Antidepressant Combos?

Should you take more than one antidepressant?

Yes, occasionally.

Less than half of people with depression get better with the first medicine they try (SSRI, SNRI, etc).

Adding a different class of medicine may work faster than switching, and it may also help treat other symptoms or health problems.

But there is no “best” next step because there are not enough facts.

Recommend CHANGING antidepressants if a patient does not respond to an optimized dose after 4 to 6 weeks, or if the drug is not well tolerated.

With a partial response, customize the options to AUGMENT based on side effects, interactions, etc.

Adding bupropion to an SSRI or SNRI is often suggested, especially if a patient is tired or has low sexual desire. But people who are agitated should not take bupropion because it wakes them up.

Adding mirtazapine to an SSRI or SNRI can be an option, especially for people who have trouble sleeping or do not have much of an appetite. But stay away from mirtazapine if you do not want to gain weight.

Avoid a combination of an SSRI and SNRI. There are not much data, the benefit seems less likely because of the same mechanisms, and this combination may be riskier.

Consider adding low-dose trazodone for sleeplessness or a low-dose tricyclic for sleeplessness, headaches, or nerve pain. Low doses, on the other hand, are not likely to help depression.

If a patient takes more than one serotonergic drug, they should be told to report any symptoms of serotonin syndrome, such as sweating, tremors, etc. Most cases happen within a day or so of starting a new medicine or taking a higher dose of one.

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