Posted by SLS on November 12, 2004, at 8:13:18
In reply to Re: A little message to Scott, posted by ed_uk on November 11, 2004, at 9:03:59
> RE: amitriptyline+MAOI versus nortriptyline+MAOI
> I think it's very difficult to compare the risk of SS with these two combinations. Amitriptyline is more potent that nortriptyline as a serotonin reuptake inhibitor, at a glance it might be expected that the risk of SS would be higher with amitriptyline. On the other hand, amitriptyline appears to be more potent as an antagonist at 5-HT2a receptors. It seems likely that this might provide some protection from the SS.
When I was tried on a combination of Nardil 45mg + amitriptyline 150mg, I experienced no untoward reactions. However, I believe that the dosage of Nardil was too low to achieve clinically sufficient MAO inhibition. I have never profited from Nardil unless the dosage was at least 60mg. I did experience what I believe were the beginnings of SS when I added nortriptyline to the Nardil 75mg I had been taking. Obviously, I can't report with certainty the safety of adding amitriptyline to the same dosage of Nardil because I have never tried it.
Right now, I believe that desipramine should be the only TCA to be combined with Nardil. However, I think Parnate is less likely to produce these reactions, and would probably be a better drug to use in combinations with the other TCAs. I have taken a high dose of Parnate + imipramine and tolerated it well. I experienced a significant SS reaction to Nardil 60mg + imipramine.
> As you mention in your psychiatric drug chart, ritanserin is not selective for the 5-HT2a receptor.
It would still be great if ritanserin were available to use as an augmentor of antidepressants. Ritanserin is a great drug without an indication. I imagine the patent has expired, and we will never see it unless it is manufactured as an orphan drug.