MajorSNRI×Other antidepressants (NaSSA)
Updated · Methodology
Mechanism
Mirtazapine + SNRI – augmentation in resistant depression ('California rocket fuel'). Serotonin syndrome is rare but possible at high doses.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The combination is possible for augmentation. Keep doses low: mirtazapine 15–30 mg, duloxetine 30–60 mg/day. Monitor blood pressure, pulse, and mental status in the early weeks.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Cymbalta section 7 (2017)– ; DailyMed setid 2f7d4d67-10c1-4bf4-a7f2-c185fbad64ba
- AEMPS: Ficha técnica: Mirtazapina (nº registro 67068), sección 4.4 (2026)– AEMPS, CIMA, nº registro 67068, revisión 06/2026, sección 4.4