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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Medline on November 25, 2008, at 13:43:38
I decided to try out the quite risky treatment of Moclobemide + Escitalopram. I know all risks and if it does not work the way I hope I will go for the "real" MAOI route via Parnate (of course without any other serotonergic agent!).
There have been some older studies that show Moclobemide + SSRI might be effective in treatment resistant mood disorders. However these studies are small and direct or indirect conflict of interest is a real possibility.
AFAIK combining SSRIs with RIMAs is definitively less dangerous than combining MAOIs with serotonergic agents. But it's quite risky nevertheless, escpecially when (even small) overdoses of the involved drugs are used.
I am on 600mg Aurorix per day since about 2 weeks (300mg Moclobemide bid) . I will add 1.25mg Escitalopram on Friday and gradually increase the dose by 1.25mg every 5-7 days if I tolerate the mix good. My target Escitalopram dose is 10mg.
For security reasons I have Diazepam, Cyproheptadine and antihypertensive drugs at hand.
Posted by bleauberry on November 25, 2008, at 16:31:51
In reply to Moclobemide + SSRI combination, posted by Medline on November 25, 2008, at 13:43:38
Why don't you give Moclobemide up to 900mg a full 8 weeks before making any moves? That would be the wisest option I can think of. There is no way to predict here at 2 weeks what Moclobemide will do 6 weeks from now. Regardless of whether you have felt any hint of improvement or maybe none at all, at this point in time, you are actually just on the borderline of something to start happening. But really, and I know I'm not telling you anything you don't already know, these meds take a good 6 to 8 weeks to set into motion the brain adaptations that lead to improvement of symptoms, and yet another 3 to 6 months for them to fully develop.
Serotonin syndrome can sneak up on you after days or even weeks of everything seeming ok. I can see you have safety in mind by starting Lex at 1.25mg. I would only suggest that you stay at that dose for minimum one week before going up to 2.5mg. And then stay at 2.5mg minimum 2 weeks before going to 3.75mg. Stay there for 3 weeks. Any further increases, stay at each new dose 3 weeks.
I have had serotonin syndrome. It is not cool. It did not occur after dose increases, but rather a couple weeks after the last dose change. While serotonin syndrome can happen immediately with too much/too fast, it can also happen in an accumulative way where it takes time to build up, you don't feel it building up, and it hits out of the clear blue sky with no warning. That's what happened to me.
At least try to mimic a clinical trial by going 8 weeks on Moclobemide. Then decide what to do. Until then, just stay busy, set a date on the calendar 2 months out, and forget it until then.
Posted by mav27 on November 25, 2008, at 19:37:37
In reply to Re: Moclobemide + SSRI combination » Medline, posted by bleauberry on November 25, 2008, at 16:31:51
Ouch, hope you have better luck than me. I was on 600mg of moclobemide and decided to see what happened if i added a bit of effexor.. i only scraped a tiny bit off of an effexor tablet to be carefull.. a couple hours later you wouldn't believe the headache i had.. my head felt like it was going to explode like a bomb.
On an interesting note it made me feel drunk as well.
Posted by mav27 on November 25, 2008, at 22:21:49
In reply to Re: Moclobemide + SSRI combination » bleauberry, posted by mav27 on November 25, 2008, at 19:37:37
Posted by Medline on November 26, 2008, at 2:02:43
In reply to sorry my message should be to medline^^ (nm), posted by mav27 on November 25, 2008, at 22:21:49
I already used Moclobemide at 900-1200mg for 3 months two years ago, it didn't really help. I will try the experiment, but be extremely careful and I have a potent 5HT2A-antagonist at hand if things go wrong.
Posted by bleauberry on November 26, 2008, at 14:00:38
In reply to Moclobemide + Escitalopram, posted by Medline on November 26, 2008, at 2:02:43
> I already used Moclobemide at 900-1200mg for 3 months two years ago, it didn't really help. I will try the experiment, but be extremely careful and I have a potent 5HT2A-antagonist at hand if things go wrong.
If you've already tried it like that, and it didn't work, I fail to understand why one would go there again, when there are dozens or hundreds of other combinations/permutations to visit that you haven't.
One thing with combinations/augmentations that seems to make them work the best is when they are different mechanisms. Moclobemide and SSRI really isn't a variety of mechanisms. It is all just increasing neutrotransmitter levels. Something like Prozac + Zyprexa is different, as one is increasing neuro levels, the other is boosting those increases even more across the entire board, and at the same time interrupting feedback loops and blocking side effects and redirecting where signals go and re-instructing genes what to do, and such. Or a SSRI+stimulant thing, or a SSRI+TCA thing (increasing neuros, but also blocking many receptors), or a SSRI+antipsychotic thing, on and on. Different mechanisms.
What is the 5HT2A antagonist you have?
Posted by Medline on November 26, 2008, at 14:47:45
In reply to Re: Moclobemide + Escitalopram » Medline, posted by bleauberry on November 26, 2008, at 14:00:38
Cyproheptadine.
This is the end of the thread.
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