Posted by KarenRB53 on October 12, 2008, at 18:16:48
In reply to Re: To Scott - Nortriptyline Not Good For Atypical, posted by SLS on June 20, 2008, at 14:00:35
> > A number of the SSRIs tend to elevate TCA levels. Prozac and Paxil are particularly known for this as both block the liver enzyme cytochrome p450-2d6 (Luvox blocks cyp-3a4 which may also cause problems with elevated TCA levels). Something to watch out for with this combo. I believe Celexa is considered less likely to raise serum levels of other drugs.
> >
> > SSRIs for atypical depression aren't 100% established as effective as are MAOIs. Personally I like the MAOI-TCA combo. Nardil should be okay with nortrip although desipramine might be a better choice. Avoid clomipramine, amitriptyline with MAOIs; I'd avoid imipramine and doxepin too. These are called tertiary amine TCAs; the chemical difference between a tertiary amine and its secondary amine metabolite is the loss of a methyl group on the side chain (N-demethylation). Most of the TCAs have a propylamine side chain (exceptions include amoxapine and trimipramine).
> >
> > Err, what's Ixel?
>
> Minalcipran. SNRI. I believe it is being investigated as a treatment for fibromyalgia and other pain disorders.
>
> I have had a number of experiences with MAOI + TCA combinations. The two safest in my estimation are desipramine and nortriptyline. I can only guess that *perhaps* trimipramine would be safe, too, given its apparant lack of monoamine reuptake inhibition. Imipramine definitely produced serotonin syndrome when I added it to Nardil. I had no such trouble with desipramine.
>
>
> - Scott
>I've been looking for posts on Imipramine and found yours. I've been diagnosed with Atypical depression with Major Depression episodes. Prozac worked well for 10 yrs on and off (mostly on) but pdoc wants me to try something else and has suggested Imipramine. Any advice appreciated.
Karen
poster:KarenRB53
thread:829828
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/857108.html