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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jono_in_adelaide on August 28, 2012, at 0:15:44
MAOI + tricyclic
ie Phentlzine/Tranylcypromine + Nortriptyline/Amitriptyline?
What say you?
Posted by SLS on August 28, 2012, at 2:57:13
In reply to The ultimate antidepressant combination?, posted by jono_in_adelaide on August 28, 2012, at 0:15:44
> MAOI + tricyclic
>
> ie Phentlzine/Tranylcypromine + Nortriptyline/Amitriptyline?
>
> What say you?
Tranylcypromine + TCA produces less hypotension and urinary retension than Nardil + TCA. Of course, if you are a Nardil responder, you may not have much choice. If Nardil does work but Parnate does not, and you find the side effects of Nardil intolerable, you might then look at Marplan as the MAOI to use. I suppose amitriptyline has a better chance of working than nortriptyline, but you might not like the sedation and weight-gain it produces, especially when combined with Nardil. Do not use imipramine or clomipramine as you choice of TCA. Serotonin toxicity can develop with both drugs, although clomipramine would produce the most severe. The risk of developing serotonin syndrome is very high when combining a MAOI with a SRI. I experienced this with Parnate + Effexor and Nardil + imipramine. Fortunately, when I experimented with Effexor, I took a single 5 - 10 mg dose. My reaction was profound, but not bad enough to be rushed to the hospital. My body temperature was only slightly elevated. However, I experienced delirium and muscle rigidity that lasted for about 1 1/2 hours. I was able to get my parents to take my temperature only when I became lucid enough to do so. I don't know how high it was during the peak of symptom severity. Hyperppyrexia is the killer. I could get away with combining Parnate + imipramine, but not Nardil + imipramine. My reaction to the latter combination was most not severe, but it was disabling. I could not stand or walk. My blood pressure dropped precipitously. I had to crawl around my apartment. I also had a degree of muscle rigidity, particularly around my torso. Nardil is more serotonergic than Parnate.I have done best with Parnate + desipramine and Nardil + nortriptyline. I know a woman who did well with Nardil + doxepin. When the folks at Columbia placed me on a combination of Nardil + amitriptyline, they used subtherapeutic doses of Nardil. They had me take no more than 45 mg/day. I experienced by usual 3-day TCA response, but felt nothing thereafter. However, because the dosage of Nardil was subtherapeutic, I have no way of knowing if the combination would have worked. Equally important, I have no idea as to the propensity of that combination to produce serotonin toxicity.
How would you go about choosing which MAOI to use?
- Scott
Posted by gadchik on August 28, 2012, at 6:43:18
In reply to Re: The ultimate antidepressant combination? » jono_in_adelaide, posted by SLS on August 28, 2012, at 2:57:13
Zoloft+Klonopin, with Remeron for extra deep sleep
Posted by Phillipa on August 28, 2012, at 9:15:48
In reply to Re: The ultimate antidepressant combination?, posted by gadchik on August 28, 2012, at 6:43:18
I know of none. Did the best on just a benzo. I would not ever experiment on the only body I have as have enough problems with health without adding to them. Could experimenting be why some are treatment resistant? Maybe less is best? Phillipa
Posted by gadchik on August 28, 2012, at 12:13:03
In reply to Re: The ultimate antidepressant combination?, posted by Phillipa on August 28, 2012, at 9:15:48
I always stick with small doses of anything I take. Dont want to numb myself, just a little calmer.
Posted by jono_in_adelaide on August 28, 2012, at 18:14:29
In reply to Re: The ultimate antidepressant combination? » Phillipa, posted by gadchik on August 28, 2012, at 12:13:03
SLS - if I had tried *everything* and nothing else had worked, i guess I'd try Nardil + nortriptyline if I was at the anxious neurotic end of the spectrum, and Parnate + nortriptyline if I was at the flat, no energy end.
Phillipa - I was only suggesting these as "end of the road" approaches, for people who had tried multiple drugs and combinations, whos lives were being ruined by depression etc, and nothing to lose by pushing the limits.
Posted by Phillipa on August 28, 2012, at 20:46:45
In reply to Re: The ultimate antidepressant - SLS + Phillipa, posted by jono_in_adelaide on August 28, 2012, at 18:14:29
Wouldn't be able to find a doc here that would prescribe. It's wierd here. Phillipa
Posted by jono_in_adelaide on August 28, 2012, at 23:01:41
In reply to Re: The ultimate antidepressant - SLS + Phillipa » jono_in_adelaide, posted by Phillipa on August 28, 2012, at 20:46:45
Yeah, same, it would only be a few old school psychiatrists who would prescribe that combo here - those who learned from William Sargent in the 60's and 70's.
Posted by papillon2 on August 29, 2012, at 0:25:39
In reply to The ultimate antidepressant combination?, posted by jono_in_adelaide on August 28, 2012, at 0:15:44
Whatever works and is tolerable for the person for whom it is prescribed.
Posted by jono_in_adelaide on August 29, 2012, at 1:29:39
In reply to Re: The ultimate antidepressant combination?, posted by papillon2 on August 29, 2012, at 0:25:39
Yeah, i phrased that incorrectly, I should have said "last resort" rather than ultimate
Posted by phidippus on August 31, 2012, at 20:09:00
In reply to The ultimate antidepressant combination?, posted by jono_in_adelaide on August 28, 2012, at 0:15:44
Mirtazapine + Effexor
Eric
Posted by rjlockhart37 on September 2, 2012, at 20:59:07
In reply to The ultimate antidepressant combination?, posted by jono_in_adelaide on August 28, 2012, at 0:15:44
Zyprexa/Prozac - manic depression with psychotic symptoms
Lamictal and any SSRI - good boost but not guarenteed in severe depression
Parnate/Dexedrine - low energy depression that has caused entire functioning to fade.
Lorazpeam/Dexedrine - social depression
Wellbutrin/any SSRI - low energy depression
Effexor and Strattera or any NRI- increase in vigilence...alertness.
Stablon/with TCA or SSRI - OCD depression
LDOPA with a stimulant.
have a nice day:::)))
rj
Posted by Exister on September 5, 2012, at 13:08:05
In reply to Re: The ultimate antidepressant combination?, posted by jono_in_adelaide on August 29, 2012, at 1:29:39
Simply Nardil has been my best response so far. Various combos help but nothing yet robust enough and worth sticking with. Just starting an adjusted combo (see signature) but yet to find best doses & timing.
Ex
This is the end of the thread.
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