Major
Escitalopram × Sertraline
Selective serotonin reuptake inhibitors (SSRIs)×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Two SSRIs simultaneously raise synaptic serotonin activity. Without added clinical benefit, additive effect raises serotonin syndrome, hyponatraemia, and GI bleeding risks.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia, dilated pupils. Autonomic features: sweating, tachycardia, hypertension, fever. First signs appear within hours of co-administration.
Management
The combination is not prescribed. If one SSRI is ineffective, switch to another after a 2-week washout (or 5 weeks after fluoxetine). In severe depression, monotherapy plus mirtazapine or psychotherapy.
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.