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Re: TCA and MAOI Combo

Posted by Stephanie L. on January 23, 2000, at 20:49:46

In reply to Re: TCA and MAOI Combo, posted by Stephanie L. on January 23, 2000, at 20:25:23

> > > If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level.
> > Where can I read about this? I've found hardly any info on MAOI pharmacokinetics.
> > > According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.
> > What about amoxapine or mirtazapine? Does it say why imipramine would be more of a problem than amitriptyline or doxepin?
> > Lots of doctors are using MAOI+bupropion without problems, by the way. This combination appears to be safe. Clomipramine is contraindicated.
> > What I have read about mixing MAOIs with TCAs is that it is rarely more effective than using an MAOI alone but might be considered if both agents have been tried by themselves with partial response. There are other, less troublesome augmentation strategies, though.

I take Nardil with protriptyline (a tryicyclic, also know as Vicactil]. I have been doing so for almost 2 years. Not only that --
I also take Wellbutrin and Dexedrine.

I have had no problems with any of this.
(I had also tried desipramine and imipramine with the Nardil but they made me very groggy, even after a month of taking them.) In all cases, I began the trials of TCAs while I was taking the problem.

I have been on a MAOI diet for almost 20 years, and have not found it nearly as strict as the "lists" of dos and don'ts (in fact, a couple of my doctors told me this.)

In this latest relapse, I was severly depressed,
without letup for almost 4 years, tried suicide, was hospitalized, and tried at least 25 different meds or med combos. I went to 8 different doctors during that time. I finally found a good doctor -- a psychopharmacist who was knowledgeable and tenacious. Added to that was a consultation with a well-known doctor in Boston, who was the first to recommend taking both TCAs and MAOIs. From that point, things started to get better.

I wish you luck.




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