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Combining numerous anti-depressants

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Okay, so, hypothetically...

How many anti-depressants from different classes could a person take simultaneously? Obviously, it is very common to augment an SSRI with mirtazapine or bupropion. What about both? What about SSRI + bupropion + mirtazapine + trazadone? Where do you draw the line?

I'm not necessarily planning to do something like this myself, I'm just curious. I have taken a recent interest in pharmacology and the way that different chemicals are capable of working together in synergy.

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Hypothetically, indeed.

Where do we draw the line? We talk a lot on CB about our personal experiences with various cocktails that have been prescribed for us, their dismal failures, their mediocre mehs, and occasionally, their successes. The great benefit of this sharing is to give each other ideas for new lines of discussion with our pdocs for new things to try when our cocktails aren't performing as desired, or to help us understand why we're suddenly having dizzy spells, seeing dancing bananas, or have forgotten what sex is.

When the conversation treads over the line is when we start speculating about idiotic things to do, like take as many antidepressants as possible at once. You're not planning to do this yourself? Just curious about synergy? Mm-hm. Whatever. Let's talk for a second about serotonin syndrome.

There is such a thing as too much of a good thing. Serotonin syndrome is a really good example, and when you're taking antidepressants, it's not that hard to achieve if you're doing absurd things like, oh I don't know, trying to take as many of them as you can at once to see if they synergize in your head. Stocking up too much serotonin (The second "S" in SSRI) can lead to: agitation, restlessness, confusion, rapid heart rate, high blood pressure, dilated pupils, loss of muscle coordination, muscle rigidity, heavy sweating, diarrhea (fun), headache, shivering, goosebumps, and even threaten your life with high fever, seizures, irregular heartbeat, and unconsciousness. How's that for some synergy?

And that buproprion(Wellbutrin) that pdocs sometimes add to an SSRI? Even that can contribute to serotonin syndrome if the mix isn't right. So can the tricyclics and MAOIs. Oh, and your anti-migraine meds. And any opiate pain medication you might be taking. And lithium. Even those herbal supplements (like St. John's wart, ginseng and nutmeg, for God's sake) and OTC cough medicine can do it. And people who like to play fast and loose with their meds on their own (I have no idea whether you're one of these) sometimes also like to play fast and loose with things like MDMA, LSD, cocaine and amphetamines - which also play hell with serotonin.

But let's take a larger view. Chemistry is tricky. In a lab, trying to get molecules to form into desired compounds requires precise measures, regulated temperatures, and exacting technique - special stirring, subtle shaking, timed dripping, ice baths at the right moment and so forth. Contrast this with an eight-year-old with a chemistry set throwing things into a glass jar to see if they explode. Mixing one's own meds cocktail to see how many antidepressants one can take until they synergize is an example of the second scenario. (*~BOOM~*, and a mess afterward)

Can meds work together positively for better results? Of course they can. That's why our pdocs combine them. But the body and brain are a sloppy chemical stew, and even the best pharmacologists on the planet are only best-guessing about the full effects of these medications on our systems. Our care teams are challenged to administer what are often harsh chemicals to try to regulate poorly understood imbalances in our minds while doing us as little harm as possible. We don't assist that process by treating our brains like a beaker and doing our own ad-hoc chemistry.

We do research. We share knowledge and experience. We consult with each other and then we take the information we gather and use it to ask informed questions to our pdocs because we are involved in, and advocates for, our own mental health. But at CB we don't speculate on woolly-headed ideas about DIY prescribing. Beware of wool.

Where do we draw the line?



Right there.  Topic closed.



Edited by Cerberus
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