Combining Effexor and Cymbalta–a good example of what not to do

On the search engine terms on my blog stats the other day, I had “combining Effexor and Cymbalta” listed multiple times.  LIKE 25 TIMES.  Seems someone had a question that was not getting answered too quickly.  It brought to mind, once again, how mysterious these medications can be to people.  To most folks (and some psychiatrists it seems), an antidepressant is an antidepressant is an antidepressant.  This is just not true.  Different antidepressants hit different receptor sites and there is no reason to combine antidepressants with similar mechanisms of action.  In fact, this could be down right dangerous.  Combining like-antidepressants can put you at risk for serotonin syndrome and put you at risk for potentially dangerous increases in your blood pressure.  Also realize that ANY combination of antidepressants is outside the standard FDA guidelines and should always be accompanied by a good explaination of why this treatment is being recommended.  Combining antidepressants is a standard of practice at this point, but, again (and again and again), must be accompanied by a solid explaination.

With respect to the above combination of Effexor and Cymbalta–highly unusual. Cymbalta (a true dual-action antidepressant) works on both the norepinephrine receptors and the serotonin receptors.  Effexor (a quasi-dual acting agent) works on the serotonin receptor and, at higher doses, on the norepinephrine receptor.   I cannot even see where using this combination would make any sense, but, if your psychiatrist is recommending it, make him or her explain their reasoning behind it.  If they can’t (or won’t), don’t accept it. 

That is generally good advice for dealing with any physician who is prescribing any medicine.

–Dan Hartman, MD