Serotonin modulator and stimulator (SMS)
Inhibits serotonin reuptake via serotonin transporter (SERT); acts as a serotonin receptor modulator with agonist activity at 5-HT1A, partial agonist at 5-HT1B, and antagonist activity at 5-HT3, 5-HT1D, and 5-HT7 receptors, potentially enhancing serotonergic neurotransmission and cognitive function.
Major depressive disorder (MDD)
Generalized anxiety disorder (GAD), cognitive symptoms associated with depression, geriatric depression
Oral tablets (5 mg, 10 mg, 15 mg, 20 mg)
5–10 mg p.o. daily, titrating up to 10–20 mg/day as clinically indicated
10–20 mg/day
Half-life ~66 hours; metabolized primarily via CYP2D6 and CYP3A4; steady state in ~2 weeks
Nausea, constipation, dizziness, dry mouth, sexual dysfunction
Serotonin syndrome, hyponatremia
Monitor for serotonin syndrome and suicidality, especially in younger patients and those on other serotonergic agents
Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults with MDD and other psychiatric disorders
Vortioxetine tends to be well tolerated in older adults and is not associated with weight gain. Emerging research suggests it may improve cognitive function by modulating frontal cortex activity through mechanisms that differ from those of typical antidepressants/anxiolytics. Although evidence is limited in neurodegenerative conditions, vortioxetine may be a valuable treatment option for elderly patients experiencing depression with cognitive difficulties.