Can I take escitalopram (Selective Serotonin Reuptake Inhibitor) in the morning and melatonin at night simultaneously, and what is the order of side effects of SSRIs (Selective Serotonin Reuptake Inhibitors)?

Concurrent Use of Escitalopram and Melatonin: Safety and Side Effects

Yes, you can take escitalopram in the morning and melatonin at night simultaneously, as there are no significant harmful drug interactions between these medications. 1, 2

Timing Recommendations

• Escitalopram: Take in the morning to minimize sleep disruption

  • Starting dose: 10 mg once daily
  • Maximum dose: 20 mg daily (can increase after 1-2 weeks if needed) 2

• Melatonin: Take at night, 1.5-2 hours before bedtime

  • Typical dose: 3-5 mg
  • Do not take melatonin in the morning as it can impair alertness and psychomotor vigilance for up to 6 hours 3

Safety of Concurrent Use

Escitalopram and melatonin can be safely used together. The American Academy of Sleep Medicine confirms that melatonin is generally safe with few serious adverse effects, even when used with antidepressants 1. There is no evidence of harmful interactions between SSRIs and melatonin that would contraindicate their concurrent use.

Side Effects of SSRIs (in order of frequency)

1. Sexual dysfunction (most common)
2. Drowsiness/fatigue
3. Nausea and vomiting
4. Diarrhea
5. Dizziness
6. Dry mouth
7. Headache
8. Sweating
9. Tremor
10. Weight gain 2

Cardiovascular Considerations

Escitalopram carries some risk of QT interval prolongation, particularly at higher doses. The European Heart Journal classifies escitalopram as a Class B drug (has propensity for QT prolongation) 1. This risk is dose-dependent and more significant:

• In patients over 60 years of age
• At doses exceeding 20 mg daily
• When combined with other medications that prolong QT interval

Managing SSRI Side Effects

• Nausea: Take escitalopram with food
• Sleep disturbances: Morning administration of escitalopram helps minimize insomnia
• Sexual dysfunction: May require dose adjustment or medication change if severe
• Dizziness: Usually temporary and improves with continued use

Melatonin Considerations

• Choose reliable, high-quality melatonin preparations (United States Pharmacopeial Convention Verified when possible) 1
• Common side effects include headache, dizziness, and daytime sleepiness
• Melatonin is generally well-tolerated with no serious adverse events reported in long-term studies 1

Monitoring Recommendations

1. Monitor for improvement in sleep quality and mood symptoms
2. Watch for any unusual side effects, particularly in the first few weeks
3. If you have any history of heart conditions, consider ECG monitoring due to escitalopram's potential QT effects 1

Cautions

• Avoid taking melatonin in the morning as it can significantly impair alertness and reaction time 3
• Some studies suggest SSRIs may affect melatonin secretion patterns, but this doesn't contraindicate their concurrent use 4, 5
• If you experience worsening depression, anxiety, or sleep disturbances, consult your healthcare provider

This combined approach of morning escitalopram and evening melatonin can effectively address both mood disorders and sleep disturbances without significant risk of harmful interactions.