Q. Can anxiety medications be combined?

Answered by
Dr. Parth N. Nagda
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 01, 2022

Hi doctor,

My psychiatrist has decided for years to use only a combo (SSRI+Wellbutrin XL) to control and manage my chronic GAD and SAD. It is important to note that I cannot deal with anxiety without these medications. I am discussing a new plan with him and would appreciate your feedback. Furthermore, I would like to know which of the next SSRIs can be attached to Wellbutrin XL and has the fewest side effects in terms of weight gain, sexual dysfunctions, especially erections, fatigue, sedation, and tremors. Also, is it safe for the liver, heart, circulation, and brain when used long-term? Are the combinations Prozac 20 mg with Wellbutrin XL 300 mg or Zoloft 50 mg with Wellbutrin XL 300 mg? Please be specific, avoid theoretical information, and be close to your experiences as much as possible.



Welcome to

I understand your concern.

I have found tablet Prozac (Fluoxetine) more effective in my practice than tablet Zoloft (Sertraline), even though textbooks say that is not the case. Also, Fluoxetine helps with weight loss, while Sertraline is supposed to be neutral. There is no sedation with Fluoxetine, it has got a long half-life, and patients find it more activating to reduce lethargy. Also, there are no long-term side effects on the body with this drug.

Problems with erections are also uncommon. Instead, most patients have reported a delay in orgasm compared to erection difficulty. To help improve erection, you can take Arginine (L-arginine) supplements or PDE5 inhibitors (phosphodiesterase type 5). In addition to these medications, I always advise my patients to practice deep breathing exercises three to four times per day. It also helps to repeat it during times of stress. You could also try yoga, meditation, or a search for progressive muscle relaxation on the internet. Finally, in addition to medications, seeing a clinical psychologist for a few cognitive behavioral therapy sessions can help with anxiety management.

Hi doctor,

Thank you for the reply.

My specialist prescribed a combination of tablet Prozac 20 mg and tablet Wellbutrin XL 300 mg. This combination is works well for me, but one side effect I have noticed is fatigue and hand tremors, which are not as severe. What do you think? Is it safe to continue using this combination while neglecting this side effect and not thinking about it? And do these side effects negatively impact sexual performance, or do they have no effect at all?



Welcome back to

I understand your concern.

The tremors are due to tablet Wellbutrin (Bupropion hydrochloride). So you could either ignore it or take a low dose of tablet Propranolol (Inderal) 10 mg to stop them. Also, I do not think it affects sexual performance. Only if you reduce a little weight, your sexual performance will improve. So try focusing on that, and till then, you can try using tablet Sildenafil (Viagra) or tablet Tadalafil (Cialis) to enhance erection.

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