Three Antidepressant Medications; Is This Ok?

Reader’s Question

I am still in Iraq but getting ready to go home to my next duty station. I have had a bad year here and started getting highly irritated. After reading a book by DR Cantrell about PTSD I went in for counseling. Since I could only sleep about a hour a day, I was put on Seroquel to help me sleep and Zoloft for Stress. About the same time I needed a refill for my migraine meds (due to a head injury three years ago). The doc changed my meds from the useless Topamax to Elavil.

In doing some research online I found out that I have been suffering depression for years in addition to whatever is going on in my head from this war. I also found out that there may be issues with the mixture of drugs I am on. I have progressed my meds to 150mg of Elavil and 75mg Seroquel at night. In the morning I take 100mg of Zoloft and they added a 100mg of Wellbutrin for ED. When I have a migraine attack I take an Imitrex injection. All the meds have served their purpose. My headaches have decreased and I now do not have disturbing thoughts and can sleep.
Having just added the Wellbutrin I have noticed a change in my body that I have not pinpointed yet. My question is does this combination of meds cause problems, or is it lethal?

Our Consulting Clinical Psychologist’s Reply

Psychiatrists often use several medications in combination, as each medication targets a specific neurotransmitter. In your situation, you are taking three antidepressants (Elavil, Zoloft, and now Wellbutrin) that all target the neurotransmitter Serotonin. Imitrex may also have some Serotonin action. In short, I think you have reason to be concerned about these medications in combination.

I’d be concerned about the development of what we call “Serotonin Syndrome”. This is a reaction often encountered when several Serotonin-increasing medications are taken at the same time. The symptoms can feel like having the flu with sweats, hot flushes, stomach distress, etc. This can be very serious and can cause additional medical problems.

I would recommend monitoring your physical symptoms. At the first sign of flu-like symptoms I’d consult your physician. I’d also recommend making your physician aware that you are concerned about the possibility of “Serotonin Syndrome” (look it up on the Internet for additional information). While you may have only a few symptoms at this point due to your chronic depression, as your depression improves you may find the antidepressant medications too strong and may need to adjust your dosage.