Posted by SLS on August 28, 2012, at 2:57:13
In reply to The ultimate antidepressant combination?, posted by jono_in_adelaide on August 28, 2012, at 0:15:44
> MAOI + tricyclic
> ie Phentlzine/Tranylcypromine + Nortriptyline/Amitriptyline?
> What say you?
Tranylcypromine + TCA produces less hypotension and urinary retension than Nardil + TCA. Of course, if you are a Nardil responder, you may not have much choice. If Nardil does work but Parnate does not, and you find the side effects of Nardil intolerable, you might then look at Marplan as the MAOI to use. I suppose amitriptyline has a better chance of working than nortriptyline, but you might not like the sedation and weight-gain it produces, especially when combined with Nardil. Do not use imipramine or clomipramine as you choice of TCA. Serotonin toxicity can develop with both drugs, although clomipramine would produce the most severe. The risk of developing serotonin syndrome is very high when combining a MAOI with a SRI. I experienced this with Parnate + Effexor and Nardil + imipramine. Fortunately, when I experimented with Effexor, I took a single 5 - 10 mg dose. My reaction was profound, but not bad enough to be rushed to the hospital. My body temperature was only slightly elevated. However, I experienced delirium and muscle rigidity that lasted for about 1 1/2 hours. I was able to get my parents to take my temperature only when I became lucid enough to do so. I don't know how high it was during the peak of symptom severity. Hyperppyrexia is the killer. I could get away with combining Parnate + imipramine, but not Nardil + imipramine. My reaction to the latter combination was most not severe, but it was disabling. I could not stand or walk. My blood pressure dropped precipitously. I had to crawl around my apartment. I also had a degree of muscle rigidity, particularly around my torso. Nardil is more serotonergic than Parnate.
I have done best with Parnate + desipramine and Nardil + nortriptyline. I know a woman who did well with Nardil + doxepin. When the folks at Columbia placed me on a combination of Nardil + amitriptyline, they used subtherapeutic doses of Nardil. They had me take no more than 45 mg/day. I experienced by usual 3-day TCA response, but felt nothing thereafter. However, because the dosage of Nardil was subtherapeutic, I have no way of knowing if the combination would have worked. Equally important, I have no idea as to the propensity of that combination to produce serotonin toxicity.
How would you go about choosing which MAOI to use?
Some see things as they are and ask why.
I dream of things that never were and ask why not.
- George Bernard Shaw