While I am on an antidepressant, can I still take other medicines for depression?
It is always
important to inform any doctor you see of all depression medications that
you are taking, including any herbal or over-the-counter supplements.
Although many depression medications can be taken concurrently, the
potential for reactions exists between many medications as well; thus,
consideration must be given for this. Sometimes the potential reaction is
minimal and may be due to additive side (e.g., sedating effects may
combine). Other times, the presence of one medication can influence the
elimination of the other medicine from the body, either allowing
excessive accumulation or causing too rapid a depletion.
Consequences
can thus be toxicity or a lack of efficacy. The SSRIs have specific
enzyme groups that metabolize the medication. Each SSRI has a different
profile as to the enzymes involved in its own metabolism. MAOIs are
generally contraindicated in combination with all other antidepressants
because of the risk for serotonin syndrome, which can be fatal (although
there are certain combinations that skilled clinicians can prescribe in a
methodical way to minimize the risks). Serotonin syndrome occurs when an
excess of serotonin exists in the central nervous system. Symptoms
include tremor, confusion, incoordination, sweating, shivering, and
agitation. Most SSRIs are contraindicated in combination with
thioridazine (Mellaril) as well because of a risk of cardiac toxicity.
SSRIs should be used cautiously in combination with sibutramine (Imitrex),
commonly prescribed for migraine, because of a risk for serotonin
syndrome. St. John's wort, an herbal preparation used for depression,
should be avoided when on a prescribed antidepressant, also because of a
potential risk for serotonin syndrome. Again, there are some
circumstances when a psychiatrist will combine two SSRIs, for example,
but this is typically done cautiously and under his or her guidance.
MAOIs have very specific guidelines on foods to be avoided. Likewise,
MAOIs can have significant interactions with other medications. As noted
previously here, they are not to be combined with most other
antidepressants. In fact, MAOIs have to be discontinued 2 weeks before a
trial of another antidepressant, or the other antidepressant is to be
discontinued for 2 weeks before initiating an MAOI. There are many
over-the-counter medications to be avoided, such as pseudoephedrine and
oxymetazoline; thus, it is important to check with your doctor and
pharmacist before taking an over-the-counter medication while on an MAOI.
This is sound policy with all medications, not just psychotropics.
