Can Fluoxetine and Duloxetine be taken together? (3 warnings) 

In this blog post, we are going to answer the question, “Can Fluoxetine and Duloxetine be taken together?”. Both Fluoxetine and Duloxetine are antidepressants which are considered strong ones for the management and treatment of depression. 

In some cases, these two antidepressants are combined together and this is what we are going to discuss in this blog. We will also look at some common pros and cons of the combination of these two meds. 

Can Fluoxetine and Duloxetine be taken together?

Yes, Fluoxetine and Duloxetine can be taken together, but only if recommended by your prescribing physician. Both of these antidepressants are considered strong meds for the management and treatment of depression, anxiety, and several other mental health conditions. 

However, this combination may not cause beneficial effects in every other individual and it may interact negatively with some of the other prescription medications for such patients. This is why you should only take this combination if prescribed by your healthcare provider. 

It is not suitable to self-medicate, especially when your mental health is at stake. However, monotherapy of either Fluoxetine or Duloxetine is considered quite beneficial and tolerable.

How do Fluoxetine and Duloxetine work? 

Fluoxetine and Duloxetine are antidepressants in nature but they belong to two separate classes of antidepressants and have slightly different mechanisms of action. Fluoxetine (brand name: Prozac) is a selective serotonin reuptake inhibitor (SSRI). 

It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). This way more serotonin is available in the synaptic cleft to bind to its respective receptors. 

Duloxetine (Brand name: Cymbalta), on the other hand, is a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by inhibiting the reuptake of two excitatory monoamine neurotransmitters; serotonin and norepinephrine. 

It does so by blocking serotonin and norepinephrine transporters, SERT and NET respectively. This makes more serotonin and norepinephrine available to bind to their respective receptors. They together can be used for the treatment of the following health conditions:

Major depressive disorder (MDD) 

Depression is a clinical condition, but major depressive disorder (MDD) is an entirely different condition. Depression is mostly managed by monotherapy and either Fluoxetine or Duloxetine is enough to manage the symptoms associated with mild to moderate episodes of depression. 

However, MDD does not respond that well to monotherapy. Some people have persistent depression that, no matter how properly they take their antidepressants or take care of themselves, does not go away. This is where combination therapy is required. 

According to a study, the combination of Fluoxetine and Duloxetine can be beneficial for the treatment of MDD and people can tolerate it well at lower doses. If the doses exceed the usual limit, this combination can take a drastic turn and is capable of making your mental health condition much worse. 

Obsessive-compulsive disorder (OCD) 

The concomitant use of Fluoxetine and Duloxetine hold great clinical importance in the management and treatment of symptoms associated with OCD. This disease can become quite disturbing because of the damage it causes.

People with OCD tend to repeat the same activity over and over again. With time, they develop a negative perception of almost everything because of the voices in their heads which tell them to do a number of disturbing things. 

Such people can become quite dangerous for themselves as well as their loved ones. As this condition progresses, monotherapy with even the strongest of antidepressants fails to work. 

This is where the combination of Fluoxetine and Duloxetine can significantly help some people recover. However, it may not be a good choice of treatment for everyone. 

Post-traumatic stress disorder (PTSD) 

The combination of Fluoxetine and Duloxetine can also be used in the management and treatment of post-traumatic stress disorder. PTSD can also become quite problematic, especially if the disease keeps progressing without proper management. 

Several studies have indicated that untreated PTSD can trigger psychosis in patients and treating that condition needs a whole new treatment regimen. This is why PTSD should always be treated properly. 

Studies suggest that the combination of Fluoxetine and Duloxetine can help manage the worst kinds of PTSD. Low doses of Fluoxetine and Duloxetine are generally well tolerated in such patients and it slowly starts to provide them relief from their disturbing symptoms and manic episodes. 

Anxiety disorders

The combination of Fluoxetine and Duloxetine can also be used in the management and treatment of generalised anxiety disorder (GAD) and social anxiety disorder (SAD). 

The combination of these two, at low doses, has helped millions of people overcome their anxious personalities and has helped calm them down. 

However, it may not be a good choice of treatment for every person. This is why you should ask your healthcare provider before taking Fluoxetine and Duloxetine together. 

What are the warnings associated with the use of Fluoxetine and Duloxetine together? 

A few warnings have been issued to ensure the safe and effective use of Fluoxetine and Duloxetine together. These include: 

• Suicidal warning
• Pregnancy warning 
• Serotonin syndrome warning

Suicidal warning 

Both Fluoxetine and Duloxetine are associated with a suicidal warning, especially in users younger than 24 years of age. In fact, the Food and Drug Administration (FDA) has issued this warning that these meds can induce suicidal behaviour in some populations. 

You can imagine how this warning doubles up when you take two of such medications. This is why you should always consult your healthcare provider and weigh the pros and cons before using these meds, especially if you’re younger than 24 years of age. 

If you’re a parent and your child takes antidepressants, you should definitely monitor their behaviour. If they seem depressed, or dull, or if they seem to give up on everything, keep an eye on them. Try to talk them out of it and seek medical help immediately. 

Pregnancy warning 

Both Fluoxetine and Duloxetine can be dangerous for a growing baby, especially during the third trimester. If you’re a pregnant woman who has been taking a combination of antidepressants, talk to your healthcare provider as soon as you can to discuss the future treatment. 

Both of these antidepressants can also be passed into the breast milk and may cause side effects in breastfed babies. This is why always inform your doctor if you’re a breastfeeding mother. 

Serotonin syndrome warning 

The risk of serotonin syndrome is the biggest concern when it comes to the combination treatment of Fluoxetine and Duloxetine. Both of these meds are associated with increasing the amount of active serotonin in your body. When taken together, both drugs do their part. 

They both increase the levels of serotonin in your body. If the doses of these drugs are not adjusted, they can make the amount of serotonin unbearably high, which gives rise to the symptoms associated with serotonin syndrome. The syndrome occurs as a result of too much serotonergic activity and it can be of various intensities. 

Conclusion 

In this blog post, we have discussed the concomitant use of Fluoxetine and Duloxetine. Fluoxetine, the generic name for Prozac, is an SSRI. It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). 

Duloxetine, a generic name for Cymbalta, is an SNRI. It works by inhibiting the reuptake of two excitatory monoamine neurotransmitters; serotonin and norepinephrine. It does so by blocking serotonin and norepinephrine transporters, SERT and NET respectively. 

They can be used in combination, but only if your healthcare provider believes that it is a good treatment option for you. Make sure you use these two properly. Overdosing on two antidepressants can become your worst nightmare. 

FAQs: Fluoxetine and duloxetine taken together 

Are Fluoxetine and Duloxetine the same?

No, Fluoxetine and Duloxetine are not the same. Fluoxetine, generic name for Prozac, is an SSRI. It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). 

Duloxetine, generic name for Cymbalta, is an SNRI. It works by inhibiting the reuptake of two excitatory monoamine neurotransmitters; serotonin and norepinephrine. It does so by blocking serotonin and norepinephrine transporters, SERT and NET respectively.

What is the best antidepressant to take with duloxetine?

There are a number of antidepressants that can be used instead of Duloxetine. However, Duloxetine is considered a strong antidepressant. It is a serotonin-norepinephrine reuptake inhibitor (SNRI). 

It works by inhibiting the reuptake of two excitatory monoamine neurotransmitters; serotonin and norepinephrine. It does so by blocking serotonin and norepinephrine transporters, SERT and NET respectively. Other SNRIs, SSRIs, Mirtazapine, Wellbutrin and many other antidepressants can be used in place of Duloxetine.

Can you take two antidepressants at the same time?

Yes, you can take 2 antidepressants at the same time, but only if prescribed by your healthcare provider. Your doctor will suggest to you the best possible combination that would be compatible with your body’s physiology and your condition. 

There are some antidepressants which are not compatible with one another and may cause disturbing side effects, and only a healthcare provider can determine which combination can be dangerous. This is why you should never take such matters into your own hands and always consult your doctor. 

How do I switch from Duloxetine to Fluoxetine? 

In order to switch from Duloxetine to Fluoxetine, your healthcare provider may slowly start to taper off Duloxetine, while starting Fluoxetine from the lowest effective dose. Dose tapering for Duloxetine withdrawal is important to protect you from the disturbing symptoms associated with Duloxetine withdrawal. This is why you should talk to your healthcare provider about the best antidepressant switching strategy and should never stop Duloxetine or any other antidepressant abruptly. 

What two antidepressants work well together?

There are a huge number of possibilities when it comes to the combination of antidepressants. It’s hard to tell which one is considered the best, as all of the combinations act uniquely for different mental health conditions. 

However, research suggests that the combination of two SSRIs, mainly Sertraline and Escitalopram is considered a good, safe, and effective choice for the treatment and management of depression, anxiety, and several other mental health conditions. 

Is there a medication that treats both depression and anxiety?

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the management and treatment of both depression and anxiety. These meds can help relieve the symptoms associated with mild to moderate episodes of depression while providing relief in patients with a generalised anxiety disorder (GAD) and social anxiety disorder (SAD).

 However, it usually takes 4 to 8 weeks for these meds to start working. If you’re being treated with SSRIs, you should remain patient and take your meds properly. Make sure you do not stop the treatment halfway.

References 

• Drug Interactions between Cymbalta and Prozac https://www.drugs.com/drug-interactions/cymbalta-with-prozac-949-2273-1115-648.html
• Eun-Jin Cheon, Jun-Yeob Lee, and Bon-Hoon Koo – Effectiveness of Duloxetine Monotherapy Compared to Combination Therapy with Other Antidepressants in Patients with Major Depressive Disorder: A Short-Term, Retrospective Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4965656/
• Prozac Capsule – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-6997/prozac-oral/details
• Duloxetine https://www.nhs.uk/medicines/duloxetine/