Posted by SLS on June 20, 2008, at 14:00:35
In reply to Re: To Scott - Nortriptyline Not Good For Atypical » bulldog2, posted by Crotale on June 20, 2008, at 12:46:19
> A number of the SSRIs tend to elevate TCA levels. Prozac and Paxil are particularly known for this as both block the liver enzyme cytochrome p450-2d6 (Luvox blocks cyp-3a4 which may also cause problems with elevated TCA levels). Something to watch out for with this combo. I believe Celexa is considered less likely to raise serum levels of other drugs.
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> SSRIs for atypical depression aren't 100% established as effective as are MAOIs. Personally I like the MAOI-TCA combo. Nardil should be okay with nortrip although desipramine might be a better choice. Avoid clomipramine, amitriptyline with MAOIs; I'd avoid imipramine and doxepin too. These are called tertiary amine TCAs; the chemical difference between a tertiary amine and its secondary amine metabolite is the loss of a methyl group on the side chain (N-demethylation). Most of the TCAs have a propylamine side chain (exceptions include amoxapine and trimipramine).
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> Err, what's Ixel?Minalcipran. SNRI. I believe it is being investigated as a treatment for fibromyalgia and other pain disorders.
I have had a number of experiences with MAOI + TCA combinations. The two safest in my estimation are desipramine and nortriptyline. I can only guess that *perhaps* trimipramine would be safe, too, given its apparant lack of monoamine reuptake inhibition. Imipramine definitely produced serotonin syndrome when I added it to Nardil. I had no such trouble with desipramine.
- Scott
poster:SLS
thread:829828
URL: http://www.dr-bob.org/babble/neuro/20080418/msgs/835648.html