What is the best antidepressant to take with Methadone?

In this blog post, we are going to answer the question, “What is the best antidepressant to take with Methadone?”. Methadone is an opioid analgesic that is used for the management of severe pain. However, it may not be so easy to deal with for some people. 

This blog will cover the safety and efficacy of the concomitant use of Methadone and antidepressants. We will also discuss the risks of using them and tips to ensure their proper use. 

What is the best antidepressant to take with Methadone?

It is difficult to name the best antidepressant to take with Methadone because there is no single combination that works for everyone. There are a whole lot of antidepressants that can be combined with Methadone, but not every combination is a good one. 

This is why you should always consult your healthcare provider to make sure what combination of Methadone and antidepressant will work for you. Methadone is an opioid analgesic and it is associated with a number of side effects. 

It is also considered addictive because of the calming sensation it causes. This is why it should be used cautiously and precautions should be taken when it is combined with any antidepressant. 

What combinations of Methadone and antidepressants can be taken?

Methadone can be combined with some the antidepressants like selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and some tricyclic antidepressants (TCAs). However, not every single drug belonging to these classes makes a good pair with Methadone. 

Methadone with selective serotonin reuptake inhibitors (SSRIs) 

Methadone, when combined with SSRIs, can increase the risk of serotonin syndrome, which is a rare and serious condition. It occurs when there is too much serotonergic activity in your body. 

The excessive amount of serotonin can cause a number of complications by binding to its respective receptors in your body. Some research studies have indicated that SSRIs can slow down the metabolism of Methadone and make it available in your body for a longer period of time. 

This can increase the toxicity of Methadone as more drug is absorbed in the body. This is why dose adjustment is considered a key when it comes to the combination of treatments in which two or more potent drugs are involved. Common SSRIs include:

• Zoloft (Sertraline) 
• Lexapro (Escitalopram) 
• Celexa (Citalopram) 
• Paxil (Paroxetine) 
• Prozac (Fluoxetine) 

Methadone with serotonin-norepinephrine reuptake inhibitors (SNRIs) 

Methadone can also be paired with an SNRI, depending on the choice of drug. However, the combination of Methadone and SNRI possess the same threat as this combination can also increase the risk of serotonin syndrome. 

Although the risk is considered moderate, it can still affect the quality of life in more ways than you can imagine. Serotonin syndrome is no joke and it has even taken lives before. Common SNRIs include:

• Effexor (Venlafaxine) 
• Pristiq (Desvenlafaxine) 
• Ixel (Milnacipran) 
• Fetzima (levomilnacipran) 

Methadone with tricyclic antidepressants (TCAs) 

Methadone can also be combined with tricyclic antidepressants (TCAs), but this pair is considered dangerous. The combination of these two drugs is associated with a number of disturbing side effects. 

TCAs were once considered the first line of drugs for the treatment and management of depression and several other mental health-related problems. However, these meds cause side effects so prominent that it was difficult for people to bear them. 

This is why TCAs were then replaced by newer and safer antidepressants like SSRIs and SNRIs. If we talk about Methadone, it is also one of those meds which may not be tolerated well by people. 

This is why experts believe that the combination of TCAs and Methadone is not a good one and should be avoided unless absolutely necessary. If you’re taking this combination, the most important thing to bear in mind is that you should take as little as possible. 

Drug administration should be on time and it should not be taken more than the prescribed amount. Overdosing on Methadone and TCAs can be deadly. Yes, deadly, and it has taken many lives in the past as the chances of survival become thin when you have high amounts of both Methadone and TCAs in your body at the same time. 

Common TCAs include:

• Elavil (Amitriptyline) 
• Pamelor (Nortriptyline) 
• Tofranil (Imipramine) 

What are the consequences of the concomitant use of Methadone and antidepressants? 

There are some disturbing consequences associated with the concomitant use of Methadone and antidepressants. These include:

• The risk of serotonin syndrome 
• Unbearable insomnia or sedation
• Sexual side effects 
• Psychological side effects 

The risk of serotonin syndrome 

The most important and the biggest risk associated with the concomitant use of Methadone and antidepressants is serotonin syndrome. As both of the drugs are capable of altering the amount of active serotonin in your brain, there is a chance of serotonin syndrome.

It is considered rare, yes, but it can happen. The highest risk of serotonin syndrome is associated with the combination of Methadone and Monoaminoxidase inhibitors (MAOIs). 

This is why the combination treatment of Methadone and MAOIs is contraindicated and should not be prescribed to anyone. Other antidepressants are also associated with the risk of serotonin syndrome, but they can still be used in moderate doses. 

Some of the symptoms associated with serotonin syndrome include:

• Excessive sweating 
• Fever with chills
• confusion
• Restlessness and fatigue
• Headache, which often feels like your head is pounding
• Changes in blood pressure and/or temperature
• Nausea
• Vomiting
• Diarrhoea
• Bradycardia
• Tremors
• Muscle twitching and muscle pain
• Shivering and goosebumps

These symptoms can become extremely intolerable, and serotonin syndrome can lead to life-threatening complications.

Unbearable insomnia or sedation

Both Methadone and antidepressants are associated with insomnia or sedation as side effects. Some people become insomniacs. They can’t fall asleep or even if they do, they continue to wake up in the middle of the night after small intervals. 

This side effect can significantly reduce the quality of your life as insomnia causes daytime fatigue and it becomes difficult for you to perform daily life activities. 

Some people suffer from increased sedation when they are being treated with a combination of Methadone and antidepressants. This can also cause blackouts when the two drugs are consumed in high amounts. 

This is why it is best to start the treatment from the lowest effective dose. However, it is extremely difficult to predict who will suffer from insomnia and who will be subjected to excessive drowsiness. 

There is no way to be certain how your body will react once it is exposed to the combination of Methadone and antidepressants. This is why you should always stick to your doctor’s recommended dose and should never increase the frequency of dose administration on your own. 

Sexual side effects 

Both Methadone and antidepressants are associated with some sexual side effects like loss of libido, inability to have an erection in men, and inability to have an orgasm in women. When these two are combined together, they may cause more pronounced sexual side effects. 

Studies suggest that men are more susceptible to such side effects and they may suffer from erectile dysfunction if they continue the treatment in some cases. 

This is why you should always monitor your sexual side effects closely if you’re being treated with Methadone and antidepressants. If you notice anything different or unusual, immediately report to your healthcare provider. 

Psychological side effects 

Both Methadone and antidepressants are also associated with some psychological side effects like anxiety, agitation, irritability, nervousness, restlessness, or paranoia. 

When both of these meds are prescribed together, some people may suffer from unusual psychological side effects which can literally ruin the entire personality of a human being. They lose the ability to see and think about things clearly. 

They find it difficult to make even the simplest of decisions. They often forget things as common as their address or contact number. This is why psychological side effects should be closely monitored. 

Conclusion 

In this blog post, we have discussed the best antidepressant to take with Methadone. Methadone is an opioid analgesic that is used for the management of severe pain. However, it may not be so easy to deal with for some people. 

It is difficult to name the best antidepressant to take with Methadone because there is no one combination that works for everyone. There are a whole lot of antidepressants that can be combined with Methadone, but not every combination is a good one. 

This is why you should always consult your healthcare provider to make sure what combination of Methadone and antidepressant will work for you.

FAQs: best antidepressant to take with methadone 

Can you mix antidepressants with methadone?

You can take antidepressants with Methadone, but only if prescribed by your healthcare provider. It is difficult to name the best antidepressant to take with Methadone because there is no one combination that works for everyone. There are a whole lot of antidepressants that can be combined with Methadone, but not every combination is a good one. This is why you should always consult your healthcare provider to make sure what combination of Methadone and antidepressant will work for you.

What can I take for anxiety while on methadone?

There are some meds that can be taken for anxiety when taking Methadone. The most common anti-anxiety medications are benzodiazepines, but some healthcare providers do not advise people to take Methadone and benzodiazepines together. They both can dangerously slow down your brain and organ functions. They both are addictive and there are chances of misuse or overuse. This is why you should always stick to your doctor’s recommended dose and take such meds carefully. 

Can you take BuPROPion while on methadone?

You can only take Bupropion and Methadone together if your doctor thinks that you can achieve a good therapeutic response from the combination treatment. Both Methadone and Bupropion are associated with some common side effects like Convulsions. The chances of getting these side effects are lower when these meds are used individually. However, the combination treatment can increase the risk of disturbing side effects and the doses should be properly adjusted in order to prevent that from happening. 

Is it OK to take SSRIs and methadone?

Methadone, when combined with SSRIs, can increase the risk of serotonin syndrome, which is a rare and serious condition. It occurs when there is too much serotonergic activity in your body. The excessive amount of serotonin can cause a number of complications by binding to its respective receptors in your body. Some research studies have indicated that SSRIs can slow down the metabolism of Methadone and make it available in your body for a longer period of time. 

Can methadone make depression worse?

Yes, Methadone can make your depression worse. It may not be prescribed to a patient who is already suffering from major depressive disorder (MDD). It is because Methadone is associated with side effects related to your mood. Depression, anxiety, agitation, and restlessness are common with Methadone. Make sure you do not have any underlying mental health conditions before you start taking Methadone. 

References 

• Shaul Schreiber et al. J Mol Neurosci. (2014) – Interaction of different antidepressants with acute and chronic methadone in mice, and possible clinical implications https://pubmed.ncbi.nlm.nih.gov/24057890/#:~:text=Possible%20clinical%20implications%20of%20these,methadone%2Dinduced%20effects%20and%20should
• Varan Perananthan, Nicholas A. Buckley (2021) – Opioids and antidepressants: which combinations to avoid https://www.nps.org.au/australian-prescriber/articles/opioids-and-antidepressants-which-combinations-to-avoid