This week at Ruby Mental Wellness, we’re exploring the world beyond SSRIs and SNRIs — focusing on atypical antidepressants and tricyclics. These options include Viibryd (vilazodone), Trintellix (vortioxetine), Wellbutrin (bupropion), and the Tricyclic Antidepressants (TCAs).
🧠 How These Medications Work
- Viibryd (Vilazodone): Increases serotonin like SSRIs but also partially stimulates serotonin receptors. Think of it as giving serotonin a boost and a nudge to do its job better.
- Trintellix (Vortioxetine): Enhances serotonin levels and fine-tunes how serotonin receptors respond — potentially helpful for cognitive fog.
- Wellbutrin (Bupropion): Works on dopamine and norepinephrine. It’s energizing, boosts focus, and is less likely to cause sexual side effects. Classically not recommended for anxiety, but some patients do very well with it. Also used off-label for ADHD.
- Tricyclics (e.g., amitriptyline, nortriptyline): Affect serotonin and norepinephrine. These are older medications that still work well, especially when sleep or pain is a major concern.
🧩 Why We Might Choose One Over Another:
- Viibryd: Great option when SSRIs cause sexual side effects or if anxiety is also present.
- Trintellix: Helpful for people who feel foggy or mentally slowed by depression. Also tends to have fewer sexual side effects.
- Wellbutrin: Best for people dealing with fatigue, low motivation, or attention issues. A good choice when SSRIs cause sedation or sexual dysfunction.
- TCAs: Considered when someone also has chronic pain, migraines, or sleep disturbances.
💡 Clinical Pearls:
- Wellbutrin can be stimulating and may increase anxiety in some — but for others, it’s just what they need.
- Viibryd and Trintellix are often chosen for their better sexual side effect profiles.
- TCAs can be very helpful for physical symptoms but need more monitoring (due to heart effects, sedation, etc).
⚠️ Common Side Effects and Tips to Manage Them:
- Viibryd: May cause stomach upset — always take it with food.
- Trintellix: Can cause nausea or headaches — try taking it at night or with a light snack.
- Wellbutrin: May cause insomnia, dry mouth, or anxiety — take it earlier in the day and drink plenty of water.
- TCAs: Can lead to dry mouth, weight gain, constipation, and drowsiness — stay hydrated, eat fiber-rich foods, and take at bedtime.
🗣️ Important Topics to Discuss with Your Provider:
- Any history of seizures (especially before starting Wellbutrin)
- Concerns about sexual side effects or weight gain
- If you have chronic pain, migraines, or sleep issues
- If past medications caused overstimulation or jitteriness
🎯 Key Takeaway: Not all antidepressants work the same — and that’s a good thing. These alternatives can be tailored to your unique symptoms, needs, and side effect concerns. At Ruby Mental Wellness, we’ll help you find the right fit with care and intention.