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MAOI combined with tricyclic

Posted by Jedi on August 13, 2005, at 2:51:36

In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Tom Twilight on July 27, 2005, at 9:54:30

> Could/would you take 10mg amitriptyline (with 10mg Parnate) for sleep? You reckon Zolpidem would be better? Any other suggestions?
> > Declan
> Hey Declan
> I'm not Ed, but I'm on 30mgs of Marplan, last night I took 20mgs of Amitryptaline for sleep
> I felt fine the next day
> I imagine that the major risk from this combination is serotonin syndrome, but at low doses I don't imagine this would be a problem
> Still its early days

Though officially contraindicated the MAOI/tricyclic combination has been well studied. I have used phenelzine with nortriptyline (the active metabolite of amitriptyline) with no problem. The usual method is to add the MAOI to an established dosage of tricyclic or start the two simultaneously. Some people have been able to go the other way, but it is more risky. At the small dosage your describing, I don’t know.

Here is an abstract of a long-term combination study:

J Affect Disord. 1995 Jun 8;34(3):187-92.

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.

PMID: 7560546 [PubMed - indexed for MEDLINE]




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