Can Venlafaxine and Mirtazapine be used together?

Hello,

Welcome to icliniq.com.

Combination antidepressant therapy works better if first line monotherapy has not been effective. I note that you are diagnosed with depression, anxiety and PTSD which can sometimes be challenging but gets better with the right treatment regimen. Different combination or augmentation strategies are used for better response. Usually, it will involves combining different types of antidepressants.

Venlafaxine (SNRI type) and Mirtazapine (NaSSA type) is a known combination deemed to be safe and used therapeutically. Adding Wellbutrin (Bupropion) is not used routinely but the rationale is understandable. Bupropion is a NDRI (norepinephrine-dopamine reuptake inhibitor) type atypical antidepressant. Bupropion is also used in smoking cessation.

In your case, Is Bupropion used as an additional augmentation drug or to counteract any side effect like sexual dysfunction? Combination of antidepressants can lead to relatively more side-effects including serotonin syndrome. Decision to combine drugs is made by carefully weighing up the benefits and risks involved. If benefits outweigh the possible risks, it is worthwhile trying the combination cautiously. Risk will be more if you have any pre-existing health problems like hypertension, seizures, etc. Complex decision like this are usually made by psychiatrists in specialist/tertiary medical centres.

Whenever combination antidepressants are used, the prescribing consultant and treating team will have to follow up closely, monitoring the dose response and look out for any treatment emergent side effects. Usually there will be regular follow up reviews especially during the initial period. Also always inform or remind if you visit any other doctor about being on combination antidepressants if you are prescribed any other medication (like certain antibiotics) to avoid possible drug interactions.

Finally, I believe you are also receiving psychotherapy in addition to medication. In many instances, psychotherapy acts as a good augmentation strategy to manage depression and anxiety disorders.

Hello, Welcome back to icliniq.com.

I presume your treating team is considering adding Wellbutrin (Bupropion) to counteract sexual dysfunction.

As I mentioned earlier, using tablets of Venlafaxine and Mirtazapine together is well known. Adding tablet Wellbutrin is not very common, but the rationale behind the thought is understandable. You may know that the risk of side effects will always be there, even if you take a single medication. The risk of side effects can be potentially higher if you take three medicines. Still, any potential risk can be managed by starting on a low dose and having regular reviews with your doctor for monitoring whilst on this medication.

Regarding your other query about alternative strategy, why are you considering reducing the dose of tablets Venlafaxine and Mirtazapine? You are only on a low dose of Mirtazapine (15 mg) and a moderate dose of Venlafaxine (150 mg). If sexual dysfunction is a significant concern, Mirtazapine is a better choice and has a favorable side effect profile. You can discuss with your doctor about potentially reducing Venlafaxine and increasing Mirtazapine.

But a word of caution here, any amendment and alteration to dosage need to be done only following a thorough assessment of your current mental state examination, treatment response, and tolerability to current medication. It is impossible to give generic tapering advice without completely knowing your current circumstances, as the advice will be incorrect. So it is advisable to discuss your specific concerns in detail with your treating doctor.

Hope this helps.

Thank you.