This month a new antidepressant came to market. Viibryd continues the trend of ever stranger new drug names (generic name vilazodone) and comes with the claim that it won’t lead to sexual dysfunction in the vast majority of users. Whether this turns out to be the case will likely determine whether Viibryd is a hugely popular new drug or just another strangely named addition to an already saturated field of SSRI type antidepressants. Viibryd is technically in a class of its own, having both serotonin reuptake properties and functioning as a post synaptic partial serotonin agonist.
The SSRI drugs prevent the reuptake of serotonin from the space between nerve endings, and lead to an increased concentration of serotonin in this space. Viibryd in addition to this function is a partial serotonin agonist. An agonist is any drug that simulates the activity of a chemical in the body. This additional function could at least in theory alter the usually side effects of an SSRI as well as alter its potential benefits.
In two relatively small studies Viibryd was found to be effective as an antidepressant, but had a very low incidence of sexual dysfunction. Specifically the incidence of orgasmic dysfunction in women and ejaculatory delay or dysfunction in men was less than 3% and very near the rates with placebo. The published rates of these side effects with all of the currently available SSRIs, including fluoxitine (Prozac), sertraline (Zoloft), paroxitine (Paxil) and others, as well as with the SNRIs like venlafaxine (Effexor) and Cymbalta are greater than 15%, and in my experience prescribing these drugs are even higher. By far the most common SSRI and venlafaxine side effects are various aspects of sexual dysfunction, especially orgasmic dysfunction. These are common enough and annoying enough that I often see patients in the office who have stopped their antidepressant medications because of their sexual dysfunction side effects.
The major factor that Viibryd is going to have to overcome is that there are several highly effective generic SSRI antidepressants on the market that are available on the discount pharmacy $4./ month offerings. As a branded antidepressant which will almost certainly be much higher priced Viibryd is going to have to show a clear benefit to gain traction in this highly competitive and saturated market. If Viibryd is found by patients and physicians to be as effective as the currently available SSRIs at treatment of depression, and really not cause orgasmic dysfunction in women and have a very low incidence of sexual dysfunction overall it is going to be a nice addition to our options for treatment of depression. I’ll reserve my judgement at this time, as prior releases of new SSRIs were touted as having lower likelyhood of these side effects. I remember the claim that Celexa side effects of sexual dysfunction were low, but in aftermarket experience Celexa (citalopram) turned out to cause only minimal if any less frequent sexual dysfunction that the SSRIs already on the market.
Viibryd is reported to have a bit higher incidence of gastrointestinal side effects than most of the SSRIs, and to avoid these side effects it is recommended that patients taper up fairly quickly in dosage. It will be interesting to see if this leads to taking an extra week or two for clinical efficacy. One of the issues we face in prescribing antidepressants in general is that they don’t work immediately, rather tend to take 2-4 weeks to start to help. Adding another week or two of ramp up in dosing may be a bit of a drawback to acceptance or Viibryd by patients. I expect the role of Viibryd to be as a second choice of an antidepressant in patients who experience bothersome sexual dysfunction on another SSRI, and Viibryd is tried as a way to avoid that problem.
Viibryd was developed by Clinical Data which was acquired by Forrest Laboratories earlier this year. Forrest also has Lexapro and Celexa as branded antidepressants, and is expected to make a big marketing push for this new product. From the surge of drug reps at my office it certainly seems like they are throwing all of their weight behind I’m anxious to see if Viibryd lives up to its marketing hype and really does work without causing sexual dysfunction. If so I expect it to be hugely successful. The market for antidepressants is huge, with Effexor and Cymbalta, two branded SNRIs having sales of over $2 billion annually. Expect the $1.1 billion Forrest paid for Clinical Data to be a bargain if Viibryd works as advertised. I plan to go slow and see how this all pans out.
I have been on Cymbalta 60 mg daily for 6 years with good results. However, the past 6 months I have noticed breakthrough depression and finally hit a wall 2 weeks ago with a major depressive episode that left me bedridden & sobbing for 5 days. My doctor prescribed Viibryd in addition to Cymbalta. I found the 10 mg to be very effective with relief of symptoms & no side effects, but the 20 mg made me irritable & sleepless. Is it common to prescribe a small dose of Viibryd with the max dose of Cymbalta? It seems to be working but I’m worried about it messing up my brain somehow.
Nikki: I have no experience with this type of regimen using Viibryd. Your psychiatrist likely has more experience, though with any new medication experience grows over time. DrP.
Ann: No specific data i kinow about regarding this but I can think of no reason Viibryd and alcohol should be really different from the other SSRIs. DrP.
Dr. Pullen,
After being on Lexapro for 2 years with non-existent libido as a side effect, my doctor switched me to Viibrid today. My concern is that I read that Viibrid should not be taken if you drink alcohol because it may intensify the effects of alcohol
(like other ssri’s) or worsen the depression. At home, I don’t drink often, but my husband and I have a vacation scheduled and I would like to be able to have a few drinks. I have been able to have a few drinks while taking Lexapro without a problem, so I am concerned about the worsening depression with Viibrid. Do you have any information on this?
Hi Dr. Pullen: So glad that I came upon your site. My therapist just suggested Viibryd to me as an alternative to Lithium.
I am now on a low dosage of Lithium and in conjunction take Prozac. At this point I’m looking for alternatives because of the weight gain that the Lithium has caused and continues to cause.
Have there been any scenarios where Viibryd was used as a supplemental, such as Abilify, with success? I’ve been trying to find a suitable med regimen for some time, with the primary goal of removing the Lithium.
Any thoughts would be appreciated. Thanks so much.
Kathey: Feedback like yours is interesting. As with all new medications the aftermarket experience of patients will get back to their prescribing physicians and help them modify their prescribing patterns based on patient feedback. DrP.
Dr. Pullen, What are Viibryd’s side effects? My doctor just took me off of Viibryd and put me back on Prozac. I have been on SSRI’s for 15 or so years and have tried almost all of them. I believe Viibryd was the worst for me. Side effects? I have lost my ability to have an orgasm on Viibryd. My appetite was out of control on Viibryd where this was never an issue before. I am mad at the world and everything sets me off. The name brand Prozac medicine has worked for me the best.
3-1/2 weeks on Viibryd. I’ve previously taken Prozac, Cymbalta, Lexapro, Zoloft, and comb. Zoloft & Lamictal. Much more energy, mood improving, sex drive has returned after more than a year hiatus. Only new neg.effect is some nausea when highest dose started, but mostly worn off already. Very pleased so far.
I’m finishing week 5 on Viibryd. I bottomed out with crying spells the first 4 weeks. I’ve been having hot flashes/ sweating and stomach upset. My doctor suggested I give it 3 more weeks since the first 2 weeks are low dosage. I am being treated for depression and have been on Prozac 40 mg for years. I did not complain of sexual dysfunction, so I wonder why he wanted to try me on something brand new and expensive.
jerry- no suggestions
I have been taking Viibryd for 10 weeks now. I was so excited at first because I didn’t have erectile dysfunction as I have had with a Cymbalta, Lexapro and a few others I’ve tried. Now, in my 10th week I have ED again. It’s weird because I noticed it coming on as my dosage was increased during my starter pack. Now, my ED causes me to ejaculate before I actually feel the orgasm. I have noticed a difference in my depression;however, ED is not an otpion if I am to continue taking anti depressants including Viibryd. Any solotuions?
I have been on Viibryd for over a month now and will have to discontinue it due to persistent nausea. I do have to say, the concept that there is no sexual dysfunction made me chuckle. My libido has dropped significantly since starting this. I hope it works for you all, but I was really disappointed with my experience.
Casey: This is a new med, I do not believe it has GAD indication from the FDA at this point, I think it’s too early in the aftermarked drug experience for many docs, myself included to have much feedback re anxiety and this med. Re other meds, you need to address that with your doctor.
Dr. P, I have been on Viibryd for about 7 weeks because I was having panic/anxiety Attacks almost everyday for months, having panic attacks also started to cause me to be depressed…So my doctor gave me Viibryd, For the most part it has worked great on the depression front but the last few days I’ve been back to having anxiety attacks. Is this medication suited to treat GAD or just depression? Without being too specific, should I be on an anti anxiety med also?? Thank You!
Gina, I cannot give you specific suggestions. You may want to consult a psychiatrist or your primary care doctor again. I do not usually combine an SNRI like Savella and an SSRI like Celexa. Maybe they will suggest adding a tiny dose on one of the later generation antipsychotics as that sometimes helps severe depression. Good luck.
I was on Celexia for years but was really feeling more depressed in the last couple of months (didn’t want to get out of bed or do anything) so my doctor switched me to this new antidepressant Viibryd. At the end of the second weeks of taking it, I am extremely depressed and am waking up crying in the middle of night remembering tragedies from the past. I am already on Savella for my chronic body pain & Fibromyalgia, and if the Viibryd doesn’t work, can anyone suggest a well known antidepressant for me? My insurance will not usually approve new antidepressants, only the tried and true which are also cheap in cost. I want to feel motivated again and not just barely making it through the day every day. Any suggestions, please?
Had to quit the Viibryd. Wasn’t doing anything after 8 weeks. Switching to Zoloft today. Going to AA meetings and setting a quit date – hoping that quitting the booze will help with the depression, anxiety and OCD. Good luck everyone!
Melissa. Suicide is a concern with all antidepressants. If you feel suicidal you need to see you doctor ASAP. Otherwise you are likely OK to stick with it for a while. Be sure to follow up with your doctor to discuss the medication efficacy.
I’ve been on Viibryd for three weeks now (one week at 10mg, one week at 20mg, and one week at 40mg). From what I’ve read, it seems like it takes a month for this medication to be fully effective. In the meantime, is it normal for me to be feeling more depressed? Is this my brain trying to adjust to the med?
Is it ok to take Oleptro and Viibryd together?
Dr. Pullen,
I appreciate your post about Viibryd and am glad I stumbled upon your website!
I was wondering if you have any information regarding taking Viibryd with other anti-depressants and mood stabilizers. I take Wellbutrin XL and small doses of Depakote, Lamictal and Klonopin. I am weaning off of Prozac and am on day eight of my sample pack of Viibryd.
So far, I’ve been sleepy, sluggish and a little zoned out. However, I seem calmer and a bit less depressed, though I’m still not motivated to do much.
I have Bipolar I, and I think I’ve tried nearly every antidepressant out there.
I would appreciate any thoughts, advice, etc.
Thanks again for offering information and guidance on your website!
Nina
Sy: I really cannot give specific individual advice in this forum. You need to discuss the transition from Lexapro to Viibryd with your doctor. In general when switching from one SSRI type med to another it is not necessary to taper one to go on another. Heart palpitations are not a common Lexapro side effect.
Thanks very much!
Hi Dr. Pullen. Thank you for this website! I was just given a sample trial of Viibryd by my doc and I am currently taking 10mg/day of lexapro which works good but I have a loss of libido. Do I need to slowly ween from lexapro while using the 10mg samples of viibryd? I know you can’t stop cold turkey with lexapro but my doc just said starting taking 10 mg/day of the new viibryd for 30 days and report back to him. Also, does lexapro cause heart palps? I have been getting them nightly for almost 1 month now and have been on lexapro for about 8 months now at the same 10 mg/day dosage. Thanks for your reply doc.
John, Alcohol has an inherent central nervous system depressant effect, and it can be very difficult to treat depression in heavy drinkers. Maybe you can get help with the alcohol issue and see if you do better? Good Luck.
Hi Dr. Pullen,
This drug has done little for me. It’s barely touched my depression, it’s helped a bit with the OCD, and it’s increased my anxiety. In the past several years, most SSRI’s have either not worked, or have made me feel anxious or ramped up. Mood stabilizers have done the same thing.
I drink too much and have had an alcohol problem for years. Could this be blocking the benefits?
Thanks very much!
John
Hi Dr. Pullen,
My husband just found this site for me after we were talking about the cost. He is apprehensive in spending $75/mo. on this drug. I believe I am your first to take Viibryd.
I have another week of the sample pack. I am finding the drug to be exactly what I was looking for. After a few years on Wellbutrin & dealing with higher anxiety & also vision changes (watery eyes/squinting) and then Buspar (which made me sleepy on higher doses & feel calm but in my own world). I used to notice that I’d almost want to get out of the house more on Buspar. I believe the generic Wellbutrin & Buspar both helped my sex drive.
Now with Viibryd, from day 1 I did have intestional upset. And I mean cramping too. That has since went away, & I’ve also been on an antibiotic for a week too, so I am going more frequently, but no pain. Wellbutrin was constipating, so the change is welcome. I suppose I would compare Viibryd to like taking quadruple the dose of Miralax daily. But again, the antibiotic might be helping that along.
I almost immediately felt relief with worry from day 1. I hadn’t weaned off Wellbutrin much & just jumped right in with Viibryd. I did notice a bit of the spaced out feeling that Wellbutrin would give in the beginning, but my 24/7 every min. of the day worry about my past cancer was now suddenly behind me. All the wasted energy into an OCD like obsession about cancer was gone. And here’s the cool part. After taking Wellbutrin for so long and actually in tune to the strange feelings in the frontal part of my brain on that drug, I began to notice on Viibryd that if negative thoughts were coming to mind that they were being absolutely blocked. I remember back to my college psych class when my professor drew on the board how SSRI’s work. All I can tell you is this is true. I can feel it working. Now I’ll still get feelings of anxiety and I have taken a Xanax (.25) daily. But it’s not anxious thoughts, it’s more just nerves now. I try to limit my caffeine intake, but I have to say that I am finally enjoying the natural alertness that coffee provides, because coffee and Wellbutrin do not mix. One thing I will mention about Wellbutrin is back when I was on my first round ever of zoloft (during chemo) and Wellbutrin (post chemo) I did feel the worries subside. But zoloft killed my sex drive & Wellbutrin made it better, but probably made my anxiety worse! My husband is even weaning off of Wellbutrin. I think it worked with appetite control & some focus (he and I are both a little ADD) but he is still so much easier frustrated. I know Wellbutrin doesn’t calm like SSRI’S do. I wish we can both afford Viibryd. He might be better on Celexa. He did fine on Prozac (during my chemo/stressful time for us) but he was way too laid back and gained weight. Another plus for Viibryd is less of a feeling of insomnia at night. But I still take 5mg. of ambien nightly. Wellbutrin is the ultimate alert drug, but doesn’t help with organization. With Viibryd, I am calm, focused, content, not one day of pms irritability, and I no longer dislike WA when the weather is gray. (we are not from here) I can find the good in life. I used to feel kind of an emotional flatness on Wellbutrin. With Viibryd, I just feel balanced. I think it’s a wonderful drug for OCD. But financially speaking, I do think the drug co. have just stuck Buspar in an SSRI. So taking them separate might be more cost effective. But not taking any chances. I am willing to try Celexa, if the cost gets to be too much. I’ll keep in touch. : )
I’ve been on Viibryd for two and a half weeks now. Four days ago I went up to the 40mg, the last jump. I’m feeling like I want to get angry at everything. Just aggitated at the little things. I think it’s the medication so I’m holding back. I feel jittery too. Should I stop or lower the dosage?
I have been on Viibryd for over a month now…finally I have my sex drive back…depression is under control and not really any side effects..that I know of. I hope it keeps working…not sure what my insurance will pay after these first two months of free meds…..just hope i can afford it..have real crappy insurance with major corp I work for….but the medicine is great.
I have been taking this medication for 4 weeks now. I have noticed an increase in my sex drive and seems to be working very well. I believe exercise and good eating habits plays a part in my positive effects of this medication. Time will tell if it changes till then I have no complaints.
I was just prescribed the drug today after being off of pristiq for 3 days. I’m very nervous and unsure about how this drug is going to effect me. i was having major withdraw symptoms from pristiq and the dr. gave me this today b/c he said it has less (or no?) chemicals than any other ssri. I gained a lot of weight on pristiq and am so nervous about gaining more on this drug. if anyone has any advice or encouragement it’s very appreciated! i’m very nervous about this new medication.
See my response to Jessica re weight gain. — DrP.
I know of no studies on OCD, and currently Viibryd does not carry an FDA indication for OCD. Most of the SSRI medications have some efficacy in OCD so I’m not surprised you may have been prescribed Viibryd off label for OCD. In my experience any of the SSRI meds can be associated with weight gain in a minority of patients. Viibryd too new to have a real track record. If you continue to gain weight you should talk to your physician.
Are there any studies showing if this drug will help with OCD? I am also wanting to know if this drug causes weight gain. I have been on this medication for 3 weeks now going on 4 weeks and I have gained 10 pounds. Could this weight gain be a result of taking this medication?
I started taking Viibryd and found that the accelrated method of getting to the right dosage was easy, and I could track symptom changes better. I think there should be different levels for different people – my biggest concern is weight gain any info on this and viibryd?
no problem with upset stomach with Viibryd. So far, this is the best one yet! Just hope my workers comp. will decide to pay for it.
I have tried pristiq, broke out in a rash. I tried cybalta, felt like a zombie. num feeling. I am now on Viibryd and feel great. as far as the sex goes, my feelings have increased!
I’m not going to never take viibryd ever again! it give me the shits all day long. did not matter if I had some water, etc. I had to go and shit not 8 min. later (give or take).
Hi,
my psych. just prescribed ‘Viibryd’ I have taken everything out there. I am skeptical of drugs. DBT and cognitive therapy have helped me the most.
I feel super depressed now,today.
Ready to pop pill,want a quick fix.
Ha,Ha… In my mind the drug company’s just want to make more money.
Lexapro is in the SSRI class of medications. Viibryd also functions as an SSRI but also as a partial agonist of the post-synaptic serotonin receptor. This means that in addition to increasing the concentration of seratonin in the synaptic area it also stimulates the receptor for serotonin. What does this mean in terms of therapy? Good question. Time may tell. The hope is that it may avoid some SSRI side effects and work in some patients where medications like Lexapro does not.
What is the major differences between Lexapro & Viibryd?
Id like to say I’ve been using viibryd for 2 weeks now and I feel great. No side effects and def no sexual side effects. If anything sex is more enjoyable!
Not at all.
Hello Dr. P-
Do you have any sort of financial relationship with Forest?
Thanks
As someone who is clinically depressed due to a sexual dysfunction I was recently prescribed this. This is the first time for me taking any sort of antidepressant, so I really have no idea what to expect other than to feel better in about a month or two. While I do realize it is new and may very well end up having sexual side effects, I personally don’t see it actually worsening my sex life since I already have great difficulty with sex. I do hope you keep updating with any information you may find.
Hello Dr. Pullen,
I read your post about viibryd and I would like to
know if since that time, you have any more
information about this drug and if people using it
are finding it effective for depression and
without the sexual side effects that it claims.
Thank you.
I think it’s too early to say anything about these issues. They are occasional with all of the SSRIs so time will tell. Thanks for the question though. These are other SSRI issues users face.
Has there been any talk of lessened emotional blunting after sustained use of Viibryd? After long-term use of fluoxitine, there is a feeling of ennui or malaise, which requires a kicker drug to restart the interest in life in general. Also, has there been any talk of a lessened incidence of weight gain?
Thank you for your input.
As I mention in the post, time will tell. If it really has low sexual dysfunction it is going to be really popular. Time will tell.
hi dr pullen! i enjoyed reading your article. you brought up some very valid points. based upon my own research and experience, it seems that every time a new ssri or snri gets approval the drug companies always report lower sexual side effects in their latest drug. i do remember this starting with celex as you have mentioned. this also was the case with lexapro, cymbalta and pristiq. i have tried all of these meds and they all have the same sexual side effects..and if you look at the studies, they all show a low incidence of SSEs..if you look at the studies comparing cymbalta to placebo, it is certainly not much more impressive than viibryd..they are both aroud the same as far as delayed ejaculation..therefore i am very skeptical about viibryd..i have seen tons of reviews of cymbalta, pristiq etc. and people are still getting sexual dysfunction. why would viibryd be any different?? any thoughts?