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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Russel on March 22, 2000, at 18:08:14
Hi,
I've been on Paxil for three months now and it's doing nothing for me at all. I'm considering augmenting it with a TCA. Has anyone had good experience with Paxil and TCAs? If so, what TCAs have been successful for you?Thanks,
russ
Posted by Cam W. on March 22, 2000, at 21:06:00
In reply to Paxil and TCAs, posted by Russel on March 22, 2000, at 18:08:14
Russ - There is a risk of serotonin syndrome when combining SSRIs with TCAs. I know it has been done using low doses of both, but this should only be done under the close supervision of your physician. Personally, I would not use both of these drugs together. - Cam W.
Posted by Russel on March 23, 2000, at 0:28:02
In reply to Re: Paxil and TCAs, posted by Cam W. on March 22, 2000, at 21:06:00
Cam--
A friend has been using Prozac and desipramine together for two years now and it has been extremely successful for him. He's had such good luck that I feel very inclined to try my luck as well...even at the risk of serotonin syndrome. Do you know of certain TCAs that might be riskier than others when used in combo with Paxil?russ
>
> Russ - There is a risk of serotonin syndrome when combining SSRIs with TCAs. I know it has been done using low doses of both, but this should only be done under the close supervision of your physician. Personally, I would not use both of these drugs together. - Cam W.
Posted by Cam W. on March 23, 2000, at 6:30:47
In reply to Re: Paxil and TCAs, posted by Russel on March 23, 2000, at 0:28:02
Russ - The use of Prozac with Desipramine would be a safer SSRI/TCA combination. Prozac more selectively blocks serotonin reuptake amd Desipramine more selectively blocks norepinephrine reuptake. Serotonin syndrome becomes more of a problem when you combine an SSRI with a TCA that has more serotonin reuptake blocking action than norepinephrine blocking action (eg esp Clomipramine). Other TCAS lie on a spectrum between Desipramine and Clomipramine in their abilities to block these 2 reuptake pumps.As an aside, adding Desipramine to Prozac is similar to increasing an Effexor dose from, say 150mg to 300mg (Effexor begins to block the norepinephrine reuptake pump at this point, instead of just the serotonin reuptake pump). Remember, just because a drug combination works for someone else, does not mean that it will work for you. Ask your doctor if he thinks that the Desipramine augmentation might be a good choice for your type of depression. Good luck - Cam W.
Posted by ChrisK on March 23, 2000, at 6:37:13
In reply to Paxil and TCAs, posted by Russel on March 22, 2000, at 18:08:14
If you are getting NO reaction to the Paxil you may want to try the TCA on its own. My experience has been that augmentation works when you are getting SOME benefit from a med but it doesn't get you all the way to your goal. I never reacted to the SSRI's and in the end switched to a TCA (Nortriptyline). That switch helped a lot but didn't "cure" me of the depression. I have since augmented the TCA a couple of times which has worked out well for me.
If the Paxil really is doing nothing I would look into switching your AD completely rather than try to augment something that isn't working.
Chris
Posted by Scott L. Schofield on March 23, 2000, at 7:16:08
In reply to Re: Paxil and TCAs, posted by Cam W. on March 22, 2000, at 21:06:00
>
> Russ - There is a risk of serotonin syndrome when combining SSRIs with TCAs. I know it has been done using low doses of both, but this should only be done under the close supervision of your physician. Personally, I would not use both of these drugs together. - Cam W.
Is there some greater risk with using Prozac in such a combination as opposed to the other SSRIs.
I had been on relatively high doses of Paxil and Norpramin (desipramine) in combination with no ill effects. Combining a TCA with an SSRI is not an uncommon practice here in the US. Perhaps there is a greater risk of serotonin syndrome with using one of the more serotonergic tertiary TCAs, but I haven't heard anything that would contraindicate such a combination. Anafranil (chlomipramine) is the exception, as usual.
- Scott- Scott
Posted by ruth on March 23, 2000, at 11:31:39
In reply to Re: Paxil and TCAs, posted by Scott L. Schofield on March 23, 2000, at 7:16:08
Russ--
I take 20 mg's of prozac with 75 mg's of
desipramine. It's worked very well with me. I
plan on going down to 10 mg's of prozac soon,
to hopefully get rid of some of prozac's side
effects. Prozac worked fine for me too, but
seems even better with desipramine, a more
complete relief of the depression, rather than a
"I'm not miserable anymore, but I'm not exactly
happy either"...ruth
Posted by Tom on April 13, 2000, at 11:43:02
In reply to Re: Paxil and TCAs, posted by ruth on March 23, 2000, at 11:31:39
> Russ--
>
> I take 20 mg's of prozac with 75 mg's of
> desipramine. It's worked very well with me. I
> plan on going down to 10 mg's of prozac soon,
> to hopefully get rid of some of prozac's side
> effects. Prozac worked fine for me too, but
> seems even better with desipramine, a more
> complete relief of the depression, rather than a
> "I'm not miserable anymore, but I'm not exactly
> happy either"...
>
> ruthHas anyone tried Paxil with Nortryptiline (sp?). I currently take desipramine, but its too activating. My doc wanted me to add Paxil to it, but I think that will compound problems. I'm leaning toward switching to Nortrip at my next visit, with a backup plan of adding Paxil to it if it isn't too activating.
Posted by Phil on April 13, 2000, at 18:00:45
In reply to Re: Paxil and TCAs, posted by Tom on April 13, 2000, at 11:43:02
Your plan is better!!
Phil
This is the end of the thread.
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