Remnants Posted March 16, 2017 Share Posted March 16, 2017 Has anyone had any experience with taking two AD's together. I'm already on Mirtazapine 45mg & today my doctor said to stay on that but to start another one called cymbalta. She wants me to start on 30 & go up to 60mg. They're different classes of AD's too I believe. Things are really bad & I'm willing to try anything right now. It just makes me a bit nervy. I googled it & it only says what I had already suspected; serotonin syndrome being a possible reaction which I'm sure she's aware of. I go back to see her in a week. Just wanted to see if this is a normal practice. 1 Link to comment Share on other sites More sharing options...
jt07 Posted March 16, 2017 Share Posted March 16, 2017 Yes, it is quite a normal practice. I take citalopram (Celexa) with mirtazapine (Remeron), and I have for six years now. I never had any problems. Serotonin syndrome is one of those theoretical problems that is rarely seen in practice in the absence of an MAOI or multiple antidepressants of the same class. 1 Link to comment Share on other sites More sharing options...
iaawal Posted March 16, 2017 Share Posted March 16, 2017 Yup, I've taken two antidepressants at the same time (wellbutrin and another AD) for about 2.5 years. Never experienced any issues. 1 Link to comment Share on other sites More sharing options...
Remnants Posted March 16, 2017 Author Share Posted March 16, 2017 Thanks everyone, that makes me feel better about it Link to comment Share on other sites More sharing options...
melissaw72 Posted March 16, 2017 Share Posted March 16, 2017 I am on prozac and wellbutrin. 1 Link to comment Share on other sites More sharing options...
notloki Posted March 16, 2017 Share Posted March 16, 2017 (edited) Bupropion and aripiprazole (Abilify). A number of AD's with Bupropion, Effexor and Remeron are some of the AD combos I have been on. Edited March 24, 2017 by notloki Link to comment Share on other sites More sharing options...
Iceberg Posted March 16, 2017 Share Posted March 16, 2017 Remeron and trazodone Link to comment Share on other sites More sharing options...
CrazyRedhead Posted March 16, 2017 Share Posted March 16, 2017 Wellbutrin, Clomipramine, and Trazodone here. Although technically, my pdoc prescribes the Trazodone off-label for sleep issues, not depression. Link to comment Share on other sites More sharing options...
mjs190 Posted March 18, 2017 Share Posted March 18, 2017 An SNRI (like Cymbalta or Effexor) + Remeron is pretty common for depression that is tough to treat. The combination is sometimes called California Rocket Fuel. FWIW, I also currently take 2 AD's: Wellbutrin and Cymbalta. 1 Link to comment Share on other sites More sharing options...
Remnants Posted March 18, 2017 Author Share Posted March 18, 2017 Thanks everyone I felt better starting it knowing it was common place. Link to comment Share on other sites More sharing options...
Flash Posted March 18, 2017 Share Posted March 18, 2017 I'm thinking of adding Trintellix to my Cymbalta. I've never been on full-strength doses of two ADs at the same time, but the Cymbalta alone is not cutting it. And no AD has ever launched me into mania, and I've been on my fair share, quite a few of them multiple times. Everyone's MI manifests differently. There's a bit of a learning curve to figuring out what you can and cannot do. Best of luck! Link to comment Share on other sites More sharing options...
mikl_pls Posted March 22, 2017 Share Posted March 22, 2017 I've taken tricyclics like protriptyline and nortriptyline with an MAOI before and a stimulant, as well as desipramine 75 mg + Cymbalta 120 mg. I've also tried the California Rocket Fuel combo with Pristiq and Remeron, but unfortunately it didn't work for me. Link to comment Share on other sites More sharing options...
Sleeeeeep77 Posted March 24, 2017 Share Posted March 24, 2017 Has anyone used Effexor and Cymbalta together?....?.. Link to comment Share on other sites More sharing options...
mikl_pls Posted March 24, 2017 Share Posted March 24, 2017 That would probably be a redundant combination. While Effexor's and Cymbalta's ratio of SRI to NRI are different, you're taking two SNRIs and saturating your serotonin transporters (SERTs) to the point where you can't get any more serotonin reuptake inhibition, and you'd get only modest increase in NET inhibition for norepinephrine reuptake inhibition. If you want a good combo for your Effexor (if I remember correctly, that's what you're on now), you have several options. Venlafaxine + mirtazapine = boost in serotonergic and noradrenergic reuptake inhibition (and if you get high enough in venlafaxine, you'll get some weak dopamine reuptake inhibition). Mirtazapine doesn't actually cause reuptake inhibition at all, it just blocks certain receptors to cause release and enhanced neurotransmission of certain neurotransmitters (serotonin and norepinephrine). Venlafaxine + nortriptyline = this gives a good boost to venlafaxine's rather weak noradrenergic profile, and is one of, if not the safest, tricyclics to take, especially in combination with other meds. (You could also substitute nortriptyline for protriptyline or desipramine.) With this combination, the noradrenergic part can be tweaked according to your needs instead of taking it in the fixed proportion according to venlafaxine's pharmacology (30:1 SRI:NRI). I'm not sure if this drug is available in your area, but the above combination would be not unlike venlafaxine + reboxetine, the latter being a pure norepinephrine reuptake inhibitor. The effect would be the same—you'd be able to tweak the NRI part of your meds without affecting the serotonergic part (which really by 75 mg venlafaxine, the SRI part is maxed out and any higher doesn't yield more SRI) I think you said you can't get bupropion where you live, which is too bad because that would enable triple reuptake inhibition. And your pdoc is a jerk and won't prescribe stimulants... Venlafaxine + atypical antipsychotic (personally I'd prefer something like aripiprazole (dopamine partial agonist), or Rexulti/Vraylar if you have it in your country, but otherwise, ziprasidone, Saphris (if available), Latuda (if available)). The reason for an atypical antipsychotic is that they antagonize 5-HT2A receptors which causes dopamine release in certain parts of your brain, and the dopamine partial agonists in particular are nice because if there are dopamine pathways in which dopamine levels are low, they will act as an agonist and stimulate the dopamine receptors, but if there are dopamine pathways with too much dopaminergic activity, it will act as an antagonist. So a combo like venlafaxine and an atypical antipsychotic (whether a dopamine partial agonist or dopamine antagonist) would enable you to have serotonin + norepinephrine + dopamine levels increased. Do you know if flupenthixol is available where you live? Because in low doses (1-3 mg), it can antagonize the presynaptic dopamine receptors, causing a disinhibition of dopamine release, and combined with venlafaxine, that would also yield a trimonoaminergic profile. Sulpiride (50-200 mg) and amisulpride (≤ 50 mg) in low dosages do the same thing, if they're available where you live. That's about all I can think of off the top of my head... Oh... Sometimes venlafaxine is combined with nefazodone, but you have to be careful with nefazodone because of liver toxicity (then again there are drugs worse than it and they don't get black box warnings about it...) Link to comment Share on other sites More sharing options...
notloki Posted March 24, 2017 Share Posted March 24, 2017 I agree, it is a redundant combination. Link to comment Share on other sites More sharing options...
notloki Posted March 24, 2017 Share Posted March 24, 2017 As to taking 2 AD's and Serotonin Syndrome(SS), you are unlikely to have major problems until you get to the MAOI's. It can be life threatening mixing MAOI's and many psychiatric and non psychiatric meds. SS seems to need two dissimilar agents and not just more of the same. Link to comment Share on other sites More sharing options...
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