Posted by SLS on October 22, 2002, at 7:12:30
In reply to Re: maoi augmentation » Ted Abel, posted by jsarirose on October 21, 2002, at 1:37:50
Hi.
> > I have been on Nardil for a mumber of years now. Its benefit is starting to diminish. I want to augment it. I have already tried lithium and pindolol, with no positive results.
> > What else might work? Can tyrosine or d-phenyline be added safely?Generally, but not always.
> I take Parnate, I'm not sure if the augmentation for Nardil follows the same path.
Generally, I think this is true, but with a few exceptions. I think Parnate is less likely to produce significant drug-drug interactions than is Nardil. One strategy that is often overlooked is to try using very high dosages of Parnate. Many people, myself included, have gone up to 120mg and occasionally higher. I am familiar with at least one case in which the patient did not respond until he raised the dosage to 300mg.
Combining a MAOI with a tricyclic can be very effective. One of the tricyclics, desipramine (Norpramin), is safe to add to either Nardil or Parnate. In addition, I have found that for Parnate only, imipramine (Tofranil) and nortriptyline (Pamelor) are also safe. However, Nardil and Parnate are very different drugs, despite their both inhibiting the MAO enzyme (monoamine oxidase).
Recently, when I tried adding either nortriptyline or imipramine, I developed Serotonin Syndrome, a potentially serious reaction that can occur when two very serotonergic drugs are combined. Both of these tricyclics do inhibit the reuptake of serotonin (5-HT); imipramine more potently than nortriptyline. However, desipramine affects only norepinephrine (NE).
It is my guess that Nardil affects serotonin substantially more than does Parnate. This might be why Nardil is so effective for a wider range of psychiatric conditions (social anxiety, atypical depression, OCD). This would be consistent with my disparate experiences when adding serotonergic tricyclics to Nardil versus Parnate.
A stimulant such as amphetamines (Dexedrine) and (Adderall), methylphenidate (Ritalin) can also be combined with both MAOIs, and even with MAOI - tricyclic combination described above.
Other "mood-stabilizers) such as Lamictal and Neurontin are often good to try.
Sorry. Too long.
- Scott
poster:SLS
thread:124257
URL: http://www.dr-bob.org/babble/20021019/msgs/124654.html