fluvoxamine + paroxetine + sertraline

This is a combination of three selective serotonin reuptake inhibitors (SSRIs): fluvoxamine, paroxetine, and sertraline. Each drug individually acts by inhibiting the reuptake of serotonin (5-HT) in the central nervous system, thereby increasing synaptic serotonin levels and enhancing serotonergic neurotransmission. All three are primarily indicated for the treatment of major depressive disorder and obsessive-compulsive disorder, with additional indications for anxiety disorders and other psychiatric conditions. Combining these agents is not standard clinical practice due to significant risks, including a high potential for serotonin syndrome—a potentially life-threatening condition caused by excessive serotonergic activity—as well as increased risk of adverse effects such as nausea, headache, insomnia, sexual dysfunction, and gastrointestinal disturbances[1][3][4][7]. There is no evidence supporting enhanced efficacy from combining multiple SSRIs; instead, this combination poses substantial safety concerns.