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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ace on April 10, 2004, at 0:24:49
OK kids,
Im going to try this stragedy after 1 more week of my tryptophan plan!
Im in a rush and am a lazy bum so please answer these qstns which i am too lazy to look up!
1. How long would Nardil have to be stopped before adding the TCA
2. Could the TCA be Amitrypt???
3. Nardil + Reboxetine produced depression. Which TCA is least noradrenergic? (You get my gist?!)
Peace and Happy Easter to all of you and Dr Bob!,
Ace
Nardil 60
L-Tryptophan 2 gram
Zyprexa 2.5
Posted by snapper on April 10, 2004, at 1:23:02
In reply to MAOI + TCA- info please now!, posted by ace on April 10, 2004, at 0:24:49
Ace, ....Nardil King!!! Why would you go to a TCA if nardil is so awsome- I have heard than maoi's and *some* TCA's can be combined but again if Nardil is working so good as you have reported,,then why rock the cradle??
snapper
Posted by Sad Panda on April 10, 2004, at 1:39:53
In reply to MAOI + TCA- info please now!, posted by ace on April 10, 2004, at 0:24:49
> OK kids,
>
> Im going to try this stragedy after 1 more week of my tryptophan plan!
>
> Im in a rush and am a lazy bum so please answer these qstns which i am too lazy to look up!
>
> 1. How long would Nardil have to be stopped before adding the TCA
>
> 2. Could the TCA be Amitrypt???
>
> 3. Nardil + Reboxetine produced depression. Which TCA is least noradrenergic? (You get my gist?!)
>
>
>
> Peace and Happy Easter to all of you and Dr Bob!,
>
> Ace
> Nardil 60
> L-Tryptophan 2 gram
> Zyprexa 2.5
>
Hi Ace!> 1. How long would Nardil have to be stopped before adding the TCA
You should be able to add a TCA cautiously without stopping Nardil.
> 2. Could the TCA be Amitrypt???
NO! It is too Serotoninergic, even worse is Imipramine and Clomipramine.
> 3. Nardil + Reboxetine produced depression. Which TCA is least noradrenergic? (You get my gist?!)
Trimipramine.
The only reasons to add TCA's is for their NE activity to boost energy or as a low dose for sleep aids(Trimipramine or Doxepin). Best to add would be Desipramine or Nortriptyline. The Tertiary TCA all metabolize into NE boosting Secondary TCA's anyhow. Just because you had a bad reaction to Reboxetine doesn't mean you will have a bad reaction to the NE from TCA's.
Exactly what effect are you trying to achieve?
Cheers,
Panda.
Posted by rod on April 10, 2004, at 7:20:23
In reply to MAOI + TCA- info please now!, posted by ace on April 10, 2004, at 0:24:49
> OK kids,
>
> Im going to try this stragedy after 1 more week of my tryptophan plan!
>
> Im in a rush and am a lazy bum so please answer these qstns which i am too lazy to look up!
>
> 1. How long would Nardil have to be stopped before adding the TCA
>Do you want to stop it again? I think you want to augment? General rule is 2 weeks.
> 2. Could the TCA be Amitrypt???
>Yes, but thats dangerous and I dont think you meet the criteria for treatment resistant depression unresponsive to both a MAOI and TCA. You are totally hyperresponsive to Nardil in my opinion. Nothing thats justifying such a combination. I guess it would result in sero syndrome in your case, but who knows
------------
J Clin Psychiatry. 1994 Aug;55(8):336-9. Related Articles, LinksTreatment response of depressed outpatients unresponsive to both a tricyclic and a monoamine oxidase inhibitor antidepressant.
McGrath PJ, Stewart JW, Nunes EN, Quitkin FM.
New York State Psychiatric Institute, New York 10032.
BACKGROUND: Data regarding effective treatment options for the minority of patients refractory to initial antidepressant trials are essential to guide therapeutic choices and to sustain the hope of patients and perseverance of clinicians. Few such data are available concerning the treatment of patients refractory to treatment with both a tricyclic antidepressant and a monoamine oxidase inhibitor given singly. METHOD: In a study of mood reactive depressed patients, most of whom met Columbia criteria for atypical depression, 20 patients refractory to vigorous 6-week double-blind trials of both imipramine and phenelzine given singly were given clinician's choice open treatment. A chart review of course in open treatment was conducted. RESULTS: Eleven patients (55%) had a full response to subsequent treatments, principally continued phenelzine and the combination of phenelzine with amitriptyline. Another 6 (30%) had at least moderate benefit from a variety of other treatments. CONCLUSION: These data suggest that even among patients who have failed to respond to two vigorous trials of different antidepressants, at least half appear to benefit from other pharmacologic regimens.
Publication Types:
* Clinical Trial
* Randomized Controlled Trial
PMID: 8071301 [PubMed - indexed for MEDLINE]
2: J Pharm Sci. 1994 Jan;83(1):100-3. Related Articles, LinksTranylcypromine does not enhance the effects of amitriptyline on 5-HT2 receptors in rat cerebral cortex.
Goodnough DB, Baker GB.
Department of Psychiatry, University of Alberta, Edmonton, Canada.
The combination of amitriptyline (a tricyclic antidepressant) and tranylcypromine (a monoamine oxidase inhibitor) has been reported to be effective for treatment of refractory depressed patients. In the study reported here, this drug combination was compared with amitriptyline administered alone on the number and affinity of 5-HT2 receptors in rat brain. Male Sprague-Dawley rats were given vehicle (distilled water), amitriptyline (3.5 mg/kg/day), or tranylcypromine and amitriptyline (0.5 and 3.5 mg/kg/day, respectively) in combination subcutaneously via osmotic minipumps for 4, 10, or 28 days. A membrane fraction prepared from whole cortex was employed for studying binding to 5-HT2 receptors ([3H]ketanserin as the radioligand). The combination of amitriptyline and tranylcypromine produced a small but significantly greater down-regulation (decrease in number) of 5-HT2 sites than did amitriptyline alone after 10 days of administration; at 4 and 28 days, both amitriptyline and the drug combination had produced down-regulation, but there was not a significant difference between the two treatments. These data suggest that the antidepressant efficacy observed with this combination is not likely due to an enhanced effect on 5-HT2 receptors.
PMID: 8138895 [PubMed - indexed for MEDLINE]
-----------------------> 3. Nardil + Reboxetine produced depression. Which TCA is least noradrenergic? (You get my gist?!)
>Well, sad panda is right. I also think of trimipramine, which has quite no affinity tho the reuptake pumps of noradrenalin and serotonin. Maybe also Opipramole, which is primarey a H antag, D2 antag. and sigma antag.
>
>
> Peace and Happy Easter to all of you and Dr Bob!,
>
> Ace
> Nardil 60
> L-Tryptophan 2 gram
> Zyprexa 2.5Happy Easter also to all
Roland
Posted by SLS on April 10, 2004, at 9:56:22
In reply to Re: MAOI + TCA- info please now!, posted by rod on April 10, 2004, at 7:20:23
If one were to add a tricyclic to Nardil, I would recommend desipramine. Even nortriptyline might be too serotonergic that it might produce a serotonin syndrome type of reaction. Parnate is much more forgiving when combining with TCAs.
- Scott
Posted by djmmm on April 10, 2004, at 11:44:21
In reply to MAOI + TCA- info please now!, posted by ace on April 10, 2004, at 0:24:49
> OK kids,
>
> Im going to try this stragedy after 1 more week of my tryptophan plan!
>
> Im in a rush and am a lazy bum so please answer these qstns which i am too lazy to look up!
>
> 1. How long would Nardil have to be stopped before adding the TCA
>
> 2. Could the TCA be Amitrypt???
>
> 3. Nardil + Reboxetine produced depression. Which TCA is least noradrenergic? (You get my gist?!)
>
>
>
> Peace and Happy Easter to all of you and Dr Bob!,
>
> Ace
> Nardil 60
> L-Tryptophan 2 gram
> Zyprexa 2.5Bupropion, Trazodone, Remeron* and all TCA's (other than clomipramine) can be safely combined with MAOIs
*Hoes MJ, Zeijpveld JH. Mirtazapine as a treatment for serotonin syndrome. Pharmacopsychiatry 1996;29(2):81.
Posted by gardenergirl on April 10, 2004, at 11:59:03
In reply to MAOI + TCA- info please now!, posted by ace on April 10, 2004, at 0:24:49
> OK kids,
>
> Im going to try this stragedy after 1 more !
>
> 1. How long would Nardil have to be stopped before adding the TCAAce, I thought you never, never, never were going to stop Nardil again???
gg
Posted by SLS on April 10, 2004, at 15:29:31
In reply to Re: MAOI + TCA- info please now!, posted by djmmm on April 10, 2004, at 11:44:21
Hi.
> Bupropion, Trazodone, Remeron* and all TCA's (other than clomipramine) can be safely combined with MAOIs
I developed what my doctor identified as a serotonin syndrome type reaction when combining Nardil 60mg + imipramine 300mg. I'm not sure whether it was or not. However, I did experience severe hypotension and dystonia among other things. I never experienced anything similar when combining Nardil + desipramine, though. For me, no such reaction occurs when the dosage of Nardil is kept at 45mg or lower, even when combined with amitriptyline.
Parnate 120mg + desipramine 300mg was OK.
Everyone is so different. I would recommend caution when adding a TCA. Supposedly, it is safer to add an MAOI to an ongoing treatment of TCA or start them together than it is to add a TCA to a MAOI. I've done it both ways without a problem. MAOI with Wellbutrin seems safe. I've done that. There have been reports of adverse events when combining MAOI with Remeron. There is some debate whether or not these incidences were serotonin syndrome. I would guess that the NE alpha 2 receptor antagonism produced by Remeron might yield sympathetic overload and dysautonomia. Again, everyone is so different. The potential of MAOIs to produce serious adverse reactions when coadministered with other drugs should be respected. I don't know what to think when it comes to Remeron. I do like the idea of using TCAs, but with Nardil, I think it might be best to use desipramine.
- Scott
Posted by SLS on April 10, 2004, at 15:35:44
In reply to Re: MAOI + TCA- info please now!, posted by SLS on April 10, 2004, at 15:29:31
Oh, the suggestion to try adding trimipramine is interesting.
- Scott
Posted by djmmm on April 10, 2004, at 16:13:34
In reply to Re: MAOI + TCA- info please now!, posted by SLS on April 10, 2004, at 15:29:31
Here is the link concerning MAOIs and TCA's:
MAO inhibitors:
An option worth trying in treatment-resistant cases
Jonathan O. Cole, MD
Senior consultant in psychopharmacology
McLean Hospital, Belmont, MA
Professor of psychiatry, Harvard Medical SchoolJ. Alexander Bodkin, MD
Chief, Clinical Psychopharmacology Research Program
McLean Hospital, Belmont, MA
Assistant professor of psychiatry, Harvard Medical School
Posted by ace on April 11, 2004, at 22:25:12
In reply to Re: MAOI + TCA- info please now!, posted by djmmm on April 10, 2004, at 16:13:34
This is the end of the thread.
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