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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by sophia04 on June 15, 2010, at 1:31:11
I am trying desperately to get some relief from my fibromyalgia symptoms - primarily afternoon/evening bouts of debilitating fatigue + flu-like symptoms and wide-spread chronic pain. I've been taking parnate for my depression + anxiety for 3 years and it's been very effective, but gradually my fibro symptoms have gotten worse. my sister also has fibro and has done quite well on amitriptyline, i'd like to try it too, but my doctors insist that it can't be taken w/ parnate. i see that some other folks here combine the two. is this the case? can you share why you're taking the two together and if you needed certain precautions, i.e. dose, etc?
thank you!
Posted by Conundrum on June 15, 2010, at 10:44:32
In reply to can you take Parnate with Amitriptyline?, posted by sophia04 on June 15, 2010, at 1:31:11
Some people here have mentioned nortriptyline + Parnate. perhaps that would help just as well and be more acceptable. I believe it is somewhat less toxic and people have tried it. I wonder if Gilman has any info on his site about it?
Posted by europerep on June 15, 2010, at 13:33:34
In reply to Re: can you take Parnate with Amitriptyline? » sophia04, posted by Conundrum on June 15, 2010, at 10:44:32
there was a study where parnate plus amitriptyline was not just good, but also reduced sensitivity to tyramine, i.e. risk for a hypertensive episode, but it is of course an extremely dangerous combination..
if I had to take it I'd like cut a 20mg amitriptyline into twenty pieces and go up veery slowly.. it should probably be done in a hospital..
Posted by Christ_empowered on June 15, 2010, at 23:49:48
In reply to can you take Parnate with Amitriptyline?, posted by sophia04 on June 15, 2010, at 1:31:11
Hey. I googled that combo and tca+maois. It looks like tca+maois were used together in patients a good bit in the 60s, I guess before they realized a) maois can be dangerous and b) adding a reuptake inhibitor to the mix can make things tricky. I also found some studies from the 80s suggesting improved response to the combo (as opposed to either alone) in a treatment-resistant subset of patients. The only TCA I saw that was absolutely *not* to be mixed with an MAOI was clomimpramine. On the other hand, I also saw an article reporting that, based on a limited sample of patients, TCA+MAOI combos really weren't that great and the potential benefits were far outweighed by the very real health concerns.
It seems to me that a MAOI+stimulant combo would be more likely to work and the results would probably be more predictable (they were still using stimulants pretty often for depression well into the 70s, so I imagine there's a good bit of data and experience on amphetamines+MAOIs).
Whatever combo you end up on, I just hope you take into consideration the limited benefits available from drug treatment and the very serious risks you may be taking, especially over the long haul. That said: I wish you well.
Posted by inanimate peanut on June 26, 2010, at 1:49:36
In reply to Re: can you take Parnate with Amitriptyline?, posted by Christ_empowered on June 15, 2010, at 23:49:48
I'm considering adding Notriptyline to Parnate. I have lots of articles about combos of MAOIs and TCAs if you're interested.
Posted by sophia04 on June 26, 2010, at 15:14:49
In reply to Re: can you take Parnate with Amitriptyline?, posted by inanimate peanut on June 26, 2010, at 1:49:36
Christ_empowered, I am also considering Notriptyline. Would be very interested in seeing articles about combos of MAOIs and TCAs. Please send link if you can.
H
Posted by desolationrower on June 30, 2010, at 16:23:52
In reply to can you take Parnate with Amitriptyline?, posted by sophia04 on June 15, 2010, at 1:31:11
this is a low level of parnate, but some of the effects of higher dose might overlap with tca.
The Safety and Efficacy of Combined Amitriptyline and Tranylcypromine Antidepressant Treatment
A Controlled Trial
Javad Razani, MD; Kerrin L. White, MD; Judith White, MA; George Simpson, MD; R. Bruce Sloane, MD; Ronald Rebal, MD; Ruby Palmer, RN, MA
Arch Gen Psychiatry. 1983;40(6):657-661.
AbstractSixty patients meeting DSM-III criteria for major depression were assigned randomly to double-blind treatment for four weeks according to fixed-dosage steps with (1) amitriptyline hydrochloride alone, up to a maximum dosage of 300 mg/day; (2) tranylcypromine alone, up to 40 mg/day; or (3) the combination of amitriptyline hydrochloride, up to 150 mg/day, and tranylcypromine, up to 20 mg/day. The conditions of patients in all three treatment groups improved equally. The combined treatment did not produce a higher frequency of side effects, and no side effects, such as hypertensive or hyperthermic crises, occurred in any patient. Both amitriptyline alone and combined treatment produced substantially more anticholinergic side effects than did tranylcypromine. These results support the safety and efficacy of the combined treatment, although claims for superior efficacy over single-antidepressant treatments in this heterogenous population were not supported.
(Arch Gen Psychiatry 1983;40:657-661)
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