If you have a mental health condition like depression, your doctor may suggest the drug vilazodone (Viibryd). It’s one of many antidepressants, but it’s slightly different from the rest.
Vilazodone hydrochloride stands out from other antidepressants because it belongs to two categories of antidepressants: It’s a selective serotonin reuptake inhibitor (SSRI) and a 5-HT1A partial agonist. Each type of antidepressant has a different mechanism to help you regulate serotonin levels, which is linked to better moods. It amps up serotonin in two ways, not just one.
Here are some key things to know about this medication.
Conditions That Vilazodone (Viibryd) Treats
Your doctor may prescribe vilazodone if you have major depressive disorder (MDD), which is also known as depression.
Some doctors also prescribe it off-label to treat bipolar depression, anxiety disorders including PTSD, chronic pain, and hot flashes. Vilazodone isn’t specifically approved for those conditions, but it can help some people who have them.
Usually, doctors choose vilazodone for adults with depression if you’ve tried another antidepressant without success.
Vilazodone isn’t approved for children.
How Vilazodone (Viibryd) Works
Your brain makes serotonin, a chemical that carries signals between nerve cells called neurons in your brain. Serotonin is linked to good moods and sleep. Experts believe that higher serotonin levels lessen the feelings of depression.
Vilazodone is an SSRI, a type of antidepressant that ups the amount of serotonin in your brain. After serotonin sends a message, the nerve cells usually reabsorb it. But the SSRI blocks that from happening so that the serotonin works longer in your brain. Vilazodone also is a partial agonist, which means it stimulates serotonin receptors.
The dual functions of being an SSRI and partial agonist give you two ways to get more serotonin.
How to Take Vilazodone (Viibryd)
You take the tablet by mouth with a glass of water and food.
You’ll probably start with 10 milligrams a day for 7 days. If needed, your doctor can move you up to a 20-milligram dose. You can go up to a 40-milligram pill if you need to, but wait 7 days before increasing your dose.
You may see improvements in your appetite, sleep, and energy levels in as soon as 1 to 2 weeks. That’s a sign that vilazodone is working. But it may take 6 to 8 weeks before you feel less depressed or more interested in activities. That’s about the same as other antidepressants.
If you stop using vilazodone, don’t do it suddenly. Coming off an antidepressant suddenly can cause serious side effects. These can range from nausea and anxiety to seizures and headaches. Your doctor can advise you how to reduce the dose gradually.
Side Effects of Vilazodone (Viibryd)
Like other antidepressants, you may have side effects with this drug. These can range from minor, like nausea, to serious ones like seizures.
Some side effects like nausea and feeling tired are temporary and go away after your body gets used to the medicines. But others are a warning sign to talk to your doctor and see if you should stop taking it.
Common side effects
The most common side effects of vilazodone are:
- Diarrhea
- Nausea
- Vomiting
- Difficulty sleeping
Less common side effects
Side effects that aren’t as common include:
Mania or hypomania such as bursts of energy, reckless behavior, racing thoughts, or feeling elated or irritated can happen if you have bipolar disorder and take vilazodone.
Sexual problems can happen to men and women. You may have decreased sex drive, trouble keeping or having erections, and delayed or inability to ejaculate.
Vilazodone has lower rates of sexual side effects than other antidepressants. Others with low sexual side effects include bupropion (Wellbutrin XL, Wellbutrin SR), mirtazapine (Remeron), and vortioxetine (Trintellix).
Serious side effects
Call your doctor right away if you notice severe side effects. Some can be potentially deadly. Serious issues may include:
Seizures. If you have epilepsy or a history of seizures, vilazodone may worsen your condition.
Discontinuation syndrome may happen if you quit taking vilazodone suddenly. You may have it if you notice mood changes, sweating, shock sensations, confusion, seizures, or ringing in your ears.
Higher risk of bleeding can happen if you take vilazodone with other medications like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), or other blood thinners.
Angle-closure glaucoma happens when your iris bulges. It can lead to blindness. It can happen suddenly or gradually. If your vision gets blurry, you get headaches or eye pain, or you see colored rings around lights, talk to your doctor right away.
Low sodium levels in your blood (hyponatremia), whose side effects can include:
- Headache
- Memory changes
- Difficulty focusing
- Confusion
- Unsteadiness or falling
More serious side effects of low sodium include:
- Hallucinations
- Fainting
- Coma
- Respiratory arrest
- Seizures
- Death
Serotonin syndrome is when you have too much serotonin in your body. It can cause symptoms like:
- Agitation
- Hallucinations
- Coma
- Fast heartbeat
- Dizziness
- Blood pressure changes
- Sweating
- Seizures
- Nausea or vomiting
- Stiff or twitching muscles
- Lack of coordination
- Diarrhea
- Tremors
Vilazodone (Viibryd) Drug Warnings
Before you start vilazodone, your doctor may ask if you’re pregnant, planning on becoming pregnant, or breastfeeding.
They’ll ask about any other medications you take, to check for interactions. Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, or antiplatelets can raise your risk of bleeding. Also, tell your doctor if you eat grapefruit regularly because it can interfere with how the medication works.
If you have a history of bipolar disorder, let your doctor know. The drug can cause mania or hypomania.
Tell your doctor if you have a seizure disorder.
Once you start vilazodone, it may lead to too much serotonin in your body. This is called serotonin syndrome, and it can give you side effects. Vilazodone can also cause angle closure glaucoma and sexual dysfunction. Some people have suicidal thoughts or allergic reactions when they take vilazodone. Call your doctor if any of these happen.
Who Shouldn’t Take Vilazodone (Viibryd)?
Ask your doctor if you should take vilazodone while on a monoamine oxidase inhibitor (MAOI) -- that’s another type of antidepressant. Experts say you shouldn’t start taking vilazodone within 14 days of stopping an MAOI.
How Well Does Vilazodone (Viibryd) Work?
In four studies, people who took vilazodone reported improvements in mood compared to those who didn’t take the medication.
There hasn’t been much research to compare vilazodone’s effectiveness against other antidepressants. One small study found it worked better than escitalopram (Cipralex, Lexapro).
People in another study who took vilazodone or sertraline (Zoloft) both saw improvements in depression. The researchers say vilazodone caused less sexual side effects and weight gain compared to sertraline.
Another study found vilazodone worked better, and was better tolerated, than amitriptyline (Elavil) or escitalopram.
Long-Term Effects of Vilazodone (Viibryd)
Vilazodone was approved by the FDA in 2011. In studies done since then, people reported adverse reactions such as:
- Irritability
- Sleep paralysis
- Hallucinations
- Suicide attempts or thoughts
- Rash
- Acute pancreatitis
People reported those symptoms voluntarily, so it’s hard to say if the drug actually caused them.
Studies find that it works well for some people, but there’s not much evidence about how well it works as a long-term treatment. Overall, it seems to work as well as other antidepressants. More evidence is needed to know that for sure.
Researchers aren’t sure if vilazodone’s unique combination of being an SSRI and a partial agonist means it works better than other antidepressants. They haven’t tested it in people with treatment-resistant depression. They’ve only started to look at how well it works in those who haven’t responded to SSRIs or SNRIs (two other types of antidepressants).
