Brintellix is vortioxetine, an antidepressant used for major depressive disorder. It comes as 5 mg, 10 mg and 20 mg tablets. Its distinguishing feature is an effect on the cognitive symptoms of depression — the poor concentration and mental fog that often persist after mood improves.
What is Brintellix?
The South African Medicine Price Registry lists Brintellix as Schedule 5 tablets containing vortioxetine hydrobromide at 5 mg, 10 mg and 20 mg.
Vortioxetine is described as a multimodal antidepressant, and the description is accurate rather than marketing. Most antidepressants work in one way: SSRIs block the reuptake of serotonin, SNRIs block serotonin and noradrenaline.
Vortioxetine does that and acts directly on several serotonin receptor subtypes — blocking some, stimulating others. The downstream effect is that it influences not only serotonin but also noradrenaline, dopamine, acetylcholine, histamine and glutamate signalling in parts of the brain.
Two practical consequences follow from that broader action:
Cognitive symptoms. Depression impairs concentration, memory, processing speed and decision-making, and these frequently persist after mood has lifted — leaving people unable to work properly while technically “better”. Vortioxetine has trial evidence for improving these cognitive symptoms, and that evidence appears at least partly independent of its effect on mood. That is unusual, and it is the main reason a prescriber chooses it.
Sexual side effects. These are common with SSRIs, frequently persistent, frequently not discussed, and a leading reason people stop antidepressants without telling anyone. Vortioxetine has a lower rate of them, which for some people is decisive.
The three strengths reflect dose adjustment. Treatment usually starts at 10 mg, with 5 mg used in older patients or where side effects are troublesome, and 20 mg where more effect is needed.
What is Brintellix commonly used for?
- Major depressive disorder — its registered use, in adults.
- Depression with prominent cognitive symptoms — poor concentration, mental fog, slowed thinking. This is where it is most often chosen deliberately.
- Depression where sexual side effects have been a problem on a previous antidepressant.
- Depression in older adults, where its side effect profile and cognitive effects are relevant.
- Anxiety symptoms accompanying depression.
- Switching from another antidepressant that has not worked or has not been tolerated.
Three things shape whether treatment succeeds, and they apply to every antidepressant:
It takes weeks. Sleep, appetite and energy often improve first, at two to four weeks; mood typically lifts by four to six; full benefit can take eight to twelve. The first fortnight is when side effects have arrived and benefit has not — which is exactly when people stop.
It works better alongside therapy than alone, for most people.
Do not stop when you feel better. Treatment normally continues for at least six months after recovery, and longer after repeated episodes. Stopping early is among the most reliable predictors of relapse.
How Brintellix fits into this medicine category
| Group | Examples | Where it fits |
|---|---|---|
| Multimodal antidepressants | Vortioxetine (Brintellix) | Depression, particularly with cognitive symptoms; fewer sexual side effects |
| SSRIs | Fluoxetine, escitalopram, sertraline | First-line; well established; sexual side effects common |
| SNRIs | Venlafaxine, duloxetine | Depression, anxiety, some nerve pain |
| Tricyclics | Amitriptyline (Trepiline) | Depression and nerve pain; more side effects |
| Mirtazapine | Mirtazapine | Depression with poor sleep and appetite |
| Sleep agents | Zolpidem and related | Short-term insomnia |
Antidepressants differ more in side effects and tolerability than in average effectiveness, which is why a poor experience with one does not predict a poor experience with another. See the mental health and neurology medicines hub.
What to check before using Brintellix
Tell your doctor if you have ever had a manic episode, or been diagnosed with bipolar disorder. An antidepressant given alone in bipolar disorder can trigger mania. This is among the most important questions before starting any antidepressant, and it is easily missed if nobody asks.
Also tell your doctor or pharmacist if you:
- Take MAOI antidepressants, or have taken one recently — this combination is dangerous and requires a washout period.
- Take tramadol, triptans for migraine, lithium, other antidepressants, or St John’s wort — all raise the risk of serotonin syndrome in combination.
- Take warfarin, aspirin or anti-inflammatories. Antidepressants affecting serotonin also affect platelets, raising bleeding risk.
- Take bupropion, quinidine, fluoxetine or paroxetine, which raise vortioxetine levels, or rifampicin, carbamazepine or phenytoin, which lower them.
- Have epilepsy, liver or kidney disease, or a bleeding disorder.
- Have low sodium, or take diuretics — antidepressants can lower sodium, particularly in older people.
- Have glaucoma.
- Are pregnant, planning pregnancy or breastfeeding. Untreated depression in pregnancy carries its own risks, so this is a discussion rather than an automatic stop.
- Are under 25. There is a small increased risk of suicidal thoughts early in treatment in younger people, which is why close monitoring in the first weeks matters.
Practical points: take it once daily at the same time, with or without food; do not stop abruptly without advice; avoid alcohol, at least early on; do not drive until you know how it affects you; and make sure someone knows you have started, so they can notice changes you may not.
Possible cautions and when to ask a pharmacist or doctor
The commonest effect by a clear margin is nausea, particularly in the first weeks and at higher doses. It usually settles, and taking the tablet with food helps. Others include headache, dizziness, dry mouth, constipation, diarrhoea, itching and abnormal dreams.
Sexual side effects occur less often than with SSRIs but are not absent. If they happen, say so — they are a legitimate reason to adjust treatment, not something to endure or to stop quietly over.
Get emergency help for:
- Serotonin syndrome — agitation, confusion, fever, sweating, shivering, muscle twitching, a racing heart. More likely when another serotonergic medicine has been added.
- Thoughts of harming yourself, or a sudden worsening of mood. Most likely in the first weeks and in younger people — tell someone immediately and seek help the same day.
- A manic episode — elevated mood, racing thoughts, greatly reduced need for sleep, risky behaviour.
- Seizures.
- Unusual bruising or bleeding, black stools, or vomiting blood.
- Confusion, marked drowsiness, headache with nausea, or unsteadiness — possible low sodium, more common in older people.
- Swelling of the face, lips or tongue, difficulty breathing, or a blistering rash.
Contact your doctor if there is no improvement after four to six weeks at a proper dose, if side effects are not settling, if nausea is preventing you eating, if you are thinking of stopping, or if you feel worse rather than better. There are many antidepressants, and that conversation belongs with a prescriber rather than happening by quietly stopping.
Related medicine guides
Frequently asked questions
What is Brintellix used for? Major depressive disorder in adults. It contains vortioxetine, and it is often chosen where cognitive symptoms — poor concentration and mental fog — are prominent.
How is it different from an SSRI? It blocks serotonin reuptake and also acts directly on several serotonin receptors, affecting a wider range of brain signalling. In practice that means evidence for cognitive symptoms and fewer sexual side effects.
How long before it works? Sleep, appetite and energy often improve in two to four weeks; mood typically lifts by four to six, with full benefit taking up to twelve.
Is it addictive? No. It does not cause craving or dependence, though stopping abruptly can cause withdrawal symptoms.
Can I stop when I feel better? No. Treatment usually continues at least six months after recovery. Stopping early is a leading cause of relapse.
Why does it make me nauseous? Nausea is its commonest side effect, worst early on and at higher doses. Taking it with food helps, and it usually settles.
Will it affect my sex life? Less often than SSRIs, but it can. Tell your doctor if it does — it is a reason to adjust treatment, not to stop quietly.
Can I drink alcohol on it? Best avoided, particularly early on. Alcohol worsens depression and adds to drowsiness.