Psycho-Babble Medication Thread 1216

Shown: posts 1 to 10 of 10. This is the beginning of the thread.

 

TCA and MAOI Combo?? Help anyone?

Posted by Annie on November 11, 1998, at 22:23:46

I have treatment resistant depression and thought I had been on every conceivable combination with varying degrees of minor improvement. After being off meds for about 6 months so that I could take part in various trials, like rTMS and P Substance antagonists, I started to get suicidal ideations again and agreed with my doctor that I'd try the meds route again. I am currently taking 250mg of desipramine with little positive response and my doctor says the next step is to increase to 300mg and then augment with a MAO Inhibitor. I see mention of this combination on the web as being helpful in some cases, but it scares me that all the drug descriptions say the combination can be fatal. Has anyone else had success with this combo? I know it's ironic that someone who is suicidal would be afraid to die from prescribed medications, but maybe it's a control issue - LOL! In all honesty, I don't want to die, I just don't want to live like this. If this combo has a slim chance of helping me, I guess I'll take it.

 

Re: TCA and MAOI Combo?? Help anyone?

Posted by George O. on November 12, 1998, at 1:33:23

In reply to TCA and MAOI Combo?? Help anyone?, posted by Annie on November 11, 1998, at 22:23:46

> I have treatment resistant depression and thought I had been on every conceivable combination with varying degrees of minor improvement. After being off meds for about 6 months so that I could take part in various trials, like rTMS and P Substance antagonists, I started to get suicidal ideations again and agreed with my doctor that I'd try the meds route again. I am currently taking 250mg of desipramine with little positive response and my doctor says the next step is to increase to 300mg and then augment with a MAO Inhibitor. I see mention of this combination on the web as being helpful in some cases, but it scares me that all the drug descriptions say the combination can be fatal. Has anyone else had success with this combo? I know it's ironic that someone who is suicidal would be afraid to die from prescribed medications, but maybe it's a control issue - LOL! In all honesty, I don't want to die, I just don't want to live like this. If this combo has a slim chance of helping me, I guess I'll take it.

I've never taken that combo, but had great results from augmenting desiprimine with 30-60mg of buspar, that might be worth considering first as it's less complicated. George

 

Re: TCA and MAOI Combo?? Help anyone?

Posted by Toby on November 12, 1998, at 14:55:57

In reply to TCA and MAOI Combo?? Help anyone?, posted by Annie on November 11, 1998, at 22:23:46

If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level. According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.

 

Re: TCA and MAOI Combo- Thanks

Posted by Annie on November 13, 1998, at 15:49:56

In reply to Re: TCA and MAOI Combo?? Help anyone?, posted by Toby on November 12, 1998, at 14:55:57

> If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level. According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.>

Thanks for your advice. I talked with my doctor and I feel somewhat better. We talked about risk to benefit ratio and I've got to admit, it made sense. I'll get the results of the latest plasma
levels on Monday and then we'll decide where to go from here. I've been on MAOIs before, so I understand how important it is to stick to the diet. It took me years to find this doctor(and get his agreement to treat me) who is an expert on refractory depression and I trust both his expertise and his caring. It's just a scary combination and I hoped someone here had tried it and lived to tell the tale. I appreciate the information about the TCAs best used with MAOI. I may have to switch from desipramine anyway due to some side effects he found concerning. I am hopeful and that is, at least, a start.


 

Re: TCA and MAOI Combo

Posted by Elizabeth on December 13, 1998, at 20:13:21

In reply to Re: TCA and MAOI Combo?? Help anyone?, posted by Toby on November 12, 1998, at 14:55:57

> If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level.

Where can I read about this? I've found hardly any info on MAOI pharmacokinetics.

> According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.

What about amoxapine or mirtazapine? Does it say why imipramine would be more of a problem than amitriptyline or doxepin?

Lots of doctors are using MAOI+bupropion without problems, by the way. This combination appears to be safe. Clomipramine is contraindicated.

What I have read about mixing MAOIs with TCAs is that it is rarely more effective than using an MAOI alone but might be considered if both agents have been tried by themselves with partial response. There are other, less troublesome augmentation strategies, though.

 

Re: Parnate, Klonipin and Neurot Combo

Posted by Mary on January 15, 2000, at 18:51:23

In reply to Re: TCA and MAOI Combo, posted by Elizabeth on December 13, 1998, at 20:13:21

> > If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level.
> Where can I read about this? I've found hardly any info on MAOI pharmacokinetics.
> > According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.
> What about amoxapine or mirtazapine? Does it say why imipramine would be more of a problem than amitriptyline or doxepin?
> Lots of doctors are using MAOI+bupropion without problems, by the way. This combination appears to be safe. Clomipramine is contraindicated.
> What I have read about mixing MAOIs with TCAs is that it is rarely more effective than using an MAOI alone but might be considered if both agents have been tried by themselves with partial response. There are other, less troublesome augmentation strategies, though.


I have suffered for over 20 years and taken all types of medication "cocktails". My doc is listed in the 100 best in the country and I have confidense in him. I have been so desperate that he even gave me his direct beeper number How about that? Calls have always been returned immediately. After several hospitalizations and Ect bouts and constant suicidal thoughts and plans...no attempts though, we decided to try this route. After six weeks, I feel human again. I just watch everything that goes into my mouth and take and record my blood pressure twice daily. Is there anything I should know or questions that I should ask my doc? I am interested in other peoples' responses to Parnate. Is it normal to be cold all the time? Is it normal to lose appitite? I'll look forward to any answers.

 

Re: Parnate combo success

Posted by jd on January 19, 2000, at 0:54:09

In reply to Re: Parnate, Klonipin and Neurot Combo, posted by Mary on January 15, 2000, at 18:51:23

Mary,
That's great that you've had such a positive response to Parnate--MAOIs are known for sometimes being very successful when nothing else seems to work. I've very frequently heard about Parnate causing decreased appetite and weight loss, though I'm not sure if I've heard about the coldness--it's not unusual for all kinds of meds to cause a slight change in temperature regulation though. Even with all the MAOI "cautions" it seems like a small price to pay if you're feeling better! By the way, you'll note a lot of discussion about Parnate and the other MAOIs on this site, many of them in the previous months' archives.
Best to you,
jd


>
>
> I have suffered for over 20 years and taken all types of medication "cocktails". My doc is listed in the 100 best in the country and I have confidense in him. I have been so desperate that he even gave me his direct beeper number How about that? Calls have always been returned immediately. After several hospitalizations and Ect bouts and constant suicidal thoughts and plans...no attempts though, we decided to try this route. After six weeks, I feel human again. I just watch everything that goes into my mouth and take and record my blood pressure twice daily. Is there anything I should know or questions that I should ask my doc? I am interested in other peoples' responses to Parnate. Is it normal to be cold all the time? Is it normal to lose appitite? I'll look forward to any answers.

 

Re: Parnate, Klonipin and Neurot Combo

Posted by S. Suggs on January 19, 2000, at 4:32:45

In reply to Re: Parnate, Klonipin and Neurot Combo, posted by Mary on January 15, 2000, at 18:51:23

Hello Mary: I've been on Parnate for several months now with the best results with any antidepressant I have tried over 5 years. Yes, I am cold all the time and do have a decrease in appetite which will increase at bedtime. Best wishes and blessings,

S. Suggs

 

Re: TCA and MAOI Combo

Posted by Stephanie L. on January 23, 2000, at 20:49:46

In reply to Re: TCA and MAOI Combo, posted by Stephanie L. on January 23, 2000, at 20:25:23

> > > If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level.
> > Where can I read about this? I've found hardly any info on MAOI pharmacokinetics.
> > > According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.
> > What about amoxapine or mirtazapine? Does it say why imipramine would be more of a problem than amitriptyline or doxepin?
> > Lots of doctors are using MAOI+bupropion without problems, by the way. This combination appears to be safe. Clomipramine is contraindicated.
> > What I have read about mixing MAOIs with TCAs is that it is rarely more effective than using an MAOI alone but might be considered if both agents have been tried by themselves with partial response. There are other, less troublesome augmentation strategies, though.

I take Nardil with protriptyline (a tryicyclic, also know as Vicactil]. I have been doing so for almost 2 years. Not only that --
I also take Wellbutrin and Dexedrine.

I have had no problems with any of this.
(I had also tried desipramine and imipramine with the Nardil but they made me very groggy, even after a month of taking them.) In all cases, I began the trials of TCAs while I was taking the MAOI...no problem.

I have been on a MAOI diet for almost 20 years, and have not found it nearly as strict as the "lists" of dos and don'ts (in fact, a couple of my doctors told me this.)

In this latest relapse, I was severly depressed,
without letup for almost 4 years, tried suicide, was hospitalized, and tried at least 25 different meds or med combos. I went to 8 different doctors during that time. I finally found a good doctor -- a psychopharmacist who was knowledgeable and tenacious. Added to that was a consultation with a well-known doctor in Boston, who was the first to recommend taking both TCAs and MAOIs. From that point, things started to get better.

I wish you luck.

 

klonipin

Posted by susann on April 6, 2001, at 12:57:01

In reply to Re: Parnate, Klonipin and Neurot Combo, posted by Mary on January 15, 2000, at 18:51:23

> > > If your doctor is good, you trust him, and get to see him pretty often, then that combo can be a worthwhile effort, especially if you have tried other combinations without benefit. You have to stick with the MAO diet very carefully. It is dangerous to add a tricyclic to an MAOI but can be OK (sometimes) to add an MAOI to a tricyclic. The reason is that the tricyclic can increase the blood level of the MAOI but not the other way around, so adding a small dose of MAOI to the tricyclic won't tend to cause a toxic level of MAOI and won't do anything to the tricyclic level.
> > Where can I read about this? I've found hardly any info on MAOI pharmacokinetics.
> > > According to the 2nd edition of Psychotropic Drugs by Ward and Maxmen, it is safer to add an MAOI to doxepin, amitriptyline or trimipramine but should avoid adding an MAOI to imipramine, desipramine, venlafaxine, bupropion or SSRI's. Nevertheless, talk to your doctor and see what the exact plan is to monitor your blood levels of both medications and what his thinking is about the above cautions on adding an MAOI to other medicaitons. Good luck.
> > What about amoxapine or mirtazapine? Does it say why imipramine would be more of a problem than amitriptyline or doxepin?
> > Lots of doctors are using MAOI+bupropion without problems, by the way. This combination appears to be safe. Clomipramine is contraindicated.
> > What I have read about mixing MAOIs with TCAs is that it is rarely more effective than using an MAOI alone but might be considered if both agents have been tried by themselves with partial response. There are other, less troublesome augmentation strategies, though.
>
>
> I have suffered for over 20 years and taken all types of medication "cocktails". My doc is listed in the 100 best in the country and I have confidense in him. I have been so desperate that he even gave me his direct beeper number How about that? Calls have always been returned immediately. After several hospitalizations and Ect bouts and constant suicidal thoughts and plans...no attempts though, we decided to try this route. After six weeks, I feel human again. I just watch everything that goes into my mouth and take and record my blood pressure twice daily. Is there anything I should know or questions that I should ask my doc? I am interested in other peoples' responses to Parnate. Is it normal to be cold all the time? Is it normal to lose appitite? I'll look forward to any answers.

i was just given amitriptyline for migraines. i also am taking prozac and klonipin. is there a better schedule for taking the three. i have been taking the klonipin at night and the amitrtip


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