In today’s video, we’re taking a deep dive into Auvelity, a new antidepressant that combines Dextromethorphan and Bupropion. While Bupropion is well-established in the treatment of depression, Dextromethorphan is less familiar in psychiatric contexts. It’s primarily Vilazodone, also known by its brand name Viibryd, became available as a generic in June 2022 after 11 years of market exclusivity. With the introduction of the Viibryd generic, the price of this multimodal antidepressant has significantly decreased, making it more accessible. However, the critical question remains: is vilazodone worth prescribing?

Vilazodone is designed to combine the pharmacodynamic effects of an SSRI and buspirone, offering a potential advantage in faster onset, better anxiolytic effects, and fewer sexual side effects. Despite these promises, the vilazodone effectiveness has been shown to be similar to other SSRIs like citalopram, with no clear superiority. In fact, its number needed to treat (NNT) is 8, indicating vilazodone's modest efficacy compared to other antidepressants. The use of vilazodone for generalized anxiety disorder shows limited benefits. Although vilazodone has been tested in large trials for this condition, the results were underwhelming, with minimal effect and poor tolerability due to issues like nausea and diarrhea.

Similarly, the research on vilazodone for social anxiety disorder has not been promising, as many studies were either small or abandoned. In cases of vilazodone for anxious depression, it showed some promise but was still less effective than citalopram, making it a less ideal choice for this population. One of the key considerations when prescribing vilazodone is its impact on sexual function. While vilazodone was initially marketed as having a lower risk of sexual side effects, later studies have shown that vilazodone sexual side effects are still present, although potentially lower than those seen with SSRIs like sertraline or paroxetine. However, vilazodone tolerability remains a concern, with common SSRI-related issues like nausea, diarrhea, and insomnia also occurring with vilazodone. Vilazodone dosing instructions emphasize the importance of taking it with food, as up to half of the dose can go unabsorbed if taken on an empty stomach. Additionally, vilazodone food interactions with substances like grapefruit juice, a potent CYP3A4 inhibitor, can significantly raise vilazodone levels, complicating its use.

In conclusion, while the availability of a Viibryd generic may make vilazodone an attractive option for some patients, especially those seeking an antidepressant with potentially fewer sexual side effects, its overall benefits are modest. The vilazodone cost is lower now, but given its modest efficacy, tolerability issues, and specific dosing requirements, vilazodone should not be considered a first-line treatment. Instead, it may be best reserved for patients who have specific needs that align with vilazodone's unique profile.

Related:

• FDA Publishes Article Critical of Vilazodone Data
• Vilazodone Not Effective for Cannabis Dependence
• Viibryd Goes Generic, But Is It Worth Prescribing?
• Prescribing Newer Antidepressants