From the Guidelines
Strattera and sertraline can be taken together safely under medical supervision, with careful monitoring for potential interactions and side effects, as they affect different neurotransmitter systems and have complementary mechanisms of action. When considering the combination of these medications, it's essential to note that they are metabolized by different liver enzymes, but sertraline may interact with drugs metabolized by CYP2D6, which is also involved in the metabolism of some other medications, but not Strattera 1. The primary concern with combining these medications is the potential for increased risk of side effects like serotonin syndrome, although this is rare. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders, caution entails starting the second non-MAOI serotonergic drug at a low dose, increasing the dose slowly, and monitoring for symptoms, especially in the first 24 to 48 hours after dosage changes 1.
Some key points to consider when taking Strattera and sertraline together include:
- Monitoring for symptoms of serotonin syndrome, such as severe headache, rapid heartbeat, confusion, or tremors
- Potential increases in blood pressure or heart rate changes
- Adjusting dosages under medical supervision to minimize the risk of side effects
- Reporting any unusual symptoms to the healthcare provider immediately
- Regular follow-up with the healthcare provider to assess the effectiveness and safety of the combination treatment.
It's also important to note that medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, and a conservative medication trial may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs like sertraline 1.
From the Research
Safety of Combining Strattera and Sertraline
- The combination of Strattera (a norepinephrine reuptake inhibitor) and sertraline (a serotonin reuptake inhibitor) has been studied in the context of treating adult ADHD patients with comorbid partially responsive generalized anxiety 2.
- A study found that adjunctive atomoxetine (Strattera) to SSRIs or SNRIs in the treatment of adult ADHD patients with comorbid partially responsive generalized anxiety resulted in significant resolution of symptoms of anxiety and ADHD 2.
- However, it is essential to note that atomoxetine can cause serotonin syndrome, presumably via its effects on serotonin reuptake inhibition, especially in cases of overdose 3.
- Another study discussed the use of atomoxetine in combination with other psychotropic classes, including SSRIs, but did not specifically address the safety of combining Strattera and sertraline 4.
- The general risks associated with polypharmacy, including increased adverse effects and decreased medication compliance, should also be considered when combining multiple medications 5.
- The mechanism of atomoxetine involves inhibiting the presynaptic norepinephrine transporter and preventing the reuptake of norepinephrine throughout the brain, which may interact with the effects of sertraline on serotonin reuptake 6.