What other antidepressant can you take with sertraline? (3+ potential risks)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
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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 the antidepressants you can safely take with sertraline. We will also discuss some research studies and how one can ensure the safe and effective use of sertraline with other antidepressants.
What other antidepressant can you take with sertraline?
Sertraline can be taken with the following antidepressants:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Atypical antidepressants
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs can be taken with sertraline, a selective serotonin reuptake inhibitor (SSRI). The combination of sertraline and a suitable SNRI can help manage the symptoms associated with treatment-resistant depression or major depressive disorder. (1)
SNRIs typically include:
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq)
SSRIs like sertraline work on serotonin levels and do not primarily affect other neurotransmitters such as norepinephrine and dopamine (2). SNRIs work on both serotonin and dopamine, making these meds cover broader symptoms. (1)
According to research studies, the combination of sertraline and venlafaxine is usually considered well-tolerated, and people usually respond well to it (3). However, these combinations can increase the risk of a rare but life-threatening condition called serotonin syndrome.
This is because both sertraline and SNRIs work on serotonin levels. Dosage adjustment might be key to using these two classes of antidepressants together, but it still might not work for everyone. So, make sure you do not pair sertraline with SNRIs without consulting your healthcare provider.
Atypical antidepressants
Atypical antidepressants such as bupropion, mirtazapine, etc., can be used with sertraline. Research suggests that taking bupropion and sertraline together can offer a significant improvement in the symptoms of treatment-resistant depression and MDD (4).
Furthermore, taking bupropion with sertraline can also prevent sertraline-induced sexual side effects and potential weight gain.
This is because sertraline and bupropion have different mechanisms of action, and these meds can collectively manage serotonergic, dopaminergic, and noradrenergic systems in the brain (4).
This also reduces the chance of serotonin syndrome to some extent, as bupropion does not primarily work on serotonin levels and focuses more on norepinephrine and dopamine.
Other atypical antidepressants, such as mirtazapine, can also be used with sertraline. Research suggests that mirtazapine and sertraline together can manage the symptoms of MDD and PTSD and improve the quality of life in such patients (5,6).
Furthermore, mirtazapine, being a sedative antidepressant, can help with sertraline-induced insomnia, making falling asleep less difficult for such patients.
This can also manage MDD comorbid with insomnia effectively. However, these medications are all prescription antidepressants and should not be taken without your doctor’s approval.
What are the potential risks of combining sertraline with other antidepressants?
The potential risks of combining sertraline with other antidepressants include:
Additive side effects
When combining sertraline with other antidepressants, there is a risk of experiencing additive side effects. The intensity of these side effects may be heightened when multiple medications are taken simultaneously. (7)
| Antidepressant combination | Common side effects | Less common side effects |
| Sertraline + SNRIs | GI side effects, Insomnia, Headache, anxiety, irritation, mood changes, tiredness, dizziness, drowsiness, etc | Heart palpitations, unusual mood changes, changes in blood pressure, memory issues, etc |
| Sertraline + Bupropion | Insomnia, nervousness, dry Mouth, GI side effects, dizziness, etc. | Palpitations, blood pressure changes, increased risk of seizures, memory issues, etc. |
| Sertraline + Mirtazapine | GI side effects, weight gain, increased appetite, restlessness, tiredness, dizziness, etc | Memory issues, heart palpitations, mood changes, increased sedation, etc. |
GI (Gastrointestinal side effects typically include nausea, vomiting, diarrhoea, constipation, acid reflux, flatulence, bloating, abdominal pain, etc.
Increased risk of serotonin syndrome
One significant concern is the potential for serotonin syndrome. Serotonin syndrome is a rare but serious condition that can occur when there is an excess of serotonin in the brain.
Combining multiple antidepressants, especially those that increase serotonin levels, raises the risk of serotonin syndrome. Symptoms may include: (8)
- 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.
Cardiovascular effects
The combination of sertraline with certain antidepressants may lead to cardiovascular side effects. These can manifest as palpitations, changes in blood pressure, or QTc prolongation, which is an alteration in the heart’s electrical activity.
Increased seizure risk
Some antidepressants, notably bupropion, can lower the seizure threshold. When taken in combination with sertraline, there may be an increased risk of seizures. It’s essential to be cautious, especially in individuals with a history of seizures.
What antidepressants should not be taken with sertraline?
Antidepressants like monoamine oxidase inhibitors (MAOIs) and other serotonergic antidepressants such as escitalopram, citalopram, etc., should not be taken with sertraline.
This is because such combinations have higher risks of serotonin syndrome, and additive side effects might also be quite severe. MAOIs, in particular, inhibit the enzyme responsible for the metabolism or breakdown of excitatory chemicals, including serotonin.
This dangerously increases serotonergic activity in the brain. Other SSRIs, since they work in the same way as sertraline, can also cause this complication with more pronounced inhibition of serotonin reuptake. So, these combinations should be avoided.
Tricyclic antidepressants are also not commonly combined with sertraline due to the less safe side effect profile of TCAs.
How to ensure the safe use of sertraline with other antidepressants?
The following points are important to ensure the safe and effective use of sertraline with other antidepressants.
- Before combining sertraline with other antidepressants, consult your doctor.
- Stick to the prescribed dosages for each medication. Avoid self-adjusting doses or take these medications more often than directed.
- Limit alcohol intake and avoid illicit substances, as these can interact with antidepressants and increase the risk of side effects.
- Make sure that your doctor knows about all the other medications, both prescription and over-the-counter, that you are currently taking.
- It is important to take your medications at the right time and space them out if advised.
- Understand the symptoms of serotonin syndrome, such as agitation, hallucinations, rapid heartbeat, and muscle stiffness. Seek immediate medical attention if these symptoms occur.
As a pharmacist, I always talk about the importance of sticking to the prescribed treatment regimen. If anything concerns you, just reach out to your provider. Do not try to make any changes to your prescription on your own.
References
- Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300/
- Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547689
- Gonul AS, Akdeniz F, Donat O, Vahip S. Selective serotonin reuptake inhibitors combined with venlafaxine in depressed patients who had partial response to venlafaxine: four cases. Prog Neuropsychopharmacol Biol Psychiatry. 2003 Aug;27(5):889-91. doi: 10.1016/S0278-5846(03)00120-9. PMID: 12921926. https://pubmed.ncbi.nlm.nih.gov/12921926/
- Marshall RD, Johannet CM, Collins PY, Smith H, Kahn DA, Douglas CJ. Bupropion and sertraline combination treatment in refractory depression. J Psychopharmacol. 1995 Jan;9(3):284-6. doi: 10.1177/026988119500900313. PMID: 22297770. https://pubmed.ncbi.nlm.nih.gov/22297770/
- Arockiaraj N, Gupta R, Ahmad R, Halder S, Bhatia MS. Sertraline with desvenlafaxine and sertraline with mirtazapine as treatment initiation in MDD patients with moderate to severe depression and effect on inflammatory markers. Int J Psychiatry Clin Pract. 2023 Nov 29:1-8. doi: 10.1080/13651501.2023.2287754. Epub ahead of print. PMID: 38019131. https://pubmed.ncbi.nlm.nih.gov/38019131/
- Schneier FR, Campeas R, Carcamo J, Glass A, Lewis-Fernandez R, Neria Y, Sanchez-Lacay A, Vermes D, Wall MM. COMBINED MIRTAZAPINE AND SSRI TREATMENT OF PTSD: A PLACEBO-CONTROLLED TRIAL. Depress Anxiety. 2015 Aug;32(8):570-9. doi: 10.1002/da.22384. Epub 2015 Jun 26. PMID: 26115513; PMCID: PMC4515168. https://pubmed.ncbi.nlm.nih.gov/26115513/
- National Library of Medicine. Sertraline: MedlinePlus Drug Information [Internet]. Bethesda (MD): U.S. National Library of Medicine. Available from: https://medlineplus.gov/druginfo/meds/a697048.html
- 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
