Psycho-Babble Medication Thread 1110520

Shown: posts 1 to 6 of 6. This is the beginning of the thread.

 

Clomipramin, Tryptophan and Lithium in Combination

Posted by Skeletor on June 6, 2020, at 19:59:34

"Clomipramine, Tryptophan and Lithium in Combination for Resistant Endogenous Depression: Seven Case Studies" - August 1987 | A. S. Hale (a1), A. W. Procter (a2) and P. K. Bridges (a3)

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/clomipramine-tryptophan-and-lithium-in-combination-for-resistant-endogenous-depression-seven-case-studies/F3A1B19433959744DCF32C36C7B4A28F#

https://www.reddit.com/r/depressionregimens/comments/e70kwi/clomipramine_tryptophan_and_lithium_in/?ref=share&ref_source=embed&utm_content=title&utm_medium=post_embed&utm_name=bf891a792752497cbec4bac2c877196f&utm_source=embedly&utm_term=e70kwi

Unquestionably an extreme combination, but it seems to exhibit powerful antidepressant effects. Clomipramine on its own is regarded by many as maybe the most powerful non-MAOI antidepressant, at least in clinical practice and inpatient care, although the side effects can be quite rough, but combined with Tryptophan and Lithium it seems to be further boosted in its effect size and response rate.

Maybe worth trying before hopping on ECT / MAOIs...

One has to be careful because it is a small sample case "study", but nonetheless quite interesting to read. I encourage all those who have a view or experience to share it with us, regarding the aforementioned medications and especially the combination. Greetings!

 

Re: Clomipramin, Tryptophan and Lithium in Combination

Posted by linkadge on June 7, 2020, at 8:14:18

In reply to Clomipramin, Tryptophan and Lithium in Combination, posted by Skeletor on June 6, 2020, at 19:59:34

Hey,

You could always through an MAOI into the mix for added serotonin greatness (kidding - DON'T DO THIS).

To be honest, I found that clomipramine was easier to tolerate than an SSRI (less agitation, apathy and insomnia).

I'm currently taking lithium, venlafaxine and mirtazapine. The venlafaxine + mirtazapine is kind of like clomipramine. Occasionally I add some tryptophan without (apparent) problems.

Linkadge

 

Re: Clomipramin, Tryptophan and Lithium in Combination

Posted by undopaminergic on June 7, 2020, at 9:15:57

In reply to Re: Clomipramin, Tryptophan and Lithium in Combination, posted by linkadge on June 7, 2020, at 8:14:18

> Hey,
>
> You could always through an MAOI into the mix for added serotonin greatness (kidding - DON'T DO THIS).
>

"Throwing" a MAOI into the mix would be irresponsible and reckless, but the dose always makes the poison. If you need this combination, which is improbable but not unthinkable, you should start with the MAOI and reach a steady dose, then carefully introduce the precursor or the (S)SRI. Liquid preparations of SSRIs would be particularly appropriate for this purpose.

-undopaminergic

 

Re: Clomipramin, Tryptophan and Lithium in Combination » linkadge

Posted by Skeletor on June 7, 2020, at 10:57:46

In reply to Re: Clomipramin, Tryptophan and Lithium in Combination, posted by linkadge on June 7, 2020, at 8:14:18

> Hey,
>
> You could always through an MAOI into the mix for added serotonin greatness (kidding - DON'T DO THIS).
>
> To be honest, I found that clomipramine was easier to tolerate than an SSRI (less agitation, apathy and insomnia).
>
> I'm currently taking lithium, venlafaxine and mirtazapine. The venlafaxine + mirtazapine is kind of like clomipramine. Occasionally I add some tryptophan without (apparent) problems.
>
> Linkadge
>
>

But apparently Amitriptyline / Nortriptyline + MAOI is a very powerful combo. Clomipramine and Imipramine + other strong SRIs would cause serotonin toxicity and maybe death...

Interesting that you could tolerate Clomipramine easier than SSRIs... why didn't you stay on it?

How are you doing on the Mirtazapine?

 

Re: Clomipramin, Tryptophan and Lithium in Combination » undopaminergic

Posted by Skeletor on June 7, 2020, at 11:00:15

In reply to Re: Clomipramin, Tryptophan and Lithium in Combination, posted by undopaminergic on June 7, 2020, at 9:15:57

> > Hey,
> >
> > You could always through an MAOI into the mix for added serotonin greatness (kidding - DON'T DO THIS).
> >
>
> "Throwing" a MAOI into the mix would be irresponsible and reckless, but the dose always makes the poison. If you need this combination, which is improbable but not unthinkable, you should start with the MAOI and reach a steady dose, then carefully introduce the precursor or the (S)SRI. Liquid preparations of SSRIs would be particularly appropriate for this purpose.
>
> -undopaminergic
>

Better idea: add Amitriptyline. It doesn't seem to cause Serotonin syndrome when added to MAOI. It maybe can reach 70 - 80% SERT occupation at high doses, but it is a very strong 5HT2 antagonist and that might attenuate serotonin toxicity in combination with MAOI.

 

Re: Clomipramin, Tryptophan and Lithium in Combination

Posted by undopaminergic on June 7, 2020, at 11:26:04

In reply to Re: Clomipramin, Tryptophan and Lithium in Combination » undopaminergic, posted by Skeletor on June 7, 2020, at 11:00:15

>
> Better idea: add Amitriptyline. It doesn't seem to cause Serotonin syndrome when added to MAOI. It maybe can reach 70 - 80% SERT occupation at high doses, but it is a very strong 5HT2 antagonist and that might attenuate serotonin toxicity in combination with MAOI.
>

Yes, that was the best working hypothesis last time the topic of this combination came up here.

-undopaminergic


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