Posted by jane d on February 5, 2002, at 23:25:01
In reply to How do I safely augment SSRIs with anafranil?, posted by Peter Jay on February 4, 2002, at 15:39:22
Peter,
First of all I'd like to apologize if the following is too simplistic. I couldn't tell from your posts just what you already know.
The problem with combining these particular drugs (Anafranil/clomipramine and Prozac), as Petters has said, is that each of these drugs hasthe potential to increase the level of the other one by effecting the enzyme system that breaks the drugs down. It's a matter of the whole being greater than the sum of the parts. In other words if your friend adds the clomipramine to the Prozac the effect is like she had raised the Prozac at the same time. Sometimes that it the whole point but since she is already taking such a high dose of Prozac your friend may not have room to go that much higher. I worry that your friend is risking serotonin syndrome.
There's a lot being published about these interactions (the cytochrome p450 system) but my impression is that it will still not tell you how to do this safely. There is still a lot that is unknown. Some drugs haven't been studied. Hypothetical reactions don't alwaays occur as predicted. There are also individual variations between one person and the next. Perhaps one of these variations is why your friend is not reacting to the Prozac; perhaps not.
I hate to say this but I really think that, instead of trying to calculate the doses yourself, your best bet here would be to use this energy looking for a new psychiatrist. Perhaps just for a consultation about the medication if your friend is otherwise happy with the first one. At least that way she gets the benefit of the doctors clinical experience to add to what is published.
Jane
poster:jane d
thread:92851
URL: http://www.dr-bob.org/babble/20020131/msgs/93033.html