Major
Established
الوصف
Combining duloxetine and sertraline, two serotonergic antidepressants, markedly increases the risk of serotonin syndrome without added efficacy.
الآلية
Both agents inhibit SERT; duloxetine additionally inhibits NET, resulting in robust serotonergic and noradrenergic excess when combined.
الأهمية السريرية
Dual antidepressant therapy of this type is not evidence-based and carries significant serotonin toxicity risk.
التدبير
Avoid concurrent use; if augmentation is needed, consult a psychiatrist for evidence-based strategies.