Viibryd™: The Next Blockbuster Antidepressant?

While smack-dab in the middle of my personal and professional planning during January of this year, the FDA went ahead and approved another antidepressant. As a psychopharmacology writer and speaker, this should teach me not to turn my back for even one second.

This new one is Viibryd™ (vilazodone), manufactured by Massachusetts company Clinical Data, Inc. As I write this piece, I have absolutely no idea how to pronounce this drug’s brand-name, but I’m sure someone will tell me soon (if you know, please pass along).

At first glance, Viibryd seems promising. It’s not simply another “me-too” Prozac, Lexapro, Effexor, Cymbalta or Wellbutrin. Its biochemistry is somewhat more impressive: It combines the actions of serotonin antidepressants (like Prozac and Lexapro) with the mechanism of the anti-anxiety drug Buspar. Buspar acts on serotonin also, so in effect, Viibryd provides a dual-action effect on serotonin.

So is Viibryd a blockbuster waiting to happen? Well, it could be if one believes that low brain serotonin is responsible for depression. There’s no shortage of well-respected clinicians who just don’t buy this notion. After all, science has not been able to convincingly show a serotonin deficit in depression. And although it’s true that Prozac, Zoloft, Lexapro and other serotonin antidepressants have helped millions of people, they may be acting by a completely different mechanism that remains poorly understood.

Another issue is that Viibryd isn’t quite as “new” as its maker would have us believe. Physicians and other prescribers have been combining serotonin antidepressants with Buspar for years. This has been a fairly common combination, but frankly, many psychiatrists in particular, believe that Buspar’s efficacy is nothing to write home about. The combination is also considerably less expensive. Who knows, maybe Viibryd will deliver the goods, and the drug is not simply a retread like so many others that preceded it to market. We’ll see.

The holy grail of antidepressant treatment remains elusive, but exciting advances have certainly left the starting blocks. Neuroscience has begun to track genetic fingerprints that will eventually pave the way for a more sophisticated understanding of what’s actually happening in the brains of depressed patients, with the goal of taking the guesswork out of what antidepressant will work for whom.

I can imagine a day when a clinician, faced with a patient who has major depression, will be able to order a gene scan that will predict response to a certain medication. This will ease the burden on the trial-and-error, hit-or-miss process that unfortunately characterizes so much of antidepressant management today.

————————————————————

Joe Wegmann is a licensed clinical social worker and a clinical pharmacist with over 30 years of experience in counseling and medication treatment of depression and anxiety. Joe’s new book, www.pesi.com. To learn more about Joe’s programs or to contribute a question for Joe to answer in a future article, visit his website at www.thepharmatherapist.com, or e-mail him at joe@thepharmatherapist.com.