Vortioxetine
Atypical antidepressants
Atypical antidepressants
A 'multimodal' antidepressant: it blocks serotonin reuptake and acts on several serotonin receptors. Nausea is the main early side effect.
Quick facts
- Group
- Atypical antidepressants
- Target
- Serotonin transporter (SERT); also 5-HT3, 5-HT7 and 5-HT1D receptors (antagonist) and 5-HT1A and 5-HT1B (partial agonist); the 5-HT3A receptor is shown
- Used for
- Major depressive disorder in adults
- Key effects
- Nausea and vomiting · Constipation · Unusual dreams
- Monitor
- Mood and suicidal thoughts · Bleeding
- ATC
- N06AX26
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows vortioxetine bound to the extracellular domain of the human 5-HT3A receptor, one of the serotonin receptors it blocks.
Vortioxetine is a potent inhibitor of the serotonin transporter, as SSRIs are, and also acts directly on serotonin receptors: it is a partial agonist at 5-HT1A and 5-HT1B receptors and an antagonist at 5-HT1D, 5-HT3 and 5-HT7 receptors. The antidepressant effect builds over weeks.
- Blocks the serotonin transporter (like an SSRI)
- Blocks 5-HT3, 5-HT7 and 5-HT1D receptors
- Partial agonist at 5-HT1A and 5-HT1B receptors
- Mood improves over several weeks
Indications
- Major depressive disorder in adults Major depressive disorder →
Adverse effects
Common
- Nausea and vomiting
- Constipation
- Unusual dreams
- Sexual problems (lower libido, delayed orgasm or ejaculation)
Contraindications
- MAO inhibitors (including linezolid and intravenous methylene blue) now or within two weeks
- Hypersensitivity to vortioxetine
Key interactions
- MAO inhibitors
- Serotonin syndrome; at least 21 days must pass after stopping vortioxetine before an MAOI is started.
- St John's wort, tryptophan and other serotonergic drugs
- Higher risk of serotonin syndrome.
- Alcohol
- Worse side effects.
What is monitored
- Mood and suicidal thoughts, especially in the first months
- Bleeding, particularly with anticoagulants or antiplatelets
- Symptoms of serotonin syndrome when other serotonergic drugs are added
Administration and safety
- Oral tablet once a day at about the same time.
- Not stopped abruptly: headache, mood change, dizziness or tingling can follow.
- The dose is changed only by the prescriber.
Pregnancy and breastfeeding
Pregnancy or plans for pregnancy are discussed with the prescriber, weighing untreated depression against drug exposure.
Nursing care
- Before: ask about MAOI use, bleeding problems and seizures.
- During: ask about nausea (usually early) and sexual side effects, which can lead to stopping.
- Watch mood and suicidal thoughts; involve family.
- Teach the signs of serotonin syndrome and of angle-closure glaucoma.
Pharmacokinetics
- Absorption
- Oral tablet, once a day, with or without food.
- Onset and duration
- Full benefit may take several weeks.
Test yourself
Think of the answer, then tap the question to see it.
Why is vortioxetine called 'multimodal'?
It inhibits the serotonin transporter and also acts directly on several serotonin receptors (antagonist at 5-HT3, 5-HT7, 5-HT1D; partial agonist at 5-HT1A and 5-HT1B).
What is its most common early side effect?
Nausea.
How long must one wait after stopping vortioxetine before starting an MAO inhibitor?
At least 21 days.
Connections
← Back to the class: Atypical antidepressants
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Vortioxetine: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); Human serotonin 5-HT3A receptor in complex with vortioxetine (nanodiscs, ECD, active/distorted conformation) (RCSB Protein Data Bank, 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.