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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 TheOutsider on October 10, 2004, at 16:18:01
This obviesly doesn't sound like an ideal combination!
Problem is I'm taking Clomipramine which helps with my depression but doesn't do much for social anxiety.
I currently don't have a decent doc to work with, so I was thinking of adding Ultram (when needed) for SA.
Is this a terrible idea? I know it theoreticaly could cause serotonin syndrome!
Posted by Squiggles on October 10, 2004, at 19:15:09
In reply to Clomipramine with Ultram? Is it safe?, posted by TheOutsider on October 10, 2004, at 16:18:01
Well, i did read that Dr. Bob
started this site with the intention
of adressing professionals; but i
think you are not, right? If so,
shouldn't you be consulting your
dr. on this question? After all,
you will not be prescribing yourself.That's what I would do to see if it
safe.Squiggles
Posted by TheOutsider on October 11, 2004, at 6:24:34
In reply to Re: Clomipramine with Ultram? Is it safe?, posted by Squiggles on October 10, 2004, at 19:15:09
> Well, i did read that Dr. Bob
> started this site with the intention
> of adressing professionals; but i
> think you are not, right? If so,
> shouldn't you be consulting your
> dr. on this question? After all,
> you will not be prescribing yourself.
>
> That's what I would do to see if it
> safe.
>
> SquigglesI'm certaily not a proffesional, I'm a fairly well informed amataur!
My current doctors is very unhelpful and untrusting, I don't feel secure with him and besides he's actually not to concerned about what happens to me.
That's why I asking here!
Posted by Larry Hoover on October 11, 2004, at 6:58:03
In reply to Clomipramine with Ultram? Is it safe?, posted by TheOutsider on October 10, 2004, at 16:18:01
> This obviesly doesn't sound like an ideal combination!
>
> Problem is I'm taking Clomipramine which helps with my depression but doesn't do much for social anxiety.
> I currently don't have a decent doc to work with, so I was thinking of adding Ultram (when needed) for SA.
> Is this a terrible idea? I know it theoreticaly could cause serotonin syndrome!From an interaction standpoint, tramadol is metabolized by enzymes 2D6, and a little less by 3A4, and so is clomipramine. However, clomipramine also has two other enzymatic routes to transformation. Both drugs are active as taken, and also have active metabolites (i.e. the products of the enzymatic transformations).
By taking these two drugs together, you're going to influence the balance between parent drug and active metabolite. You're going to distort the half-life of the parent a little bit, extending it. You may not subtle changes in the effect of the clomipramine, as a result.
Despite all that I've said, the critical parameter vis a vis serotonin syndrome is dose. Although both drugs have reuptake activity, it is not uncommon to combine drugs with reuptake activity. For example, I've use a small but substantial dose of a tricyclic to modify the effects of an SSRI. It's not a forbidden sort of combination, but instead, one that requires you to be attentive to the physical effects of doing so.
I don't anticipate a big problem combining the two drugs you are considering combining. But, the proof will only come by doing the experiment. Ensure that you know the symptoms of serotonin syndrome, and follow a reasonable plan of augmentation: Start low, go slow. Start at a low dose of tramadol, and don't even think of increasing it until you have some experience of its effects, under a variety of situations.
Lar
Posted by Squiggles on October 11, 2004, at 8:46:27
In reply to Re: Clomipramine with Ultram? Is it safe?, posted by TheOutsider on October 11, 2004, at 6:24:34
> > Well, i did read that Dr. Bob
> > started this site with the intention
> > of adressing professionals; but i
> > think you are not, right? If so,
> > shouldn't you be consulting your
> > dr. on this question? After all,
> > you will not be prescribing yourself.
> >
> > That's what I would do to see if it
> > safe.
> >
> > Squiggles
>
> I'm certaily not a proffesional, I'm a fairly well informed amataur!
>
> My current doctors is very unhelpful and untrusting, I don't feel secure with him and besides he's actually not to concerned about what happens to me.
> That's why I asking here!
That *is* a problem. Sorry to hear that;
I wonder if there is a directory of
doctors either on this list or on the net
in general, for your area that you can
consult for medical concerns you may have
in the future, e.g. if the advice you get
here works one time, but not another.Anyway, good luck - i just saw Larry's post
which looks very knowledgeable.Squiggles
Posted by TheOutsider on October 11, 2004, at 15:02:50
In reply to Re: Clomipramine with Ultram? Is it safe?, posted by Squiggles on October 11, 2004, at 8:46:27
Thanks Larry, your post is very sensible.
Squiggles-Sorry I didn't mean to sound snappy in my post, I know your trying to advise me to the best.
The situation I'm in is very frustrating, its probably difficult for those in the USA to imagine how bad doctors can be in the UK!
For example you can't get stimulants proscribed in the UK for love nor money. Even though I've had two seperate diagnosis of ADD I still can't get treatment!
Posted by Squiggles on October 11, 2004, at 16:05:29
In reply to Thank you Larry Hoover, Sorry Squiggles!, posted by TheOutsider on October 11, 2004, at 15:02:50
I did not take offense. I find it
interesting that you say the U.K. health
care is less user-friendly, than that of the
U.S.It would be interesting to see which
countries are the best for patient-doctor
relations in this respect, but how could you gather such information? Or do the medical organizations such as the APA, and the CMA
or the Royal College of Physicians, have similar policies?Sometimes I wonder if too much power is not
attributed to individual physicians to
act autonomously;Squiggles
This is the end of the thread.
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