Major
citalopram × Sertraline
SSRI (selective serotonin reuptake inhibitor)×Selective serotonin reuptake inhibitors (SSRIs)
Mechanism
Two SSRIs simultaneously – serotonin syndrome without therapeutic rationale. Citalopram itself prolongs QT.
Symptoms
Serotonin syndrome: agitation, confusion, tremor, myoclonus, hyperreflexia. Autonomic features: sweating, tachycardia, fever.
Management
The combination is not prescribed. When switching SSRIs, allow a 1-week washout. For augmentation: mirtazapine or agomelatine (different class).