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

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

  • Kim

    Dear Dr. Dan

    I have a disease called Sweet’s Syndrome and all of my drs are perplexed as to why it is recurring cyclically on a monthly basis and worse with each skin outbreak. When the prednisone did not work they put me on a combination of 75mg of Effexor and 60 mg of Cymbalta each day. I have been taking them for about two months and now my doctor has dropped me “there is a conflict between the doctors in the group” (I have no insurance and it is immpossible to find another internist at this time.)

    MY QUESTION: How do I taper myself off of these two medications?

    Any Advice is much appreciated

  • Kim–It is not clear to me why the docs would put you on a combination of antidepressants to treat what appears to be an auto-immune disorder (unless, of course you were depressed). While prednisone is most often effective, your resistance to this is potentially concerning. You need to be under medical care for this and make sure nothing else is going on to cause the recurrances of the skin lesions. Great health system, no? About getting off the Effexor and Cymbalta, I would definitely get off the Effexor first. That is associated with more withdrawal symptoms than getting off Cymbalta. Typically, getting off Effexor is as simple as taking 37.5 mg daily for a week and then stopping. If you don’t have the smaller capsules but have a supply of 75’s, open the capsules and dump half of it out. Crude but effective. The same with the Cymbalta. You would go down like you go up. 30 mg for a while (a month if there is no hurry) then stop. As always, it is better if done while under the care of a physician, but what can you do when your physician drops you? Good luck.
    –DH MD

  • anne

    currently taking effexor. effectiveness marginal. still depressed and still anxious in social circumstances, perhaps, I just need more time with that aspect. what, if any other drug might I combine with the effexor to help with the depression?