Can someone take Lexapro (escitalopram) and Cymbalta (duloxetine) together for anxiety?

Combining Lexapro (Escitalopram) and Cymbalta (Duloxetine) for Anxiety

Taking both Lexapro (escitalopram) and Cymbalta (duloxetine) together for anxiety is not recommended due to the increased risk of serotonin syndrome, which can be potentially life-threatening.

Risks of Combining These Medications

• Combining two serotonergic drugs (SSRI + SNRI) significantly increases the risk of serotonin syndrome, which can cause mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity 1
• Symptoms of serotonin syndrome can develop within 24-48 hours after combining medications and can include confusion, agitation, tremors, muscle rigidity, hypertension, tachycardia, fever, seizures, and even death in severe cases 1
• Both medications work on similar neurotransmitter pathways - Lexapro is a selective serotonin reuptake inhibitor (SSRI) while Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI), creating redundancy and increased risk 1

Individual Medication Efficacy for Anxiety

Lexapro (Escitalopram)

• Escitalopram is an effective first-line treatment option for anxiety disorders 2, 3
• It has demonstrated efficacy in generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder 4, 5
• Escitalopram is the most selective SSRI available with minimal drug interactions compared to other SSRIs 2, 3

Cymbalta (Duloxetine)

• Duloxetine is an effective treatment for generalized anxiety disorder 6
• It is a potent serotonin and norepinephrine reuptake inhibitor (SNRI) 6
• Duloxetine has FDA approval for generalized anxiety disorder 1

Appropriate Treatment Approach

• When choosing between medications for anxiety, select either an SSRI (like escitalopram) OR an SNRI (like duloxetine), but not both simultaneously 1
• For treatment-naïve patients, all second-generation antidepressants (including SSRIs and SNRIs) are equally effective; medication choice should be based on patient preferences, adverse effect profiles, cost, and dosing frequency 1
• If one medication is ineffective or only partially effective, the appropriate approach is to switch to a different medication class rather than adding a second medication with similar mechanisms 1

Monitoring and Safety Considerations

• If transitioning between these medications is necessary, a washout period is recommended to avoid serotonin syndrome 1
• Common side effects of both medications include nausea, dizziness, dry mouth, fatigue, headache, sexual dysfunction, and sweating 1
• Both medications can cause discontinuation syndrome if stopped abruptly; a slow taper is recommended 1

Alternative Approaches

• If a patient has partial response to one medication, consider optimizing the dose of the current medication before switching or adding another agent 1
• For severe or treatment-resistant anxiety, referral to a psychiatrist for specialized care may be appropriate 1
• Cognitive-behavioral therapy (CBT) can be effectively combined with either medication as an alternative to multiple pharmacological agents 1

Remember that the goal of treatment is to achieve symptom remission with the lowest risk of adverse effects. Using either Lexapro or Cymbalta alone is safer and equally effective compared to combining them for anxiety treatment.