View Full Version : Fluoxetine - Ritalin - Mirtazapine Combination

12-07-16, 12:35 PM
Hi folks,

currently Im on some pretty strong combination of meds because of a depression which started with a complete loss of the ability to sleep about 4 months ago.

To deal with my disorder I now take 40 mg Prozac in the morning to cope with the depression per se. I also take about 20 mg Mirtazapine and about 20 mg Seroquel in the evening to get me into sleep mode (+ some valerian and sometimes melatonine).
In the last weeks I started to feel better regarding the depression symptoms and have the feeling that the Prozac is working its magic. So far so good.:)

Last week I was also diagnosed with an attention deficit disorder (ADS) and my doc wants me to start taking Ritalin (immediate release version to find the appropriate dosage). :eek:
Now Im more than a bit worried about the possible side-effects regarding drug interactions. I worry about interactions regarding the serum level of the different drugs in my bloodstream.

As far as I know Fluoxetine as well as Methylphenidat seem to inhibit CYP2D6 which could lead to elevated serum levels of both Fluoxetine as as well as Ritalin. I read about the possible side effects regarding CYP2D6 enzyme on corepsych.
Doctor Charkles Parker (author of the website) suggests switching Prozac to Venlafaxine, which does not inhibit CYP2D6.
Doctor Parker talking about mixing Prozac and Stimulants:

Has anyone been on such a combo of meds or a maybe similar combination?
Is there reason to worry about adding Ritalin to my daily medication? Should I switch to a different SSRI/SNRI before I start Ritalin?

thank you!

12-07-16, 05:18 PM
The enzyme P450 CYP2D6 metabolizes amphetamines and/or prozac.
If someone takes porzac and an amphetamine both drugs are in a
competition about CYP2D6. This competition will result in prelonged
half-life and/or increased meds effectiveness or very weird effects.
I just had this CYP2D6 confusion with pantoprazol and Vyvanse/Elvanse
which is a proton pump inhibitor to reduce stomachs acids and it is no fun.

Methylphenidate is no amphetamine but a derivate of it which does not affect CYP2D6.

Why is your doc not prescribing some dexamphetamine like Elvanse or
Attentin which also can lift moods? I know amphetamines are last option
in germany but it is unhuman to treat you like a laboratory rat and test
every ****** up pill on your brain.

Your doc is no ADHD professional using three antidepressant at once.

Best wishes!

12-14-16, 11:50 AM
Thank you very much for the elaborated and detailes response. Those are the type of quality answers that I hoped for when registering.