Trazodone Addition to Paroxetine and Mirtazapine in a Patient with Treatment-Resistant Depression: The Pros and Cons of Combining Three Antidepressants

Table 1

Triple antidepressant combinations (drug family, active principle, and respective dosages) described in literature with good clinical outcomes (efficacy and tolerability).

Triple antidepressant combination	Study
SSRI (escitalopram 10 mg) + TCA (amitriptyline 25 mg) + NARI (reboxetine 2 mg)	Restifo [15]
TeCA (mianserin 20 mg) + TCA (nortriptyline 75 mg) + NARI (reboxetine 1 mg)
SNRI (venlafaxine 150 mg) + NaSSA (mirtazapine 7.5 mg) + NARI (reboxetine 1 mg)
MAOI (tranylcypromine 70 mg) + TCA (nortriptyline 100 mg) + SARI (trazodone 50 mg)	Thomas et al. [22]
MAOI (phenelzine 60 mg) + TCA (nortriptyline 150 mg) + SARI (trazodone 400 mg)
SSRI (paroxetine 40 mg) + NaSSA (mirtazapine 30 mg) + SARI (trazodone 150 mg)	Present report

MAOI: monoamine oxidase inhibitor; NARI: noradrenaline reuptake inhibitor; NaSSA: noradrenergic and specific serotoninergic antidepressant; SARI: serotonin antagonist/reuptake inhibitor; SNRI: serotonin/noradrenaline reuptake inhibitor; SSRI: selective serotonin reuptake inhibitors; TCA: tricyclic antidepressants; TeCA: tetracyclic antidepressant.