Vortioxetine
2022-08-13: SSRI reference:
Vortioxetine #
- brenden: Vorti is a superior SSRI due to 5ht1a post synaptic partial agonism, leading to both quicker efficacy and less sexual side effects. Fluvoxamine has high sigma 1 agonism, which has also shown some promise in OCD however I don’t think that makes fluvoxetine necessarily superior and I’ll explain why. https://pubmed.ncbi.nlm.nih.gov/17349995/
Sigma 1 activation seems to occur downstream from 5ht3 activation according to this study as it required the increased ca2+ to activate sigma 1. So I would expect this effect to be opposed by strong 5ht3 antagonists like tropi. https://www.researchgate.net/publication/257007227_Fluvoxamine_increased_glutamate_release_by_activating_both_5-HT3_and_sigma-1_receptors_in_prelimbic_cortex_of_chronic_restraint_stress_C57BL6_mice
When fluvoxetine is combined with tropisetron, it still had better efficacy for OCD than fluvoxetine alone. https://pubmed.ncbi.nlm.nih.gov/31575326/
The actual method for 5ht3 antagonists benefitting OCD is from inhibiting cortico-mesolimbic dopamine release. I therefore have to question if fluvoxetine is the best choice as it seems 5ht3 antagonism enhances the effects through the above and outweighs the benefits of sigma 1 agonism for OCD.
In this case vortioxetine also being 5ht3 antagonist and with less side effects may not be a bad idea to try.
istradeffyline is also proven effective for OCD in mice- https://www.eneuro.org/content/6/1/ENEURO.0366-18.2019