What is a good antidepressant to take with Lexapro? (1+ benefits)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
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Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss what antidepressant is a good option to combine with Lexapro (escitalopram), a selective serotonin reuptake inhibitor. We will also discuss some potential benefits and risks of combining Lexapro with another antidepressant and how one can ensure safe use.
What is a good antidepressant to take with Lexapro?
Wellbutrin (bupropion) is considered a good antidepressant to take with Lexapro (escitalopram) because of how it works. The major concern with antidepressant combinations is the risk of increased side effects and serotonin syndrome – a condition associated with too much serotonergic activity in the brain (1).
Wellbutrin is considered a good option because it’s an atypical antidepressant that does not work the way Lexapro does – a selective serotonin reuptake inhibitor (SSRI). (2)
Lexapro is the most selective SSRI, causing the most inhibition of serotonin reuptake compared to other members of this class (3). It does not affect other neurotransmitters enough to create a clinically significant response.
This primary effect of Lexapro on serotonin makes it unsuitable to pair with other medications that can also increase serotonin levels, such as other SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs), and serotonergic antidepressants like trazodone.
The effects of Wellbutrin on serotonin are minimal, as it primarily acts on two other monoamine neurotransmitters – norepinephrine and dopamine. It is sometimes also known as a norepinephrine and dopamine reuptake inhibitor (NDRI). (4)
In fact, Wellbutrin is the only NDRI approved in the US to treat depression. This mechanism of action makes Wellbutrin a good option to be combined with serotonergic antidepressants like Lexapro. These meds can together work on three excitatory chemicals involved in the pathophysiology of depression.
What are the benefits of taking Lexapro with a compatible antidepressant?
Taking Lexapro with a suitable antidepressant can offer the following potential benefits: (2,4)
Treatment of major depressive disorder (MDD)
Using a single antidepressant may not always effectively manage major depressive disorder. Combining Lexapro with a compatible antidepressant enhances the overall treatment approach, helping MDD in a better way.
Reduced Lexapro-induced side effects
Pairing Lexapro with a suitable antidepressant can mitigate specific side effects associated with Lexapro use, such as Lexapro-induced sexual disturbances or weight gain. Taking Lexapro with a low-dose sedative antidepressant can manage insomnia associated with this SSRI.
What are the side effects of taking Lexapro with another antidepressant?
Taking Lexapro with another antidepressant like Wellbutrin can cause the following side effects: (2,4)
Additive side effects
When taking two compatible antidepressants together, there’s a possibility of experiencing additive side effects. These can include:
- early anxiety
- sleeping issues
- Tiredness
- Nausea
- Vomiting
- disturbed stomach
- diarrhoea or constipation
- dry mouth.
While these side effects are common with many antidepressants individually, their occurrence may intensify when the medications are used in combination.
Risk of serotonin syndrome
Serotonin syndrome is a rare but potentially serious condition that is triggered by too much serotonergic activity in the brain. Since Lexapro primarily affects serotonin levels, combining it with another antidepressant that also affects serotonin levels may increase the risk of serotonin syndrome.
However, it’s crucial to note that the likelihood of this side effect is dose-dependent, with higher doses increasing the chances.
Some signs and symptoms associated with serotonin syndrome are: (1)
- Agitation or restlessness
- Confusion
- Rapid heart rate
- Dilated pupils
- Loss of muscle coordination or twitching muscles
- Excessive sweating
- Shivering or goosebumps
- High blood pressure
- Dilated pupils
- Diarrhoea
- Headache
- High fever
- Shivering or tremors
- In severe cases, it can lead to seizures or unconsciousness.
Risk of seizures
Certain antidepressants, such as Wellbutrin, carry a rare risk of causing seizures. Lexapro, while generally considered low-risk for seizures, may lower the seizure threshold in some cases.
Combining these medications could potentially increase the risk of convulsions, especially in individuals who are susceptible to seizures.
What antidepressants should not be taken with Lexapro?
The following antidepressants should be avoided with Lexapro:
Other Selective Serotonin Reuptake Inhibitors (SSRIs)
Using Lexapro with other SSRIs can increase the risk of serotonin syndrome. Since these medications have similar side effect profiles and both work on serotonin levels, combining them may lead to potentially dangerous additive side effects.
Tricyclic Antidepressants (TCAs)
The combination of Lexapro with TCAs may result in a less favourable side effect profile. TCAs often have more side effects compared to newer antidepressants, and combining them with Lexapro could intensify the overall adverse effects.
Monoamine Oxidase Inhibitors (MAOIs)
MAOIs should never be paired with Lexapro. MAOIs inhibit enzymes responsible for breaking down neurotransmitters like serotonin. When taken together, the levels of serotonin can increase dangerously, leading to serotonin syndrome – a potentially life-threatening condition.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Similar to SSRIs, combining Lexapro with SNRIs may not be preferred due to the risk of serotonin syndrome. SNRIs also affect serotonin levels, and the additive effects of both medications could be more pronounced.
How to ensure the safe use of Lexapro with another antidepressant?
The following points are important to ensure the safe and effective use of Lexapro and another compatible antidepressant, such as Wellbutrin:
- Stick to the recommended doses. Exceeding doses can increase the risk of side effects and potentially lead to serotonin syndrome.
- Regular monitoring of side effects is important as even compatible antidepressants may cause adverse reactions. Report any unusual symptoms or discomfort to your provider.
- Follow the recommended timing and spacing of the two antidepressants.
- Make sure you inform your doctor about all the medications you are taking, including OTC meds.
- Alcohol should be avoided while taking antidepressants, including Lexapro. Alcohol can negatively impact mental and physical health, and its interaction with antidepressants may exacerbate side effects or reduce the effectiveness of the medication.
As a pharmacist, I always help my patients understand how important it is to ensure the safe and effective use of antidepressant combinations. You strictly have to stick to the recommended doses to prevent side effects or any other complications.
It is also important to note that antidepressants are prescription medications and should never be combined without your doctor’s approval.
References
- Simon LV, Keenaghan M. Serotonin Syndrome. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29493999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482377
- Landy K, Rosani A, Estevez R. Escitalopram. 2023 Nov 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491666. https://www.ncbi.nlm.nih.gov/books/NBK557734
- Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. J Psychiatry Neurosci. 2006 Mar;31(2):122-31. Erratum in: J Psychiatry Neurosci. 2006 Jul;31(4):228. PMID: 16575428; PMCID: PMC1413963. https://pubmed.ncbi.nlm.nih.gov/16575428/
- Huecker MR, Smiley A, Saadabadi A. Bupropion. 2023 Apr 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262173. https://www.ncbi.nlm.nih.gov/books/NBK470212