sertraline + citalopram + escitalopram + paroxetine

This is a combination of four selective serotonin reuptake inhibitors (SSRIs): sertraline, citalopram, escitalopram, and paroxetine. Each drug acts primarily by inhibiting the serotonin transporter (SERT), increasing synaptic serotonin levels in the central nervous system. Escitalopram also has allosteric properties at SERT. These agents are widely used as antidepressants for major depressive disorder and other mood disorders. Combining multiple SSRIs is not standard clinical practice due to increased risk of adverse effects such as serotonin syndrome; however, each agent individually is approved for depression and related conditions[1][2][3][4]. The primary mechanism involves blockade of presynaptic reuptake of serotonin, enhancing serotonergic neurotransmission.