Posted by Elizabeth on May 31, 2001, at 23:10:33
In reply to Re: Tricyclics-Elizabeth, Cam, John L. and others, posted by Shirley 2 on May 31, 2001, at 5:44:52
Shirley --
Although you didn't provide enough information to describe a known depressive subtype, I think there is a good chance you would respond either to TCAs or SSRIs.
It is possible to combine TCAs and SSRIs safely. For example, you could try Luvox, as your doctor recommends, and then add desipramine or nortriptyline if you have a partial response. If I were in your shoes, I'd want to know the doctor's rationale for wanting to try Luvox.
A caveat about the combination approach: because Luvox is an inhibitor of several hepatic enzymes involved in TCA metabolism (cytochromes P450 1A2, 3A4, and 2D6 in particular), it can alter serum levels of tricyclics and their metabolites. (Most of the SSRIs do this.) Therefore, if you're going to use such a combination, you should be monitored for elevated TCA levels. This is particularly important if you're going to be on nortriptyline, which has an inverted U-shaped dose-response curve: it becomes less effective when serum levels exceed 150 ng/mL or so (disclaimer: I may be misremembering the numbers here).
You're entering relatively uncharted territory, and I can't help but admire your courage. Godspeed.
-elizabeth
poster:Elizabeth
thread:64764
URL: http://www.dr-bob.org/babble/20010530/msgs/64975.html