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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 18 to 42 of 64. Go back in thread:
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.
Posted by TheOutsider on November 9, 2004, at 6:31:47
In reply to Re: The Forbidden Combination, posted by ed_uk on November 9, 2004, at 6:11:22
> 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!!!!
>
Sorry I should have read your post more carefully!
Posted by ed_uk on November 9, 2004, at 6:45:20
In reply to Re: The Forbidden Combination, posted by ed_uk on November 9, 2004, at 6:11:22
The manufacturer of reboxetine, a selective norepinephrine reuptake inhibitor, claims that it should not be combined with an MAOI. They say this despite the fact that there doesn't appear to be any scientific evidence to support the existence of an interaction. Their warning seems to be based purely on the fact that serious interactions have been reported between MAOIs and other antidepressants.
Has anyone ever been treated with a combination of an MAOI plus desipramine, reboxetine or lofepramine? Was is helpful? Did an interaction occur? I know Scott has tried it- there must be someone else who has!
Nortriptyline is somewhat less selective as a NRI. Serotonin syndrome is possible with Nort+MAOI. Has anyone found this combination useful?
Ed.
PS. I just found a reference to an article which apparantly reports a serious interaction between phenelzine(Nardil) and desipramine. Here it is...
Bowen LW. Fatal hyperpyrexia with antidepressant drugs. BMJ (1964) 2, 1465.
I will find the journal in the library shortly. I will post what I find.
Posted by ed_uk on November 9, 2004, at 7:00:25
In reply to Re: The Forbidden Combination, posted by vwoolf on November 9, 2004, at 6:21:37
Hello...
I am very sorry that my post has upset you. You should immediately throw away any old medication that you have. You need to do it now while you are feeling ok. Squiggles didn't seem to make the same point as you did, maybe that was what he/she meant, I don't know.
Despite what you say, I think my question was reasonable. People use hundreds of different methods to kill themselves, taking an MAOI with an SSRI is not a pleasant one. Symptoms such as severe agitation and distress may occur as a result.All the best...
Ed
Posted by darkhorse on November 9, 2004, at 7:21:02
In reply to Re: The Forbidden Combination, posted by ed_uk on November 9, 2004, at 6:11:22
Hi Ed again,
I tried Moclobemide 300mg + Prozac20mg + Xanax for more than a month or so ,and all I had was an annoying restless leg before sleep...I do not think that Moclobemide made a difference at all and so I stopped it.
- Also I tried Moclobemide solo and did nothing at all no good or badd effects!
- I tried Parnate and added ludiomil..no problem (Ludiomil is an NA)
- I tried to combine Citalopram + Moclobemide (again!) but it gave me chills,cold feet and other unpleasant effects from first day so I stopped immediatley ....
Oh! and I also tried Fluvoxamine with Moclobemide for a few days with no bad or good effects so I stopped.
-Last, I took Parnate with Tramadol which is supposed to have 5ht proporties for a few days and I started to have persistent mild headeach so I stopped !
Just for the record I will try to remember all ADs I took through the years (As I did with BZ0) :
- Imipramine (Tofranil)
- Desipramine (Norpramin)
- Clomipramine (Anafranil)
- Amitriptyilne (Tryptizol/Elavil)
- Nortriptyline (Nortrilen/Pamelor)
- Protriptyline (Vivactil)
- Doxepin (Sinequan)
- Dothiepine (Prothiaden)
- Opipramol (Insidon)
- Melitracen (Deanxit)
- Dibenzapine (Noveril)
- Maprotiline (Ludiomil)
- Tranylcypromine (Parnate)
- Moclobemide (Aurorix)
- Selegiline (Jumex)
- Viloxazine (Vivalan)
- Buspirone (Buspar)
- Septiline (Japan only)
- Mianserin (Tolvon)
- Mirtazapine (Remeron)
- Trazodone (Trittico)
- Nefazodone (Serzone)
- Tianeptine (Stablon)
- Amineptine (Survector)
- Bupropion (Zyban/Wellbutrin)
- Reboxetine (Edronax)
- Milnacipran (Ixel)
- Venlafaxine (Efexor)
- Fluvoxamine (Faverin/Luvox)
- Paroxetine (Seroxat/Paxil)
- Citalopram (Cipram/Celexa)
- Escitalopram (Cipralex/Lexapro)
- Sertraline (Lustral/Zoloft)
- Fluoxetine (Prozac..etc)
-St.John's Wort
- Flupenthixol (Fluanxol)
- Sulpiride (Dogmatil)
- Amisulpride (Solan)
..... some I took for days only and some for months !Best regards,
Adam
Posted by darkhorse on November 9, 2004, at 7:25:57
In reply to Re: MAOI plus SELECTIVE Norepi reuptake inhibitors, posted by ed_uk on November 9, 2004, at 6:45:20
Hello ED,
As mentioned I took Ludiomil + Parnate ... no problem at all !
Also I took Reboxetine+Selegiline 5mg..no bad side effects except increased sweating.Oh! I remember now that I switched immediatley from Parnate to Amitriptyline with no problem at all.
Adam.
Posted by Larry Hoover on November 9, 2004, at 7:33:47
In reply to Re: The Forbidden Combination, posted by vwoolf on November 9, 2004, at 6:21:37
> 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.
I respectfully have to disagree with the entire premise you presented. It is a component of informed consent to have been made aware of potentially fatal drug interactions with medications you have been prescribed. You ought to have known about this risk, of MAOI + SSRI = potentially fatal drug interaction. You ought to have been told before you were given access to the MAOI. And, you ought to have been advised to clear out old and left-over meds, returning them to the pharmacy or doctor's office for disposal.
This warning is part of the patient's version of the drug information leaflet, too. Please read those.
Lar
Posted by ed_uk on November 9, 2004, at 7:37:08
In reply to Re: The Forbidden Combination: My AD list » ed_uk, posted by darkhorse on November 9, 2004, at 7:21:02
Wow, you have tried many drugs? Which ADs do you like best? For depression I like lofepramine (Gamanil).
Many of the drugs you list are not available in England eg. melitracen, desipramine(formerly available), protriptyline (recently discontinued here), opipramol, dibenzapine, septiline, viloxazine(formerly available), tianeptine, amineptine...
I would be interested to know how you found amineptine...
Thank you.
Ed
Posted by ed_uk on November 9, 2004, at 7:41:46
In reply to Re: The Forbidden Combination » vwoolf, posted by Larry Hoover on November 9, 2004, at 7:33:47
Larry Hoover said....I respectfully have to disagree with the entire premise you presented. It is a component of informed consent to have been made aware of potentially fatal drug interactions with medications you have been prescribed. You ought to have known about this risk, of MAOI + SSRI = potentially fatal drug interaction. You ought to have been told before you were given access to the MAOI. And, you ought to have been advised to clear out old and left-over meds, returning them to the pharmacy or doctor's office for disposal.
This warning is part of the patient's version of the drug information leaflet, too. Please read those.
Lar
I am glad that I did not offend everyone! There are many drugs which can be dangerous at therapeutic doses, in overdose and in combination with certain other drugs. Because psycho-babble is a forum about drugs, I feel that it is very important that we are able to discuss these safety issues.
ed
Posted by SLS on November 9, 2004, at 7:53:36
In reply to Re: The Forbidden Combination: My AD list » ed_uk, posted by darkhorse on November 9, 2004, at 7:21:02
Hi Adam.
I am truly sorry that you should have so long a list. I am in a similar situation. I have a persistent bipolar depression for which I have received mild, but unacceptable, benefit from:
MAOI
TCA
Lamictal
Effexor
Cymbalta
Abilify
> - Septiline (Japan only)Can you provide some details about this drug?
Thanks.
- Scott
Posted by ed_uk on November 9, 2004, at 8:02:58
In reply to Re: The Forbidden Combination, posted by ed_uk on November 9, 2004, at 7:41:46
Some interesting reports......
Just before you look at the reports I'd like to make a few comments.....
Amitriptyline (Elavin/Tryptizol) is a tricyclic AD which acts as a dual reuptake inhibitor. One of its other actions is to block certain postsynaptic serotonin receptors. Isocarboxazid (Marplan) is a traditional MAOI, similar to Nardil.
Before you read the reports I think it's important to mention that combining amitriptyline with an MAOI could result in a serious interaction. Adverse effects could include mania, serotonin syndrome and seizures. Nevertheless, succesful use of amitriptyline/isocarboxazid has been reported in the literature. Please remember that all the TCAs are different to each other. Combining clomipramine or imipramine with MAOIs seems to be especially hazardous.
Report no. 1...J Affect Disord. 1995 Jun 8;34(3):187-92. Related Articles, Links
A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.Berlanga C, Ortega-Soto HA.
Division of Clinical Research, Mexican Institute of Psychiatry, Mexico, DF.
Treatment-resistant depression is a clinical complication that not infrequently affects a certain number of patients. Within the treatment strategies proposed for this condition, the association of a MAO inhibitor (MAOI) with a tricyclic antidepressant has gained reputation both for its unusual efficacy, as for its potential toxicity. However, when cautions are taken, it may be safely administered. Most reports on this combination have been carried in nonresistant patients and, when resistant patients are included, only the acute phase of the treatment is reported. In this study, a group of well-defined resistant patients received an open trial with the association of isocarboxazide and amitryptiline (n = 25). Those who responded were followed during the next 3 years (n = 12) and every 6 months an attempt was made to discontinue the MAOI and continue only with amitryptiline. At the end of the study, 4 patients maintained response with single medication, 6 still required both drugs and 2 relapsed. No clinical differences were apparent between the outcome groups, except that those who maintained their response only with the 2 combined drugs had more previous depressive episodes than the others. The isocarboxazide/amitryptiline combination may be a good treatment option for at least some forms of resistant depression. The safety of this treatment modality is confirmed, even when given for long periods of time. The study also suggest that there are no clinical characteristics in resistant depression that may predict the treatment outcome but, perhaps in some patients, a combined treatment is required to obtain a broader biochemical effect that could convert them from nonresponders to responders.
Report no. 2...
Br J Psychiatry. 1990 Jan;156:115-8. Related Articles, Links
Comment in:
Br J Psychiatry. 1990 Jul;157:145-6.
Br J Psychiatry. 1991 Jul;159:162-3.Efficacy of combined antidepressant therapy in resistant neurotic disorder.
Tyrer P, Murphy S.
St Charles' Hospital, London.
A 35-year-old woman with persistent affective and phobic symptoms responded dramatically to a combination of isocarboxazid and amitriptyline, and this improvement was maintained over the next three-and-a-half years. Isocarboxazid was replaced by placebo, using double-blind procedure. The change to placebo was accompanied by a marked increase in anxiety and depressive symptoms, which resolved when active isocarboxazid was reintroduced. It is suggested that combined antidepressant therapy still has a place in the treatment of resistant neurotic disorder.
Does anyone have any experience of combined MAOI/amitriptyline treatment??
Ed
Posted by ed_uk on November 9, 2004, at 8:05:42
In reply to Re: The Forbidden Combination: My AD list » darkhorse, posted by SLS on November 9, 2004, at 7:53:36
Yes, it would be very helpful and interesting if you could share your experiences of some of the most 'exotic' ADs that you have used. Many of them are not available in the UK or the USA. I have never heard of septiline until today.
Thanks,
Ed
Posted by darkhorse on November 9, 2004, at 8:21:56
In reply to Re: The Forbidden Combination: My AD list, posted by ed_uk on November 9, 2004, at 7:37:08
> Wow, you have tried many drugs? Which ADs do you like best? For depression I like lofepramine (Gamanil).
>
> Many of the drugs you list are not available in England eg. melitracen, desipramine(formerly available), protriptyline (recently discontinued here), opipramol, dibenzapine, septiline, viloxazine(formerly available), tianeptine, amineptine...
>
> I would be interested to know how you found amineptine...
>
> Thank you.
>
> EdFor Major depression I guess I have to say that Imipramine is my no.1 . The best combination was Imipramine 50-75 + Amitriptyline 25 mg
- My second best was Fluoxetine,even though I took it for a milder depression and as a replacement for the above mentioned,after gaining weight (I did not know that Prozac was goinig to give me weight gain + sexual inhibition-unlike imipramine) but all in all Tofranil and Prozac were the longest I took,all other AD's had bigger problems and side effects , did not work at all,or even worse, made depression worse (eg Wellbutin,Reboxetine,Milnacipran)
Tofranil vs Prozac :
Tofranil really killed all my severe depressive syndroms within 2 months, and is good for anxiety,obsessive thoughts and 2 things that Prozac & SSRis do not have : increase of focus and concentration + motivation and energy....
Prozac, however is bewtter for anxiety and obsessions and gives you a "who cares" feelings which is a very relaxing feeling,but it kills motivation and concentrations on the long run....
I tried all other SSRIs and they either did not work (Citalopram,Fluvoxamine) &Sertraline) or had very bad side effects (Seroxat&Escitalopram)
So I guess my top 5 AD's are :
1- Tofranil.
2- Prozac
3- Tryptizol(in low doses)
4- Efexor
5- Ludiomil.and if I ever again have a blown- up major depression I will go back to maybe Tofranil 50mg +Prozac 20 mg.
I got Survector (Amineptine) while it was still available in Egypt,and,I had to raise the dose to 600-800 to feel better,but actually it gave me an artificial stimulating effect which was not good for the long run...I think it is more of a stimulant than a true AD like Imipramine...
Regards,
Adam
Posted by darkhorse on November 9, 2004, at 8:31:57
In reply to Re: The Forbidden Combination: My AD list » darkhorse, posted by SLS on November 9, 2004, at 7:53:36
> Hi Adam.
>
> I am truly sorry that you should have so long a list. I am in a similar situation. I have a persistent bipolar depression for which I have received mild, but unacceptable, benefit from:
>
> MAOI
> TCA
> Lamictal
> Effexor
> Cymbalta
> Abilify
>
>
> > - Septiline (Japan only)
>
> Can you provide some details about this drug?
>
> Thanks.
>
>
> - ScottHello Scott,
Thank you for your understanding..I think that is why we can share in this board some of what we've gone through..
As for Septiline ,I took it while in Japan(I do not remember the brand name),as an addition to Fluoxetine,and all I know it it is very similar in action to Mianserin& Mirtazapine (5ht2,H2,NE2)so it helped reduce my anxiety and made a better sleep and increase my appetite...How was your experience with duloxetine? what other AD that is closest in effect to it,and is it worth the money and the side effects?
Best Regards,
Adam
Posted by ed_uk on November 9, 2004, at 8:35:27
In reply to Re: The Forbidden Combination: My AD list, posted by darkhorse on November 9, 2004, at 8:21:56
Adam, thank you for your response. :-) There is something to learn from the fact that your favourite AD is one of the oldest psychiatric meds of all. New drugs are not always the best! Hmmmm, why does lexapro come to mind, i think i'll just stick with citalopram!
Ed
Posted by ed_uk on November 9, 2004, at 9:54:54
In reply to Re: The Forbidden Combination: My AD list, posted by ed_uk on November 9, 2004, at 8:35:27
I promised above that i'd find the letter to the British Medical Journal called 'fatal hyperpyrexia with antidepressant drugs'.
I can't type it all out though because I'd be here for ages, it took me long enough to find it!........At noon on 28 August 1964 a 41-year old woman was admitted to this hospital with a diagnosis of depression and 'hysterical' behaviour. She gradually became comatose and showed signs of sympathetic over-stimulation with dilated pupils, flushed skin, perspiration, hypersalivation, and rigid legs with ankle clonus. Her pulse was regular at 150, BP 130/70 mmHg, temperature 40 Celsius (104 F), and her respiration was shallow with increasing cyanosis. These signs suggested overdose with antidepressant drugs, it was confirmed that she has been taking phenelzine, desipramine and chlorpromazine. She was transferred to a general hospital, where she died at 5 p.m. the same day............ A report from the forensic science lab showed that chlorpromazine and desipramine had been found in the tissues, but only at therapeutic amounts. No phenelzine was found in the tissues but it was suggested that this could still have produced a reaction even if it had not been taken for a number of days. (after all MAO inhibition can persist, *addition by me!*) ..............she had been taking phenelzine regularly in doses of 15mg thrice daily until the day before her death. Six weeks previously she had been prescribed desipramine, 50mg thrice daily, but did not take this regularly and certainly not for 48 hours before her death, because she felt that it did not help her. The amount of tablets left in each bottle showed that there was no eveidence of overdose....
What does anyone think...Here are some possibilities that I thought of....
1. SS caused by interaction between phenelzine and desipramine (which is very selective as a NRI, but not completely devoid of effect on serotonin reuptake!). Maybe she was very sensitive to desipramine's very weak serotonin reuptake inhibition.
2. SS caused by phenelzine alone. (After all, there are cases of SS with SSRIs alone, but no fatalities).
3. NMS due to the chlorpromazine--- but her 'ankle clonus' is characteristic of the SS.
4. She had actually taken another drug that the pathologist did not test for eg. imipramine from a friend (imipramine is metabolised to desipramine).
Anyway, this was the only report I could find which suggested an interaction between an MAOI and a selective NRI in humans. Here is an excerpt from a rat study which also suggestes the possibility of interaction......
'Myoclonic phenomena such as forelimb flexor-extensor movements, head and body twitches, occurred in *phenelzine pretreated* rats after paroxetine, fluoxetine, clomipramine, imipramine, amitriptyline and *desipramine.* Wet dog shakes, the most intense phenomenon, were obtained *only* after paroxetine, fluoxetine, clomipramine and imipramine (SRIs). Myoclonic features were prevented when pretreatment included p-chlorophenylalanine but were unaffected when this incorporated alpha-methyl-p-tyyrosine; there were attenuated by methysergide, cyproheptadine, clozapine or pimozide. The myoclonic phenomena were reproduced by combination of 5-hydroxytryptophan but not L-3,4-dihydroxyphenylalanine with clomipramine.
Ed
Posted by SLS on November 9, 2004, at 10:27:23
In reply to Re:A Combination which has caused much controversy, posted by ed_uk on November 9, 2004, at 8:02:58
> Does anyone have any experience of combined MAOI/amitriptyline treatment??I once combined Nardil 45mg + amitriptyline without sequalae. However, for me, I don't think I obtain adequate MAO inhibition until I get to 60mg of Nardil. I can't conclude that this combination would be without hazard.
Which serotonergic actions of amitriptyline do you think provide protection from serotonin syndrome? How about nortriptyline?
- Scott
Posted by SLS on November 9, 2004, at 10:39:05
In reply to Re: The Forbidden Combination: My AD list, posted by darkhorse on November 9, 2004, at 8:31:57
Hi Adam.
> As for Septiline ,I took it while in Japan(I do not remember the brand name),as an addition to Fluoxetine,and all I know it it is very similar in action to Mianserin& Mirtazapine (5ht2,H2,NE2)so it helped reduce my anxiety and made a better sleep and increase my appetite...
Hmmm.
Japan also has a drug called rolipram. I'm not sure what the brand name is. It is debatable how effective it is, but its mechanism is different from anything else out there. It is a phospodiesterase inhibitor, and works on second messengers.
> How was your experience with duloxetine?
I experienced a significant antidepressant effect in the third week that disappeared quickly. I went up to 90mg, but that did very little but make me sleepy and impacted negatively on motivation.
> what other AD that is closest in effect to it,and is it worth the money and the side effects?
I would say Effexor is pretty close. As to whether or not it is worth trying Cymbalta, some people here have reported improvements in both anxiety and depression. However, the posts I have seen have lacked descriptions of the severity of depression being treated, and the degree of improvement experienced. You might want to wait a month or two more to see how Cymbalta works for people more long-term. Perhaps you can start a new thread.
- Scott
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