Posted by Dennison on January 6, 2002, at 10:27:32
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by OldSchool on January 5, 2002, at 21:16:12
> > First of all, let me make it clear that I am fully
> > aware of the dire risk of producing serotonin syndrome
> > (which, of course, can turn fatal) by combining an SSRI
> > with an MAO inhibitor (and thus why professional
> > references strenuously forbid against attempting such
> > a cocktail).
> >
> > Now, my situation... I'm attempting to transition away
> > from an SSRI (fluvoxamine) to an MAOI (phenelzine).
> > However, the last time I attempted this (following my
> > doc's conservative -we must go it very slow- directions) during the lag time
> > between transitioning from the old drug to the new drug,
> > I had a devastatingly rapid relapse which sent me to hospital, where
> > I required ECT treatments just to get me partially out of what to
> > me was the most hopessly desolate and urgently horrible bout of
> > depression I have ever fallen into in so short a time.
> > I had tried to discontinue fluvoxamine many times before,
> > only to quickly return to it when depressive symptoms started
> > to become too much for me to be able to handle while waiting for
> > the extended process (i.e. for old drug to eventually leave my system
> > -plus a few days medication free for even more safety-
> > and then (to ward against nasty surprises) begin the
> > MAOI at subclinical dosages and then in the weeks ahead
> > gradually work dosages up ever so slowly until (someday)
> > reaching the usual effective starting dose.
> >
> > Therefore, (and this is where my upcoming query stems from),
> > I am without my doc's knowledge currently in the process
> > of transitioning from fluvoxamine to phenelzine by my own
> > desperate method of choice, by overlapping the dosage-with
> > drawal process of the former with the commencement and
> > dosage-build up process of the latter. So far I've
> > reduced the fluvoxamine dosage from it's previous
> > 200mg/d to 112.5mg/d; and I've managed to (slowly;
> > by increments of 7.5mg/d) increase the phenelzine up
> > to 30mg/d. (Usual effective starting dose for phenelzine
> > is 45mg/d.)
> > So far, I've experienced no signs or hints (both subjective
> > and objective) suggestive of any degree of serotonin syndrome.
> > However, considering that my knowledge and medical skills
> > in this enterprize are not in any way sophisticated, I
> > realize I have only been very lucky, so far. But my
> > aim still exists to keep increasing the phenelzine,
> > whilst decreasing the fluvoxamine, in tandem, trying
> > to maintain "complementary homeostasis", as it were,
> > (i.e. decreasing fluvoxamine while taking enough phenelzine
> > to prevent a serotonergic-withdrawal syndrome and/or
> > depressive relapse), until I can comfortably stop the
> > fluvoxamine altogether and be stable on the phenelzine instead.
> >
> > Now, I guess my query is then for any information (preferable
> > from a professional with experience specific to this)
> > which can be offered me to help me complete this
> > SSRI to MAOI transition -whilst overlapping the two- as
> > safely and successfully as possible; an attempt to change
> > antidepressants _without_ having to experience a painfully
> > dangerous relapse while escaping the odds of development
> > of a life threatening serotonin syndrome. Thank you,
> >
> > Triss
>
> I actually had a psychopharmacologist tell me that its possible to combine an SSRI with an MAOI in severe treatment resistant depression. I told some people about it and a few of them told me I ought to report this doctor to the medical board. LOL
>
> If it was me Id play by the rules and go 15 days washout between SSRI and MAOI. Some cut it short to ten days.
>
> How about this idea? Switch from the Luvox directly to a tricyclic antidepressant like Elavil or Surmontil? And use the tricyclic to keep you afloat for the two week washout? Then add the MAOI...you can safely combine MAOIs with certain tricyclics, thats an old time expert psychopharmacology trick.
>
> Then pull the tricyclic off when you go on the MAOI. This way you dont crash when you go off the Luvox.
>
> Old SchoolHi- I was taking efflexor before going on Parnate another "maoi" as is nardil, I waited only 4 days didn't have even a hint of a problem. Course efflexor does have a real short half -life. Real Quandry is if your're on Prozac and are switching to an maoi- " 5 week washout" period yikes!!! Long half-life of prozac and it's metabolite norfluoxetine-good in a sense if you're just going off prozac period, sense likehood of withdrawal is considerably less, but 5 weeks whew that is a toughie!!! Btw cyproheptadiene and methylsergide which quickly relieve serotonin syndrome and are used as standard anectdotes, are sometimes given to people just in case serotonin syndrome happens to manifest itself. They are also sometimes given to people on ssri's with sexual difficulties resulting from serotonergic effects to be used on a "prn" basis before planned sexual activity.
poster:Dennison
thread:88818
URL: http://www.dr-bob.org/babble/20020103/msgs/89037.html