Vilazodone arrived with bold promises.
Marketed internationally as Viibryd, and in India under names like Vilano, Vilaz, Vilapride, Vilaplex, Vilazod, it positioned itself as a new-age antidepressant with a unique identity:

SSRI + 5-HT1A partial agonist → faster onset, fewer sexual side effects, and better anxiety relief.

Psychiatrists were intrigued.
Patients were hopeful.
Pharmaceutical companies were enthusiastic.

But as months turned into years, enthusiasm evaporated.
Vilazodone, despite its interesting mechanism, slowly slipped out of mainstream practice.

Let’s explore why.

Why Vilazodone Originally Looked Like a Breakthrough

Its dual mechanism set it apart:

• SERT inhibition (SSRI effect)

• 5-HT1A partial agonism (buspirone-like)

This suggested:

• faster antidepressant onset

• better anxiety relief

• smoother emotional tone

• fewer sexual side effects

• less weight gain

On paper, Viibryd/Vilano/Vilaz looked like a fusion of:

• escitalopram

• buspirone

• bupropion

—rolled into one pill.

Psychiatry was ready for something fresh and modern.

But the reality was complicated.

Where Vilazodone Lost Traction

1. Severe Early GI Side Effects

This was the biggest practical blow.

Up to 40–50% of patients taking Vilano, Vilaz, Vilapride reported:

• nausea

• stomach cramps

• diarrhoea

• discomfort after food

The nausea was so intense in some that they stopped within days.

In antidepressants, first impressions matter.
Vilazodone failed the first week for too many patients.

2. The “Faster Onset” Promise Didn’t Hold True

Marketing claimed:

• quicker improvement than SSRIs

• earlier emotional relief

• rapid anti-anxiety benefits

But in real life:

• onset was no faster

• anxiety relief wasn’t superior

• improvement resembled standard SSRIs

Patients felt misled.
Clinicians felt underwhelmed.

3. It Required Food — and Patients Hate Food Rules

Vilazodone must be taken with food for proper absorption.

Not snacks.
Not tea.
Not empty stomach.

For Indian patients with:

• inconsistent meal timing

• skipped breakfasts

• light dinners

• irregular schedules

…this rule created practical chaos.
Miss the meal → miss the effect.

4. Not Better Than Cheaper SSRIs

Compared to escitalopram (very cheap in India), vilazodone:

• wasn’t more effective

• wasn’t more tolerable

• didn’t reduce sexual dysfunction enough

• didn’t help energy or motivation

• cost 3–5× more

For most patients, the math was simple.
Why pay more for similar or worse effects?

5. Anxiety Relief Was Overstated

Many clinicians expected vilazodone to behave like:

• an SSRI (for mood)

• plus buspirone (for anxiety)

But real-world reports showed:

• persistent anxiety

• jitteriness in some

• no special advantage over escitalopram or sertraline

The 5-HT1A agonism was mechanistically interesting but clinically unimpressive.

Where Vilazodone Still Works Well

Despite losing mainstream traction, vilazodone can shine in specific patients.

It works well for:

• mild-to-moderate depression with anxiety

• patients fearing weight gain

• those who can’t tolerate sedation

• people wanting a clean, activating profile

• individuals sensitive to sexual dysfunction on SSRIs (though vortioxetine is better)

For the rare patient who tolerates the GI effects, Vilano/Vilaz can feel sharp, light, and clean.

But the group is small.

Vilazodone’s Place in 2025

Today, vilazodone:

• is used infrequently

• is overshadowed by escitalopram, sertraline, desvenlafaxine, bupropion, and vortioxetine

• remains expensive relative to benefit

• offers no decisive clinical advantage

It has become a second-line experiment, not a first-line favourite.

A molecule that had the right theory—but the wrong lived experience.

Vilazodone’s Legacy

Vilazodone is a reminder that:

• elegant mechanisms don’t guarantee felt benefits

• severe early side effects destroy trust

• claims of “faster action” must be proven, not promised

• antidepressants succeed only when patients stay on them

Medicines must feel good, not just sound good.

Vilazodone sounded like the future.
Patients felt otherwise.

About the Author

Dr. Srinivas Rajkumar T, MD (AIIMS), DNB, MBA (BITS Pilani)
Consultant Psychiatrist & Neurofeedback Specialist
Mind & Memory Clinic, Apollo Clinic Velachery (Opp. Phoenix Mall)
✉ srinivasaiims@gmail.com 📞 +91-8595155808