Can you use Citalopram and Duloxetine together? (3 research studies) 

In this blog post, we are going to answer the question, “Can you use Citalopram and Duloxetine together?”. Both Citalopram and Duloxetine are strong antidepressants and can be used to treat a variety of mental health conditions. 

They are both used individually for the management of mild to moderate episodes of depression. However, persistent depressive illness may not respond well to monotherapy. This blog will cover the combination of Citalopram and Duloxetine. 

Can you use Citalopram and Duloxetine together?

Yes, you can use Citalopram and Duloxetine together, but only if your healthcare provider prescribes this combination. This is because combination treatments usually have adjusted doses because basic therapeutic doses of two strong antidepressants can not be tolerated well. 

This is because you should always consult your healthcare provider if you think that your mental health condition needs a combination of antidepressants and monotherapy is not good enough for you. 

What does research suggest? 

Many research studies have investigated the combination treatment of antidepressants. Such meds are not considered so easy to deal with, especially when you’re taking more than one at the same time. 

A 2017 study indicated that Citalopram in combination with Duloxetine has a better response rate in the treatment and management of major depressive disorder (MDD). 

The study revealed that when the effects of this combination therapy were compared with monotherapy, it was clearly seen that the depressed patients responded well to the combination, even those who did not respond to the monotherapy. 

This is because MDD is the most severe kind of clinical depression and it usually does not respond well to monotherapy. Even if it does, it fails to uphold that therapeutic response. It can still respond to higher doses of monotherapy, but they are not easily tolerated. 

Another study indicated that Citalopram and Duloxetine work well together, especially when the doses are adjusted. These meds can significantly decrease the frequency of panic attacks, especially in people with post-traumatic stress disorder (PTSD). 

However, the same study also revealed that not every test participant was comfortable with this combination treatment. Some did not respond well to it and they suffered from intolerable side effects. Such volunteers were removed from the study. 

This clearly indicates that the combination of Citalopram and Duloxetine may not work well for every other individual. If your doctor has recommended this combination, make sure you take it as properly as you can. Proper and timely dose administration is the key to a good therapeutic response. 

What is the difference between Citalopram and Duloxetine? 

Both Citalopram and Duloxetine are strong antidepressants. They are prescribed quite frequently and they have a good therapeutic background. However, both of them belong to different classes of antidepressants. 

Citalopram (brand name: Celexa) 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.

What are the side effects associated with the use of Citalopram and Duloxetine together? 

Both Citalopram and Duloxetine are associated with some disturbing side effects. Some of them are common and may make you suffer from something called ‘synergistic side effects. 

These side effects occur when you take two or more meds which can cause the same type of side effects. This is why dose adjustment is crucial when it comes to combination treatment with antidepressants. Let’s look at the side effects individually. 

Side effects of Citalopram 

Citalopram (Celexa) is associated with the following side effects:

• Nausea 
• Vomiting 
• Diarrhoea or Constipation 
• Acid reflux or heartburn 
• Abdominal pain 
• Loss of appetite 
• Weight gain or loss 
• Excessive sweating or night sweating (nocturnal/night hyperhidrosis) 
• Frequent urination 
• Polydipsia or excessive thirst
• Tremors 
• Muscle twitching and pain
• Drowsiness 
• Dizziness 
• Excessive tiredness or fatigue 
• Insomnia or inability to fall asleep 
• Xerostomia or dry mouth 
• Dysmenorrhea or heavy periods
• 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. 

Side effects of Duloxetine 

Duloxetine (Cymbalta) is associated with the following side effects:

• Drowsiness
• Fatigue
• Sleepiness or hypersomnia
• Decreased salivation leading to dry mouth 
• Vertigo 
• Loss of appetite 
• Excessive sweating
• Constipation or diarrhoea 
• Weight gain or loss
• Abdominal pain
• Bloating 
• Flatulence 
• Headache 
• Muscular pain 
• Urinary problems 
• Vision problems 
• Low sodium levels 
• Orthostatic Hypotension. 

Both of these meds can also generate an allergic response in some individuals. Make sure you should report to your healthcare provider if you exhibit any sign of an allergic reaction or any unusual side effect. 

As stated earlier, this combination may not work well for every other individual. Some people can not tolerate the presence of two antidepressants in their bodies at the same time. 

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

A few warnings have been issued to ensure the safe and effective use of Citalopram and Duloxetine together. Both Citalopram 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. The risk of serotonin syndrome is the biggest concern when it comes to the combination treatment of Citalopram 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. 

Both Citalopram 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. 

Conclusion 

In this blog post, we have discussed the concomitant use of Citalopram and Duloxetine. Both Citalopram and Duloxetine are strong antidepressants and can be used to treat a variety of mental health conditions. 

They are both used individually for the management of mild to moderate episodes of depression. However, persistent depressive illness may not respond well to monotherapy. 

This is why this combination is preferred and it works well for the management and treatment of the major depressive disorder (MDD). Make sure you consult your healthcare provider if you exhibit any sign of an allergic reaction or any unusual side effect. 

FAQs: Citalopram and duloxetine together 

Is duloxetine stronger than citalopram?

Yes, Duloxetine is considered stronger than Citalopram. It is because of the mechanism of action of these antidepressants. Citalopram (brand name: Celexa) is a selective serotonin reuptake inhibitor (SSRI). It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). 

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. 

What is the best antidepressant to take with duloxetine?

There are a number of antidepressants that can be used instead of Cymbalta. However, Cymbalta 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. 

Are duloxetine and citalopram the same thing?

No, Duloxetine and Citalopram are not the same things. Citalopram (brand name: Celexa) is a selective serotonin reuptake inhibitor (SSRI). It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). 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. 

What is the best combination of antidepressants?

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. 

How do you know if Cymbalta is not working?

Antidepressants are meant to provide relief in the symptoms associated with depression, anxiety, or any other mental health-related problem. However, if you have been taking Cymbalta for a while now and you don’t see any change in your condition, it might indicate that Cymbalta is not working for you. If it makes you experience a number of disturbing side effects, then it clearly indicates that Cymbalta is not the right choice of antidepressant for you. 

What drugs should not be taken with citalopram?

• 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 

References 

• Drug Interactions between citalopram and duloxetine https://www.drugs.com/drug-interactions/citalopram-with-duloxetine-679-0-949-0.html#:~:text=Using%20citalopram%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/
• Citalopram https://www.nhs.uk/medicines/citalopram/