# Trintellix



## Bill Cosby (Feb 1, 2017)

Has anyone tried this, and would care to share their experiences? I got prescribed it yesterday.


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## Gillman fan (Sep 24, 2016)

I am sorry that you have the misfortune to have a doctor who is proud to believe that by prescribing the "latest" most "advanced" medicines they are doing you a great service.

Trintillex is basically a standard SSRI that also tickles some of your other receptors more specifically. You will notice benefit faster than other SSRIs because it is hitting serotonin receptor 1A. The problem is that this particular receptor develops a VERY RAPID tolerance to any type of direct stimulation. And most trintillex patients also experience pretty severe nausea, my doctor would routinely prescribe an anti-nausea drug that is actually an anti-psychotic with rather restricted application.

So it kicks in with a "serenic" effect that is different than an untargeted serotonin boost, plus nausea. Then both effects wear off quickly. Basically in the long run it is no better or worse than a standard SSRI, except for the drug company and the insurance company paying your bills.

This is an example of drug companies promoting the latest "on patent" drug without any proof it is more effective than older drugs, and doctors swallow it up because of clever presentations and marketing that make a convincing case on why the drug "should" work well given that it is a state of the art example of rational medicine design.

Here is Dr. Gillman's writeup (the real Dr. Gillman): 
http://www.psychotropical.com/vortioxetine


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## watertouch (Nov 4, 2013)

^Interesting, the betablocker Pindolol is sometimes used for its effect on 5HT1A, to speed up or enhence the effect of SRIs.


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## Bill Cosby (Feb 1, 2017)

Gillman fan said:


> I am sorry that you have the misfortune to have a doctor who is proud to believe that by prescribing the "latest" most "advanced" medicines they are doing you a great service.
> 
> Trintillex is basically a standard SSRI that also tickles some of your other receptors more specifically. You will notice benefit faster than other SSRIs because it is hitting serotonin receptor 1A. The problem is that this particular receptor develops a VERY RAPID tolerance to any type of direct stimulation. And most trintillex patients also experience pretty severe nausea, my doctor would routinely prescribe an anti-nausea drug that is actually an anti-psychotic with rather restricted application.
> 
> ...


I've taken Lexapro, Effexor, and Luvox, as well as St. John's and 5-HtP. Honestly, I just want something that works. I don't care if it's been on the market for a day, or for decades. I hate having apathy, lethargy, and low energy.


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## Caedmon (Dec 14, 2003)

Gillman fan said:


> Trintillex is basically a standard SSRI that also tickles some of your other receptors more specifically. You will notice benefit faster than other SSRIs because it is hitting serotonin receptor 1A. The problem is that this particular receptor develops a VERY RAPID tolerance to any type of direct stimulation.


That's very interesting about 5ht1a receptors. I hadn't heard about that, but it does make logical sense. Why can nothing be simple, haha.


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## Gillman fan (Sep 24, 2016)

OP:


bobbindy47 said:


> I hate having apathy, lethargy, and low energy.


SSRIs are one of the worst drugs you can take for apathy. I mean, I don't mean to spoil your drug trial. Maybe it works perfectly and you never need to come to these forums again. A minority of people have these symptoms improve because of SSRIs. BUT let me mention how psychiatry tends to work.

Most people come in to see a psychiatrist, and if they don't present with something like psychosis they will walk out of the door with a script for an SSRI. Usually what the patient says during the meeting doesn't matter, the outcome is usually the same: Rx SSRI,

Apathy is deeply tied in to how SSRIs work. It isn't a "side effect." It is the reliable and predictable result when you hit serotonin receptor 2C with more than it is used to. For many people, apathy is almost part of the treatment. They come in to the first meeting complaining about various things to the doctor. After a few weeks, they come in to the doctor and they don't have anything to complain about! :clap

Some of the posts I have read in these forums have been both funny and sad. One poster explained that she felt very apathetic, and admitted this was a problem, but somehow she couldn't find any reason to be bothered by this. Apathy begets apathy.Also I think that people who are susceptible to apathy experience greater sexual side effects on SSRIs.

I have experienced this side effect myself, I am quite susceptible to it and it is one of the symptoms I hope to treat. SSRI apathy, at its best, is sort of a serene "I feel wonderful, I don't care" sort of apathy instead of a depressive "I feel like sh*t, I don't care" apathy.

Anyway what I am saying may not translate into direct advice for you - for now. Do your drug trial as your doctor instructed you. You might just be one of the rare lucky winners who does great with SSRIs with no side effects. BUT if your apathy gets worse, the next time you talk to your doctor you need to be assertive. Common practice is just to keep on writing prescriptions for different SSRIs. Don't let your Dr. do this.

Two meds that may improve your depression and apathy at the same time are Wellbutrin and Nortriptyline. Nortriptyline is great at dealing with SSRI side effects in general.


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## Gillman fan (Sep 24, 2016)

Also Caedmon - how are you doing? Haven't seen you around much. What is your dosage of Parnate at?


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## Bill Cosby (Feb 1, 2017)

Gillman fan said:


> OP:
> 
> SSRIs are one of the worst drugs you can take for apathy. I mean, I don't mean to spoil your drug trial. Maybe it works perfectly and you never need to come to these forums again. A minority of people have these symptoms improve because of SSRIs. BUT let me mention how psychiatry tends to work.
> 
> ...


I have days where I wake up and I feel great, days where I feel depressed and hate everything about myself, and days where I just don't care about anything. If I talk to my doc, he'll find another prescription. It'll be like checking off meds from a list, and keep experimenting until we reach something. I've found caffeine brought my ambition, smile, and cockiness back. What do I do?


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## jaiho (Feb 14, 2015)

I think SSRIs can be useful but only with augmentation strategies, like Zoloft + Wellbutrin or Zoloft + Nortriptyline.
As Gillman says, Sertraline is the only SSRI that's really worth using considering it increases dopamine and has evidence for efficiency matching the TCAs.

It still remains to be seen how good Trintellix is. The 5ht1a agonist mechanism can be good for sexual side effects (Because it reduces SERT binding to 50 % ) 
5ht1a agonism is a good thing, especially with 5ht2a/c antagonism.


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## User5 (Jun 22, 2010)

Been on Trintellix for three weeks. Began at 5mg, now at 10. Have begun to feel motivated, more social and less anxious. Nausea and vertigo were a slight issue, but that's getting better. Thus doesn't feel like the SSRIs I've tried (Zoloft and Paxil which made me feeling nothing).

So far so good, but, as others have mentioned, Trintellix is prone to poop out fast.


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## SFC01 (Feb 10, 2016)

bobbindy47 said:


> I have days where I wake up and I feel great, days where I feel depressed and hate everything about myself, and days where I just don't care about anything. If I talk to my doc, he'll find another prescription. It'll be like checking off meds from a list, and keep experimenting until we reach something. I've found caffeine brought my ambition, smile, and cockiness back. What do I do?


If caffiene helps then would imagine something like wellbutrin or nortriptyline may be useful for you ? You can always tell the GP you dont like the side effects of trintellex and switch quicker.


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## Bill Cosby (Feb 1, 2017)

Thanks for the replies. I've only been on the med for 4 days. I can't say that any of these side effects are caused by medication yet. I'll meet by doc in 2 weeks, so hopefully I'll notice something then.


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## Gillman fan (Sep 24, 2016)

Trintillex also had a great start for me, and I have had a total non-response to other SSRIs. I will say that 5ht1a agonism has a different "feel" than the general SERT boost from an SSRI... I remember very distinctly having the serene and empathogenic 5ht1a feeling poop out and a much number feeling take over completely within the space of a few weeks. It simply wasn't the same med I started out on.

Jaiho may be right the 5ht1a agonism provides a marginal advantage, and I also agree that an SSRI + augment is a good strategy. All in all, trintillex isn't a terrible med and might be somewhat better than other SSRIs, I guess I just wanted to point out how far it falls short of the puffery and marketing used to hawk it. 

5ht1a agonism kicks in quickly and it feels damn good, it is the closest you can (legally) come to an experience like MDMA. You will enjoy this part! Just be aware that the drug may function differently over time.... just keep watch and have self awareness of your symptoms past the first two weeks, when it might feel like Trintillex is delivering a miracle.


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## Caedmon (Dec 14, 2003)

Gillman fan said:


> Also Caedmon - how are you doing? Haven't seen you around much. What is your dosage of Parnate at?


I am well, thanks! I am on 50 mg Parnate. I'm so ready for springtime and longer days. I may try planting peas again this year.


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## User5 (Jun 22, 2010)

Gillman fan said:


> Trintillex also had a great start for me, and I have had a total non-response to other SSRIs. I will say that 5ht1a agonism has a different "feel" than the general SERT boost from an SSRI... I remember very distinctly having the serene and empathogenic 5ht1a feeling poop out and a much number feeling take over completely within the space of a few weeks. It simply wasn't the same med I started out on.
> 
> Jaiho may be right the 5ht1a agonism provides a marginal advantage, and I also agree that an SSRI + augment is a good strategy. All in all, trintillex isn't a terrible med and might be somewhat better than other SSRIs, I guess I just wanted to point out how far it falls short of the puffery and marketing used to hawk it.
> 
> 5ht1a agonism kicks in quickly and it feels damn good, it is the closest you can (legally) come to an experience like MDMA. You will enjoy this part! Just be aware that the drug may function differently over time.... just keep watch and have self awareness of your symptoms past the first two weeks, when it might feel like Trintillex is delivering a miracle.


You're definitely not alone with the sudden drop in effectiveness.


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## bintuae (Feb 25, 2012)

Drugs affect each person differently. For me, Trintellix was just like the other SSRIs: apathy, complete loss of libido, no motivation, etc. At 20 mg, it's even worse (gave me confidence tho). threw the remaining boxes in the trash.


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## naes (Nov 1, 2013)

I was just put on it. So far nada.


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## naes (Nov 1, 2013)

jaiho said:


> I think SSRIs can be useful but only with augmentation strategies, like Zoloft + Wellbutrin or Zoloft + Nortriptyline.
> As Gillman says, Sertraline is the only SSRI that's really worth using considering it increases dopamine and has evidence for efficiency matching the TCAs.
> 
> It still remains to be seen how good Trintellix is. *The 5ht1a agonist mechanism can be good for sexual side effects (Because it reduces SERT binding to 50 % )
> 5ht1a agonism is a good thing, especially with 5ht2a/c antagonism.*


Is it good for sexual side effects because it is a partial agonist? Also, what does 5ht2a/c do? And where are you learning all this?


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## jaiho (Feb 14, 2015)

naes said:


> Is it good for sexual side effects because it is a partial agonist? Also, what does 5ht2a/c do? And where are you learning all this?


By excessive googling and reading neuropharmacology papers :grin2:

http://psychopharmacologyinstitute....ceptors/#The_mechanism_of_action_of_buspirone
Buspirone is a 5ht1a agonist and can explain what that function does.

https://www.ncbi.nlm.nih.gov/pubmed/16433010
https://selfhacked.com/2015/07/25/5-ht2c/
5HT2C receptors

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC446220/
http://www.nature.com/npp/journal/v28/n2/full/1300057a.html
5HT2A receptors


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## DarkHoarse (May 17, 2017)

This was the last SSRI I took. It surprisingly didn't give me a feeling of apathy and lethargy like most other SSRI's gave me, but didn't give me any relief from anxiety or depression either. The strange thing is that it gave me a really weird side effect; I had muscle aches. It would come randomly, usually when I would tense a muscle at first. Eventually it got to the point I had really weird pain in my arm muscles from simply brushing my teeth. Keep in mind, this was just my experience; apparently some people really respond well to Trintellix.


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## genetictestingfan (Sep 1, 2017)

*Anxiety stable, 2 yrs on Trintellix after genetic testing*

I have a had a very successful experience with Trintellix.

It was prescribed to me by my psychiatrist after genetic testing revealed that I do not metabolize most SSRIs effectively (a result, med by med, which squares with my treatment history).

I had the expected nausea for a few weeks and it resolved. I also had monstrous headaches when we tried titrating up from 10mg to 15mg. The headaches resolved when we went back to 10 mg.

I have had no other side effects.

I take it at bedtime.

It has changed my life.

I would not have tried it without the genetic testing - I am done taking any med for which genetic testing is available if I have not been tested for that med. No amount of pitching by a doc, patient or company will ever influence my decision-making again until I have the genetic information when it is available.

What works for you may not work for me or anyone else on this forum. And vice versa. GET TESTED!
we do not need to waste our tine on someone else's guesses about what will work for us,


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## sadness (May 9, 2006)

genetictestingfan said:


> I have a had a very successful experience with Trintellix.
> 
> It was prescribed to me by my psychiatrist after genetic testing revealed that I do not metabolize most SSRIs effectively (a result, med by med, which squares with my treatment history).
> 
> ...


Did you get Genesight testing? I only had 3 anti depressants that showed up on the "use as directed" column.


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## Maslow (Dec 24, 2003)

Trintellix doesn't have the sexual dysfunction associated with SSRIs. That alone makes it worth looking into.


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## ladysmurf (Jan 3, 2012)

i can't really understand why some people say this is the best SSRI ever , that it's better than the older SSRI's..it did nothing for me.


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## ladysmurf (Jan 3, 2012)

Maslow said:


> Trintellix doesn't have the sexual dysfunction associated with SSRIs. That alone makes it worth looking into.


yes its partly atypical or something..


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