clomipramine + imipramine + nortriptyline

This is a combination of three tricyclic antidepressants (TCAs): clomipramine, imipramine, and nortriptyline. Each medication works by inhibiting the reuptake of neurotransmitters in the brain, with different selectivity profiles. Clomipramine has higher affinity for serotonin reuptake, imipramine affects both serotonin and norepinephrine, and nortriptyline primarily affects norepinephrine. This combination is not standard clinical practice and carries significant risks of adverse effects including serotonin syndrome, anticholinergic effects, cardiac arrhythmias, and seizures due to overlapping mechanisms and drug interactions.