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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by RetiredYoung on July 29, 2004, at 11:20:39
I've read on numerous occasions that certain tricyclic ADs should not be mixed with certain SSRIs. However, some mixes actually seem to be appropriate.
Anyone have a source or more info as to which TCA/SSRI combos are effective and safe, and why others are not?? Txs.
Posted by linkadge on July 29, 2004, at 11:59:30
In reply to TCAs and SSRIs - A good mix?, posted by RetiredYoung on July 29, 2004, at 11:20:39
Oftentimes an activating tryciclic like nortriptaline or desipramine is added to an SSRI.
Linkadge
Posted by Larry Hoover on July 29, 2004, at 12:13:01
In reply to Re: TCAs and SSRIs - A good mix?, posted by linkadge on July 29, 2004, at 11:59:30
> Oftentimes an activating tryciclic like nortriptaline or desipramine is added to an SSRI.
>
> LinkadgeOr a sedating one, if SSRI activation/insomnia is a problem. The dose of the TCA, as a proportion of its own therapeutic dose (when used alone) is a rough measure of the threat of interaction. It's really a medical management issue, to closely observe for adverse interactions.
Lar
Posted by King Vultan on July 29, 2004, at 12:19:20
In reply to TCAs and SSRIs - A good mix?, posted by RetiredYoung on July 29, 2004, at 11:20:39
> I've read on numerous occasions that certain tricyclic ADs should not be mixed with certain SSRIs. However, some mixes actually seem to be appropriate.
>
> Anyone have a source or more info as to which TCA/SSRI combos are effective and safe, and why others are not?? Txs.The caution has to do with enzyme interactions between certain SSRIs and tricyclics that can boost blood plasma levels of the tricyclic to dangerous levels (all tricyclics are lethal in overdose). The big one to be concerned about is the extremely powerful 2D6 enzyme inhibition of both Prozac and Paxil. These two drugs should not be combined with tricyclic antidepressants unless you really know what you're doing. This would include starting out at a low level of the tricyclic and then monitoring blood plasma levels of the tricyclic to make sure that the dosage is at a safe level.
Todd
Posted by RetiredYoung on July 29, 2004, at 12:30:41
In reply to Re: TCAs and SSRIs - A good mix?, posted by King Vultan on July 29, 2004, at 12:19:20
Also, there's one particular TCA - which I believe is Clomimpramine - that shouldn't be mixed with any SSRIs?? Serotonin overload being the issue there.
Posted by King Vultan on July 29, 2004, at 14:19:31
In reply to Re: TCAs and SSRIs - A good mix?, posted by RetiredYoung on July 29, 2004, at 12:30:41
> Also, there's one particular TCA - which I believe is Clomimpramine - that shouldn't be mixed with any SSRIs?? Serotonin overload being the issue there.
>Yes, that's a good point. Serotonin syndrome is quite possible in that kind of combination.
Todd
Posted by Larry Hoover on July 29, 2004, at 17:37:31
In reply to Re: TCAs and SSRIs - A good mix?, posted by King Vultan on July 29, 2004, at 12:19:20
> The caution has to do with enzyme interactions between certain SSRIs and tricyclics that can boost blood plasma levels of the tricyclic to dangerous levels (all tricyclics are lethal in overdose). The big one to be concerned about is the extremely powerful 2D6 enzyme inhibition of both Prozac and Paxil. These two drugs should not be combined with tricyclic antidepressants unless you really know what you're doing. This would include starting out at a low level of the tricyclic and then monitoring blood plasma levels of the tricyclic to make sure that the dosage is at a safe level.
>
> ToddGeez, my brain is dead. 2D6 activity! Doh!
I think my problem comes from the Solost, errr, Zoloft I'm taking. Maybe they should rename it unsertraline.
Lar
Posted by Sad Panda on July 30, 2004, at 10:46:22
In reply to TCAs and SSRIs - A good mix?, posted by RetiredYoung on July 29, 2004, at 11:20:39
> I've read on numerous occasions that certain tricyclic ADs should not be mixed with certain SSRIs. However, some mixes actually seem to be appropriate.
>
> Anyone have a source or more info as to which TCA/SSRI combos are effective and safe, and why others are not?? Txs.
>
>As remedies to SSRI side effects, low doses of Amitriptyline, Doxepin or Trimipramine are great add on's. They give a great nights sleep, counter anorgasmia & give instant anxiety relief.
Desipramine & Nortriptyline are ideal for stimulation in high doses. Choose Nortriptyline if you have trouble with sleep or anxiety.
I think an SSRI + Nortriptyline is probably more effective with less side effects than either SSRI's or TCA's alone.
Cheers,
Panda.
This is the end of the thread.
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