How is cyproheptadine and an ssri safe to use together? don't they both affect the serotonin transmitter? but often prescribed together by docs. thx

Serotonin antagonist: Cyproheptadine blocks receptors for serotonin, histamine, and acetylcholine. In my experience it is THE BEST treatment for akathisia. There are a handful of very old small studies suggesting antidepressant benefit. But it may worsen anxiety in some patients. It has been suggested as a way to block SSRI-induced sexual side effects. I almost never meet anyone whose doc prescribes it w/ SSRI meds.