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
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??