![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 64. This is the beginning of the thread.
Posted by ed_uk on November 8, 2004, at 10:13:02
Hello everyone...
Perhaps the most feared drug interaction in all of psychopharmacology is that which may occur when an SSRI is combined with an MAOI. The potentially fatal Serotonin Syndrome appears to be a frequent outcome.It is clear from the literature, however, that not all patients treated with this combination develop serious side effects. It is even possible that some people may benefit from this hazardous form of treatment.
I would be very interested to hear from anyone who has taken a serotonin reuptake inhibitor (eg. an SSRI, venlafaxine, clomipramine, imipramine) at the same time as an MAOI such as Nardil or Parnate.
Why did you take this combination?
-treatment resistant depression
-OCD
-An uncontrolled anxiety disorder etc.What were the effects of this combination?
-serotonin syndrome
-therapeutic benefit
-seizuresThe incidence of the Serotonin Syndrome seems to be much lower with moclobemide+SRI than it is with a classical MAOI+SRI. Has anyone ever been treated with this combination?
Thank you for reading my post...
All the best,
Ed.
Posted by Squiggles on November 8, 2004, at 10:50:59
In reply to The Forbidden Combination, posted by ed_uk on November 8, 2004, at 10:13:02
> Hello everyone...
> I would be very interested to hear from anyone who has taken a serotonin reuptake inhibitor (eg. an SSRI, venlafaxine, clomipramine, imipramine) at the same time as an MAOI such as Nardil or Parnate.
>....
> All the best,
> Ed.
>
>imipramine is NOT an SSRI - are you a doctor?
Are you intrested for research or have you
taken these combinations or a friend?It would be generous of you if you could provide
some links from say Virtual Hospital on this
for example.Tx
Squiggles
Posted by Larry Hoover on November 8, 2004, at 11:15:27
In reply to Re: The Forbidden Combination, posted by Squiggles on November 8, 2004, at 10:50:59
> imipramine is NOT an SSRI - are you a doctor?
It's effect is mediated by inhibition of serotonin reuptake, but it is not called an SSRI. It's merely a semantic distinction, not a scientific one.
Lar
Posted by Squiggles on November 8, 2004, at 11:21:34
In reply to Re: The Forbidden Combination » Squiggles, posted by Larry Hoover on November 8, 2004, at 11:15:27
> > imipramine is NOT an SSRI - are you a doctor?
>
> It's effect is mediated by inhibition of serotonin reuptake, but it is not called an SSRI. It's merely a semantic distinction, not a scientific one.
>
> LarI'm not going to search for these deadly
combos because i am in a rush. But your
statements are alarming -- not to me because
those are not my drugs, but to other people
here.I think in lieu of the high danger cited
in your remarks, you may supply some medical
references to back up these remarks.Maybe, PubMed for exmaple,
Squiggles
Posted by ed_uk on November 8, 2004, at 11:23:54
In reply to Re: The Forbidden Combination, posted by Squiggles on November 8, 2004, at 10:50:59
Hello squiggles!!!
No, I'm not a doctor I'm a pharmacy student!
You are absolutely right, Imipramine(Tofranil) is not an SSRI (*selective* serotonin reuptake inhibitor) but that's not what I said. Imipramine is, however, a serotonin reuptake inhibitor. It is not *selective* because it inhibits the reuptake of norepinephrine as well: it is metabolised to desipramine. Imipramine can therefore be described as an inhibitor of serotonin *and* norepinephrine reuptake. As a result, the serotonin syndrome can occur if a person takes imipramine at the same time as an MAOI. I decided to mention imipramine(Tofranil), clomipramine(Anafranil) and venlafaxine(Effexor) because all of these drugs can inhibit the reuptake of serotonin.I have never taken this combination myself and I doubt that I ever will. My anxiety and depression are quite well controlled at the moment. I am interested in this combination because of the large number of people who suffer from treatment-resistant depression and anxiety. I would be very interested to hear whether anyone on psycho-babble has actually benefitted from this combination. The much feared SS does not occur in everone who dares to take it...
Here is some info from the textbook Stockley's drug interactions.....
........A very high incidence (25 to 50%) of adverse effects occurred in 12 patients taking fluoxetine/Prozac (10 to 100 mg daily) with either phenelzine/Nardil (30 to 60 mg daily) or tranylcypromine/Parnate (10 to 140 mg daily), and in 6 other patients started on either of these MAOIs 10 days or more after stopping the fluoxetine. There were mental changes such as hypomania, racing thoughts, agitation, restlessness and confusion. The physical symptoms included myoclonus, hypertension, tremor, teeth chattering and diarrhoea......I would like to work in the field of psychopharmacology in the future. I am particularly interested in depression, bipolar disorder and anxiety.
I am sure that someone will have an interesting experience to share... ace?
Please do not think that I am suggesting that anyone should take this combination of drugs. It is clearly very dangerous. I am simply interested to hear whether anyone has received this treatment in the past.
Squiggles, if you'd like me to get you any information about psychopharmacology I'll try my best. We have access most of the major medical journals in the university library.
All the best...
Ed
Posted by Squiggles on November 8, 2004, at 11:38:06
In reply to Re: The Forbidden Combination, posted by ed_uk on November 8, 2004, at 11:23:54
> Hello squiggles!!!
> No, I'm not a doctor I'm a pharmacy student!
Tx.Stockley's (edition please and complete reference,
page):
> Here is some info from the textbook Stockley's drug interactions.....
> ........A very high incidence (25 to 50%) of adverse effects occurred in 12 patients taking fluoxetine/Prozac (10 to 100 mg daily) with either phenelzine/Nardil (30 to 60 mg daily) or tranylcypromine/Parnate (10 to 140 mg daily), and in 6 other patients started on either of these MAOIs 10 days or more after stopping the fluoxetine. There were mental changes such as hypomania, racing thoughts, agitation, restlessness and confusion. The physical symptoms included myoclonus, hypertension, tremor, teeth chattering and diarrhoea......These are adverse effects. Adverse effects,
come with just about every psychiatric drug.
They can be reversed or controlled with dose
adjustment or cessation of the drug.Where is the Serotonin syndrome, here?
Do you know what it is - you must - it
is very serious - look it up and give
us a definition - e.g. hyperpyrexia,
and rigidity of all muscles.
I don't see it here.I am a layman, btw.
Squiggles
Posted by ed_uk on November 8, 2004, at 12:13:33
In reply to Re: The Forbidden Combination, posted by Squiggles on November 8, 2004, at 11:21:34
*A warning to everyone who has read my post*
Please read my post carefully, at *no* point did I suggest that anyone should consider taking a combination of a serotonin reuptake inhibitor and an MAOI in the future. This combination can be fatal. (See reference 1 below.) I was asking whether anyone has been treated with this combination in the past. Some people may have received this combination inadvertently eg. if an MAOI was started soon after stopping fluoxetine (Prozac)-an SSRI which is notable for its long half life.
It is very important to bear in mind that there are *no* clinical trials which support the efficacy of combining an SSRI with an MAOI, I was asking to hear people's personal experiences of this combination.
REF 1. Numerous fatalities have been reported due to SRI-MAOI interactions. The TCA clomipramine is an example of a drug which inhibits the re-uptake of serotonin. Tranylcypromine is an MAOI which is sold under the brand name Parnate. Here is a summary of the interaction...
Anaesthesia. 1987 Jul;42(7):760-3. Related Articles, Links
Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction.Tackley RM, Tregaskis B.
In spite of intensive therapy, an otherwise fit 34-year-old man died following the hyperpyrexial reaction to an interaction between tranylcypromine and clomipramine. There was no evidence of drug overdose, but severe disseminated intravascular coagulation developed which proved fatal.
....The hyperpyrexial reaction was almost certainly what we now know to be the serotonin syndrome.
Posted by ed_uk on November 8, 2004, at 12:35:46
In reply to Re: The Forbidden Combination, posted by Squiggles on November 8, 2004, at 11:38:06
Squiggles, I will provide you with the source. I am also I layman, I never claimed to be anything but :-)
The information was from Stockley's drug interactions online. There is no page number. I have the latest edition of the textbook at home but I don't have it with me.
Stockley's goes on to say.....'The symptoms seen appear to be consistent with the serotonin-syndrome which is typified by CNS irritability, increased muscle tone, shivering, altered consciousness and myoclonus.'
The serotonin syndrome can be thought of both as an adverse effect and an as a drug interaction. It has occasionally been reported in patients given SSRIs *alone* as well as in people given venlafaxine alone. It has also been reported to occur in patients receiving a wide variety of different drug combinations.
The serotonin syndrome occurs on a spectrum. It can be mild, moderate or it can be severe. Severe SS has often been seen in people who have received an MAOI plus a serotonin reuptake inhibitor.
Here is some information about the symptoms which may occur in the SS...
Am J Psychiatry. 1991 Jun;148(6):705-13.
The serotonin syndrome.
Sternbach H.
Department of Psychiatry, UCLA-Neuropsychiatric Institute, Los Angeles.
OBJECTIVE AND METHOD: A review of the literature on the serotonin syndrome in animals and human beings was conducted, and 12 reports of 38 cases in human patients were then analyzed to determine the most frequently reported clinical features and drug interactions, as well as the incidence, treatment, and outcome of this syndrome. FINDINGS: The serotonin syndrome is most commonly the result of the interaction between serotonergic agents and monoamine oxidase inhibitors. The most frequent clinical features are changes in mental status, restlessness, myoclonus, hyperreflexia, diaphoresis, shivering, and tremor. The presumed pathophysiological mechanism involves brainstem and spinal cord activation of the 1A form of serotonin (5-hydroxytryptamine, or 5-HT) receptor. The incidence of the syndrome is not known. Both sexes have been affected, and patients' ages have ranged from 20 to 68 years. Discontinuation of the suspected serotonergic agent and institution of supportive measures are the primary treatment, although 5-HT receptor antagonists may also play a role. Once treatment is instituted, the syndrome typically resolves within 24 hours, but confusion can last for days, and death has been reported. CONCLUSIONS: The serotonin syndrome is a toxic condition requiring heightened clinical awareness for prevention, recognition, and prompt treatment. Further work is needed to establish the diagnostic criteria, incidence, and predisposing factors, to identify the role of 5-HT antagonists in treatment, and to differentiate the syndrome from neuroleptic malignant syndrome.
Ed
Posted by Squiggles on November 8, 2004, at 12:41:39
In reply to Re: The Forbidden Combination, posted by ed_uk on November 8, 2004, at 12:35:46
I checked and found this article which you
must be referring to:1: Anaesthesia. 1987 Jul;42(7):760-3. Related Articles, Links
Fatal disseminated intravascular coagulation following a monoamine oxidase inhibitor/tricyclic interaction.
Tackley RM, Tregaskis B.
In spite of intensive therapy, an otherwise fit 34-year-old man died following the hyperpyrexial reaction to an interaction between tranylcypromine and clomipramine. There was no evidence of drug overdose, but severe disseminated intravascular coagulation developed which proved fatal.
Publication Types:
* Case Reports
PMID: 3631476 [PubMed - indexed for MEDLINE]
:-(Squiggles
Posted by ed_uk on November 8, 2004, at 12:48:57
In reply to Re: The Forbidden Combination, posted by Squiggles on November 8, 2004, at 12:41:39
Squiggles, why do you say this......'I'm not going to search for these deadly combos because i am in a rush. But your statements are alarming -- not to me because those are not my drugs, but to other people here.'
It is very rare for people to be prescribed an MAOI+SRI. I don't think my statements were alarming at all. Anyone who has been prescribed such a combination must have been informed of the risks.
Ed
Posted by ed_uk on November 8, 2004, at 13:11:54
In reply to Re: The Forbidden Combination, posted by ed_uk on November 8, 2004, at 12:48:57
Hello...
It looks like Scott had a bad experience combining an MAOI with venlafaxine, does anyone else have any experiences...SLS said......'All I can say is that I know of no way to confidently predict which people will experience a life-threatening reaction to such a combination and which will not. Once upon a time, in an act of desperation, I decided to take a nibble off a small piece of venlafaxine (Effexor) to see how it would react with the Parnate I was taking. Within ten or fifteen minutes, I experienced vertigo and I had to lay down. I couldn't get myself to sit up in bed. I became incoherent and hardly knew where I was. I made no sense at all when speaking to my parents. I told them not to worry about me, that I understood what I did wrong, and that I simply had to reboot the system. No problem.
I can't emphasize enough what a tiny amount of Effexor I bit off. Because of its short half-life, I chose Effexor purposely to test for the potential of developing serotonin syndrome when combining a serotonin reuptake inhibitor with an MAOI. If something went wrong, it should dissipate relatively quickly. It did. So did my notions of trying it ever again.'
Posted by jasmineneroli on November 8, 2004, at 13:15:41
In reply to Re: The Forbidden Combination, posted by ed_uk on November 8, 2004, at 12:48:57
Squiggles,
Ed's original post was clear to me when I first read it.
Firstly, he didn't lump Imipramine in with the SSRI's, or call it one. He differentiated between SSRI's, SNRI's and TCA's (by drug name on the last two drug classes, but not in the first - the SSRI's). He put them all together because they all have an affect on serotonin, and people might not be aware of that.
Secondly, it's evident that Ed was asking for people's EXPERIENCES, *IF* they had been prescribed both a seratonergic drug and a MAOI drug together.
I see no advice/opinion/encouragement in his post, for anyone to combine these drugs. He is searching for information, in particular with reference to people with treatment-resistant illnesses.
I found your remarks to be somewhat antagonistic in nature, rather than a request to clarify what his post meant.
Are you doing OK? You seem a little bit "off" today?
Take care.
Jas
Posted by ed_uk on November 8, 2004, at 13:38:40
In reply to Re: The Forbidden Combination-Squiggles, posted by jasmineneroli on November 8, 2004, at 13:15:41
Thank you Jas :-)
I thought my post was clear, I really hope it was.
Sadly, at the moment, there isn't any known way of predicting who will experience serious symptoms of the SS when an SRI is combined with an MAOI. If there was a reliable method available, the combination might possibly be helpful for the treatment of people with serious mental health problems which haven't responded to anything else. This is why I was interested.In particular, I was wondering whether the combination might ever be beneficial in the treatment of conditions like OCD which involve the serotonin pathways in the brain.
There has been a little bit of research into the combination of moclobemide (Manerix- a reversible inhibitor of MAO-A) and an SSRI.
Psychopharmacology (Berl). 1995 Jun;119(3):342-4. Related Articles, Links
Combined SSRI-RIMA treatment in refractory depression. Safety data and efficacy.Ebert D, Albert R, May A, Stosiek I, Kaschka W.
Department of Psychiatry, University of Erlangen, Germany.
Eighteen patients with refractory depression (dysthymia with superimposed major depression) were treated with a combination of fluvoxamine(Luvox/Faverin) and moclobemide for 6 weeks and compared with 18 patients treated with fluvoxamine only. Both groups had improved only slightly after 8 weeks of TCA treatment and 6 weeks of SSRI treatment. Two main observations can be made concerning safety and efficacy. Firstly, side effects in the SSRI-RIMA group were minimal. Secondly, the SSRI-RIMA combination treatment significantly improved depression in refractory depressed patients, with a decrease in depression of about 40%. The SSRI monotherapy group also significantly improved, though only by about 20%, indicating that positive effects of SSRI treatment may still develop even after 12 weeks of treatment. In conclusion, the study gives further support to the hypothesis that SSRI-RIMA combinations may be safe and well tolerated. This treatment may also offer some therapeutic advantages in at least some patients who have not responded to conventional pharmacological treatment.
Here is a summary of another little study...
J Clin Psychiatry. 1994 Jan;55(1):24-5. Related Articles, Links
Combined SSRI-moclobemide treatment of psychiatric illness.Joffe RT, Bakish D.
Mood Disorders Program, Clarke Institute of Psychiatry, Toronto, Ontario, Canada.
BACKGROUND: To determine the efficacy and safety of a serotonin selective reuptake inhibitor (SSRI) combined with moclobemide in the treatment of 11 patients with various DSM-III-R diagnoses. METHOD: Subjects received moclobemide in doses of 150 to 800 mg/day together with sertraline (N = 5) in doses of 25 to 200 mg/day or fluvoxamine (N = 6) in doses of 50 to 200 mg/day. Patients were carefully monitored for side effects and for clinical response at the end of the trial, which lasted a minimum of 5 weeks. RESULTS: The combination was tolerated extremely well. Insomnia was the most common side effect, occurring in 5 of 11 subjects. A marked or complete therapeutic response was noted in 8 of 11 subjects. CONCLUSION: This open clinical trial suggests that combined SSRI-moclobemide treatment appears to be safe and well tolerated. It may also have therapeutic effects in treatment-refractory patients.
Sadly, the SS may also occur with SSRI+Moclobemide.......
J Anal Toxicol. 2001 Mar;25(2):147-51. Related Articles, Links
Comment in:
J Anal Toxicol. 2001 Nov-Dec;25(8):716-7.
A fatal case of serotonin syndrome after combined moclobemide-citalopram intoxication.Dams R, Benijts TH, Lambert WE, Van Bocxlaer JF, Van Varenbergh D, Van Peteghem C, De Leenheer AP.
Laboratorium voor Toxicologie, Universiteit Gent, Belgium.
We present a case involving a fatality due to the combined ingestion of two different types of antidepressants. A 41-year-old Caucasian male, with a history of depression and suicide attempts, was found deceased at home. Multiple containers of medication, the MAO-inhibitor moclobemide (Aurorix), the SSRI citalopram (Cipramil), and the benzodiazepine lormetazepam (Noctamid) as active substance, as well as a bottle of whiskey were present at the scene. The autopsy findings were unremarkable, but systematic toxicological analysis (EMIT, radioimmunoassay, high-performance liquid chromatography-diode-array detection [HPLC-DAD], gas chromatography-nitrogen-phosphorus detection, and gas chromatography-mass spectrometry) revealed the following: ethanol (0.23 g/L blood, 0.67 g/L urine), lormetazepam (1.65 microg/mL urine), cotinine (0.63 microg/mL blood, 5.08 microg/mL urine), caffeine (1.20 microg/mL urine), moclobemide (and metabolites), and citalopram (and metabolite). There upon, we developed a new liquid chromatographic separation with optimized DAD, preceded by an automated solid-phase extraction, for the quantitation of the previously mentioned antidepressive drugs. The results obtained for blood and urine, respectively, were as follows: Ro 12-5637 (moclobemide N'-oxide) not detected and 424 microg/mL; Ro 12-8095 (3-keto-moclobemide) 2.26 microg/mL and 49.7 microg/mL; moclobemide 5.62 microg/mL and 204 microg/mL; desmethylcitalopram 0.42 microg/mL and 1.22 microg/mL; and citalopram 4.47 microg/mL and 19.7 microg/mL. The cause of death was attributed to the synergistic toxicity of moclobemide and citalopram, both antidepressants, which, by intentional or accidental combined ingestion, can produce a potentially lethal hyperserotoninergic state. Based on the history of the case and pharmacology of the drugs involved, the forensic pathologists ruled that the cause of death was multiple drug intoxication, resulting in a fatal "serotonin syndrome," and that the manner of death was suicide.
Overall, severe symptoms of the SS seem to occur occasionally when an SSRI is given with moclobemide.....
An open 6-week study in 50 patients with major depression on fluoxetine (or paroxetine) 20 mg daily to which was added up to 600 mg moclobemide daily, indicated that the combination was **possibly effective.** However *one patient developed symptoms suggesting the toxic serotonin syndrome.* Other adverse effects occurred in other patients, the clearest one being insomnia, with dizziness, nausea and headache also occurring frequently. *The high rate of adverse events suggests that there may be a clinically significant interaction.*
I hope this information is of interest...
Ed
Posted by gardenergirl on November 8, 2004, at 13:40:46
In reply to Re: The Forbidden Combination-Squiggles, posted by jasmineneroli on November 8, 2004, at 13:15:41
> Squiggles,
> Ed's original post was clear to me when I first read it.
> Firstly, he didn't lump Imipramine in with the SSRI's, or call it one. He differentiated between SSRI's, SNRI's and TCA's (by drug name on the last two drug classes, but not in the first - the SSRI's). He put them all together because they all have an affect on serotonin, and people might not be aware of that.
> Secondly, it's evident that Ed was asking for people's EXPERIENCES, *IF* they had been prescribed both a seratonergic drug and a MAOI drug together.
> I see no advice/opinion/encouragement in his post, for anyone to combine these drugs. He is searching for information, in particular with reference to people with treatment-resistant illnesses.I agree with Jas. I never read in his post that this combination was okay.
gg
Posted by ed_uk on November 8, 2004, at 14:20:24
In reply to Re: The Forbidden Combination-, posted by gardenergirl on November 8, 2004, at 13:40:46
Thank you gg, I was a bit upset by squiggles. I feel better now. I just want to hear any experiences that people have.
Ed
Posted by Willyee on November 8, 2004, at 15:25:04
In reply to The Forbidden Combination, posted by ed_uk on November 8, 2004, at 10:13:02
> Hello everyone...
> Perhaps the most feared drug interaction in all of psychopharmacology is that which may occur when an SSRI is combined with an MAOI. The potentially fatal Serotonin Syndrome appears to be a frequent outcome.
>
> It is clear from the literature, however, that not all patients treated with this combination develop serious side effects. It is even possible that some people may benefit from this hazardous form of treatment.
>
> I would be very interested to hear from anyone who has taken a serotonin reuptake inhibitor (eg. an SSRI, venlafaxine, clomipramine, imipramine) at the same time as an MAOI such as Nardil or Parnate.
>
> Why did you take this combination?
> -treatment resistant depression
> -OCD
> -An uncontrolled anxiety disorder etc.
>
> What were the effects of this combination?
> -serotonin syndrome
> -therapeutic benefit
> -seizures
>
> The incidence of the Serotonin Syndrome seems to be much lower with moclobemide+SRI than it is with a classical MAOI+SRI. Has anyone ever been treated with this combination?
>
> Thank you for reading my post...
>
> All the best,
> Ed.>
I am a poster child for challenenging the Moais no-no list.I am not bragging about this,i just came to the conclusion that the docs themselves came damn near close to hospitilizing me,with little concern of interaction,so whats the difference.I also decedided living with the feelings,just isnt living,and i accepted the dangers if it meant possably getting better,so i have experminted with parnate over the past 4 years.
I have tried it with numerous things,from kava kava,to ghb,to most of your common sedatives,to certain nutrients,caffeine,beta blocker benzos etc.
From all this,i will tell you,the one thing that truly was harmful,was adding it to an ssri,or imiprimine the tca,they actualy did their home work on that,and if i can only go by my exper,i will say DO NOT TAKE A MAOI WITH another ssri or tca anti-depressant.
What it did was put my brain in a lock,i had small seizures in my legs,constant twitching,i also had a very scary hugh where you talk a lot,but you know you are making yourself noticable and talking nonsense,worst off it will make it impossable to sleep,you have to wait the interaction out,theres no way around it,forget adding a benzo to help this will add to the situation and worsen it,there is also when it ends a rebound depression,one i can only imagine is like the one described the day after x or other hard street drug.
I would not do it again,i have tossed every ssri,and other anti depressant away.Now i am not advocating expierments,but the one surprising thing i was able to combine was parnate,and liquid deprenyl.Parnate seems most active the 30-60 min of its ingestion,so when i took liq depr at different times in the day,at small doses it did not seem to have any side effects,and i went through an entire bottle over time of this.
Vivarin too,has worked well in combo with parnate.My goal is too keep the monster at bay,one pill will not do this for me,so i have bult a small aresnal,this however took time and painstaking trial and error,and of course its not done yet,and at and direction the industry is moving,prob wont be in my lifetime,at least the substances i have discovered for myself now allow me to function,i.e go to work,date,workout,watch tv,and i have more good days than bad.
I wish i had the option of a single pill,or two that consistently helped,that is what i search for,for now i listen to my body,and try to take what i feel it needs at the moment.
Note: I think its responsable to note i spent tons of research on parnate before deceding to start augmenting it.It is not a medication to take lightly.
>
Posted by Willyee on November 8, 2004, at 15:36:26
In reply to Re: The Forbidden Combination, posted by ed_uk on November 8, 2004, at 14:20:24
> Thank you gg, I was a bit upset by squiggles. I feel better now. I just want to hear any experiences that people have.
> Ed
I have very limted time when i post,breaks between work,so i did not see the entire thread.I agree your post did not seem to promote such a combo in anyway.
I do get frustrated at times at how people jump when certain things are mentioned.We are adults and need to take responsability.If a person mentions there exper with for instance a Maoi and another substance,that doesent mean they are recomending it for the reader,the reader needs to understand posts are information from individuals not professionals,theres no trials listed or medical abstracts.
I would hate to see information held back because the person is afraid by mentioning it someone will take that experieance as a recomendation.Walking on eggshells stinks.
Posted by TheOutsider on November 8, 2004, at 15:44:12
In reply to Re: The Forbidden Combination, posted by ed_uk on November 8, 2004, at 11:23:54
I have to say Squiggles can sound a bit snappy/jugmental at times, I don't think he/she means any harm but perhapse Squiggles could be more careful.
Regarding the combinations of MAO and SSRI I have some experience, I also know it can be done.
I think combining is often done when the patient is in hospital so they can be monitored.I personaly combined Moclobemide with low dose Citalopram on a one of occasion, it made me feel ok but I did have the feeling that if I'd gone higher it might not have been good.
I also combined Moclobemide with generic Fluoxetine which caused a panic attack!I think that Clomipramine and an MAO might go well together, Clomipramine is a Serotonin antagonist as well as a re-uptake inhibitor, which helps reduce the chance of serotonin syndrome apparently.
I don't mean to be jugmental but are you sure you want to try this combination? How about combining a stimulent like Dexedrine with Nardil, I personaly think this would be safer, I know others will disagree!
Posted by Squiggles on November 8, 2004, at 16:50:55
In reply to Re: The Forbidden Combination-Squiggles, posted by jasmineneroli on November 8, 2004, at 13:15:41
> Are you doing OK? You seem a little bit "off" today?
> Take care.
> JasLOL - i'm off every day! I'm a beeper -
get used to it :-)Squiggles
Posted by Squiggles on November 8, 2004, at 16:58:01
In reply to Re: The Forbidden Combination, posted by TheOutsider on November 8, 2004, at 15:44:12
> I have to say Squiggles can sound a bit snappy/jugmental at times, I don't think he/she means any harm but perhapse Squiggles could be more careful.
I will. Sorry about that.BTW, I just got back from my doctor's appointment. "-)
Squiggles
Posted by jasmineneroli on November 8, 2004, at 23:36:34
In reply to Re: The Forbidden Combination-Squiggles, posted by Squiggles on November 8, 2004, at 16:50:55
Ha!
OK. Just don't go upsetting people, or Dr. Bob will boot you out :). Be careful just how loud you beep!
Jas
Posted by jasmineneroli on November 8, 2004, at 23:48:21
In reply to Re: The Forbidden Combination-Squiggles, posted by ed_uk on November 8, 2004, at 13:38:40
No prob. Ed :)
I think it's definitely worth exploring MAOI's in combo with other drug classes, as long as it is done in a very controlled setting, like hospital. It would seem to me to be very dose dependant, to be safe AND successful.
I would expect a very selective SSRI like Citalopram or Escitalopram would be a more risky choice to combine. I would be leery of any SSRI MAOI combination, but perhaps a SNRI or TCA would have less risk?
Your research examples seem to bear that out.
As to the Belgian study of the person that died, holy...can u say "overdose"??? i.e purposefull.
I might bring this discussion up with my Pdoc next trip, purely for interest's sake!
Jas
Posted by SLS on November 8, 2004, at 23:50:50
In reply to Re: The Forbidden Combination, posted by TheOutsider on November 8, 2004, at 15:44:12
> Regarding the combinations of MAO and SSRI I have some experience, I also know it can be done.
> I think combining is often done when the patient is in hospital so they can be monitored.
>
> I personaly combined Moclobemide with low dose Citalopram on a one of occasion, it made me feel ok but I did have the feeling that if I'd gone higher it might not have been good.
> I also combined Moclobemide with generic Fluoxetine which caused a panic attack!
>
> I think that Clomipramine and an MAO might go well together, Clomipramine is a Serotonin antagonist as well as a re-uptake inhibitor, which helps reduce the chance of serotonin syndrome apparently.
>
> I don't mean to be jugmental but are you sure you want to try this combination? How about combining a stimulent like Dexedrine with Nardil, I personaly think this would be safer, I know others will disagree!
While the reversible MAOI moclobemide and serotonin reuptake inhibitors have been combined successfully, I don't think the same can be said of the irreversible MAOIs like Parnate, Nardil, and Marplan. It is my impression from the literature and from personal experience that the chances of developing serotonin syndrome from combining the irreversibles is greater than 50%. If you are still inclined to try such combinations, be sure to learn the symptoms of serotonin syndrome thoroughly so as to catch it at the very beginning of its induction. Still, I wouldn't recommend that anyone try it.In order of severity, I have experienced serotonin syndrome from:
Parnate + Effexor
Nardil + imipramine
Nardil + nortriptyline
clorgyline + trazodoneI would avoid clomipramine.
In my experience, combining MAOIs with amphetamine, methylphenidate, or desipramine is safe.
- Scott
Posted by ed_uk on November 9, 2004, at 6:11:22
In reply to Re: The Forbidden Combination, posted by SLS on November 8, 2004, at 23:50:50
Hello everyone, thank you for answering my post...
As I mentioned earlier, I have **No** intention of taking an MAOI in combination with an SSRI!!!!
I brought the subject up because I was interested to hear people's experiences; I expected to get a few responses because of the number of people on this board who have suffered from treatment-resistant depression who may have experimented with this combo out of shear desperation.
As Scott said, combining clomipramine with an MAOI is very dangerous!
All the best...
Ed
Posted by vwoolf on November 9, 2004, at 6:21:37
In reply to Re: The Forbidden Combination, posted by ed_uk on November 9, 2004, at 6:11:22
I have to put in a word here, to say that I agree with Squiggles. I have no interest in pharmacology, and seldom visit this board, but I suffer from suicidal ideation quite frequently, and was immediately caught by the word "fatal" in the posts. I was taking SSRI's for some time last year before I stopped and went onto MAOI's. This post has now made me aware that in my stash of left-over pills I have a potentially lethal combination. I would rather not have this information. I am fine at the moment, but on my next down cycle this knowledge will be in my head. I think one needs to be more careful on boards like this.
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