From the Guidelines
Sertraline, buspirone (Buspar), and atomoxetine can be prescribed together under careful medical supervision, but caution is required due to potential serotonin-related interactions between sertraline and buspirone. Sertraline is a selective serotonin reuptake inhibitor (SSRI) antidepressant commonly used to treat depression, anxiety disorders, OCD, and PTSD at doses ranging from 25-200mg daily 1. Buspirone (Buspar) is an anti-anxiety medication that affects serotonin and dopamine receptors, typically prescribed at 5-30mg daily in divided doses for generalized anxiety disorder. Atomoxetine is a norepinephrine reuptake inhibitor used primarily for ADHD treatment at doses of 40-100mg daily, with a usual starting dose of 40 mg po daily and titration every 7-14 days to a maximum dose of 100 mg/d 1.
Key Considerations
- Combining these medications requires careful monitoring for symptoms, especially in the first 24 to 48 hours after dosage changes, due to the risk of serotonin syndrome 1.
- Sertraline has been associated with discontinuation syndrome, and caution is advised when starting or stopping the medication 1.
- Atomoxetine has been shown to be efficacious in treating ADHD, with a medium effect size compared to placebo, and may be considered as a first-line treatment option in certain cases, such as disruptive behavior disorders or substance use disorders 1.
- Common side effects of these medications may include nausea, headache, insomnia, and sexual dysfunction, and patients should never adjust dosages or stop taking them without medical guidance.
Dosage and Administration
- Sertraline: 25-200mg daily, with a recommended initial dosage of 25 to 50 mg per day and a maximum dosage of 200 mg per day 1.
- Buspirone: 5-30mg daily, in divided doses, for generalized anxiety disorder.
- Atomoxetine: 40-100mg daily, with a usual starting dose of 40 mg po daily and titration every 7-14 days to a maximum dose of 100 mg/d 1.
Special Considerations
- Medical education, training, and experience are necessary to safely and effectively prescribe these medications, particularly when combining them 1.
- Parental oversight of medication regimens is of paramount importance in children and adolescents 1.
- The treatment effects of these medications are not usually observed until several weeks after initiation of treatment, and patients should be advised to be patient and not to adjust dosages or stop taking them without medical guidance 1.
From the Research
Combination of Sertraline, Buspar, and Atomoxetine
- There is limited research on the specific combination of sertraline, buspar, and atomoxetine. However, studies have investigated the use of atomoxetine in combination with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) 2, 3.
- One study found that atomoxetine monotherapy was effective in treating attention-deficit/hyperactivity disorder (ADHD) symptoms, and anxiety and depressive symptoms also improved 2.
- Another study found that adjunctive atomoxetine to SSRIs or SNRIs was effective in treating adult ADHD patients with comorbid partially responsive generalized anxiety 3.
- Regarding the combination of serotonergic agents, a case study reported severe adverse effects, including serotonin syndrome, when a patient was prescribed paroxetine and buspirone concurrently 4.
- While there is no direct evidence on the combination of sertraline, buspar, and atomoxetine, the available studies suggest that combining atomoxetine with SSRIs or SNRIs can be effective and generally well-tolerated 2, 3.
Potential Interactions and Side Effects
- The combination of serotonergic agents, such as buspirone and SSRIs, can increase the risk of serotonin syndrome 4.
- Atomoxetine has been found to be generally well-tolerated, with common side effects including dry mouth, insomnia, nausea, and decreased appetite 5.
- The use of atomoxetine in combination with SSRIs or SNRIs may increase the risk of cardiovascular side effects, such as increased heart rate and blood pressure 2, 5.