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Re: MAOI + TCA- info please now!

Posted by rod on April 10, 2004, at 7:20:23

In reply to MAOI + TCA- info please now!, posted by ace on April 10, 2004, at 0:24:49

> OK kids,
>
> Im going to try this stragedy after 1 more week of my tryptophan plan!
>
> Im in a rush and am a lazy bum so please answer these qstns which i am too lazy to look up!
>
> 1. How long would Nardil have to be stopped before adding the TCA
>

Do you want to stop it again? I think you want to augment? General rule is 2 weeks.

> 2. Could the TCA be Amitrypt???
>

Yes, but thats dangerous and I dont think you meet the criteria for treatment resistant depression unresponsive to both a MAOI and TCA. You are totally hyperresponsive to Nardil in my opinion. Nothing thats justifying such a combination. I guess it would result in sero syndrome in your case, but who knows

------------
J Clin Psychiatry. 1994 Aug;55(8):336-9. Related Articles, Links

Treatment response of depressed outpatients unresponsive to both a tricyclic and a monoamine oxidase inhibitor antidepressant.

McGrath PJ, Stewart JW, Nunes EN, Quitkin FM.

New York State Psychiatric Institute, New York 10032.

BACKGROUND: Data regarding effective treatment options for the minority of patients refractory to initial antidepressant trials are essential to guide therapeutic choices and to sustain the hope of patients and perseverance of clinicians. Few such data are available concerning the treatment of patients refractory to treatment with both a tricyclic antidepressant and a monoamine oxidase inhibitor given singly. METHOD: In a study of mood reactive depressed patients, most of whom met Columbia criteria for atypical depression, 20 patients refractory to vigorous 6-week double-blind trials of both imipramine and phenelzine given singly were given clinician's choice open treatment. A chart review of course in open treatment was conducted. RESULTS: Eleven patients (55%) had a full response to subsequent treatments, principally continued phenelzine and the combination of phenelzine with amitriptyline. Another 6 (30%) had at least moderate benefit from a variety of other treatments. CONCLUSION: These data suggest that even among patients who have failed to respond to two vigorous trials of different antidepressants, at least half appear to benefit from other pharmacologic regimens.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial


PMID: 8071301 [PubMed - indexed for MEDLINE]


2: J Pharm Sci. 1994 Jan;83(1):100-3. Related Articles, Links

Tranylcypromine does not enhance the effects of amitriptyline on 5-HT2 receptors in rat cerebral cortex.

Goodnough DB, Baker GB.

Department of Psychiatry, University of Alberta, Edmonton, Canada.

The combination of amitriptyline (a tricyclic antidepressant) and tranylcypromine (a monoamine oxidase inhibitor) has been reported to be effective for treatment of refractory depressed patients. In the study reported here, this drug combination was compared with amitriptyline administered alone on the number and affinity of 5-HT2 receptors in rat brain. Male Sprague-Dawley rats were given vehicle (distilled water), amitriptyline (3.5 mg/kg/day), or tranylcypromine and amitriptyline (0.5 and 3.5 mg/kg/day, respectively) in combination subcutaneously via osmotic minipumps for 4, 10, or 28 days. A membrane fraction prepared from whole cortex was employed for studying binding to 5-HT2 receptors ([3H]ketanserin as the radioligand). The combination of amitriptyline and tranylcypromine produced a small but significantly greater down-regulation (decrease in number) of 5-HT2 sites than did amitriptyline alone after 10 days of administration; at 4 and 28 days, both amitriptyline and the drug combination had produced down-regulation, but there was not a significant difference between the two treatments. These data suggest that the antidepressant efficacy observed with this combination is not likely due to an enhanced effect on 5-HT2 receptors.

PMID: 8138895 [PubMed - indexed for MEDLINE]
-----------------------

> 3. Nardil + Reboxetine produced depression. Which TCA is least noradrenergic? (You get my gist?!)
>

Well, sad panda is right. I also think of trimipramine, which has quite no affinity tho the reuptake pumps of noradrenalin and serotonin. Maybe also Opipramole, which is primarey a H antag, D2 antag. and sigma antag.

>
>
> Peace and Happy Easter to all of you and Dr Bob!,
>
> Ace
> Nardil 60
> L-Tryptophan 2 gram
> Zyprexa 2.5

Happy Easter also to all

Roland


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poster:rod thread:334782
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