Psychiatrist Questions Psychiatrist

Is this combo safe?

I have depression and insomnia. My psychiatrist has me on 5 medications. Oxcarbazepine, lorazepam, citalopram, mirtazapine, and Quetiapine. I just want to get a quick answer if this is a safe combo.

Female | 26 years old
Medications: Oxcarbazepine, lorazepam, citalopram, mirtazapine, and Quetiapine
Conditions: insomnia, depression

4 Answers

PsychiatristPsychiatrist
Hello Madam, 

I am unable to answer the question as I am a licensed psychologist and not a psychiatrist. You may want to get a 2nd opinion from another psychiatrist or need to ask your PCP.  
Take care and remain safe. 

Dr. Lata Sonpal
NO! Get a second opinion from an ethical and CONSCIENTIOUS Board Certified psychiatrist.
You are being treated as if you have a brain disease. What you are describing, however, does not sound like a brain disease. My suspicion is that you are reacting to some difficult life challenges. I would suggest that you look at a larger view of our mental health system as described in a book called The Anatomy of an Epidemic by Robert Whitaker. He also has a very useful website called Mad in America. The answer to your question about safety is that it depends on what you are experiencing. A more important question, in my opinion, is whether all these medications are helping you. In my 50 years of experience, I have not found such a combination helpful. Finding an experienced therapist would be far more helpful.
I am not a prescribing MH professional. That said, it always is important to be smart about the MH medications you are taking regarding their relevance for treatment, their side effects and interaction effects with each other. You need to get this from the prescribing medical doctor as well as verify this with your pharmacist. Listed below are the meds you indicated as well as their side effects.
Oxcarbazepine is an anticonvulsant. It works by decreasing nerve impulses that cause seizures and pain. Oxcarbazepine is used either alone or with other medicines to treat partial seizures. More common side effects are: Change in vision; change in walking or balance; clumsiness or unsteadiness; cough; crying; dizziness; double vision; false sense of well-being; feeling of constant movement of self or surroundings; fever; mental depression; sensation of spinning; sneezing; sore throat; uncontrolled back-and-forth or rolling eye movements
Lorazepam is used to treat anxiety. Lorazepam belongs to a class of drugs known as benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA). Side effects include Drowsiness, dizziness, loss of coordination, headache, nausea, blurred vision, change in sexual interest/ability, constipation, heartburn, or change in appetite may occur. Other side effects are: mental/mood changes (such as hallucinations, depression, thoughts of suicide), slurred speech or difficulty talking, vision changes, unusual weakness, trouble walking, memory problems, signs of infection (such as fever, persistent sore throat).
Citalopram, sold under the brand name Celexa among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used to treat major depressive disorder, obsessive compulsive disorder, panic disorder, and social phobia. Common side effects of Celexa include: constipation, nausea, diarrhea, upset stomach, decreased sexual desire, impotence, difficulty having an orgasm, dizziness, drowsiness, tiredness, sleep problems (insomnia), dry mouth, increased sweating or urination, weight changes, and cold symptoms such as stuffy nose, sneezing, sore throat, or cough.
Mirtazapine is used to treat depression. It improves mood and feelings of well-being. Mirtazapine is an antidepressant that works by restoring the balance of natural chemicals (neurotransmitters) in the brain. Side effects can be: dizziness, drowsiness, lightheadedness, increased appetite, weight gain, dry mouth, or constipation. Serious side effects are: swelling of the hands/feet, shaking (tremor), confusion, signs of infection (e.g., fever, persistent sore throat). May cause a condition called serotine toxicity syndrome: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.
Quetiapine is used to treat certain mental/mood conditions (such as schizophrenia, bipolar disorder, sudden episodes of mania or depression associated with bipolar disorder). Quetiapine is known as an anti-psychotic drug (atypical type). It works by helping to restore the balance of certain natural substances (neurotransmitters) in the brain. This medication can decrease hallucinations and improve your concentration. It helps you to think more clearly and positively about yourself, feel less nervous, and take a more active part in everyday life. It may also improve your mood, sleep, appetite, and energy level. Quetiapine can help prevent severe mood swings or decrease how often mood swings occur. Side effects include: constipation, drowsiness, upset stomach, tiredness, weight gain, blurred vision, or dry mouth. Serious side effects are: restlessness/constant need to move, shakiness (tremor), mental/mood changes (such as increased anxiety, depression, thoughts of suicide), difficulty swallowing, constipation with persistent abdominal pain, persistent nausea/vomiting, loss of appetite, yellowing eyes/skin, interrupted breathing during sleep, trouble urinating