Prescribing Tri-cyclic Antidepressant with Zoloft

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Prescribing Tri-cyclic Antidepressant with Zoloft

Question:

Should a person be prescribed both a tri-cyclic antidepressant and Zoloft?

Answer:

If a person with depression does not feel better after trying one or more antidepressants alone, psychiatrists often suggest combining drugs that work in different ways. The combination of Zoloft (generic name sertraline) and a tricyclic antidepressant is an example.

Numerous surveys show that this combo is still fairly common. With the advent of newer drugs, other combinations are supplanting this duo.

Each class of antidepressant medication has its own unique biological effect. Zoloft is one of the selective serotonin reuptake inhibitors (SSRIs). They selectively boost the action of the chemical serotonin. SSRIs are a common first choice for antidepressant therapy.

More often than not, people need to try a few different medications alone or in combination before they find the treatment that works best for them.

When Zoloft was first marketed, tricyclics had already been in wide use for decades. They were the major class of antidepressants available as an alternative to SSRIs. Thus, a combination of an SSRI like Zoloft plus a tricyclic was among the first combination therapies to be tried, and it did help many people.

In the last several years, a large study has been underway. Called STAR*D (for "Sequenced Treatment Alternatives to Relieve Depression"), its aim has been to evaluate the value and tolerability of various depression treatments. Single drugs, combinations of drugs and psychotherapy are being compared.

There is still a lot of work to do before we know which treatments are best and in what sequence they should be offered. There is hope that as we learn more about the biology of depression, we'll develop better ways to predict which treatment is best for which person. Right now, however, it is trial and error.

For the treatment of depression, other medication combinations have become more common, but some psychiatrists do still suggest the SSRI/tricyclic combo. If your doctor recommends it to you, make sure you review the potential benefits and possible side effects of each drug. Your doctor should also dose the drugs keeping possible drug interactions in mind. For example, SSRIs tend to push up the blood levels of tricyclics, so you're likely to need a lower dose than if you were taking a tricyclic by itself.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.

Last updated:	July 20, 2009