Posted by linkadge on December 25, 2018, at 21:01:14
In reply to Anyone ever augment a TCA with Zoloft or Remeron?, posted by Schlepo on December 24, 2018, at 10:02:23
I haven't used a TCA with Zoloft per se, but I have used combinations of TCAs and SSRIs (amitriptyline, nortriptyline and escitalopram). I have also used mirtazapine (Remeron) with SSRIs. I have also used (briefly) a TCA / mirtazapine combination (nortriptyline and mirtazapine).
There are no direct interactions between mirtazapine, TCAs or SSRIs. In theory, they can all increase serotonergic function and there are case reports of serotonin syndrome. However, its not on the same level as with MAOIs. I've never had an interaction with the mentioned meds, although I only used low doses.
Mirtazapine and nortriptyline were effective together, although both increase norepinephrine (through different mechanisms) and so blood pressure should be monitored. Mirtazapine can be a useful adjunct to an SSRI, if sleep and appetite are issues. Adding a TCA (especially the noradrenergic ones) to an SSRI can provide an additional (complimentary) mechanism and can help with sleep and / or energy levels.
Mirtazapine and TCAs share some common mechanisms (5-ht2a/c antagonism, and antihistamine effects). You may find some overlap in the effect of say, mirtazapine and a TCA like amitriptyline (i.e. both are sedating, and typically taken before bedtime).
Sertraline is mainly an SSRI (with some weaker effects on dopamine reuptake). Adding a TCA like nortriptyline would provide additional norepinephrine reuptake - i.e. having some effect on all three monoamines.
Linkadge
poster:linkadge
thread:1102596
URL: http://www.dr-bob.org/babble/20181024/msgs/1102610.html