Can you take Duloxetine and Sertraline together? (5+ side effects) 

In this blog post, we are going to answer the question, “Can you take duloxetine and sertraline together?”. Both Duloxetine and Sertraline 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 you take Duloxetine and Sertraline together?

Yes, you can use Duloxetine and Sertraline 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 Duloxetine or Sertraline is considered quite beneficial and tolerable. 

What is the difference between Duloxetine and Sertraline? 

Both Duloxetine and Sertraline are antidepressants in nature but they belong to two separate classes of antidepressants and have slightly different mechanisms of action. Duloxetine (Brand name: Cymbalta) 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 and control the symptoms associated with depression, anxiety, and several other mental health conditions. 

Sertraline (brand name: Zoloft), on the other hand, 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 and this way, Sertraline counteracts the symptoms associated with depression, anxiety, and several other mental health conditions.

What is the clinical significance of using Duloxetine and Sertraline together? 

Duloxetine and Sertraline do hold some clinical importance when it comes to the combination of these antidepressants. The most important benefit of the combination of Duloxetine and Sertraline is its activity against major depressive disorder (MDD). 

This is considered a serious type of clinical depression and it often fails to respond to monotherapy with even the strongest of antidepressants. This is why combination therapy holds more chances of fighting against this nerve-racking, persistent type of depression. 

Studies suggest that even low doses of Duloxetine and Sertraline show good responses in patients with MDD. However, there is a certain limit to which the doses can be increased. In combination treatment, two antidepressants get into your system at the same time. 

If the doses are not adjusted, it could give rise to a number of complications. The combination can also be used for the management and treatment of anxiety and related symptoms.

Both Duloxetine and Sertraline are approved by the Food and Drug Administration (FDA) for the treatment of anxiety. The combination of these meds can also help patients with obsessive-compulsive disorder (OCD) recover. 

OCD can take a serious turn if the disease progresses without a proper treatment plan. This is why a combination of antidepressants is preferred over monotherapy to achieve a better and more promising therapeutic response. 

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

What are the common side effects associated with the use of Duloxetine and Sertraline? 

Both Duloxetine and Sertraline are associated with some side effects of their own and some of these side effects match. This means that there is a chance that both of these antidepressants can cause more prominent side effects as compared to when they are used individually. 

This is why dose adjustment is extremely important in this case. If both of these antidepressants are taken at the same dose that is preferred in monotherapy, there is a huge possibility of your body not accepting these meds. 

Antidepressants can change the entire chemistry of your brain if not used properly. This is why dose adjustment should be a top priority. Let’s look at some of the common side effects of both Duloxetine and Sertraline:

• Nausea
• Diarrhoea 
• Flatulence 
• Vomiting 
• Dizziness 
• Drowsiness 
• Weight gain or loss 
• Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
• Frequent urination 
• Polydipsia or excessive thirst
• Tremors 
• Muscle twitching and pain
• Acid reflux or heartburn 
• Abdominal pain 
• Flu-like symptoms, including irritation in eyes and runny nose
• Loss of libido in both males and females. Males may suffer from an inability to release, while females may suffer from an inability to have a climactic experience. 

Make sure you talk to your healthcare provider as soon as you can if you exhibit any sign of an allergic reaction soon after taking this combination therapy for the first time. Some people are naturally allergic to some meds and there is no way to predict that before actually taking the med. 

In case of overdose, immediately reach out to the hospital and inform them how much drug has been taken and when. If you have accidentally missed a dose, take it as soon as you remember. If a lot of time has passed, it’s better to skip the dose and take the next one on time. 

Apart from these side effects, there are chances of some more serious complications that could arise in some people. The risk of serotonin syndrome is the biggest concern when it comes to the combination treatment of Duloxetine and Sertraline. 

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. Some of the symptoms associated with this disturbing syndrome include:

• The rapid change in blood pressure 
• Uncontrollable heartbeat
• Vision problems 
• Auditory and visual hallucinations
• Erratic behaviour 
• Fever with chills
• Muscle Shivering 
• Nervousness 
• Convulsions 
• Confusion 

This is why it is extremely important to ensure the proper use of these meds. Do not take any more than what your healthcare provider has prescribed. 

Conclusion 

In this blog post, we have discussed the concomitant use of Duloxetine and Sertraline. Sertraline, the generic name for Zoloft, 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: Can you take duloxetine and sertraline together 

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.

What drugs should not be taken with duloxetine?

• Monoaminoxidase inhibitors (MAOIs). The combination use can increase the risk of serotonin syndrome. 
• Non-steroidal anti-inflammatory drugs (NSAIDS). The combination use can increase the risk of bleeding. 
• Pimozide. The concomitant use can increase the plasma concentration(availability of a drug in the blood) of pimozide to much higher levels. It can result in life-threatening arrhythmia.
• Controlled substances, including all narcotic analgesics. The concomitant use can cause severe psychological side effects. 
• Mood stabilisers 
• Alcohol 

Can you take 2 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. 

Which is better, Duloxetine or Sertraline? 

Both Duloxetine and Sertraline are considered strong antidepressants. Duloxetine may work for some better in a better way as compared to Sertraline, and vice versa. There is no way to predict which one will suit you the best unless you actually take them. Sertraline is an SSRI. 

It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). Duloxetine 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.

How do I switch from Duloxetine to Sertraline? 

In order to switch from Duloxetine to Sertraline, your healthcare provider may slowly start to taper off Duloxetine, while starting Sertraline 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. 

References 

• Drug Interactions between duloxetine and sertraline https://www.drugs.com/drug-interactions/duloxetine-with-sertraline-949-0-2057-0.html#:~:text=Using%20sertraline%20together%20with%20DULoxetine,shivering%20or%20shaking%2C%20blurred%20vision%2C 
• 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/#:~:text=With%20respect%20to%20the%20combination,%2C%20bupropion%2C%20sertraline%20and%20fluoxetine.
• Duloxetine https://www.nhs.uk/medicines/duloxetine/
• National Library of Medicine – Sertraline https://medlineplus.gov/druginfo/meds/a697048.html