![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 69. Go back in thread:
Posted by Tom Twilight on July 26, 2005, at 16:07:02
In reply to Re: I don't hate amitriptyline (Elavil) anymore....... » ed_uk, posted by Nickengland on July 26, 2005, at 15:52:49
Funnily enough I'm going to try Amitriptyline tonight for Marplan Insomnia
I'd heard you had a bad experience, which put me off a bit, but I'm not suprised now I know that you were using such a high dosage.
I started Clomipramine at 20mgs, and felt sleepy all day
Dosage is very important with the TricyclicsGlad it helped anyway
Posted by ed_uk on July 26, 2005, at 16:26:19
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Tom Twilight on July 26, 2005, at 16:07:02
Hi Tom!
>Funnily enough I'm going to try Amitriptyline tonight for Marplan Insomnia.......
I'd try taking a quarter of a 10mg tablet to start with. Don't want to risk the serotonin syndrome! You'll need to increase the dose very gradually ....while looking for symptoms of the serotonin syndrome. In fact, Surmontil would be a safer TCA to combine with Marplan for sleep. I'd rather take zolpidem (Stilnoct) though.
It's funny, amitriptyline is a local anesthetic. If the powder from the tablet gets into contact with your mouth, it might feel a bit numb!
>Dosage is very important with the Tricyclics....
I agree. Most people take 10-50mg for insomnia, usually 10-25mg initially. 50mg is too high for a starting dose..... yet the UK manufacturer recommends starting at 75mg for depression!
Up to about 200mg amitriptyline can be used to treat depression. I can't imagine taking that much. Cliffstone took 300mg.
Kind regards
~Ed
Posted by ed_uk on July 26, 2005, at 16:30:27
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Tom Twilight on July 26, 2005, at 16:07:02
>I'd heard you had a bad experience, which put me off a bit, but I'm not suprised now I know that you were using such a high dosage.
I was prescribed the 50mg tablets. I took one. It wasn't nice!
It was about 6 years ago so I didn't know that 50mg was too high for an initial dose :-(
~Ed
Posted by Phillipa on July 26, 2005, at 18:50:33
In reply to Re: I don't hate amitriptyline (Elavil) anymore....... » Tom Twilight, posted by ed_uk on July 26, 2005, at 16:30:27
I still can't believe that doc might have given me a TCA with upper! Fondly, Phillipa
Posted by KaraS on July 26, 2005, at 20:41:17
In reply to Re: I don't hate amitriptyline (Elavil) anymore....... » Tom Twilight, posted by ed_uk on July 26, 2005, at 16:30:27
Now you have some idea why I like doxepin so much. Even on the low dosage I always sleep so well (aside from the fact that it takes care of my anxiety).
It may be old and not so pretty but it sure works well for some things (and without tolerance).
Posted by Declan on July 27, 2005, at 0:14:15
In reply to I don't hate amitriptyline (Elavil) anymore......., posted by ed_uk on July 26, 2005, at 15:38:46
Hey Ed
Could/would you take 10mg amitriptyline (with 10mg Parnate) for sleep? You reckon Zolpidem would be better? Any other suggestions?
Declan
Posted by Tom Twilight on July 27, 2005, at 9:54:30
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Declan on July 27, 2005, at 0:14:15
Could/would you take 10mg amitriptyline (with 10mg Parnate) for sleep? You reckon Zolpidem would be better? Any other suggestions?
> DeclanHey 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 dayI 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
Posted by Declan on July 27, 2005, at 16:42:32
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Tom Twilight on July 27, 2005, at 9:54:30
So you're feeling a bit better, Tom? With the Marplan?
Declan
Posted by ed_uk on July 27, 2005, at 17:31:17
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Declan on July 27, 2005, at 0:14:15
Hi Declan,
>Could/would you take 10mg amitriptyline (with 10mg Parnate) for sleep?
Surmontil (trimipramine) would be safer. Amitriptyline inhibits the reuptake of serotonin and can cause the serotonin syndrome when combined with Parnate. Nevertheless, some people combine them with good effect.
>You reckon Zolpidem would be better?
Probably less side effects. Some risk of dependence.
Low-dose trazodone was the traditional choice for MAOI insomnia.
Kind regards
~Ed
Posted by ed_uk on July 27, 2005, at 17:32:47
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Tom Twilight on July 27, 2005, at 9:54:30
Hi Tom!
>I felt fine the next day.
I thought you would do :-) I was just concerned about the risk of SS.
Did it help you sleep?
Kind regards
~Ed
Posted by ed_uk on August 7, 2005, at 16:24:07
In reply to I don't hate amitriptyline (Elavil) anymore......., posted by ed_uk on July 26, 2005, at 15:38:46
Hi!
I'm still taking a low dose of amitriptyline at night. It's surprisingly ok, I haven't really had any side effects. I take 10-30mg.
~Ed
Posted by ed_uk on August 7, 2005, at 16:42:19
In reply to Amitriptyline is ok, posted by ed_uk on August 7, 2005, at 16:24:07
How did you find it?
~Ed
Posted by KaraS on August 7, 2005, at 18:06:04
In reply to Amitriptyline is ok, posted by ed_uk on August 7, 2005, at 16:24:07
> Hi!
>
> I'm still taking a low dose of amitriptyline at night. It's surprisingly ok, I haven't really had any side effects. I take 10-30mg.
>
> ~Ed
It's supposed to be more sedating than doxepin, isn't it?K
Posted by ed_uk on August 8, 2005, at 14:06:37
In reply to Re: Amitriptyline is ok » ed_uk, posted by KaraS on August 7, 2005, at 18:06:04
Hi K,
>It's supposed to be more sedating than doxepin, isn't it?
Not really, it's variable which TCA people find to be the most sedating.
Ed xx
Posted by darkhorse on August 11, 2005, at 8:50:07
In reply to Has anyone tried amitriptyline for depression?, posted by ed_uk on August 7, 2005, at 16:42:19
> How did you find it?
>
> ~EdHI ED!
Yes I tried it 25 mg + 50 mg of imipramine : it oimmediatly improved my sleep and anxiety. Hmmmm,this was a very good combination .
After trying so many TCA's I believe the golden rule is to go very slowly 10 -25- 50 -75 mg in 2-3 weeks,because in this way the body get accustomed to the drug and things like sedation and dry mouth ..etc start to fade totally.That is why people can take up to 200mg with no big side effects.The only lasting side effect is an increase in appetite and weight gain.All the best,
Dark Horse.
Posted by darkhorse on August 11, 2005, at 8:53:03
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 8, 2005, at 14:06:37
> Hi K,
>
> >It's supposed to be more sedating than doxepin, isn't it?
>
> Not really, it's variable which TCA people find to be the most sedating.
>
> Ed xxIn my experience Mirtazapine,Trazodone and Doxepin are more sedating.
Mianserin,Nefazodone and Amiriptyline come 2nd.
All the best!
Dark Horse.
Posted by ed_uk on August 11, 2005, at 14:27:47
In reply to Re: Has anyone tried amitriptyline for depression? » ed_uk, posted by darkhorse on August 11, 2005, at 8:50:07
Hi DH!
>I believe the golden rule is to go very slowly 10 -25- 50 -75 mg in 2-3 weeks
I agree absolutely!
~Ed (Edward)
Posted by KaraS on August 11, 2005, at 17:57:31
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 8, 2005, at 14:06:37
Sad Panda used to use 100 mg. of amitriptyline along with Effexor. It worked very well for him.
k
Posted by ed_uk on August 12, 2005, at 1:17:24
In reply to Re: Amitriptyline is ok » ed_uk, posted by KaraS on August 11, 2005, at 17:57:31
Hi K!
Have you ever tried amitriptyline?
~Ed x
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
>Hi,
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.
JediHere 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]
Posted by darkhorse on August 13, 2005, at 3:57:50
In reply to MAOI combined with tricyclic, posted by Jedi on August 13, 2005, at 2:51:36
I tried Amitriptyline 25mg with Tranylcypromine 60mg with no ill effects.
Not all TCA's are containdicated with MAOIs;the more serotonergics are more dangerous, so apart from Clomipramine,Imipramine,all SSRIs,Venlafaxine,Duloxetine(and maybe Milnacipran),any other Antidepressant would not cause a problem(e.g all other TCAs,Maprotiline,Reboxetine,Trazodone,Mirtazapine..etc)
Posted by KaraS on August 13, 2005, at 15:09:15
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 12, 2005, at 1:17:24
> Hi K!
>
> Have you ever tried amitriptyline?
>
> ~Ed xOnly once. The first doctor I went to for anxiety/depression gave me a 75 mg. sample of amitriptyline to take. I was out for a couple of days. I know it was way too big a starting dose but still I've never gone near it again!
K
xx
Posted by ed_uk on August 13, 2005, at 18:15:58
In reply to Re: Amitriptyline is ok » ed_uk, posted by KaraS on August 13, 2005, at 15:09:15
Arghhhhhhh! Start at 10mg if you want to try it - I'd expect you'd like it.
~Ed
Posted by KaraS on August 13, 2005, at 19:06:24
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 13, 2005, at 18:15:58
> Arghhhhhhh! Start at 10mg if you want to try it - I'd expect you'd like it.
>
> ~Ed
Probably but what's the advantage over doxepin? They're very similar, aren't they?L
Posted by Jedi on August 13, 2005, at 19:09:27
In reply to Re: MAOI combined with tricyclic » Jedi, posted by darkhorse on August 13, 2005, at 3:57:50
> I tried Amitriptyline 25mg with Tranylcypromine 60mg with no ill effects.
>
> Not all TCA's are containdicated with MAOIs;the more serotonergics are more dangerous, so apart from Clomipramine,Imipramine,all SSRIs,Venlafaxine,Duloxetine(and maybe Milnacipran),any other Antidepressant would not cause a problem(e.g all other TCAs,Maprotiline,Reboxetine,Trazodone,Mirtazapine..etc)Hi,
Obviously the US prescribing information provided by Pfizer for phenelzine is overly conservative. What this does is make it very difficult for people to know what is really dangerous and what is not. I have eaten many of the foods and taken many of the medications that are warned about in the prescribing information for phenelzine and tranylcypromine. However, I will not advise another person to do the same. I do my own research and take my own chances. I have been burned in the past listening to advice from pharmacists and MDs. Once a supermarket pharmacist told me a cough syrup I asked them about would be fine with phenelzine as long as it didn’t contain dextromethorphan. That should have been my clue right there that she didn’t know what she was talking about. I had misplaced my reading glasses or I could have seen the microscopic print, 30mg pseudoephedrine hydrochloride. That was a $1000 mistake: a mild hypertensive crisis, a trip to the ER, and a CT scan later. It could have been much worse. If she didn’t know the answer for sure, that’s what those computer terminals are for.The best source for actual MAOI food restrictions I’ve found:
http:/www.dr-bob.org/babble/20010814/msgs/75408.html
This list was compiled by Elizabeth; “the guru of treatment resistant depression”. In my experience with MAOIs, I’ve found it to be very accurate. Does anyone know what Elizabeth is doing now? She was a wealth of knowledge in the earlier days of babble.
JediPrescribing information for phenelzine:
http://www.pfizer.com/pfizer/download/uspi_nardil.pdf… “CONTRAINDICATIONS
NARDIL should not be used in patients who are hypersensitive to the drug or its
ingredients, with pheochromocytoma, congestive heart failure, a history of liver disease,
or abnormal liver function tests.
The potentiation of sympathomimetic substances and related compounds by MAO
inhibitors may result in hypertensive crises (see WARNINGS). Therefore, patients being
treated with NARDIL should not take sympathomimetic drugs (including amphetamines,
cocaine, methylphenidate, dopamine, epinephrine, and norepinephrine) or related
compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine, and
phenylalanine). Hypertensive crises during NARDIL therapy may also be caused by the
ingestion of foods with a high concentration of tyramine or dopamine. Therefore, patients
being treated with NARDIL should avoid high protein food that has undergone protein
breakdown by aging, fermentation, pickling, smoking, or bacterial contamination.
Patients should also avoid cheeses (especially aged varieties), pickled herring, beer, wine,
liver, yeast extract (including brewer’s yeast in large quantities), dry sausage (including
Genoa salami, hard salami, pepperoni, and Lebanon bologna), pods of broad beans (fava
beans), and yogurt. Excessive amounts of caffeine and chocolate may also cause
hypertensive reactions.NARDIL should not be used in combination with dextromethorphan or with CNS
depressants such as alcohol and certain narcotics. Excitation, seizures, delirium,
hyperpyrexia, circulatory collapse, coma, and death have been reported in patients
receiving MAOI therapy who have been given a single dose of meperidine. NARDIL
should not be administered together with or in rapid succession to other MAO inhibitors
because HYPERTENSIVE CRISES and convulsive seizures, fever, marked sweating,
excitation, delirium, tremor, coma, and circulatory collapse may occur. ...
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.