Are you saying that we know which serotonin-affecting drugs will cause serotonin storm in combination? Or that they all could? Or that one patient should never be on multiple serotonin-affecting agents? I'm not trying to be smart. Just curious. I thought many psychiatrists just piled on SSRI after SSRI, etc
Yes we do know the majority of the combinations. However, when a new drug comes out and is given to the public we will almost always find some new side effect that was not discovered in the initial clinical trials. In my opinion the use of multiple SSRIs is not warranted. The normal procedure is to try one and if it does not work, stop that one and start the patient on a different SSRI. The anti depressants are very patient specific and it is not unusual to try several until the best one for a particular patient is found.
However, it is not uncommon for a patient to be on two different anti depressants at the same time and this is perfectly rational. The SSRIs can affect sleep and make it difficult. It is very common to give an SSRI in the morning and a non specific re uptake inhibitor at bedtime. The non specific ones will have a sedative side effect and make sleep much easier and also have good anti depressant activity.