Posted by inanimate peanut on July 22, 2010, at 22:33:07
In reply to Re: Need some advise » Conundrum, posted by jade k on July 22, 2010, at 20:49:03
Yeah, that's the natural warning thrown up with MAIOs/ TCAs, too, which are safe if combined correctly. Actually, just going to wikipedia gets us a debate "Mirtazapine and MAOIs are said to be contraindicated by some sources; however, there is no true indication that this is actually the case, and there is no proper literature on the subject warning against the combination whatsoever. Only a single study has mentioned anything significantly important regarding the combination, and they reported that it does not result in any incidence of serotonin-related toxicity.[119] "
Here's the study saying that Remeron and MAOIs together do not lead to serotonin syndrome:
Biological Psychiatry Volume 59, Issue 11, Pages 1046-1051 (1 June 2006)
14 of 21
A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug ActionP. Ken Gillman
Received 22 June 2005; received in revised form 9 November 2005; accepted 10 November 2005. published online 06 February 2006.Data now exist from which an accurate definition for serotonin toxicity (ST), or serotonin syndrome, has been developed; this has also lead to precise, validated decision rules for diagnosis. The spectrum concept formulates ST as a continuum of serotonergic effects, mediated by the degree of elevation of intrasynaptic serotonin. This progresses from side effects through to toxicity; the concept emphasizes that it is a form of poisoning, not an idiosyncratic reaction. Observations of the degree of ST precipitated by overdoses of different classes of drugs can elucidate mechanisms and potency of drug actions. There is now sufficient pharmacological data on some drugs to enable a prediction of which ones will be at risk of precipitating ST, either by themselves or in combinations with other drugs. This indicates that some antidepressant drugs, presently thought to have serotonergic effects in animals, do not exhibit such effects in humans. Mirtazapine is unable to precipitate serotonin toxicity in overdose or to cause serotonin toxicity when mixed with monoamine oxidase inhibitors, and moclobemide is unable to precipitate serotonin toxicity in overdose. Tricyclic antidepressants (other than clomipramine and imipramine) do not precipitate serotonin toxicity and might not elevate serotonin or have a dual action, as has been assumed.
Thanks to Jade for encouraging me to research to find the article I need to show to my doc when I ask to try Remeron-- I hadn't fuly looked into the issue yet :-). I'll also have to post this for Willful who was specifically concerned for the recent US articles on the safety on MAOI/TCA combos.
poster:inanimate peanut
thread:954637
URL: http://www.dr-bob.org/babble/20100720/msgs/955540.html