title: Vortioxetine: A multimodal antidepressant or another selective serotonin reuptake inhibitor?
abstract: OBJECTIVE
  The treatment of depressive disorders remains unsatisfactory for many patients with regard to efficacy and tolerability. Vortioxetine has been registered by regulatory authorities for the treatment of major depressive disorder. This paper aims to provide clinicians with a brief overview of vortioxetine and its place in treatment.
  
  
  CONCLUSIONS
  Vortioxetine is a serotonin reuptake inhibitor with additional serotonergic receptor effects of uncertain significance; hence, its classification as 'multimodal'. The half-life is about 2.75 days and steady state requires about 14 days. Metabolism is hepatic and involves cytochromes 2D6 and 3A4/5. Antidepressant efficacy in major depressive disorder has been established in registration studies, but the effectiveness of vortioxetine in 'real world' patients and in comparison to other antidepressants needs further investigation. The recommended dose range is 5-20 mg. Nausea, constipation and vomiting are the most common side effects. Sexual dysfunction may occur at higher doses but there appears to be low risk of weight gain and sedation. There is still much to learn about this drug, particularly whether it has unique characteristics in comparison to existing antidepressants. At present, vortioxetine can be considered as an antidepressant option in patients with established major depressive disorder who have not responded adequately to other antidepressants.
authors.affiliation: Monash University and Centre of Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia nicholas.keks@monash.edu.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Keks
authors.affiliation: Monash University, Eastern Health and Centre of Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Hope
authors.affiliation: Psychotropic Drug Advisory Service at the Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.
authors.forename: Christine
authors.initials: C
authors.lastname: Culhane
mesh_terms: D003865:Major Depressive Disorder / Q000188:drug therapy*; D006801:Humans; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D013440:Sulfides / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D000078784:Vortioxetine
chemical_list: D010879:Piperazines; D017367:Selective Serotonin Reuptake Inhibitors; D013440:Sulfides; D000078784:Vortioxetine
keywords: major depressive disorder; pharmacotherapy; vortioxetine