Can you use Paxil and Cymbalta together? (3 Pros and Cons) 

In this blog post, we are going to answer the question, “Can you use Paxil and Cymbalta together?”. Both Paxil and Cymbalta 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 use Paxil and Cymbalta together?

Yes, you can use Paxil and Cymbalta together, but only if recommended by your prescribing physician. The combination of Paxil and Cymbalta is approved by the Food and Drug Administration (FDA) for some cases. 

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 Paxil or Cymbalta is considered quite beneficial and tolerable. 

Let’s look at how these meds work. Paxil, brand name for Paroxetine, 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, Paxil counteracts the symptoms associated with depression, anxiety, and several other mental health conditions. 

Cymbalta (Duloxetine) 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. 

What are the pros and cons associated with the use of Paxil and Cymbalta together? 

Every single combination of medications has some pros and cons of its own. One combination may work for some people, but there’s no way to guarantee that it will work for everyone. The same is the case with the combination of Paxil and Cymbalta. 

Some people have gained a number of benefits from these two antidepressants and some have labelled them as a ‘life-saving’ combination. Some people, on the other hand, could not even tolerate them two together. 

The presence of two antidepressants in their body at the same time did not deliver the result they would have hoped for. This is why you should always stick to your doctor’s recommendations. 

Your healthcare provider knows which combination is compatible with your body physiology and your mental health condition. Let’s look at some of the pros and cons associated with the use of Paxil and Cymbalta together. 

Pros

The combination of Paxil and Cymbalta has the following pros:

• Active against major depressive disorder (MDD) 
• Better management of severe anxiety disorders
• More satisfying outcomes in post-traumatic stress disorder (PTSD) 

Active against major depressive disorder (MDD) 

The most important benefit of the combination of Paxil and Cymbalta 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 Paxil and Cymbalta 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. 

Better management of severe anxiety disorders

The combination of Paxil and Cymbalta can help in the management of severe types of anxiety, like 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 Paxil and Cymbalta together. 

More satisfying outcomes in post-traumatic stress disorder (PTSD) 

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

Cons

The combination of Paxil and Cymbalta has the following cons:

• Risk of serotonin syndrome 
• Increased gastrointestinal side effects 
• Possibility of psychological side effects

Risk of serotonin syndrome

The risk of serotonin syndrome is the biggest concern when it comes to the combination treatment of Paxil and Cymbalta. 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 

Increased gastrointestinal side effects 

Gastrointestinal side effects can significantly impact the future of your treatment with Paxil and Cymbalta. This is because many people can not tolerate these two meds together simply because their stomachs can not bear the presence of these two antidepressants at the same time. 

As we have discussed earlier, this combination may not work well for everyone. It includes those people who have gastrointestinal diseases, like peptic or duodenal ulcers, Irritable bowel syndrome, and some other GI diseases. 

This is why you should always give your medical history properly and should mention it clearly if you frequently suffer from an upset stomach. It can help your doctor determine if you can bear the combination of Paxil and Cymbalta. Both of these meds are associated with some disturbing gastrointestinal side effects of their own. 

Possibility of psychological side effects

Another main concern is the effect of too much serotonin on your brain. Not just that, we have just observed that both of the drugs are associated with some common psychological side effects like anxiety, agitation, and sleep disturbances. 

These harmful effects can really add up when Paxil and Cymbalta are used together. Some people suffer from excessive sleepiness which can decrease their mental alertness. 

Some people suffer from insomnia and stay up almost all night. This also affects their energy levels and mental alertness during the daytime. 

Conclusion 

In this blog post, we have discussed the concomitant use of Paxil and Cymbalta. Paxil, brand name for Paroxetine, is an SSRI. It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). 

Cymbalta, the brand name for 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. 

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: Paxil and Cymbalta together 

What antidepressant works well with Cymbalta?

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 Paxil and Cymbalta the same?

No, Paxil and Cymbalta are not the same. Paxil, brand name for Paroxetine, is an SSRI. It works by inhibiting the reuptake of serotonin by blocking serotonin transporters (SERT). Cymbalta, brand name for 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.

What should you not mix with Cymbalta?

There are a lot of medications that should not be paired with Cymbalta. Some of these include:

• Antidepressants like Monoaminoxidase inhibitors (MAOIs) 
• St John’s wort 
• Tryptophan 
• Tyramine containing foods
• Grapefruit juice
• Some other medications 

What medications should not be taken with Paxil?

• 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 

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. 

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. 

References 

• Drug Interactions between Cymbalta and Paxil CR https://www.drugs.com/drug-interactions/cymbalta-with-paxil-cr-949-2273-1800-1155.html#:~:text=Using%20PARoxetine%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/