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Mixing Some Antidepressants and Migraine Drugs May Cause Lethal Serotonin Syndrome


U.S. Food and Drug Administration (FDA) published a warning that mixing certain sSRI/SNRI-type of antidepressant medications and triptan-based migraine drugs may cause a potentially lethal condition called Serotonin Syndrome.

2010 Updates:

Information for Healthcare Professionals: Venlafaxine (marketed as Effexor) – Selective Serotonin Reuptake Inhibitors (SSRIs), Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), 5-Hydroxytryptamine Receptor Agonists (Triptans)

Public Health Advisory – Combined Use of 5-Hydroxytryptamine Receptor Agonists (Triptans), Selective Serotonin Reuptake Inhibitors (SSRIs) or Selective Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs) May Result in Life-threatening Serotonin Syndrome

According to the FDA website, when the body has too much serotonin, symptoms of Serotonin Syndrome will occur. These symptoms may include restlessness, hallucinations, loss of coordination, fast heart beat, rapid changes in blood pressure, increased body temperature, overactive reflexes, nausea, vomiting, and diarrhea. Usually symptoms happen when the drug dose is increased or when the patient is started on the drug.

The FDA website listed some commonly prescribed drugs within the classes at risk:

SSRIs and a Combination Drug Containing an SSRI
* Celexa (citalopram)
* Fluvoxamine
* Lexapro (escitalopram)
* Paxil (paroxetine)
* Prozac (fluoxetine)
* Symbyax (olanzapine/fluoxetine)
* Zoloft (sertraline)

* Cymbalta (duloxetine)
* Effexor (venlafaxine)

* Amerge (naratriptan)
* Axert (almotriptan)
* Frova (frovatriptan)
* Imitrex (sumatriptan)
* Maxalt and Maxalt-MLT (rizatriptan)
* Relpax (eletriptan
* Zomig and Zomig ZMT(zolmitriptan)


Written by Jane Chin

July 20th, 2006 at 10:30 am

  • C

    Good Afternoon,

    My name is C. and I have been ‘somewhat’ diagnosed with Bipolar disorder, however my Doctor does not want to say yes or no due to potential error (miss-diagnosis). She has given me a prescription of Seroquel, which I had taken before, but this time she suggests I take it at my high points, but what about my low points. The reckless euphoria can be beat, but the hopelessness I feel like I can’t go on. Do you have any suggestions? Should I be on another Med. for my down time? I was on Celexa and Seroquel at the same time before but I had many suicide attempts. I just want to feel normal. Thanks for your time. Hope to hear from you soon. Take Care! C.

  • Dear C,

    I can understand your concern for your “low points.”

    You may want to seek a second opinion with a psychiatrist who specializes in treating bipolar disorder. I’m not sure if the doctor you are visiting is your family doctor or a specialist.

    I encourage you to call your insurance carrier’s mental health division and ask for a referral to a specialist in the BP area.

    Best wishes,

  • C.

    Thank you very much much Dr.Chin. I appreciate the feed back and have talked to my psychiatrist and counsellors and they have put on Celexa once again, and am feeling much better. Take Care 🙂


  • jackie

    is it ok to mix citalopram with effexor?the dr is slowly taken my husband off effexor to start him on citalopram he went from 300 mgs to 150 to 75 now hes on 35mgs then after that iam to start him on the citalopram 20mgs, but hes depression is there i was wondering if it would be ok if i started the citalopram she also has him on 4mgs f risperidone,maybe iam losing my mind but afetr all these years iam looking for a wonder drug!

  • Jackie,

    I’d follow your husband’s doctor’s instructions EXACTLY as given and not change anything. If you are noticing side effects or concerns with your husband, you would want to notify his doctor immediately and ask what, if anything, may be done.

    Best wishes,
    Jane Chin

  • Leda

    Is it okay to mix citalopram and and acetaminophen? I take 40mg of Celexa every day, and was never told if taking 1000mg of acetaminophen would alright, or if that would cause some kind of reaction.

  • Leda,

    I’d ask your psychiatrist that question. Here’s some additional information that may be useful:

    My understanding is that both drugs are metabolized in the liver through the cytochrome P450 enzyme system, although acetaminophen is only metabolized 5% in the liver, and when acetaminophen is mixed with alcohol, this becomes a potentially harmful 5%. If the same enzymes process both drugs, then the drug levels of one or both drugs may be different in the blood when compared to taking either citalopram alone or acetaminophen alone.

    P450 CYP3A4 and CYP2C19 enzymes metabolize citalopram. Based on this link, acetaminophen is metabolized by P450 CYP2E1, so it appears that the drugs go through different enzymes in the liver.

    Most of the caution I’ve found re: acetaminophen and citalopram involve formulations of narcotic drugs that include acetaminophen, but not acetaminophen alone. For example:

    Citalopram Interactions (scroll down)

    Best wishes,

  • amy

    has mixing wellbutrin sr and seroquel ever worked for anyone ?

    • Sarah

      This is extremely dangerous- to mix these medications!
      They can be actually very counterproductive in many, if not all, people.
      Seroquel raises blood sugar levels. It is supposed to be used for PSYCHOSIS. But some Dr.’s prescribe it to sad, sleep-deprived women patients, to, as they say, ‘take the edge off,and help you sleep’. When asked if this powerful anti-psychotic medication is being prescribed for psychosis, they say ‘ no, no- you are not psychotic. It will take the edge off and help you sleep’. This is extremely bad medicine and very unethical,dangerous prescribing.
      Wellbutrin can help depressed people, but alone…not mixed with other medicines. Wellbutrin though can trigger a depressive illness to change into a bipolar mani episode!
      I would try prayer, meditation,exercise(yoga,pilates,walking outside in the fresh air,jogging,etc.), natural carrot (and other veg/fruit)juices made by you yourself,breathing exercises, music therapy,art therapy,vitamins and everything natural, before trying these drugs. Wellbutrin had many dangers and side effects on its own. It might help in the short term (3-9 months) to end a very severe suicidal depression, but may trigger a manic swing even in a person who has not had manic episodes.
      It should never be used with seroquel! Seroquel also has many class action lawsuits against the company who manufactures it for causing diabetic onset and causing all sorts of other health problems. Please do not take seroquel at all. Quacks often give 2-3 different very poweful potent psychotropic drugs to counteract side effects at the same time. Dangerous and toxic.
      Other measures should be tried.
      You were called into being by God, who values and loves you beyond all measure. May God bless you with a cessation of psychological negative symptoms,and heal you, or help you find one medication that does help you.

      • Elaine

        I am bi-polar (cyclothymia disorder) where my moods change from depression to mania very often. I use to be on Prozac and lamotrigine. This helped my mania but not my depression . Prozac did nothing for me. Now I am on 300 mg Wellbutrin which i take in the morning and it gives me energy which helped me exercise and it reliefed my depression . I am down to 150 mg seroquel XR which I take about 3 hours before going to sleep. It is a psychotic drug that helps me sleep most nights by putting my mine to rest. I occasionally take ativan for anxiety and panic attacks as required. I also have chronic migraines which I take a triptan medication . I have no drug interactions. I have been bi- polar for many years and with this new combination of drugs I have not had suicide thoughts for months. I can now feel more comfortable leaving the house and seeing friends again. I hope this combination works for a long time. This is the best I felt in years.
        E sleep

  • Rachel

    What are the risks of mixing Paxil and Sandoz with weed. My husband is on both medication and I think he has started smoking pot.

  • Rachel,

    As a general rule, mixing any medications without the doctor’s oversight is a very bad idea, and mixing any medications with weed is both a very bad idea and a potentially dangerous idea. It may be time to have an honest talk with your husband about this because he may be putting himself at medical risk without realizing it.


  • Jessica

    Can you take Axert if you are currently taking 10mg of Lexapro a day? What can you take if you have a headache? Is Tylenol okay?

  • carole

    I take very low dose of celexa is it okay to take maxalt for an occasional miagraine

  • sheila

    hi i was just wondering if mixing celexa and relpax is okay?

  • Hi Jessica, Carole, and Sheila –

    For these types of questions you definitely need to ask your doctor. You want to be careful mixing any medications (prescription or otherwise) whether one or both is/are “low dose” or regular dose.

    Sheila, since Celexa and Relpax are both listed above in the post relating to the serotonin syndrome risk, you will need to check with your psychiatrist regarding the pharmacology of the drugs and whether the dosages you’re taking (I assume you are taking both) are within what your doctor believes to be acceptable.


  • danielle

    hi can i mix celexa and cymbalta together… i liked celexa, however, hated the hunger and cymbalta makes me less patience…

  • Colt

    Hey there. Ive had ongoing problems with doctors, to the point of gettin very frustrated. I went in there with a problem in my stomach and anxiety… I came out with antidepressants, which I was very cautious about because I know myself I have never been depressed or really down. They gave me Venlafaxine, started it on 75 Mg’s. I got every single side effect, and bad. then they changed it, to Citalopram, 20 mg’s. and it made me feel WIRED and high on drugs like you wouldnt believe. Now, I used to get a slight halucination, and almost everything it says about “Seretonin Syndrome”.. which makes me wonder, why would the doctors give me all these pills for nothing? And what can happen when taking Venlafaxine, Metoclop, Ativan lorazepam, then changed to Citalopram, Clonazepam and Pariet? It seems like ALOT of pills to be prescribed just for a small anxiety problem, and problems with my stomach ( which is now diagnosed as Gastro-esophageal Reflux Disease ) I just want to be back to normal, and they wont help me. What should I do?? They are sending me for CT scans now, and Ive just been getting aggravated with there “help” as they like to call it.

  • @ Colt:

    Dear Colt, I’m sorry to hear about your experience with doctors. I’m not sure if you’ve been going to primary care physicians (sometimes also called general practitioners), but for your situation I’m surprised that you were not referred out immediately to a specialist. That said, you may want to call your insurance company and explain the situation, and perhaps point out that from their perspective, misdiagnosing you can be extremely expensive for the insurance companies given that the doctors submit bills and get reimbursed for part of their services. In addition, you now have new side effects that you didn’t have before, that requires managing, and this obviously creates additional liabilities to the insurance companies…..

    It may be time to change doctors and find one who is willing to listen to you, who doesn’t act like he or she knows everything within a 5 minute period then immediately sends you out the door with a prescription, and one who is conscientious enough to know when the scope of your symptoms is beyond his / her expertise and requires a specialist’s attention.

    Best of luck and please keep me posted,

  • Ericka

    I was diagnosed with bi-polar disorder in March. I am on Symbyax 3/25mg. It works, but my highs and lows dont come as fast as they use to. My question is can my body become resistant to Symbyax? I feel like it is not working as much anymore, and I am concerned. Suicide is not an answer, but it sometimes seems like the best choice. No more conflict within myself.


  • Hi Ericka,

    Symbyax is a combination of active ingredients in Zyprexa and Prozac. I’m not familiar with how the body can respond over time to Zyprexa, but given that Prozac is a SSRI, there may be potential for reduced response (sometimes called “serotonin poop out”).

    However, whether your body is really becoming resistant can only be determined by your physicians. If you suspect that you aren’t getting the relief you once expected, you will need to make an appointment with your doctor to see what is happening.

    I agree with you, suicide is not an answer. What you’re going through feels tough, but you are tougher.

    Best wishes to you,

  • Jill

    My question is plain and simply, is there any medicine I can take for headaches/minor aches and pains, while taking my prescribed Celexa?


  • Sarah

    My question is about mixing the antidepressant Cipralex (known as Lexapro(escitalopram))in the states with cannabis.

    I’m on ten miligram pills and have only been on it for just over one week with no real adverse side effects. When I smoked cannabis a few days ago it gave me a scary high that came with paranoia, shaking, hot and then coldness in temperature, and vomitting.

    I’m just wondering if you can explain why that might have happened to me?

    • Dear Sarah,

      I would recommend that you immediately stop smoking cannabis, as like other drugs, mixing cannabis with antidepressants may lead to side effects that can be serious (and scary, as you personally have experienced).

      I’d ask that you tell your doctor about what has happened, because the side effects you experienced are pretty serious and you should be monitored to make sure that your body’s OK.

      Best wishes,

  • Rella

    Can i take citalopram with acetaminophen or ibrofen?

    Tylenol PM?

  • joy

    my daughter recently went into an in-patient treatment center. she has been dealing with depression and anxiety she has a hard time eating sleeping and a history of self-harm. they called today and want to put her on 20mg of celexa and 25mg of seroqual. i know the are low doses but i am worried about the suicidal attempts i have read about. is it a good idea to combine the two?

    • Dear Joy, I’d recommend that you bring up your concern with the combination to the doctor treating your daughter; I assume that the doctor is aware of your daughter’s history of self harm. The doctor should monitor your daughter’s response on the drug combination very diligently and make sure that the treatment is working in the right direction. You may also want to be alert to changes in your daughter’s behavior, and report any changes that you are worried about to your daughter’s doctor. Thank you for being a caring mom. My best wishes to you, Jane.

  • k. ross

    hello I was just wondering if it was ok that my wife has been prescribed paroxetine (20mg two tabets daily) sertraline (50 mg 2 tablets daily) clonazepan (.5 mg 4x a day) is all this safe or necassary? She does not take them regularly and she sometimes drinks with them. She seems fine sometimes but wants to sleep all the time and does not do much else when she is awake except to go to work. Can I talk to her docter because I don’t think she is telling him the truth. Plus when will she be taken off these drugs or is she doomed to take them for the rest of her life? They are habbit forming and it is not something I want to live with for the rest of my life plus we have two kids. Any suggestions?

    Thank You,

    K. Ross

    • Dear Mr. Ross, no matter what drug she may be prescribed, DRINKING IS NOT OK with any meds – and it can be particularly dangerous with the clonazepan. It is not uncommon for a doctor to prescribe 2 types of antidepressants if the doctor decides that the patient can best benefit from the combination, although I would ask the doctor questions if I have questions. Sleepiness (somnolence) is a common side effect in some antidepressants, and certainly the clonazepan will make most people sleepy. I’d have that conversation with her doctor if you have concerns – it’s the doctor’s obligation to make sure that the patient is monitored very carefully, and especially if you know that she drinks sometimes, the doctor needs to know about it. Best wishes to you, Jane.

      • chris

        I currently have a bottle of celexa, zoloft, paxil and prozak lyin around somewhere. Also mass quantities of maxalt. Easy suicide? Better find out.

  • beth

    I am currently taking 200 mg of seroguil at night along with 100 mg of topamax for bipolar and in the am I take 60 mg of prozac and 300 mg of wellbutrin xl. Where can I look to find like a combined affect of all these drugs on the body? I want to be able to type in a formula of these and come up with how they interact and possible side effects with them together.

    • Dear Beth, you may want to look at the “prescribing information” or “package insert” that should be available either from the drug’s website (especially if the drug is not yet generic) or from reliable internet websites on drug information. Look at sections called “contraindications” and sections on drug interactions. The information may look intimidating at first because off all the fine print, but there is often a patient information section that tries to put into plain english what it all means to you as a patient. I’m not aware of a website that lets you type in a list and come up with drug-drug interaction potential – it’s a great idea for a website, though! Jane.

  • Katelyn

    A fam. member is currently in a psych ward at a hospital. I asked her what drugs they have her on, and she said She is currently taking effexor, prozac, neurontin, trazadone, and fasaclo.. Is the combination dangerous? If so, how? Causes? Please email me!

    • Hi Katelyn, I’m sorry to hear about your family member. Usually when a person has to be hospitalized, the mental condition is quite serious, and therefore, an intensive treatment approach is used. This can involve multiple medications given at the same time. I’d recommend that you ask the psychiatrist who is responsible for your family member your question on the combination of these drugs, and what kind of side effects there may be (drug-drug interactions). Best wishes to you, Jane.

  • I got out of drug rehab in January and cannot get a grip on my emotionc. I am not depressed but severly agiatated. It is starting to affect my family. My doctor put me on Paxil(20mg) and I saw no improvement so she switched me to Lexapro(10mg). I am desperate because I feel myself being alienated from my family and I love them dearly and have already put them through enough with the drug rehab(9weeks). Thank you

  • Leah Sellars

    I was recently prescribed 10mg of fluoextine (Prozac) for a menstrual mood disorder. I also suffer from Migraines during this time too. The pharmacist told me it was not safe to take Relpax or Maxalt for migraines while on Prozac because of possible Serotonin Syndrome. However, my doctor said it would be okay because the Prozac is at such a low dose. Does this sound legitimate or what? I’m very worried about mixing these.


    • Leah,

      If you are uncomfortable about this, no matter what the dose, let your doctor know. Tell your doctor if there are other options that can help you avoid this potential for serotonin syndrome, no matter how “remote” that chance is. It’s better that you have some peace of mind. If your doctor insists, ask that he monitor you very carefully at the beginning of therapy to make sure that you’re adjusting well and that nothing problematic occurs.


  • Margo

    Hello there! I’m very sick with bipolar and all the meds I take. I feel like I’m poisoned. I talk to my psychiatrist at least monthly and have frequent med changes. I take Topomax 200mg qd, Risperdahl 2mg hs, Wellbutrin 300mg qd, Zoloft 300 mg qd, Promethium100mg qd, Suboxone 8 mg qd, Xanax 2mg bid, other things I can’t remember, and very occasionally Ultram and Lyrica. I have nystagmus, vertigo and uncoordination episodes every 4-6- weeks. I just saw a neuro guy and her just said probably a med reaction and shuffled me off. I have anxiety and panic attacks every day since my husband and father died withid 4 weeks of each other 1 1/2 years ago when this snow balled= I haven’t been able to bounce back. I have no energy, I sit all day, started smoking, don’t eat. answer the door or phone. I can’t bear this life. Idon’t connect to antone or anything. I have a twenty year old son in college who stayed at hoe and helped me take care of his Dad through the year of lung cancer, I have a daughter who is so happy in her new merriage and 8 month old baby. So I wouldn’t commit suicide because I wouldn’t hurt them. but I don’t want to live like this. I feel like i have some serotonin syndrome, but I live in a small rural community and maybe they are uninformed. Do you have any thing to say that might help? I’m desparate.

  • Margo, I’m not sure what I can say to what you have gone through. You’ve gone through 2 major tragedies as well as other major life transitions (children moving out, therefore empty nest) in such a short time. What you are going through is a tremendous snowball of GRIEF that you must deal with. Are you getting any support from support groups for people who have lost their spouses, to start?

  • Joanne

    I have been taking 7 day trial 30mg cymbalta and prescibed 20mg Prozac together, I see it is one of the drugs you dont mix together, but it doesnt seen to effect me in no serious way. Also the 20mg Prozac isnt doing to well by it’s self is why I mix them together. The only side effect I seem to have with them being mixed together is sleepiness. Would I have to watch out later for any serious problems in the long run?

  • Darren

    My partner is in real trouble and needs help. She is a 38 year old woman, intelligent, functioning yet refuses to listen to warnings I have tried to give her. She is presently being prescibed Cipralex (10 mg.) for treatment of depression. She is a marijuana user (3-4 times daily), drinks (not everyday, but excessively at least 2 times weekly), is a heavy smoker, is on the birth control pill, takes migraine medication, and has been using cocaine. I don’t think she has advised her doctor of all the drugs she is using and he does very casual follow up visits (every couple of months). Is she putting herself in imminent danger?

    • Darren: if what you have described is an accurate description of the actions that your partner is taking, then my personal, non-medical opinion (i.e. common sense) is – yes, she is putting herself and potentially others who may be in her way when she is under the influence of drugs and/or alcohol – in danger. I am sorry to hear this is happening with her.

  • George

    I am 200lbs male, 23 yrs old. I have been put on celexa. My current dosage is 20mg. I am in my 3rd month and I haven’t notice any positive change (just side effects like nausea, numbness in the fingertips, slight tingling feeling i temple areas, disappearing trains of thought.) . In fact; my attacks seem even worse then when I started. I have two questions regarding celexa.

    1. Do i ask my doctor for a different medication or just to increase the dosage ( I have read positive testimonials that the doctor increased dosage by 20mg-60mg and they had a better result)

    2. I get many headaches and when I am sick I take cold medication. Most of the pain and cold&flu/allergy drugs contain Acetaminophen. SUDAFED( 500mg acetaminophen ) BENEDRYL ( 500mg acetaminophen ) DAYQUIL (325mg ACETAMINOPHEN). what would be an approximate safe dosage of these drugs given my current dosage of Celexa ??(sometimes 2/3 in one day – allergies and cold) . I do not use these everyday, only when I feel they are needed due an inability to work (Stock Trading)

    • Dear George:

      1. it is true that many docs prefer to increase the dosage if the patient has shown that he is tolerating the current drug, rather than switching to a new drug. That said – your symptoms described in the side effect profile does NOT suggest to me that you are “tolerating well” this drug at the current dose! Nausea should subside with time, and 3 months is a very long time, but I’m concerned with the neurological symptoms you’re experiencing. I would not brush off these neurological symptoms – please tell your doctor about these!

      2. that’s something you want to ask your doctor OR the pharmacist – things to watch out for is the clearance/metabolism of the drugs – whether or not any or all of these affect the liver enzymes (common liver enzymes that clear drugs include Cytochrome P450 isozymes 2D6 and 3A4). sometimes one drug can affect the way one of these enzymes work – and if that enzyme affected happen to be the one needed to clear out another drug – celexa for example – then you may potentially have a high level of celexa built up in your system that can become dangerous. so with this one too – please ask your doctor or pharmacist as soon as possible.

      my thoughts are with you,

  • Tabitha

    My daughter is taking 3/25 symbyax and 20 mg’s of prozac at the same time, I am wondering is this why she is doing things that she does not remember… such as smoking in the middle of the night and does not remember getting up at all(mind you, my husband or I usually find her in the floor sleeping), opening the fridge and going to sleep in the middle of the floor. Last night she was in the livingroom floor and it appeared that she may of stood up and just fell. food plate was spilled all over the floor. She is not remembering anything. What should we do?????

  • cbabybey

    How soon can i start taking cymbalta(30 mg 2x a day) after stoping effexor? My insurance company would’nt approve the cymbalta which was my doctor first choice, so I had to go on effexor. Now my insurance company approved it. I want to get off of the effexor.

  • Ed

    I am taking 60mg of Cymbalta in the am and 40mg of Prozac and 200mg XR Seroquel. I feel great any issues?

  • Ed

    taking prozac and Seroquel in the evening..

  • karen

    hi there, 2 1/2 years ago, i started a new job, it involved shifts and was a very stressful job and i developed sleeping problems, the g/p prescribed me a sleeping pill i think it was called zoplicone,i took this for about 3 months until the g/p decided to refer me to a psyciatrist for my sleeping problems, she told me i was addicted to zopliclone, and put me on seroquel, since then i have never felt right,i felt quite aggitated and nervous and plain weird, when i went back to see her, she told me to carry on taking it and prescribe me with citrolapam for anxiety, and discharged me from her care….but i am not happy as i always feel strange,i always feel tired,and not connected with the world which makes me feel aggitated, in two years my world as got smaller, i have now lost my job, through all this anxiety, and i never do anything, i dont go out,incase i feel weird and i havent been on a bus or train in ages for the same reason, it makes me anxious, and i know its all down to these tablets, im scared to just stop because of the side affects…. all because i had difficulty sleeping now my life is so small, and i used to have such a big life… i just want my normal happy life back please help

    • Dear Karen, If you think that the current med combination is not helping you and in fact has introduced new symptoms (problems, side effects) that is adding to the original problem of stress-related sleep problems, then you want to seek a second opinion about what you have been prescribed.

      Even with the adjustment to medications – you are supposed to feel “relief” from your original symptom as well as whatever new side effects that have emerged as a result of your body adjusting to the new medication. This usually takes 6-9 weeks. That your body has not adjusted and in fact your world seemed to have turned smaller and like a prison suggests that this medication combination needs to be immediately assessed.

  • Vika

    Hello my name is Vika and I was wondering if there is any other sleeping medication out there that doesn’t make you have a bad day the next day? I’m taking trezidone and I go to sleep right away after I take it but it makes me very irratable the next day! I feel like I haven’t got any sleep in a few days and so I stopped taking it, but now I can’t fall asleep sooner than midnight and I have school the next morning! I do walk and run alot but I still can’t sleep! What should I do?

  • Ashley

    Hi, I was wondering if it is okay to drink alcohol, take Prozac, and Tylenol PM. I know your response will probably be “absolutely not” but I want to know what the real dangers are and how it would impact me. I have been making efforts to stop drinking but it has been very difficult. If anything, what should I do? The Tylenol helps me sleep, but I know that it can have very bad effects on the liver when combined with alcohol. Please let me know!

  • dan

    My fiance was diagnosed with stage 3-a? lung cancer 2 weeks ago. He is on suboxone and xanax, is it safe to take these 2 meds together? Thanx

  • Tina

    Hi, I take Frova and Fiorinal for migraines. Frova really helps with smells, lights and my vision. Two months ago I was put on Tamoxifen 20mg (breast cancer). The tamoxifen was causing hot flashes so they put me on Effexor 25mg. They told me I can not mix Effexor and Frova. My question is what medicine can replace Frova I am having a hard time with smells and lights.

  • Johndoe

    Hi Jane,
    I have been diagnosed with General Anxiety Disorder and Major Depression.

    Currently I am taking 30 mg of Cymbalta. This drug has changed my life in so many ways… I finally smile sometimes. But I still have a major problem. I’ve started locking my self in my room, and its been going on for over a year. I only leave when I have to..or once in a while when I go out.

    Are there any drugs to make me want to go out more? I heard alot of good things about Prozac.. but can I mix Prozac with Cymbalta?

    I really appreciate your time.. Thanks for all your help.

  • Hi John –

    I’m glad to hear that the drug Cymbalta has made a difference for you. It does sound like something else or something new has been happening – if you have been isolating yourself for such a long time. Have you spoken with your psychiatrist or psychologist about this?

    I would have to defer to your doc about mixing the two – Prozac was listed as one of the meds that docs need to be aware of for patients taking Cymbalta:

    It is in the SNRI class of drugs which means it does have some effect on serotonin reuptake as SSRI class of drugs does, but it also affects norepinephrine (you probably already know this). Any additional drugs that work on serotonin inhibitors need to be carefully monitored if added to another SSRI or SNRI drug.

    I would approach this from a more broad angle, looking at biochemical as well as behavioral issues in the symptom you have been experiencing.

    Stay strong and ask lots of questions to your doc so you can get the answers you need!

  • Sharlene

    Hi….I suffer from migranes and for the last few years have taken Zomig (PRN) to treat them….when I was on Effexor for postpartum depression I could not take the Zomig…..I have been off antidepressants for a year but think I need to go back on them…. are there any that are safe with migrane medication? thanks!!!

  • rick maier


    i been really sick but im starting to feel a little better though. for once in my life i was completely scared on feb 14th 2011. I had gone to bed early and i woke up about 1am due to a dissturbance upon me. My body began to become stiff and i was unable to move i also had blured vision and could hear a loud buzzing sound my heart rate speed up and i couldnt speak or move . The next morning i awoke and sat at the end of my bed wondering what went on the night befor i couldnt help to think about it i thought maybe i had mixed two drugs together that i shouldnt have. is there a way that mixxing a pian meds and a cold flue medication toghether could of cuased this?

    p.s. please i need a professional opion on this

    Rick Maier

    • Rick, I’m sorry to hear that you had that scary episode! It would depend on which meds you’ve mixed: if both are over the counter, I’d definitely contact either (or both) of the manufacturers – they usually have a consumer 1-800 you can call – and ask them whether they have received reports of something similar. If the pain med was a prescription drug, then you need to tell your doctor about it ASAP because if it’s part of an adverse event (side effect) then the doctor should report it to the FDA.

      Here’s a blurb from Theraflu’s Cold & Sore Throat med – http://www.drugs.com/mtm/theraflu-cold-sore-throat.html

      What should I avoid while taking Theraflu Cold & Sore Throat (acetaminophen, pheniramine, and phenylephrine)?
      Avoid drinking alcohol while taking this medication. Alcohol may increase your risk of liver damage while taking acetaminophen. Do not use any other cold, allergy, pain, or sleep medication without first asking your doctor or pharmacist. Acetaminophen (sometimes abbreviated as “APAP”) is contained in many combination medicines. If you use certain products together you may accidentally use too much acetaminophen. Read the label of any other medicine you are using to see if it contains acetaminophen or APAP.

      Avoid using other medicines that make you sleepy (such as other cold medicine, pain medication, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by acetaminophen, pheniramine, and phenylephrine.

      This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. “

  • Vega

    I’ve been on zoloft for years. my dr added efexor. I had the initial dizziness the first 3 days. Then everything was fine for a few months. After about 2 or 3 months I started getting dizzy spells, feeling nauseous and generally sick. Is this Serotonin Syndrome? Is this a bad sign. My dr doesn’t know why it started so late after adding the efexor. she said the first week it is expected but not after 2 months.

  • dharma

    dear jane, i have just recently been put on celexa 20 mg daily. i also take 75 mg daily of topamax and maxalt mlt ocasionaly when the migraines r horrible. i havent started my celexa yet due to wondering if it safe to take w/my migraine meds. is it safe to start my celexa or should i go back and talk to my dr.?

    • Dear Dharma: when your doctor put you on the celexa did s/he know that you are also taking these other meds (topamax, maxalt)? If not then you should tell your doctor first and ask about the concerns you have about taking these drugs together during those occasions when you experience horrible migraines. Maxalt especially is a 5HT1 agonist, which is in the list of the class of drugs that when combined could produce the syndrome: http://en.wikipedia.org/wiki/Serotonin_syndrome

  • Mo


    I was wondering if you’ve ever heard or seen a credible report of serotonin syndrom in someone only taking antidepressants and cannabis? In trying to settle a bet with a friend, if anything, I’ve noticed an absence of reports of serotonin syndrome among even cannabis users who combine antidepressants with other serotonergics.

    Thanks, I’ve come up empty, but I’d almost be surprised had it really never been credibly reported.


  • Sarah

    My daughter has been on welbutrin, celexa and concerta. she has difficulty sleeping well so they have now put her on seroquil at night to help her sleep. Now she has high blood pressure her pulse is thru the roof she has fever, chest pain (she has horrible anxiety which causes tightening in her chest also) Am I correct to be concerned about seratonin syndrome?? Her blood pressure is higher than mine and I have Kidney disease from Lupus. she is Lupus free… thank God! andy suggestions or ideas would be appreciated. Thank you for your time…Sarah

  • Barbara

    I take 40mg Celexa. I also take Lyrica, Synthroid, Metopropol (hg bp md) and Hydrocodone/Apap..Occasionally I need something more to ward off the shakes from insidel. Is it safe to take .2 Xaxax?

  • Ally

    Hi, After being on 225 mg. of effexor and much weight gain, my dr. prescribed bupropion sr 150×2 per day. It is day 8 and after a little high feeling and insomnia, seem to have levelled off. I am fearful of the stated side effects, and wonder if the bad side effects can happen later on? I am 58 year old woman, and have had depression w/ anxiety for 20 years. I am usually very upbeat since on effexor, but always tired and FAT. Dr. wants to gradually take me off effexor. Has anyone else experienced this combination? Thank you.

    • oh, i forgot to mention that even socially acceptable drugs, like antidepressents – wellbutrin, paxil, lexapro, are ALL ADDICTIVE. Don’t let ’em food ya. They may not be as hard to kick as heroin, but they are most certainly addictive, as are the anti-psychotics, the pain-killers, and the anti-psychotics. That’s why I say, if you’ve got anxiety, at least get the best drug for anxiety – clonazepam, usually, or alprazolam. Just as if you’re in pain, you should have morphine or oxycodone or something good like that. While we’re at it, let’s quit pretending that ecstasy isn’t a much better antidepressant that the best legal pharaceuticals that they have for that sort of thing. but remember – exercise, exercise, exercise, and eat right!

      • Liz

        I agree with Johnny’s comments about diet and exercise as well as his comments about using xanax, etc.. I have dealt with circumstantial depression and anxiety all my life which is normal given what I’ve had to live with but I was never taught the value of nutrition and exercise for mental and emotional health until I was 40 years old by my doctor who practices preventive medicine. I no longer take any medications and never will as long as I’m conscious enough to say no. I have better health and hence, more energy and a better attitude so I can deal with the crap that life throws me every day.
        SSRI’s are very addicting and I learned the hard way. I was on paxil for 45 days and it took me over 18 months to recover from the neurological damage and frankly, I’ve never regained full brain function like I had before. My short term memory stinks, I used to be a writer and scientist and now I feel practically illiterate most days. That drug almost ruined my life and ended my life. I was not myself at all and even developed severe neuro problems including problems swallowing and severe gastric reflux. I also wanted to drink alcohol and I don’t even drink! The reason for this ( as my dr. stated) was that SSRI’s cause dysglycemia which can lead to all sorts of problems including reversed circadian rhythm, sleep disorders, weight gain, gastric problems, heart disease and more. I gained 65 lbs from paxil and again, I was only on it for 45 days!!
        Other friends of mine who took SSRIs and SSNRIs ended up with diabetes II, high cholesterol, high blood pressure, chronic migraines. I too had migraines from paxil but they stopped a few weeks after quitting paxil.
        Please don’t trust your doctor alone. Do your own research before you take these drugs. Always question authority, especially the medical authority.

  • Wendi Saito

    I have been suffering with Major Depression and GAD on and off for several years now. I am on 80mg of fluoxetine and my doctor just added effexor 75mg a day. Should I watch for interactions? I have been on the fluoxetine for about 5 years now, but just started the effexor.
    Thank you.

  • kdubs

    Is it ok to take maxalt with pristq? Just curios. Is ther bad side effect to maxalt?

  • Jackie

    Hello Dr. Chin,
    I am currently on Wellbutrin but need something to take for my persistant migraines. Can you suggest something i can ask my family Dr. for? I dont have a mental health Dr. as my insurance doesnt cover it.
    Thank you for your help.

  • most of these medications suck. The best anxiety drugs are clonazepam/klonopin or another benzodiazepene, like valium (diazepam) or xanax (alprazolam). I find clonazepam works best for anxiety, but it can also make you sleepy and dull, and it is physically addictive, like most good drugs. Suboxone/subutex/buprenorphine is an opiate; of course it’s gonna make you feel good, but it is very addictive. Also, less is more with suboxone. A miligram or two or even four is a lot. Don’t take more than 4 mg a day for heavy users, and 1mg a day light users. Celexa and lexapra are the two best antidepressants or “happy pills.” Personally, they give me a headache. I can only take 2.5 – 5 mg at a time. If you want pep, Wellbutrin is cheap speed – like amphetamines (meth or adorall), but makes you feel a little weirder. Diet pills, like adapex or adhd pills, like adorall or even ritalin, I find are better stimulants than wellbutrin. Caffeine is even a better stimulant than wellbutrin, not to mention pseudoephedrine or the real mini-thins, real ephedrine, if you can get it, and those are otc. But personally, i like downers, like benzos, and opiates like buprenorphine, but of course the best medicine is exercise, working out, developing self confidence, meditating, doing yoga, praying, hiking, bike riding, and a nutritious diet – healthy stuff. 😉 peace

  • jean

    i take floricet for migraines. i took a klonpin at 1230 is it safe to take a floricet now as i have a terrible headache

  • Joe

    I recently started taking citalopram. Actually, I only took one 20 mg pill and the next morning I woke up with a tight chest and a heart rate of 115. This was high for me as I always fall between 65-85? resting. I used to drink two glasses of red wine a night but the night before I took citalopram was my last night of drinking. Also, I started Nicotrol inhaler(to stop smoking) the same night as citalopram. I suffer from ANXIETY. I had the racing heart symptom of anxiety under control and this is why I am struggling- along with the way I feel. It has been two days an I still have a racing heart high in the morning and 90’s resting during the day . Went to the ER and they said I was fine but let me go home with no true reason and a heart rate at 95. Any thoughts ?

  • Joe: one of the common side effects of Nicotrol is anxiety:


    [scroll down to “Possible side effects of Nicotrol Inhaler”]

    The mechanism of action is to mimic the stimulatory effect of nicotine from cigarettes. Pfizer produces a brand name inhaler and the package insert (prescribing information) PDF is here:


    You may want to talk to your doctor about this anxiety side effect — it may or may not be from the inhaler but only your doctor can spend the time with you to do the medical work-up to identify potential cause of this onset of anxiety.

  • Bruce

    My wife has been on 80 mg Prozac for many years (over 10) and it has been helpful in treating panic / depression / OCD disorders. Because of the frequency of migrain headaches over the past two years (none experienced prior to two years ago) she was prescribed Lyrica. No more migrains since taking the Lyrica but severe depression has now set in even while still on the Prozac. Could the Lyrica be preventing something in the Prozac from working? We are searching for explanations. Thanks.

  • j

    I have mixed celexa and clonazepam for about 3 yrs then the dr changed me to effexor and clonazepam about 3-4 mths ago. I’m still on .5 mg of clonazepam and it doesn’t seem to be working anymore but I’m scared. to up the dose cause its addicting and i have children. the effexor is only 37.5 mg and only makes my body feel cold and weird. I suffer from ptsd mental depression anxiety & mood disorders and I really would like Somthing that will work without addiction. the meds only makes me groggy & nauseous. if you have any suggestions please feel free. thank u all.

  • Jessica

    My husband has been taking Doxepin for sleep and then was put on Cymbalta for pain. After taking ust one pill he had a serious reaction. Now he just doesn’t feel the same anymore. I don’t see Doxepin on your list of MAOI’s but I did find a website that you are not supposed to mix those two pills.

  • JUAN

    if im taking symbyax can i smoke marijuana?

  • jean

    My partner was on 75mg of effexor for over a year he has now been told to stop the effexor and the next day take 10mg of citalopram and also for the day after then to go onto 20mg a day. Was a bit concerned about changing over the drugs so quickly.

  • I have been taking celexa for over a year and have been on antidepressants for many years. I also take topamax for migraines. My doctor added cymbalta as an addition to the celexa but lately I feel as though I have been more depressed and have no desire to get out of bed. Could there be a reaction between these three pills?

  • Cait

    Hi, someone may have asked this question already but I’m wondering if it’s alright to take Pristiq with any kind of painkillers – ibuprofen or paracetemol (acetaminophen).
    I’ve recently been prescribed Pristiq for MDD and the headaches are almost unbearable, only one week in though.


  • Ryin

    I used to take celexa and liked the emotional numbness I got from it, however it made me VERY fatigued. So my doctor switched me to Prozac. Its makes me energetic, and happy. Will I get the desired effect of energetic, and emotional numbness by mixing the two?

    **Note I do consume alcohol still. No more then a 6 pack on any given day, no more then twice a week.

  • Tiffany

    Ok..So..I don’t know if this is the right place to ask this question, but I’ve tried other places and have had no answers, so here goes. I have a panic disorder and have been on 10mg of Celexa for about three months. I also have a broken tooth and can’t have surgery for at least two more months, They were giving me Norco 5.325, but then they gave me Tramadol 50mg, I’m deadly afraid of pills. It took me ages to get used to taking half a hydro and the thought of taking a new drug that an ER doctor gave me, despite my protests about celexa makes my heart palpitate. I just don’t know who to trust. I’m in a world of pain, I can’t open my mouth, I can’t lie on my side and even sharp noises seem to jarr my jaw and discomfort me greatly. I really don’t know what to do. I tried contacting my doctor but of course she and my regular dentist are both off on vacation, I swear they must golf at the same resorts ><. Please help. =(

    • One option is for you to ask your pharmacist (although I’d prefer if you can ask someone in the same medical / dental office as your primary care providers — since even if these people golf, they have other patients who can’t take vacations or time off from pain and health conditions and so they usually will delegate care to a colleague in the office). Let the pharmacist / doctors-on-call know that you’re on 10mg celexa and 50 mg tramadol and ask about drug interactions and particularly about the metabolism through the liver for both:

      Tramadol Metabolism: liver extensively; CYP450: 2B6, 2D6, 3A4 substrate; Info: active metabolite

      Celexa Metabolism: liver extensively; CYP450: 2C19, 3A4 substrate; 2D6 (weak) inhibitor

      It looks like the liver enzyme to pay attention to is CYP450 3A4.

  • Jennifer

    I have been prescribed lexapro and citalopram, both 20mg and I was wondering if it’s okay to mix those medicines, like if I lose my prescription of lexapro, then take citalopram for a few days and then back to lexapro for a few days…

    • This is a question best asked of your doctor because Lexapro and citalopram are similar/related medications but they are not technically the “same strength” that you can switch between the 2 and expect your body to potentially respond the same:


      • shaun360

        im shaun , 28 yr old … 50 mg seoquel and 60mg celexa and 20 mg soboxone daily. I was heavy in to oxys 500 a day multipul patchs and 80s , smoked and snorted. since sobonxe everything has been breat until now, im doint some coke right now. Not to sure how the soboxone is effecting my cocaine buzz if at all. what harm is this doing to my liver cause im experiencing pain lower abdomen and mad diarira and gas, what effects does marijunia have on these drugs doing there full benifit

  • Rob

    When I was 18 I got shot withe a shot gun buckeye shots I mad it but was blined out my left eye but I had 3 eye surgurys and I allso lost 60 pound the recovery was slow and painfull my doc gave me 5 diffrent eye drops 5 diffrent pain pills and lots of antibiotics but I allways took tylenal pm 2 sleep but when I was 19 my twin brother and best friend got killed so 2 sleep.i took 5 slepping pills now im 21 n I take 10 to 12 pills if I dont I cant sleep n I still think of my brother and friend n I cant sleep if I dont take them 5 nore 8 will do any thing shold I see a doc or ? ? ? –

  • Debra Barrier

    I was diagnosed with fibromyalgia about 5 months ago. I am constantly in pain and depressed. I am currently taking effexor 150mg. My Dr. just added Cymbalta 40 mg. I am worried about taken the 2 together may cause an adverse effect. I just called my dr. back and he reassured me that they were ok to take together. Please let me know.

  • all

    SWIM takes 50 mg of zoloft (sertaline) in the morning SWIM then takes some adderall for the focusing affect of the medication for his adhd is SWIM at any risk with what hes doing and how long dose the zoloft stay in his system?

  • Irene

    I have had depression/anxiety for probably 15 yr., at least. Started out with the old reliables – none helped. Finally was put on Effexor 150 mg. Went well for quite a time. Helped depression; but, had insomnia, etc. Then, I was diagnosed with Fibro and told to get ooff of Effexor and start Cymbalta – 60 milligrams. Not a problem changing as they’re in the same league of drugs. Problem – Cymbalta helps the Fibro quite a bit – it also helps me get a decent night’s sleep. Anxiety seems to be better. I feel pretty good for quite awhile while taking it. All at once, I seem to get more depressed/anxious. I mean, everything bothers me. It’s truly sad. I stop Cymbalta and start the Effexor again. Immediate help; except the Fibro pain comes back all over and now I can’t sleep. I have the Xanax and Ambien; but, really don’t care to take them all. I detest taking all these pills. My question is this – do you think an Effexor could be taken like one day and then, the Cymbalta taken the next? I just went through a mess – been on Effexor – felt pretty good except the pain of fibro and horrid sleeping. Decided to stop the Effexor and do the Cymbalta. Felt great – slept better by all means, pain slowly subsided – again. BUT, the depression/Anxiety came back full force. Spent a horrid Thanksgiving – couldn’t enjoy anything. This went on a week, at least. So, I’m sitting here – unable to sleep – again – and in Fibro pain & fog. It gets so confusing – I’m thinking of going back on Cymbalta – it’s like “Which is the better of two “evils”. I have no health insurance – I get my meds for depression/Fibro from PAP’s. I haven’t the money to see a doctor about this right now. Just wondering if you or anyone has any suggestions. I tell you – I detest living depending on pills; but, I’ve been to therapists and all over the years and it’s part Post Traumatic Stress from a hugely bad first marriage and many other factors. I’ll probably have this the rest of my life. I’d so much appreciate any type of reply. Signed – confused.

  • Irene

    P.S. to first comment. I also notice that, while on Cymbalta, I’ve lost almost 20 lbs. in 3 months. This is a great thing as I need that. I feel better that way already. The Effexor seems to bring my appetite right back. Is this also normal? Maybe I’d better just try to tolerate the Cymbalta ????

  • B


    I was suffering from migranes for about the last year and a half but as time when by they continued to get worse and worse so I went to the doctor. I have recently (last week) been put on topiramate (topamax) 1 50 mg tablet at night daily and was also prescribed sumatriptan 50mg only to be taken for when I get a severe migrane… before I was prescribed the medication I used to smoke marijuana to deal with my headaches and they would go away…my pot smoking never got in the way of my daily life activities, which leads me to my question… i was wondering if i could still smoke marijuana while taking this medication… sometimes ill get a headache during the day and this medication will make me tired… Im a college student and have school and stuff and my headaches can get in the way of my studying… I carry a 3.4 gpa but with finals coming up soon I dont want my migranes to get in the way of my studying… is it ok for me to smoke marijuana while on this medication???

  • carrie

    hi..my doc jus put me on cymbalta and i already take effexor..i read that it can be leathal.

  • I take 40 mg zoloft and now the dr has added 20mg cymbalta. Is this safe?

  • can I take cipralex together with tamoxifen? Thanks.

    I am about to start tamoxifen and read about its accompanying hot flashes. Is it safe/effective to combine it with cipralex I regularly take? The items I find are confusing.

  • FAY

    HI,I been taking zanax OOF,I don;t know for how long,1 mg twice a day,.plus my cymbalta 60 mg twice a day,plus my gabbapentin,my lortab,and my elmiron.MY main isssue here is,the DR kept telling me that ,we need to get you off xanax,because it’s not made for long term ,only for short term,and he had given me about 4 diffrerent kind of pills,in the last 2 months or so.ever since i weaned myself from the xanax,I have became a MONSTER,and now that I had emailed the doctor’s office about my situation that i have became danger to my own family,because of these medicines.he wants to send me to a rehab place.I MEAN,ALL HE HAVE to do is put me back on the xanax..any way,any help i would really appreciate it thank you dr.

  • Rodney

    I have been dealing with depression/anxiety for awhile. About 4 months ago my dr. put me on doxepin with lithium to augment the doxepin. I was taking 50mg of doxepin and 300mg of lithium and I asked my dr. if it was safe to take natural supplements with it and he said absolutely. Well, about 2 weeks later I was rushed to the hospital with possible serotonin syndrome/neuroleptic malignant syndrome and have been sick ever since. Is there anything that can help my situation? I have some memory problems, sleep problems and my GI tract seems to not be working too well and have pretty severe constipation. Any help would be very welcomed!

  • S.R.K

    my name is S.R.K and i and Bipolar1. and severally depressed. i am taking topamax and celexa together, but im not sure they are safe together. my doctor and pharmacist says it is ok, but im not sure. i just dont feel like me. can you tell me what you think?
    thank you,

  • Karen

    I have been on Celexa for several years along with lorazepam for anxiety. My anxiety has increased quite a bit so my psychiatrist suggested I take Clonazepam during the day as it has a longer half life than lorazepam. The Clonazepam has worked well for the anxiety however when I take it at night I cannot sleep well….am awake every few hours and feel very tired next day. So he then suggested I take the Clonazepam during the day and lorazepam at night (the lorazepam has always helped me get a good nights rest). I’m concerned about taking 2 benzodiazepines. Can you offer any advice on taking clonazepam and lorazepam together? I take the clonazepam in the morning and the lorazepam at night.
    Thank you

  • courtney

    Is it ok to mix pain pills with imitrex?

  • lisa

    after being on 30mgs celexa i was recently put on 3omgs of cymbalta as well. i feel suicidal and hopeless like never before. is it ever gonna get better? help! im loosing it!

  • lallu lal

    My dad was on 10mg zyprexa (1-every night) and 10mg laxapro (1 per day) until last year in january (for six months). Due to not having medical insurance and bad financial situation, we had to stop the medication. At that time he was feeling much better until last week. He was diagnosed with schizophrenia. We do have some samples of laxapro 10mg left in stock. is it okay to start taking that medicine (10mg laxapro) after a year or not? I am going to take him to doctor on Monday, but I wanted to know if I can give him the medicine for today and tomorrow. His condition is getting very bad.

  • Terry

    Hi Dr. Chin.
    I’m very concerned for my brother. It is becoming more obvious when we speak that he is suffering from a mental health disorder. The problem is, we no longer live close enough to have a face to face discussion so I can visually see how he is doing. I can only hear his voice, and it’s disturbing.

    Based on our conversations, I feel he does realize he has a mental health issue – certainly has a temper and our last few conversations, the words were slurred. I’m also not sure just how open and communicative he is with his primary care giver. According to my brother he is taken Cipralex (20mg) and 50mg of Seroquel. (He takes Plaquenil for some dertmatoloyg issues and Rx Prilosec for a chronic abdominal issue).

    Based on his common law wife, the sedation is a major concern as they have a two year old son – he’s at home with their son while she works. She has come home a few times to find him sleeping and their child running rampant. The Seroquel I know has to be taken at night due to the sedation – he apparently takes that when he wants and he has missed a dose of Cipralex, and doubled up the next day, which I scorned him for.

    My concern is, popping pills when he wants too and the occasional drink either is messing him up more, or he just does not really think medication can help. His actions tell me he is being irresponsible and I have reached out to his other half, who confirmed her concerns of his mental state. A: are these two drugs known to have effects on the stability of ones mental health – ie: talking with harmful intentions; suicidal at times B: does the other medications he takes play a role?

    Thank you in advance.

  • Audra

    Last night I had a freak out, the worst panic attack of my life. Sweating, shivering, muscle twitching, and unsettled feeling throughout my body, Especially in my neck and my toes and fingertips. It was restless leg syndrome time ten, I also had rapid heartbeat, I thought I was going to fall over, walking was hard because my legs were shaky. After reading some articles, I am convinced I experienced Serotonin Syndrome, What do I do now? Is this something I see a doctor for? Do I need immediate help?

    • Lea

      You most definetly had a panic attack and those are scary and leave you exhausted. If you had just recently started a anxiety or panic disorder medication sometimes having a panic attack is a side effect and you should most definetly talk to your docter about changing your medication or being put on one.

  • Lea

    My name is Lea. I am 16 years old and I had an over dose of the prescription Celexa. For rehab purposes I have to write a paper saying the effects of combining celexa and other prescription medications that arn’t described to you. I don’t know of many people that have over dosed on this drug so it is hard to find any helpful websites. I know I am lucky to be alive and I just need some help informing others on what dangers come with this drug.

  • Daniel Sampaio

    I have been on Topamax (generic Topiramate) for over 6 months now…my problem is COMPULSIVE BEHAVIOR…
    I started mixing it with Prozac (30mg/day) and Zanax (1mg-1mg/day)…I also had problems with PARTY DRUGS ABUSE since I was 18yo and a lot of social anxiety, depression and other symptoms…
    I started Topamax with 25mg, then went to 50mg, then 75mg, then 100mg…
    Last year, in September, after reading about side effects of psycho drugs and health industry conspiracy theories, I decided to slow down on medication….I was actually feeling a bit better too…
    I was able to decrease Prozac to 10mg, Zanax to 0.5mg and Topamax to 50mg…per day…
    Sexual impotence with Prozac was annoying me, so by November last year I had completely given up Prozac…
    My problem was: I couldn’t stop my compulsive behavior with party drugs, such as ecstasy and GHB….mixing those with MEDS is DEADLY!!! My mind is not well….depression increased, when I am not on drugs, I have social phobia, and so on…

    Since NEW YEAR I haven’t take any drugs….I went to a new psychiatrist who recommended WELLBUTRIN 150mgs and he also told me to increase Topamax to 100mg…..

    He changed Zanax to CLONAZEPAM, so I wouldn’t be addicted to the same anxiety med……I am taking 75mg of it, everyday…

    So, today my combination is: WELLBUTRIN 150mg, Topamax 100mg and Clonazepam 75mg, every day….it’s been ONE MONTH now….and my commitment to quitting drugs is full!! Here’s my description of the side effects, so far:

    – Loss of apetite for normal food (I’ve been eating junk food non-stop);
    – Social phobia;
    – Extreme depression (more than ever in my whole life)
    – I am shaky, like never before…
    – I feel like a zombie, I can’t smile, or laugh, or look at people in the eyes…
    – A feeling of despair…complete loss of hope…
    – Suicidal thoughts (this is new…I’ve been thinking about death almost everyday);

    I am seriously thinking about quitting TOPAMAX…..from what I’ve been reading everywhere, that’s the evil med……

    I am also under pyschotherapy…twice a week…

    Could you please tell me, Dr. Chin, if that mix is the cause of my problems, and if that could also cause a SEROTONIN SYNDROME?

    Greetings from Rio de Janeiro, Brazil

    • Daniel, if your drug regimen is causing you to have suicidal thoughts, then you must speak with your doctor immediately and let your doctor know that you have feeling hopeless/despair and having suicidal ideation that appears to be a direct result of the current drug combination. It is well known that SSRI-class of antidepressants can cause suicidal thoughts in some patients and especially younger patients (children and teenagers especially), which is why a doctor should always monitor patients very carefully when these medications are started and combined.

  • Sarah

    Hello Dr Chin!

    I have been on Fluoxetine (10 mg) for almost three years. Around Thanksgiving, my pain management doctor prescribed Cymbalta. I had asked at the time about it because I understood it to be an antidepressant. My doctor told me that I was on such a low dose of Prozac, that it wouldn’t have any effect. He also informed me that it wad for chronic low back pain. So I started on 30 mg for a week, and then 60 mg after that. I believe I had a severe reaction to the combination. My drinking increased (I was a one or two drinks a week MAX drinker) and I found myself craving alcohol (and coffee). I had trouble concentrating, remembering things, along with other things (diarrhea, racing heartrate, sweating and chills, dilated pupils, terrible insomnia, irregular menstrual bleeding–every 11-14 days). I felt emotionally numb. I was very passive. I felt almost comatose. I would have chunks of time where I don’t remember things, or would be “sleepwalking” around the house in the middle of the night (according to my husband) drinking beer. The insomnia was awful. I would have to take unisom to get to sleep.

    I have since quit the cymbalta (and “fired” my doctor). Long story short, I apparently left the house with my kids (2 and 10 months) and ended up crashing into a porch. My BAC was .21. I have absolutely no recollection of leaving the house, nor why I would. Obviously, I’m in some serious legal trouble. I am just confused how all of this happened. I’ve never had an alcohol problem. I don’t drink and drive, and I certainly wouldn’t do so with my kids in the car. Have you heard of any thing about dependence on alcohol and excess serotonin? I’ve found accounts of increased drinking on Cymbalta, but Eli Lilly and the FDA won’t mention anything about it. I’m not necessarily blaming the cymbalta. More the combination (and my dr). Couldn’t this happen, in theory? Affecting how serotonin and norepinepherine are absorbed in the brain, could effect dependency on substances? At least from my limited knowledge.

    Another problem I’m facing, is my doctor has stated that I had not informed him of taking the fluoxetine. I’m at a loss here, as every time I was there I was asked what medicines I was taking. Every time, I informed them I was on the fluoxetine and my prenatal (I’m breastfeeding). What is up with that? Was my record altered or is he covering? I realize you could only speculate, and that wouldn’t be fair or right. I’m just concerned because his fabrication of the truth could get me in more legal trouble (mainly with child services). Is there a way to get my record and see if this information has been altered or omitted?

    Any information you could give me about the interactions, serotonin syndrome, alcohol consumption increase, or advice about my doctor would be greatly appreciated.

  • Lachlan

    Hello Dr. Chin,

    My migraines happen to come with sudden-onset post nasal drip (but do not respond to sinus headache treatments and are triggered by common migraine triggers). I took my first Maxalt last night and it worked wonders on the head pain but the nasal-drip and tinnitus remain. Can I add a low-dose Phenylephrine HCl (10 to 20 mg) after I take a Maxalt?

  • c10

    I have bipolar personality disorder with psychotic depression, I was curious about what medication is safe to take for migraines. I was on pain medication before, and it helped extremely, but idk if I wat to take other meds due to a possible counteraction in my medication. What should I say to my psychiatrist?

  • Brad

    I have been taking Lorazapem 1mg 4x a day for apprxomiately 4 years. It started as 1mg a day to help me sleep when going through a relocation, however, the new doctor I started seeing once I moved in 2007 kept me on the lorazapem. The psychiatrist concurred, since I had no signs of depression, yet my anxiety was through the roof. Anyways, recently, my memory is becoming garbled and I decided to go a dfiferent PCP to see what we could do about getting off the lorazapem entirely. I want my brain back!!!! Anyways, long story short…he prescriped Celexa 20mg and told me to take along with the lorazapem for about 3 weeks. Then, drop down to 3 1mg lorazapem in about a month. After another month, drop to 2 lorazapem, if possible, of course. He is definitely willing to work with me to get off the lorazapem, but I am wondering if these are options you have heard off regarding the weaning off of benzodiazepines (these things work, although, they screw up your brain). Any help is greatly appreciated.

  • Brandi

    I take Lithium 600mg and Zoloft 50mg a day can I start taking adipex again to loose weight? I don’t have high blood pressure

  • Guillaume

    Dear Dr. Chin,

    Just to get your in put. My son is 13 and has been given Celexa since last year 50 mg. What I have noticed is the complication/ side effects: Suicidal idea, screaming, cutting himself and acting strange sometimes. I believe this comes from the complication of this medication. The Psychiatrist keeps telling us that this is the treatment of choice. I believe, this is a medical negligence even malpractice if I can say more and must stop. What is your suggestion?

  • Guillaume

    MY son is treated for depression according to the the Psychiatrist. Last month, the Dr stated that my son is also suffering from PTSD. Has been treated my son for the past ten months with Celexa 50 mg. Is this medication recommended for teenager?.
    Couldn’t he prescribe placebo or Psychotherapy to my son instead of Celexa

  • Ramona

    I have been on Prozac for the last few months, now at 60 mg, and am taking Lorazapan occasionally for sleeping, although I don’t like how it makes me feel the next day. I tried Gravol for sleeping but was taking too high dosages for it to work, so I stop. I am now sick and cannnot take anything with DM in it as it is will interact with the prozac, but I am not sure how. I still have trouble sleeping and staying asleep and am wondering if there is anything for that.

  • Rod

    Hi Dr. Chin!
    I have recently suffered from serotonin syndrome/neuroleptic malignant syndrome and was wondering if there is anything that could help relieve the symptoms of this? I have experienced some brain damage, nervous system damage and my digestion is way off. I was wondering if some natural supplements could help? Thanks

  • Cindy Gandy

    My brother was prescibed anti depressants anti physcotics and imetrex.. plus high blood pressure meds and cholesterol meds. Also there were more. We the family did not have any knowledge of this until he took his own life and the medical examiner brought all his meds out. Could this have made him take his own life… Please help me

  • Mark

    Can u take Lexapro and Cymbalta together?

    • No, and when you see your psych/doctor ask about this. Lexapro and Cymbalta both act on the serotonin receptor pathways even as Cymbalta also acts on the norepinephrine pathway, which means your body will see a higher level of serotonin than if you take either one alone. There is a risk of serotonin syndrome when mixing antidepressants, and Cymbalta is an antidepressant that is indicated for treating depression, anxiety (general anxiety disorder) diabetic peripheral neuropathic pain and fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and chronic low back pain (http://www.cymbalta.com/).

  • sophia

    hi my was prescribed 40 mls of prozac about 10 or 20 mls of buspar 2 times a day and 4 mls of respital 1 a day back in oct. and nov of 2011. I was only diagnosed with post pardem and angziety. The compination made soo sick soo sick. confusion loss of muscle controll everything. I was like that for almost 1 mth, until a diff. dr told me to stop. I got everything pretty much back, except I have really bad pain in my chest and all through my upper body and I get short of breath. I used to be soo health and active not any more. My live has totaly chnged in a very neg way. I can’t help but think it’s due to all that shit (meds). Please tell me if you know. By the way I’ve already seen a # of dr. including cardio. They can’t find what’s wrong. I know something is. If anyone knows or culd relate please let me know.

  • Laura

    Hi I have recently been put on sertraline for depression but i used to take zolmitriptan when i had my migraines and now have been told i can no longer take zolmitriptan i was wondering if you know of any other medications available to take as my doctor is stuck as to what to give me.

  • kickencal

    I have been on 300 mg of wellbutrin for about 5 months now and just got put on sumatriptan and have been getting some of the crazy side effects

  • jdmom

    I am on Wellbutrin XL 300 mg in the am, Pristiq 100mg before bed and I was just prescribed Topamax for migraines. Can I take all 3 together? I am nervous about mixing these 3 drugs. Thanks.

  • Dallas Harvey

    Can you take Citalopram 30 mg and Sandoz-Bupropion SR 150 mg together? I’m taking the Bupropion 150mg twice a day to quit smoking but was taking the citalopram prior to it. Now without the citalopram I don’t feel the same as I did. Please help me