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#1 Patti100



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Posted 11 July 2017 - 11:55 PM

I obviously need a medication though I am loathe to take any!  This is the latest the psychiatrist has given me. (after Lexapro which caused migraines and Effexor which caused severe heart palpitations) (I have a fib so do not need anything that causes heart problems)  I have researched Viibryd and it seems scarier than cymbalta or effexor.   Thoughts?

#2 gail


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    5 months on cymbalta, scary side effects, to get help and to return the favor if I can.

Posted 12 July 2017 - 06:54 AM

Hi Patti,

Vybrid is a a SSRI contrary to effexor or cymbalta that are SNRI's.

I prefer those with long half lives like Zoloft or Prozac though. Easier to get off. Vybrid has a 25 half life, not bad. We don't have many that are on it though. I can't pronounce myself.

I can only say, give it a try! others will chime in later. The worst to get off are cymbalta, effexor and paxil, by the way.

#3 fishinghat


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Posted 12 July 2017 - 08:14 AM

Gail's assessment is correct. I have some additional info below that I thought you might be interested in.


FDA drug insert.

Can cause severe nausea, diarrhea, etc. Take with food.

2.5 Discontinuing Treatment with VIIBRYD
Adverse reactions may occur upon discontinuation of VIIBRYD [see Warnings and Precautions (5.5)]. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible. VIIBRYD should be down tapered from the 40 mg once daily dose to 20 mg once daily for 4 days, followed by 10 mg once daily for 3 days. Patients taking VIIBRYD 20 mg once daily should be tapered to 10 mg once daily for 7 days.

5.3 Increased Risk of Bleeding
Drugs that interfere with serotonin reuptake inhibition, including VIIBRYD, increase the risk of bleeding events. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), other antiplatelet drugs, warfarin, and other anticoagulants may add to this risk. Case reports and epidemiological studies (case-control and cohort design) have demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Bleeding events related to drugs that interfere with serotonin reuptake have ranged from ecchymosis, hematoma, epistaxis, and petechiae to life-threatening hemorrhages.

Inform patients about the risk of bleeding associated with the concomitant use of VIIBRYD and antiplatelet agents or anticoagulants. For patients taking warfarin, carefully monitor coagulation indices when initiating, titrating, or discontinuing VIIBRYD.

5.4 Activation of Mania or Hypomania
In patients with bipolar disorder, treating a depressive episode with VIIBRYD or another antidepressant may precipitate a mixed/manic episode. In controlled clinical trials, patients with bipolar disorder were excluded; however, symptoms of mania or hypomania were reported in 0.1% of undiagnosed patients treated with VIIBRYD. Prior to initiating treatment with VIIBRYD, screen patients for any personal or family history of bipolar disorder, mania, or hypomania [see Dosage and Administration (2.2)].

5.5 Discontinuation Syndrome
Adverse reactions after discontinuation of serotonergic antidepressants, particularly after abrupt discontinuation, include: nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, such as electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, hypomania, tinnitus, and seizures. A gradual reduction in dosage rather than abrupt cessation is recommended whenever possible [see Dosage and Administration (2.5)].

6.1 Clinical Trials Experience
Other adverse reactions observed in clinical studies
Cardiac disorders: infrequent: ventricular extrasystoles

Reports of adverse reactions temporally associated with VIIBRYD that have been received since market introduction and that are not listed above include the following:
General Disorders and Administration Site Conditions: irritability
Nervous System Disorders: sleep paralysis
Psychiatric Disorders: hallucinations, suicide attempt, suicidal ideation
Skin and subcutaneous tissue disorders: rash, generalized rash, urticaria, drug eruption
Gastrointestinal System: acute pancreatitis

8.1 Pregnancy
Risk Summary
See drug insert for detaiked risk during pregnancy.

5. Discontinuation symptoms. Do not suddenly stop VIIBRYD without first talking to your healthcare provider. Stopping VIIBRYD suddenly may cause serious symptoms including:
⦁ flu-like symptoms such as headache, sweating, and nausea
⦁ anxiety, high or low mood, irritability, feeling restless or sleepy
⦁ dizziness, electric shock-like sensations, tremor, confusion
If your healthcare provider decides that you should stop taking VIIBRYD, your healthcare provider should slowly decrease (taper) your dose.


#4 fishinghat


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Posted 12 July 2017 - 09:17 AM

You really need to read through this as addition al warnings have been issued and additional studies have been performed as follows.


FDA approved this drug in Jan 2011

Long-term administration of the antidepressant vilazodone modulates rat brain monoaminergic systems.
Vilazodone has high affinity for the human 5-hydroxytryptamine1A (h5-HT1A) receptor and for the serotonin transporter (5-HTT). A previous in vivo microdialysis experiment showed that a single administration of vilazodone, dose-dependently increases extracellular 5-HT but not norepinephrine (NE) or dopamine (DA) levels in rat medial prefrontal cortex and ventral hippocampus. The effects of vilazodone on monoaminergic systems were assessed using single-unit extracellular recordings and microiontophoresis in the rat brain. Following depletion of 5-HT with para-chlorophenylalanine methyl-ester hydrochloride (PCPA), vilazodone still suppressed neuronal firing of dorsal raphe nucleus (DRN) 5-HT neurons to a similar extent than controls, indicating that this inhibition is via 5-HT1A receptors activation.

Efficacy and Safety of Vilazodone in Patients With Generalized Anxiety Disorder: A Randomized, Double-Blind, Placebo-Controlled, Flexible-Dose Trial.
Treatment-emergent adverse events reported in ≥ 5% of vilazodone patients and at least twice the rate of placebo were nausea, diarrhea, dizziness, fatigue, delayed ejaculation, and erectile dysfunction.
Statistically significant differences in favor of vilazodone 20-40 mg/d versus placebo were seen on all measures of anxiety and functional impairment in patients with GAD. Vilazodone was generally well tolerated, and no new safety concerns were noted.

Relative efficacy and tolerability of vortioxetine versus selected antidepressants by indirect comparisons of similar clinical studies.
Vortioxetine offers a comparable or favorable combination of efficacy (measured by MADRS/HAM-D assessments) and tolerability (measured by withdrawal rate due to adverse events) versus other antidepressants in registration studies in MDD.

Vortioxetine for major depressive disorder: An indirect comparison with duloxetine, escitalopram, levomilnacipran, sertraline, venlafaxine, and vilazodone, using number needed to treat, number needed to harm, and likelihood to be helped or harmed.
discontinuation because of an adverse event vs. placebo were 25 (17-51), 31 (19-92), 19 (14-27), 7 (5-12), 8 (7-11), 27 (15-104), and 43 (28-91)(Vortioxetine), respectively. Values contrasting response vs. discontinuation because of an adverse event were 4.3, 4.6, 1.8, 1.2, 1.4, 3.3, and 5.1(Vortioxetine), respectively.

Note - This means it has the highest dropout rate due to adverse events, mostly digestive).

Breakthrough seizures after starting vilazodone for depression.
Note - Occurs infrequently for nearly all ssri/snri.

Vilazodone: another novel atypical antidepressant drug.
This article reviews the novel atypical antidepressant drug vilazodone (Viibryd(™)), which was approved by the U.S. Food and Drug Administration in January 2011 for the treatment of major depression. Vilazodone is a dual-acting antidepressant drug, with a primary mechanism of action of blocking the serotonin reuptake transporter together with acting as a 5-HT1A receptor partial agonist. The antidepressant efficacy of vilazodone was established in two 8-week placebo-controlled studies. One long-term (52-week) open-label study has been conducted. The most common side effects are diarrhea, nausea, and headache. The drug has not been studied in pediatric patients or well studied in patients older than 65. Vilazodone is efficacious, safe, and well tolerated, but does not appear to have major efficacy advantages compared with other antidepressant drugs. However, because of its unique pharmacology and relatively benign tolerability profile, it may be a more effective alternative for patients who do not respond to or cannot tolerate currently available antidepressant drugs.

Vilazodone lacks proarrhythmogenic potential in healthy participants: a thorough ECG study.
Vilazodone had no significant effect on cardiac repolarization, heart rate, PR or QRS interval duration, or ECG morphology in healthy adult participants.

Evidence for efficacy and tolerability of vilazodone in the treatment of major depressive disorder: a randomized, double-blind, placebo-controlled trial.
Treatment-emergent adverse events with vilazodone included diarrhea, nausea, and somnolence; most adverse events were of mild or moderate intensity.
Vilazodone is effective for the treatment of MDD in adults, with symptom relief starting at 1 week, and is well tolerated at a dose of 40 mg/day.

User Reviews for Viibryd
The following information is NOT intended to endorse drugs or recommend therapy. While these reviews might be helpful, they are not a substitute for the expertise, skill, knowledge and judgement of healthcare practitioners in patient care.
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On September 6, 2016, the FDA wrote a letter to Forest Labs about Viibryd. New warnings will be added to the Viibryd label related to a link between the drug and acute pancreatitis. Acute pancreatitis can lead to serious injury and even death. Pancreatitis, especially if it reoccurs, can lead to pancreatic cancer, which is almost always fatal.
Additionally, it is expected that new warnings related to sleep paralysis will also added to the Viibryd label and prescribing information. Sleep paralysis is a condition in which a person is awake but cannot move or speak. Generally, sleep paralysis occurs upon waking and lasts less than one minute. Although sleep paralysis is a serious condition, and can cause psychological harm in the most severe cases, the condition is generally not life threatening.

After a one-year, open-label study assessing the safety and tolerability of vilazodone in people with major depressive disorder, the most common adverse effects were diarrhea (35.7%), nausea (31.6%), and headache (20.0%); greater than 90% of these adverse effects were mild or moderate.[8] Whereas in randomized controlled trials these rates were 28%, 23.4% and 13.3%, respectively.[8] In contrast to other SSRIs currently on the market, initial clinical trials showed that vilazodone did not cause significant decreased sexual desire/function as with many other antidepressants, which often cause people to abandon their use.[4]

Stopping vilazodone abruptly may result in one or more of the following withdrawal symptoms: irritability, nausea, feeling dizzy, vomiting, nightmares, headache, and/or paresthesias (prickling, tingling sensation on the skin).

#5 Patti100



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Posted 12 July 2017 - 04:22 PM

Thank you Gail and FishingHat. Will read those studies you listed FishingHat. Thank you

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