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Re: hello to all....

Posted by SLS on September 25, 2005, at 9:58:00

In reply to Re: hello to all.... » NotSoSunny, posted by zeugma on September 23, 2005, at 15:52:28

Hi.

> > I'm really sorry that I started such wars.

> No need to apologize.

I agree. You are not responsible for the behavior of others. Besides, it is often through confrontation and debate that important inroads to understanding are made.

> Lexapro is OK with Elavil as far as i know. Prozac, Paxil and Luvox are much more dangerous,

I can understand that one must be cautious when using Paxil and Luvox because they act as enzymatic inhibitors of Elavil metabolism. However, reducing the dosage of Elavil by 50% will usually compensate for this. One can always take blood-tests to monitor the levels of Elavil. What is the problem with Prozac when combined with Elavil?

Much success has been reported from using the combination of Prozac + desipramine. I have taken a combination of Paxil + desipramine without sequalae. I reduced the dosage of desipramine by 50%. Such dosage reductions are not necessary when combining tricyclics with Prozac.

Some people profit from combining Effexor with tricyclics. Here, no dosage adjustments are necessary. I feel that Effexor + Pamelor (nortriptyline) makes for a good combination. Neither drug affects the other's metabolism. I experienced a partial improvement with these two drugs.

Although serotonin syndrome is possible when combining an SRI with a tertiary tricyclic like Elavil, I doubt the risk is very high. I guess I would be more inclined to use nortriptyline than Elavil, though. Still, I had no problems combining Effexor with imipramine.

Off the top of my head, I think the order of serotoninergic potency of popular tricyclics looks something like this:

1. clomipramine
2. amitriptyline
3. imipramine
4. doxepin
5. nortriptyline
6. trimipramine
7. desipramine

- Scott

 

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