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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by Tim on May 8, 2000, at 9:48:54
Are Paxil and L-tyrosine compatible, or do they have any effect on each other at all? Does anyone have any experience with taking both of these concurrently?
Posted by AndrewB on May 8, 2000, at 13:42:42
In reply to Paxil and L-tyrosine, posted by Tim on May 8, 2000, at 9:48:54
Tim,
There shouldn't be any problem combining L-Tyrosine with Paxil. Tyrosine is an amino acid which is present in significant quantities in one's normal diet. To be safe, you can take it only in the morning, half an hour before breakfast. By doing this you will ensure that the tyrosine won't compete with tryptophan for passage across the blood brain barrier during the rest of the day. Below is an excerpt off the web that refers to someone's expereince using tyrosine in combination with another SSRI, Zoloft.
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Ask the Expert - Augmenting DepressionQ. I am veteran of SSRI poop-out. After more than four
successful years on Zoloft, it stopped working. When tyrosine
was added, it was effective for another nine months. My doctor and I then tried
various strategies that didn't work, usually because of my hypersensitivity to
side effects. Wellbutrin made me jittery even at low doses and caused insomnia.
Desipramine made me so jumpy, dumb and uncomfortable that I couldn't take
another dose. I have had similar reactions to approximately 10 other tricyclics. I
have also tried all of the other SSRIs which I couldn't tolerate. I think
augmentation is the way to go at this point. What do you think?A. I admire your tenacity, after all these complications with your treatment. So, let's go through each of your questions and see if it leads to some treatment options to discuss with your doctor. First, I think buspirone augmentation can be helpful, particularly if there is an anxiety component to the depression. In fact, there are studies showing that buspirone alone, and in high doses (at least 50 mg/day) has antidepressant properties. Pindolol studies have yielded mixed results, and this may vary from SSRI to SSRI, but I think the risks are so minimal that it might be worth trying in your case. Other medications to consider as augmenters to SSRIs would include methylphenidate (Ritalin), which works well, in my experience, but could be overstimulating to you (if it were used, I'd start with 2.5 mg per day and hold it there for a week). Alternatively, you (with your doctor's approval, of course) could try stopping the tyrosine for a week or two, then re-starting it. Sometimes this strategy works with the SSRIs as well, though some patients may experience mild-to-moderate withdrawal symptoms (flu-like symptoms) when a short-acting SSRI (Paxil, Zoloft) is suddenly stopped--so a tapering period might be better, followed by 1-2 weeks off, then a restart.
Another option would be to add a dopamine agonist, such as pergolide. I have seen this help in one case of very resistant depression. Here, too, I'd start low, and go slow with the dose. The combination of the MAO-B inhibitor selegiline (L-deprenyl) in combination with phenylalanine (another amino acid precursor) has been reported helpful (see Sabelli, Journal of Clinical Psychiatry, March 1991). To use L-deprenyl, you must be off Zoloft for at least two weeks. You did not mention Serzone...if you haven't tried this, it could be used in low doses in combination with the Zoloft, or as a single agent in much higher doses. Or, Serzone could be used in combination with most of the other agents mentioned above, except an MAOI. I don't know if you'd consider treatment in Canada, but they do have a unique MAOI up there--moclobemide--that is not available in the States. It might work for you, even though two previous MAOIs did not. Moclobemide can usually be obtained via a cooperative arrangement between your doctor and one up in Canada. Then, there's always St. John's Wort, but we know so little about how well this works, or if it can be combined safely with standard antidepressants, that I can't really recommend it.
Since you have been through the pharmacologic ringer, I think you should at least consider
something that we know does work, and that is ECT. This is a safe and very effective treatment for major depression, and can be used on a maintenance basis.As to the mechanism of "poop-out" --the undignified name says a lot about our state of
knowledge. It doesn't really fit the usual definition of tolerance since dosage increases may or may not help (with tolerance, an increase in dose virtually always--by definition--brings about a renewed response). Dopamine depletion from the SSRI is plausible, and goes along with the observation that some patients who experience this fading out of SSRI effects also experience a sort of emotional flattening and decreased response to rewarding stimuli (e.g., sex, good times,etc.). Since the reward system is mediated in large part by dopamine, this all hangs together. That may be why methylphenidate (Ritalin), which has dopamine enhancing properties, sometimes restores the SSRI response. On the other hand, the apparent success ofpindolol--which basically unlocks the valve on the neuron that produces serotonin--suggests that serotonin slow down may underlie this loss of SSRI effect. I don't think it is a pharmacokinetic effect in most cases. I do wish you and your doctor the best in dealing with your problem, and don't give up!
This is the end of the thread.
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