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Re: Tricyclics, SSRIs » SLS

Posted by Elizabeth on June 1, 2001, at 14:01:18

In reply to Re: Tricyclics, posted by SLS on June 1, 2001, at 8:34:32

> > You're entering relatively uncharted territory, and I can't help but admire your courage. Godspeed.
>
> I once combined Paxil and desipramine.

To clarify: the "uncharted territory" remark was in regard to Shirley's right-hemisphere neurological deficit which may be associated with her depression.

> I may be misremembering the numbers here ;-), but I believe I had to cut my dosage of desipramine in half. Both drugs compete for CYP450 D26. I think Luvox is metabolized mainly via 3A4, so I don't know how it would affect nortriptyline blood levels.

Luvox inhibits multiple cytochromes. Also, TCAs have multiple metabolic pathways: they undergo demethylation (e.g., imipramine - > desipramine) aromatic hydroxylation (e.g., imipramine - > 2-hydroxyimipramine; desipramine - > 2-hydroxydesipramine), and desalkylation (e.g., imipramine - > iminodibenzyl), and the hydroxy- metabolites undergo conjugation (e.g., 2-hydroxyimipramine - > 2-OH-imipramine-glucuronide) and desalkylation.

> I can't guess what dosage to make as the first target, but I wouldn't take more than 50mg before getting the first blood test.

Yeah, that's about standard I think. When I was a teenager they tried to test Prozac + desipramine on me (starting at 50 mg desipramine) but
(Typical of the incompetence of the MIT med center, they didn't do any blood testing.) I kept forgetting to take them, though, and eventually gave up on it altogether.

> I found the combination of Paxil and desipramine to be quite safe and without any adverse side effects other than those that are carried by both drugs. I don't remember that anticholinergic side effects were exaggerated, at least after a few weeks of treatment. I doubt this would be a concern with Luvox, anyway. It is much less anticholinergic than Paxil.

SSRIs in general aren't supposed to be anticholinergic at clinical doses! They might have indirect anticholinergic effects, though. I don't know anything about the interactions of the 5-HT and ACh systems.

> I am also curious about the choice of Luvox (fluvoxamine). It seems to be superior to other SSRIs for treating OCD, but I don't know how it compares as an antidepressant.

I don't think it's really superior to other SSRIs for OCD; I'd bet that's just a marketing thing. It's a fine AD; it was used in Europe even before Prozac came out.

> Of course, depression is the condition that this drug was screened and developed for. I wonder if the drug company opted to seek FDA approval for the treatment of OCD because it felt that it had a better chance of getting it approved for an indication that has fewer drugs available.

Exactly.

> How do you think Luvox compares to the other SSRIs in terms of efficacy as an antidepressant?

I think they're all about the same (YMMV). But Paxil seems to be the nastiest in terms of side effects. (Luvox has a rep for causing nausea a little bit more than the rest, tho'.)

-elizabeth


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poster:Elizabeth thread:64764
URL: http://www.dr-bob.org/babble/20010530/msgs/65051.html