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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by EERRIICC on July 30, 2005, at 13:48:47
Can a TCA be added onto an MAOI?
Posted by med_empowered on July 30, 2005, at 15:11:30
In reply to TCA_to_MAOI?, posted by EERRIICC on July 30, 2005, at 13:48:47
yes...it can done: carefully, slowly, and *only* under close observation by a shrink who has experience with this kind of combo (not just one who feels like experimenting). When TCAs and MAOIs became more popular in the 1960s (they were introduced in the 1950s), this kind of combo was attempted with some regularity, since other options were limited. Also popular would be adding a stimulant to a TCA, MAOI or (again, very cautiously) to the mix. Sedatives and neuroleptics have also been used, with varying degrees of success.
Posted by Tom Twilight on July 31, 2005, at 15:10:35
In reply to TCA_to_MAOI?, posted by EERRIICC on July 30, 2005, at 13:48:47
> Can a TCA be added onto an MAOI?
I don't see why not
With the exception of Clomipramine I think most TCAs can be combined with MAOIs
Desipramine is the best choice, because it doesn't have much effect on Serotonin, TCAs which have more of an effect on Serotonin are more risky
Here's a link were its discussed http://www.currentpsychiatry.com/article_pages.asp?AID=515&UID=10450
Posted by Jedi on August 2, 2005, at 3:34:31
In reply to TCA_to_MAOI?, posted by EERRIICC on July 30, 2005, at 13:48:47
> Can a TCA be added onto an MAOI?
The combined use of TCAs and MAOI's, though officially contraindicated, can be carefully administered by an experienced MD. The meds should be started simultaneously in low doses or the MAOI added to an established dosage of TCA. Serious consequences have resulted when adding a TCA to an established dosage of MAOI! I have used phenelzine at 60mg combined with 100mg of nortriptyline with no unusual side effects.
There are quite a few PUBMED abstracts that refer to the combined use of these two medications. Here's one:
J Clin Psychiatry. 1984 Jul;45(7 Pt 2):67-9.
The combined use of MAOIs and tricyclics.
White K, Simpson G.
Combined MAOI-tricyclic treatment remains a plausible approach to depressions refractory to single drugs. Adherence to published guidelines should minimize special risks of the combined treatment. However, such risks do exist, and should be borne in mind. Most severe reactions - characterized by hyperthermia, delirium, convulsions, and sometimes fatal outcome - have occurred after a tricyclic was added to established MAOI treatment. Combined treatment may be associated with a lower risk of hypertensive crisis than treatment with MAOI alone. There are no data from double-blind, control-group studies to demonstrate an advantage for the MAOI-tricyclic combination in refractory depression. However, almost no such data exist to establish the advantage of any other treatment in this clinical situation. Clinical experience provides the primary basis for continued consideration of this approach when usual treatments have failed.
Publication Types:
Case Reports
Clinical TrialPMID: 6376486 [PubMed - indexed for MEDLINE]
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