In what mental health scenario would a patient take both sertraline (Selective Serotonin Reuptake Inhibitor) and atomoxetine (Strattera, Non-Stimulant Norepinephrine Reuptake Inhibitor)?

From the Research

A patient with co-occurring depression and ADHD may be prescribed both sertraline and atomoxetine (Strattera) to address both conditions simultaneously, as they frequently co-exist and can exacerbate each other. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is effective in treating depression, anxiety, and related conditions by increasing serotonin levels in the brain 1, 2, 3. On the other hand, atomoxetine (Strattera) is a non-stimulant ADHD medication that works by increasing norepinephrine levels to improve attention and reduce impulsivity.

Key Considerations

• The combination of sertraline and atomoxetine is generally considered safe, as they work on different neurotransmitter systems, but patients should be monitored for potential side effects like increased blood pressure, heart rate changes, or serotonin syndrome (though this is rare with this particular combination) 4.
• Typical dosing might include sertraline 50-200mg daily and Strattera 40-100mg daily, with both medications usually started at lower doses and gradually increased.
• A psychiatrist would typically manage this regimen, adjusting doses based on symptom improvement and side effects.

Evidence-Based Recommendations

• The most recent and highest quality study, published in 2019, found that sertraline is unlikely to reduce depressive symptoms within 6 weeks in primary care but observed improvements in anxiety, quality of life, and self-rated mental health 2.
• Another study published in 2005 found that atomoxetine monotherapy appears to be effective for treating ADHD, and anxiety and depressive symptoms also improved, but the absence of a placebo-only arm does not allow us to conclude that these effects are specifically the result of treatment with atomoxetine 4.
• Overall, the combination of sertraline and atomoxetine may be a viable treatment option for patients with co-occurring depression and ADHD, but careful monitoring and dose adjustment are necessary to minimize potential side effects and optimize treatment outcomes.