Posted by Crotale on July 29, 2008, at 18:03:21
In reply to Re: MAOI-TCA combos » Crotale, posted by SLS on July 28, 2008, at 17:57:08
> The answer is both...
Oh dear....
> The acronymn, "SNRI", was originally used to denote a selective norepinephrine reuptake inhibitor. I believe it came into use around the time viloxazine, reboxetine and atomoxetine were first referred to as such. Later, "SNRI" came to mean serotonin/norepinephrine reuptake inhibitor of which there are three representatives: Effexor, Pristiq, and Cymbalta.
So, on this board, "SNRI" could mean either?
> "NARI" has since come to mean noradrenergic reuptake inhibitor.
>
> "SRI" = serotonin reuptake inhibitor (in addition to other properties).Well, yeah, I was thinking of the "selective" ones. Admittedly, the term "selective" is more a pharmaceutical co. gimmick than anything else, but "SSRI" has been around something like 20 years, IIRC (as long as Prozac)...it's not going anywhere. And it makes sense to refer to the "selective NE reuptake inhibitors" (as opposed to something like venlafaxine or, say, amoxapine (which is "selective" in the sense that it has more or less no SRI activity, only NRI, but which also blocks various receptors) in an analogous manner. How about:
S/NRI for serotonin/norepinephrine RI
and
SNaRI for selective noradrenergic RI
?> Yes. My condition was extremely resistent to monotherapy. It only took doctors and me 26 years to find a treatment that produced a robust antidepressant response.
Glad to hear you did find one eventually (err). How long has it been working?
> I was desperate. I even took a single dose of Effexor while taking Parnate to see for myself if a SRI would cause SS when combined with a MAOI.
"Just curious," huh?
> The answer is yes. It only took 45 minutes to emerge.
Yeah, I know. I did the same thing, only with Nardil, but for different reasons (was suicidal).
> I was completely incoherent and couldn't stand up. My muscles tensed up and made it impossible to get out of bed. Luckily, the reaction lasted for only an hour or so. Parnate + imipramine was without ill effect, whereas Nardil + imipramine produced moderate SS.
Do you think it's liable to be worse if you add the MAOI to the SRI or vice versa? (just curious this time, not planning on trying it)
> > (I got CSS just from taking Cymbalta. No risky mixtures required.)
>
> You'll here of this occasionally, where SS will be produced by SRI monotherapy.It was pretty freaky. The muscular rigidity wasn't as bad as with the Effexor/Nardil combo, but my BP was all over the place, I felt like I was burning up, and I was delirious.
> One day, medical science will provide us with ways to choose certain drugs and reject others based upon gene activity and PET scans.
(Or something of the sort...)
> Until then, don't give up on using clinical trial-and-error algorithms. I don't expect you will need to wait 26 years to achieve remission.
Well, it's only been 18 for me so far, with a couple of temporary successes. ECT has actually gone pretty well, but it hasn't been long enough for me to count it a success yet.
I won't say I've exactly given up on trial-and-error, but the prevalence of "me-too drugs" these days is discouraging.
> By the way, my current treatment consists of:
>
> nortriptyline 150mg
> Nardil 90mg
> Lamictal 200mg
> Abilify 20mg
> Deplin 7.5mg
> N-acetylcysteine 1800mgI had problems with TCA metabolism although I never did determine whether it was an interaction with something else I was on or an individual thing like a mutation in one of the cytochrome P450 genes (AFAIK 2D6 seems to be the one responsible for a lot of the interindividual variability in TCA metabolism). I tried Abilify recently; it made me jittery at much lower doses than you're on (and I already have problems with sleep). Never tried any form of folate...maybe I should.
Incidentally: what's the NAC for? Liver issues? I've only ever heard of that being used to prevent hepatotoxicity reactions.
-Crotale
poster:Crotale
thread:829828
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/842903.html