Fluoxetine + mirtazapine + Clomipramine?!?!

:lac:

Well - my anxiety (namely my OCD) is being very persistent this time around. Last time I was able to achieve a good quality of life with 15mg mirtazapine in combination with 60mg of fluoxetine. This time around the fluoxetine + mirtazapine isn’t doing the trick. My psychiatrist has suggested adding Clomipramine into the mix while lowering the fluoxetine. I am hesitant to say the least. If you know me, you know that serotonin syndrome is a major fear of mine. I was terrified to combine mirtazapine with fluoxetine, so I’m even more terrified to add a third serotonergic agent into the mix. Anyone have any experience with this combination (or with combining three or more serotonergic drugs?)