Effexor and Trintellix together.Effexor is a prescription drug which is medically known as Venlafaxine. It is an anti-depressant which uses selective serotonin and norepinephrine reuptake inhibitors to regulate mood and energy level. Trintellix is also known as Votrioxetine, and is also a medication used in treating depression. It does this by selective serotonin reuptake inhibitors. 

Description of Effexor

Effexor is a prescription medication that works to regulate your mood and energy levels. It may also decrease negative thoughts, anxieties, undesired fears and panic attacks. It works by trying to balance out the serotonin and norepinephrine hormone levels in your brain. 

It is generally administered to treat major depressive disorder, generalized anxiety disorder, panic disorder and social phobia. Effexor is consumed orally, in the form of a pill. It is usually administered in doses anywhere between 75 and 375 mgs, depending on the familiarity and severity of the case. 

The original version of Effexor was discontinued and replaced with the extended version called Effexor XR. The reason was because the original version required two or three doses per day, whereas the extended version required only one.

Side Effects of Effexor

• Loss of appetite
• Constipation
• Dry mouth
• Dizziness
• Sweating
• Sexual problems
• Increased risk of suicide
• Mania
• Serotonin syndrome

There have also been concerns that usage of Effexor can potentially harm a baby’s development in later stage pregnancy. 

Other Uses of Effexor

This medication can be used for multiple other conditions due to its serotonin and norepinephrine reuptake process. These include cataplexy (a type of muscular weakness), narcolepsy, attention deficit hyperactivity disorder and post traumatic stress disorder. Certain studies have shown a possible effect of Effexor in patients with obsessive compulsive disorder. 

Who should avoid Effexor?

If the patient shows a hypersensitivity towards the drug, then it is not recommended to continue using it. 

Similarly, those who experience allergic reactions to a few of its inactive ingredients such as gelatin, cellulose, iron oxide and titanium dioxide should avoid this prescription. Individuals with uncontrolled narrow-angle glaucoma, or take methylene blue injections might experience adverse reactions to Effexor.  

Description of Trintellix

Trintellix is a prescription medication that is used to treat major depressive disorder, by using Selective Serotonin Reuptake Inhibitors. It is also known as Vortioxetine or Brintellix, and is considered an atypical antidepressant, since it works in methods different to most antidepressants. 

It is used to improve mood, energy levels, sleep, appetite and possibly even increase interest in daily life. However, it is not usually recommended unless a few other antidepressants have shown little to no effect on the patient. It is an orally consumed pill and doses usually range between 5 to 20 mgs, based on need and effect. 

Side Effects of Trintellix

• Nausea
• Diarrhea
• Sexual side effects such as erectile dysfunction
• Vomiting
• Dry mouth
• Constipation 
• Dizziness
• Abnormal dreams
• Flatulence
• Itchy skin

Trintellix is recommended to be avoided during pregnancy as its effects on growing fetuses are currently unclear. It is also not recommended in use for children, as it can increase the risk of suicidal thoughts in children and adolescents. This phenomenon is not observed in adults however. 

Other uses of Trintellix

Trintellix has sometimes been used in the unapproved treatment of anxiety, even the few clinical studies have shown no correlation between administration of Trintellix and generalised anxiety disorder. Similarly, Trintellix can be used to treat obsessive compulsive disorder, but it is not approved or proven to be of use by clinical trials. 

Who should avoid Trintellix?

Trintellix should be avoided by patients who have used a MAO inhibitor in the past 14 days. Those who are allergic to the ingredients of vortioxetine should also avoid this prescription. Certain other prescriptions for migraines, Parkinson’s, etc. can interact with Trintellix and cause a severe adverse reaction, therefore total medical transparency with your doctor is recommended. 

Can Effexor and Trintellix be taken together?

Much research has been done on the effects of combination of drugs for regulating depression. Depression is a fairly common and serious condition that affects an individual’s self worth, mood, motivation and so on. Unfortunately, despite it being so prevalent depression is still not diagnosed as often as it should be. 

Therefore, those who require it do not receive treatment in the manner they need it. Antidepressants are used as a means of treatment, however they are not quick fixes. Most of them are not solely sufficient to alleviate the symptoms of depression. 

Each medication has its own effect and more often than not, more than one drug is used to treat the condition in hopes of a combined effect. This is called a “combination strategy”. They are differentiated by the enzyme inhibitory, uptake and receptor blocking processes these drugs trigger in the individual’s system. 

Antidepressant Combination Methods

Serotonergic strategy: 

Selective serotonin reuptake inhibitors are one of the most common forms of antidepressants. They can alleviate symptoms of mild and moderate depression, while also remaining relatively safe for use. They work by maintaining a level of serotonin in the brain, which is a hormone responsible for our mood. It does this by blocking the reabsorption of serotonin during neurosynaptic transmissions, thereby forcing it to remain in the brain. 

Some SSRIs approved by the Food and Drug Association of USA are Citalopram, Escitalopram, Fluoxetine, Paroxetine and Sertraline. Combining SSRIs with trazodone or nefazodone can be beneficial for individuals facing issues with aggression or insomnia, since excessive use of SSRIs can cause a spike in those issues. 

Noradrenergic strategy: 

Serotonin and norepinephrine reuptake inhibitors are another set of medications that aid in alleviating the symptoms of depression. They are also relatively common and are considered generally safe. They work by affecting brain chemistry and neurosynaptic transmissions. They inhibit and block the reabsorption of norepinephrine which would be in lower-than-required levels of function in the brain. 

By theory, combining a norepinephrine inhibitor, reboxetine or desipramine with bupropion, which is a norepinephrine and dopamine reuptake inhibitor/releaser can aid fatigue, apathy and mental and physical slowing. However, there have been no clinical studies to prove this yet.

Serotonergic and noradrenergic (and dopaminergic) strategy:

A study has shown longer remission periods when combining SSRI, fluoxetine and desipramine than alone, in patients with major depressive disorder. This may be because it activates multiple neurotransmitter systems, which might be required for a particular subset of patients of depression. 

Activating both serotonin and norepinephrine systems together can cause a stronger effect that would be beneficial to the patient. For example, combining the administration of the SSRI venlafaxine with mirtazapine can achieve this effect. 

Also, combining all three strategies has shown results as well. Administering bupropion-SR with the SSRI citalopram, showed changes in patients who had not responded to treatment of 6 weeks with either one of the strategies.  

A double-blind randomized study was conducted to observe the effects of combining norepinephrine and serotonin reuptake inhibitors to treat depression. The hypothesis was that the aforementioned combination would be more effective than either drug alone. Patients with nonpsychotic unipolar major depressive disorder were the subjects of this study. The patients were selected based on their scores on the Hamilton Depression Rating Scale. 

After a week of hospitalization, they were administered fluoxetine, desipramine under double-blind conditions (meaning both researchers and subjects did not know which patients had placebo and which had the drug). The results showed that the combination is at least nearly 50% more likely to go into remission than using either drug alone. 

However, with this one study alone we cannot claim that it is definitely more beneficial to use both Effexor and Trintellix together. Overuse of either of the two alone can trigger a rare but potentially dangerous side effect known as Serotonin Syndrome, but when combined that effect can be more likely. 

Serotonin syndrome is caused when there is an excess of serotonin in the system. Usually this is caused by one or a combination of medications. Serotonin is used in mood regulation, and in individuals with depression it is found to be low. But too much of it can lead to extreme cell activity which proves to be even fatal in some conditions. 

Symptoms include:

• Confusion
• Agitation or restlessness
• Dilated pupils
• Headache
• Changes in blood pressure and/or temperature
• Nausea 
• Vomiting
• Diarrhea
• Rapid heart rate
• Tremor
• Loss of muscle control or twitching muscles
• Shivering and goosebumps
• Heavy sweating

These symptoms are usually noticed a few hours after starting a new medication which affects serotonin levels.

The more serious symptoms are:

• Passing out
• Seizures
• High fever
• Uneven heartbeat

Some recreational drugs such as LSD and cocaine, as well as dietary supplements such as St. John’s wort and ginseng can cause serotonin syndrome when used in conjecture with antidepressants. Without treatment, serotonin syndrome can cause seizures, kidney failure, breathing trouble, coma and even death. 

Conclusion

While there lies much evidence to suggest that using both Effexor and Trintellix together can promote the processes that alleviate symptoms of depression, it is not a sure thing. Overuse of both can promote serotonin syndrome at an equal pace. Therefore, only consultation with a licensed doctor, transparent conversations and immediate informing of new developments or symptoms is the best method to determine whether either drug or both can be used to treat major depressive symptoms in an individual.

FAQ: Can I take Effexor and Trintellix together?

What is the difference between SSRIS and SNRIs?

SSRIs are selective serotonin reuptake inhibitors while SNRIs are serotonin norepinephrine reuptake inhibitors. Their uses, side effects and processes are very similar. They both inhibit the reuptake of specific neurotransmitters in the brain to alleviate the symptoms of depression. However, the major difference is that SSRIs work on serotonin whereas SNRIs work on norepinephrine as well. 

What does SR, XR and ER mean after a drug name?

These letters are used to indicate specific qualities of a particular drug. SR stands for “slow release” meaning the drug is released in the individual slowly and gradually, thereby creating more long-lasting effects. XR or ER stands for extended release, which means the drug is designed to last longer in the body. There are also CR (controlled release) and DR (delayed release).  

What are some other popular medications for depression?

Some of the most common medications for MDD are citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and sertraline (Zoloft).

Moret C. (2005). Combination/augmentation strategies for improving the treatment of depression. Neuropsychiatric disease and treatment, 1(4), 301–309.

Nelson JC, Mazure CM, Jatlow PI, Bowers MB Jr, Price LH. (2004). Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study. Current Medical Research and Opinion. 55(3), 296-300.