Does a combination of Remeron and Lexapro work? (3 possible complications) 

In this blog post, we are going to answer the question, “How well does the combination of Remeron and Lexapro work?”. Remeron, the brand name for Mirtazapine, is one of the most commonly prescribed atypical antidepressants. 

It can be used for the treatment and management of a number of mental health-related problems. Remeron can also be used in combination with Lexapro, the brand name for Escitalopram. This blog will cover the safety and efficacy of the concomitant use of these two antidepressants. 

How well does the combination of Remeron and Lexapro work?

The combination of Remeron and Lexapro works really well. Lexapro is considered one of the safest antidepressants and it pairs well with a low dose of Mirtazapine. However, this combination may not be a good choice for every other individual, but it does hold some great clinical importance. 

What is the clinical importance of the combination of Remeron and Lexapro? 

Remeron (Mirtazapine) and Lexapro (Escitalopram) can be used for the treatment and management of treatment-resistant depression or major depressive disorder (MDD). 

Several studies have revealed that persistent depression does not usually respond to monotherapy and it usually requires a combination of two compatible antidepressants. Mirtazapine does hold great clinical importance because of its unique mechanism of action. 

However, the dose of Mirtazapine can not be escalated that easily because of the side effects that are associated with the higher doses. This is why a low dose of Mirtazapine is usually paired with moderate to high doses of Lexapro or other selective serotonin reuptake inhibitors (SSRIs). 

Mirtazapine is usually initiated from 15 mg, and it is not suitable to exceed the dose of 45 mg per day, and that too when Mirtazapine is used alone. 

In combination, the dose of Mirtazapine remains at 15 mg, while the dose of Lexapro is increased gradually according to the severity of the condition and the response rate of the person taking it. 

Several studies have also indicated that the combination of Remeron and Lexapro can also be used for the safe and effective treatment and management of symptoms associated with post-traumatic stress disorder (PTSD).

PTSD can become quite resistant too, especially if it is left untreated and the disease progresses. The combination also works well for the treatment of depression comorbid with insomnia. 

This is because Remeron, at low doses, can be used for insomnia and it has pretty good reviews related to that. Some studies also suggest that Remeron can decrease the sexual side effects of Lexapro and may prevent related complications. 

However, these antidepressants produce different effects in different individuals. Some people tolerate this combination really well and they achieve their desired therapeutic response, whereas some people can’t even continue the treatment. 

If a person is allergic to either Remeron or Lexapro or both, then there is no point in the continuation of treatment. Some people are extremely sensitive to the effects of antidepressants and they simply can not tolerate such meds. 

For such people, close monitoring is required to determine the long-term therapeutic goals. Make sure you always talk to your healthcare provider before taking any such medication.

What are the possible complications associated with the use of Remeron and Lexapro together? 

There are chances of some possible complications that may arise in some patients while being treated with the combination of Remeron and Lexapro. Let’s look at some of them:

The risk of serotonin syndrome 

The risk of serotonin syndrome is the biggest concern when it comes to combining two or more antidepressants together. This is because all of these meds increase the number of excitatory neurotransmitters in your brain. 

If the doses are not properly adjusted or people don’t follow their doctor’s advice and take more than what is prescribed, the risk of serotonin syndrome increases. This is because too much serotonin, an excitatory chemical in your brain, can make your entire body start malfunctioning. 

It excessively binds to a huge number of its receptors throughout the body and causes disturbing symptoms. Some of which include:

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

Risk of gastrointestinal side effects 

Both Remeron and Lexapro are associated with gastrointestinal side effects on their own. When these two are combined, they can cause pain, tenderness, acid reflux, and other GIT-related problems in some people. 

People who are already living with conditions like gastric or duodenal ulcers are more at risk. Lexapro and Remeron may also exacerbate the symptoms associated with pre-existing gastroesophageal reflux disease (GERD). 

This is why you should carefully inform your doctor if you have any stomach-related problems before you start taking the combination of these two antidepressants. 

You should also give complete information regarding your other prescription medications (if any) to rule out the chances of any possible drug-drug interaction. 

Risk of cardiovascular side effects 

Both Remeron and Lexapro can cause arrhythmia, heart palpitations, and QT prolongation. However, they are not considered that common, but there is no way to predict who will get these side effects and who will not. 

Lexapro is usually considered safe to be used for the management and treatment of depression in cardiac patients. However, it may cause some complications when used in combination with meds like Remeron which can also cause arrhythmia and heart palpitations. 

This is why you should never start using this combination without your doctor’s approval if you are a heart patient and should always stick to your doctor’s recommended prescription. 

How to ensure the proper use of Remeron and Lexapro? 

The proper use of medications is the key to achieving the maximum therapeutic response. Both of these meds come with a black box warning as they both can induce suicidal behaviour in people less than 24 years of age. 

However, Remeron can induce suicidal behaviour in people older than that as well. This is why you should monitor your psychological symptoms carefully. 

If you are a caretaker of the person or the child receiving this combination therapy, make sure you keep a close eye on their behavioural pattern. If they seem depressed or ever talk about self-harm, immediately report to your healthcare provider. 

You should always be careful when it comes to dose administration. If you have accidentally missed a dose, you can take it as soon as you remember. If a lot of time has passed and you’re already near your next dose, it’s best to skip the missed dose and take the next one on time.

A missed dose is always better than an overdose when it comes to antidepressants. One of the rare and serious side effects of both Remeron and Lexapro is QT prolongation. This side effect can become life-threatening for cardiac patients. 

This is why you should always consult your healthcare provider before taking the combination of these two antidepressants. Although monotherapy with either Remeron or Lexapro is considered safe, a combination of these two can become dangerous, especially if the doses are not adjusted properly. 

It is also recommended to inform your healthcare provider if you are pregnant or trying to get pregnant. You should also inform your doctor if you are a nursing or breastfeeding mother. Both Remeron and Lexapro can pass into the breastmilk and may cause side effects in the breastfed baby. 

Conclusion 

In this blog post, we have discussed the concomitant use of Remeron and Lexapro. The combination of these two antidepressants is believed to work really well. Lexapro is considered one of the safest antidepressants and it pairs well with a low dose of Mirtazapine. 

However, this combination may not be a good choice for every other individual, but it does hold some great clinical importance. They both can actively be used for the treatment and management of treatment-resistant depression or major depressive disorder (MDD). 

Make sure this combination is prescribed by your healthcare provider and it holds more benefits for you as compared to risks. Self-medication is not recommended in any case and you should always stick to your doctor’s recommendations. 

FAQs: Remeron and Lexapro combination

Can you take SSRI and mirtazapine together? 

Yes, SSRIs can be used with Mirtazapine. You can take SSRIs like Zoloft (Sertraline), Lexapro (Escitalopram), Celexa (Citalopram), Paxil (Paroxetine), and Prozac (Fluoxetine). They both can actively be used for the treatment and management of treatment-resistant depression or major depressive disorder (MDD). 

Make sure this combination is prescribed by your healthcare provider and it holds more benefits for you as compared to risks. Self-medication is not recommended in any case and you should always stick to your doctor’s recommendations. 

What is a good combination with mirtazapine?

Several studies have suggested that mirtazapine works well when it is used in combination with an SSRI or an SNRI. However, a combination of antidepressants can only be taken when prescribed by your healthcare provider. 

This is because when two meds for the same illness are used, the doses are adjusted. Individual therapy comes with higher doses, while combination therapy has to be adjusted on comfortable doses to help avoid the side effects. 

Can you take another antidepressant with mirtazapine?

Yes, you can take another antidepressant with Mirtazapine. The best antidepressants to take with Mirtazapine are selective serotonin reuptake inhibitors (SSRIs) and Venlafaxine, which is a serotonin-norepinephrine reuptake inhibitor (SNRI). The rest of the classes of antidepressants do not pair well with Mirtazapine because of the side effects that are associated with them. However, these combinations may also affect some people negatively, especially when the doses are high.

What antidepressant can you add to Lexapro?

Lexapro is considered one of the safest SSRIs, in fact, one of the safest antidepressants. It can be paired with other antidepressants like Remeron (Mirtazapine) and Wellbutrin (Bupropion). However, they should not be used together without your doctor’s approval. Every condition is ideal and the pros and cons of such combinations are weighed out first. If your condition requires a combination of antidepressants then your doctor will prescribe you one. If not, you will be asked to stick to antidepressant monotherapy and I’m sure it will be enough for you. 

What Mirtazapine should not be taken with? 

• 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 Lexapro and mirtazapine https://www.drugs.com/drug-interactions/lexapro-with-mirtazapine-1013-565-1640-0.html#:~:text=Using%20escitalopram%20together%20with%20mirtazapine,shivering%20or%20shaking%2C%20blurred%20vision 
• E Álvarez et al. Actas Esp Psiquiatr. (2010) – Mirtazapine in combination https://pubmed.ncbi.nlm.nih.gov/21361055/
• Mirtazapine Tablet – Uses, Side Effects, and More https://www.webmd.com/drugs/2/drug-13706-4047/mirtazapine-oral/mirtazapine-oral/details#:~:text=Mirtazapine%20is%20used%20to%20treat,(neurotransmitters)%20in%20the%20brain.
• National Library of Medicine – Mirtazapine https://medlineplus.gov/druginfo/meds/a697009.html