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Taking Cymbalta for fibromyalgia, Prozac and Xanax for depression. What are the side effects?

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I am taking Cymbalta 60 mg once a day for fibromyalgia, Prozac 40 mg twice a day for depression, and Xanax 1 mg twice a day for depression. Could it be possible that any of these work against each other, causing more depression? Or are they safe together. I do not take them all at the same time. Thank you.
Posted Thu, 18 Jul 2013 in Depression
Answered by Dr. Anjana Rao Kavoor 52 minutes later
Hello ma'am,

Thanks for writing to us ,

You are diagnosed with fibromyalgia and depression with a medical history of osteoarthritis, asthma and anxiety.

Duloxetine (cymbalta) is a selective serotonin norepinephrine inhibitor that is indicated for the following conditions - major depressive disorder, generalized anxiety disorder, fibromyalgia, and management of neuropathic pain associated with diabetes. It increases the amount of the neurotransmitter or the brain chemical, serotonin and also norepinephrine in the body to help relieve symptoms. And hence no, it does not cause depression, it is used in the treatment of depression apart from other conditions.

Fluoxetine is a selective serotonin reuptake inhibitor that is used in the treatment of major depressive disorder, bulimia etc. Its action is to increase serotonin levels in the brain to relieve symptoms of depression.

Now do these drugs together cause more depression? No

Are these 2 drugs given together safe? There have not been major studies done on this interaction and clinical judgment is exercised when combining these medications. Hence it is used with close monitoring of patients.There is one danger of taking these 2 drugs together and that is of serotonin syndrome. Since both these drugs increase the level of serotonin in the body there can be symptoms of this rare but potentially serious and possibly fatal syndrome that presents with- autonomic instability, abdominal pain, diarrhea, confusion, delirium, increased motor activity, myoclonus, hyperpyrexia, cardiovascular shock etc.

I hope both these drugs are being prescribed by the same doctor so he/she is aware of the concomitant use. If not then make your doctor aware of it.

Alprazolam (xanax) is a benzodiazepine that is used for anxiety. It has properties of tolerance and dependence and hence it is useful when used for short duration and better not to use for long term. Discuss this with your psychiatrist. It has no serious interactions when taken with the other drugs except for some increase in drowsiness, which all patients may not experience.

Do not stop any of these drugs abruptly on being given this advice. It can cause distressing symptoms. Discuss this with your treating doctor who would know best.

Hope this answers all your queries,
Dr. A. Rao. Kavoor
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