Posted by SLS on January 19, 2016, at 16:55:11
In reply to What can safely augment Emsam?, posted by TriedEveryMedication on January 19, 2016, at 14:45:58
My vote is to add desipramine. Amphetamine, methylphenidate, bupropion, atomoxetine, or modafinil would be safe, too.
> desipramine has been the best drug for me for ADD, but my pdoc doesn't think it can be safely combined with emsam due to 5-HT action of the desipramine.
Desipramine is one of the most selective norepinephrine reuptake inhibitors (NRI) drugs available. It does not work directly on 5-HT at therapeutic dosages. For some people, it is the best ADD medication out there and is known to help increase motivation. I am dismayed that your doctor would say such a thing. Perhaps we expect too much from our doctors. There is a lot to know. Besides, using such combinations is something only the older psychiatrists would be familiar with. What can you do to change his mind about desipramine? I am currently taking Parnate with desipramine. Desipramine and nortriptyline are the two tricyclic antideperessants that combine well with MAOIs.
I guess you should use Google and Medline/PubMed to assemble a case for combining MAOIs with TCAs. Do not use imipramine or clomipramine. They are too serotonergic. I doubt you will find anything regarding Emsam specifically. It came along a little too late. No investigator would be motivated to study its use in combination with a TCA. Although I can't personally vouch for the Emsam + desipramine combination, I can't think of any reason why Emsam would be any less safe than Parnate, Nardil, or Marplan.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1085566
URL: http://www.dr-bob.org/babble/20151225/msgs/1085571.html