My experience of taking medications and some side effects and notes about Vortioxetine (Brintellix, Trintellix, Fonksera), Lamotrigine (Lamictal) and Olanzapine (Ferzapine)
Published Jan 13, 2025 by Zhymabek Roman
...
DANGER
everyone is different
Everyone is different! You may have different drug interaction, so please do not take my own experience seriously. In order to compensate this I would add my personal findings, with sources, so you would able to critically analyze results and make some conclusions by yourself. Be safe.
not doctor
I'M NOT A DOCTOR, I'm just trying to save some of you some of the confusion / frustration I've experienced. Reddit
My life mess in few sentences
Before starting, I would say that I had a rough childhood and adulthood. I was a very shy person, actually. I didn't have friends, not even neighborhood friends with whom I would be able to have some fun time.
So it continued in school, where I was abused by my classmates, had a very rough relationship with teachers, and overall had a very bad experience studying. After moving to a different school, I became more self-aware. I was very passionate about studying and always tried to push myself to my boundaries. By the way, about boundaries, these were influenced by my father. Besides that, something was hard to accomplish: communication. Thinking from my current perspective, I now believe it was more just anxiety.
And that continued until the third year of college. At that time, one girl wanted to see me as a boyfriend; in other words, she liked me. I tried to be a romantic partner, but I wasn't able to be. I were on the verge of giving up on my life. We might have been more in platonic relationship. Of course, after three years, she dumped me and gave me a compliment - I think a bad compliment that I'm not stable. That's the reason why she doesn't want to be with me.
So I started really working on myself. First was my mental health. I got an appointment with my psychiatrist, who prescribed my first medication - the antidepressant Brintellix.
So I'm here, where we're going to talk about my journey.
Personal experience
I'm (21M) taking 20mg of Brintellix since September 2024, the beginning of my treatment. This is my first medication for my mixed chronic anxiety-depressive disorder (MADD), which has been present throughout my conscious life. I'm now in approximately the third month of treatment. Apart from some initial nausea during the first few days and drowsiness in the first hour after taking the medication, I've been feeling generally stable and fine. My social anxiety has decreased, and I've become more able to interact with people without excessive overthinking. The only issue I'm experienced is difficulty concentrating on tasks at work. As a programmer, concentration is crucial for my professional performance.
After discussing my concentration problems with my psychiatrist, she prescribed 50mg Lamictal as an additional therapy to be taken alongside Brintellix. That really helpd me to just sit down and focus at something one. After some digging I thought maybe increasing to 100mg is going to be good idea. After that I increased up to 150-200mg. Some day passed and I start to notice some cognitive problem, like memory recalling issues. so I was very scared. Some stydies and sources says that Anticonvulsant mood stabilizers medicine could cause cognitive impairment. But other sources says that it's actually can improve or doesn't has side effect
After time I tried to taper off from Lamothrigine, by just taking 50mg, but next morning I got compulsive thoughts, and the are all mostly negative situatuins, mos of them arem't finished things, relationships and etc. So yeah, I immediately got back to 150mg. Cognitivie problem still hitting me. After some consideration I got a theoery - maybe that's from a bad sleep? Because I had before taking any medication really bad problem sleeping, after taking it it's worsen.
Psychiatrist prescribed me for that Phenazepam. For non post Soviet union peoples that medicine says probably nothing, because I couldn't find much evidence of usage in Reddit, so alternative medications are Clonezepam and Lorezepam for the rest of the world. In nutshell it was first developed benzodiazepine medicine in the USSR. Btw All benzodiazepine medicines has one major side effects, it's long term medicine addiction.
After taking Phenazepam, my sleep really improved. And alngwith ogition and memory! So my theory that bad sleep can cause cognitive problem is get confirm. But actually I was asking myself why it's affecting so aggresevly? I didn't had it before. So I came across this Reddit comment, with confirms that sleep and Lamthrogine has very tight connection with cognition. If you have a depression you suppose to get full rest from sleep, but by taking Lamotrigine be extra carefull about your sleep habit
I've noticed that the cognitive effects of lamotrigine are amplified when I don't sleep well. There is a bit of aphasia going on and a slight memory hit. Both have lessened over time. It's nothing that prevents me from being functional at work (systems architect). It actually helps my attention span and processingof information. On it for a little over two years. 250mg. [...]
So let's talk about folic acid. Genually, it's deficency can lead to depression. So I were taking Folic Acid, as prescribed me dermatologist based on my blood analysis. Now warning - Folic acid decreases when taking lamictal, that mentioned in pregnancy warning. But also taking folic acid alongside with lamictal decreases medication efficency or has some therapeftic effect. This one doesn't mentioned even in drugs.com on both medication interaction information. Btw Lamotrigine initially was designed to inhibit folic acid .
The mechanism of lamotrigine is not exactly known; the drug was developed as an antagonist of folic acid, but this effect was found to be weak. It is assumed that it stabilizes the neuronal membranes by affecting the sodium channels and blocks the excess release of excitatory amino acids (mainly glutamate) without reducing its normal release.
Lamotrigine has a slight inhibitory effect on dihydrofolic acid reductase and could therefore theoretically lead to an increased risk of embryofoetal damage by reducing folic acid levels. Intake of folic acid when planning pregnancy and during early pregnancy may be considered.
Folic acid did not add additional benefit for the treatment of depression. In a post hoc analysis, the subgroup of subjects that received lamotrigine and placebo had improvement compared to the groups receiving both placebos or placebo and folic acid, while the subgroup of subjects that received lamotrigine and folic acid did not have this differential improvement. This raises the question of whether folic acid supplementation may have interfered with the therapeutic action of lamotrigine in this trial.
The results suggest that folic acid supplementation may interfere with the therapeutic action of lamotrigine.
(lion mane effects - https://www.reddit.com/r/LionsManeRecovery/comments/1i3q38i/low_motivation_anhedonia/)
(add about grapefruit Brintellix overdosing) (add about expirience of spliting tablets into a half. other people expirience: https://www.reddit.com/r/trintellix/s/Ag3GJPacPb) (Most SSRI and SNRI (like cymbalta) will cause some form of tremor in long term use: https://www.reddit.com/r/EssentialTremor/comments/11qhpdt/comment/jc3fw7p/?utm_source=share&utm_medium=mweb3x&utm_name=mweb3xcss&utm_term=1&utm_content=share_button) ()
(add about ketosis - YouTube)
Also do not forget to hydrate. From personal expirience it's just helps me stabilize my mood.
https://www.askapatient.com/viewrating.asp?drug=204447&name=TRINTELLIX
Antidepressants (SSRI, SNRI, multimodal)
(about info that antidepressant may increase suicidal thoughts)
Vortioxetine (Brintellix, Trintellix, Fonksera)
Multimodal antidepressant, that
Why there is so many names? Is that generic of the medication?
Vortioxetine was previously sold under the brand name Brintellix in the United States, but in May 2016, the US Food and Drug Administration (FDA) approved a name change to Trintellix in order to avoid confusion with the blood-thinning medication Brilinta (ticagrelor). Other brand names include Torvox, Vantaxa, Voxigain, and Trivoxetin. In Europe, the name was changed from Brintellix to Fonksera, so vortioxetine can be called Brintellix, Trintellix, and Fonksera, depending on where you are.
About generic around thing... This is going to be drama
...
Benefits
- Effectiveness in Anxiety-Depression Comorbidity: Research indicates that vortioxetine can be effective for patients with major depressive disorder (MDD) who also experience high levels of anxiety. In a clinical trial, patients treated with vortioxetine showed significant improvements in both depressive and anxiety symptoms compared to those receiving other treatments like escitalopram or desvenlafaxine12.
Risks, Side effects
-
Potential Risks for Standalone Anxiety Disorders: While vortioxetine may benefit those with anxiety and depression, its strong affinity for NAT might exacerbate symptoms in individuals suffering from standalone anxiety disorders or generalized anxiety disorder (GAD). This is particularly relevant for patients with low levels of SERT, NAT, and DAT, where the modulation of norepinephrine could potentially worsen anxiety symptoms32.
-
PSSD - Post-SSRI sexual disorder: maybe common adverse effect of antidepressants.
Overdose
Vortioxetine is metabolized by cytochrome P450 enzymes4. Consuming enzyme-inhibiting medications or foods like Curcumin, Ginger, and grapefruit, may significantly increase medication dosage 5.
Olanzapine (brand name - Zyprexa)
- [[Olanzapine is an atypical antipsychotic that may be used to treat adults and adolescents aged 13 and older with schizophrenia or bipolar I disorder. For bipolar I disorder, it may be used:
- alone for manic or mixed episodes, or in combination with lithium or valproate
-
with fluoxetine for depressive episodes in people aged 10 and older
-
Olanzapine is marketed in a fixed-dose combination with fluoxetine as olanzapine/fluoxetine (Symbyax), which was approved by the US FDA for the treatment of depressive episodes of bipolar I disorder in 2003 and for treatment-resistant depression in 200967. ]{}]
Mood stabilizers:
Lithium
Lamictal
- One has to be extra careful when starting Lamictal and adjusting the dose. It’s essential to follow the instructions and make sure not to miss the dose of the medication as that can be very detrimental to the treatment and can cause serious side effects, including having a seizure. source
- Lamictal is an FDA-approved medication used to treat seizure disorders like epilepsy along with mood disorders such as bipolar. It’s also used off-label — meaning the FDA hasn’t approved it but may effectively treat — unipolar depression (also known as a major depressive episode). source
- Some recent research shows that Lamictal might be a good option for people with persistent depressive disorder (PDD) — also known as dysthymic disorder — when other antidepressants or forms of treatment haven’t helped. Other studies suggest Lamictal can significantly improve treatment-resistant unipolar depression. source
- While it’s not FDA-approved for anxiety treatment, in one study, Lamictal showed promising results in reducing stress and symptoms of chronic anxiety. More research is needed, but a Lamictal or Lamotrigine dose might be an effective off-label anxiety treatment option for some people. source
- A secondary analysis suggested that folic acid administration might dampen lamotrigine's antidepressant effect. The researchers concluded that the combination of lamotrigine and folate should be avoided, and cautioned about the potential effect of widespread folic acid fortification on lamotrigine's efficacy. source
- Lamictal and vortioxetine Interactions - Drugs.com
Grapefruit and SSRI interaction
Other antidepressants effect has ingredients
Spravato (esketamine)
nasal spray for treatment-resistant depression and with suicidal thoughts or actions for adults (? why adults)
Dextromethorphan
- Repurposing of dextromethorphan as an adjunct therapy in patients with major depressive disorder: a randomised, group sequential adaptive design, controlled clinical trial protocol | Селективные ингибиторы обратного захвата серотонина и Декстрометорфан при Сильное депрессивное расстройство - Реестр клинических исследований - ICH GCP
- An Ingredient in Cough Syrup Could Work as an Antidepressant
Auvelity (Dextromethorphan/bupropion)
Антидепресант ногового поколения. Предназначен для борьбы с большой депрессией. Approved only in US by FDA. Manual replication in homemade possible situation: Декстрометорфан (DXM) + Бупропион (Auvelity) - Страница 2 - Антидепрессанты
Фолиевая кислота в качестве дополнительной терапии к СИОЗС/СИОЗСН при большом депрессивном расстройстве
В анализе 5 исследований у пациентов с депрессией, получавших дополнительную терапию l-метилфолатом/фолиевой кислотой выявлены значительно более низкие баллы по шкале оценки депрессии Гамильтона (HAM-D), а также комбинированные баллы HAM-D и Beck Depression Inventory-II (BDI-II). Эта дополнительная терапия также привела к улучшенному ответу, увеличению скорости наступления эффекта, и снижению показателей депрессии в зависимости от продолжительности лечения. - Source: Folate as adjunct therapy to SSRI/SNRI for major depressive disorder: Systematic review & meta-analysis - PubMed
-
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9889909/ ↩
-
https://pubmed.ncbi.nlm.nih.gov/39313879/ ↩
-
https://pubmed.ncbi.nlm.nih.gov/29189941/ ↩
-
https://www.cambridge.org/core/journals/cns-spectrums/article/poor-mans-vortioxetine/300A58531C94D15C6B6474A852656FAD ↩
-
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6b28c424-0b7e-4b75-b090-f116b113554e ↩
-
https://en.m.wikipedia.org/wiki/Olanzapine ↩