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Re: Let's talk about combing SSRIs and TCAs

Posted by SLS on June 22, 2018, at 12:32:59

In reply to Let's talk about combing SSRIs and TCAs, posted by TriedEveryMedication on June 21, 2018, at 23:47:33

> So currently, I'm on 20mg of prozac and 20mg of desipramine. It seems pretty decent. SSRIs alone make me feel dopey out of it. Desipramine alone makes me a raging *ssh*l*. Together I find myself somewhat cheerful and having energy.

Does nortriptyline affect you the same way? I find that desipramine makes me somewhat edgy. Nortriptyline is more calming for me.

> (According to epocrates, this should kill me, either with serotonin syndrome or prolonged heart QT intervals or whatever.)

I never heard of nortriptyline or desipramine producing serotonin syndrome when combined with a SSRI. Can you provide a link to the webpage?

> supposedly, prozac is a potent blocker of p450 2d6, which supposedly is how desipramine is metabolized. I say "supposedly" because according to the literature, I should have an 800% AUC increase of desipramine in my blood stream.
> Yet my blood tests are showing pretty low desipramine levels. Lower than if I were taking the 100mg therapeutic dose alone.
> So what gives? Has anyone combined an SSRI and a TCA before?

While taking Paxil (paroxetine), another 2D6 inhibitor, I had to cut my dosage of desipramine in half. I took at least 100 mg/day, though. I don't know what my DMI blood levels were, but I did not experience more robust side effects than I did when I took 200 mg/day of desipramine alone. Perhaps you can continue to increase gradually using blood tests as a guide.

What is your rationale for combining Prozac and desipramine?

> how about an SSRI and moclobemide?

I would discourage this. I would expect serotonin syndrome to develop using these two drugs in combination. I don't see how reversibility would prevent this.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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