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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by RetiredYoung on October 31, 2004, at 9:37:24
I'm currently taking 250mg of Clomipramine, a tricyclic, for chronic depression. It has been somewhat beneficial, but my doctor is considering the addition of an SSRI.
I remember one time reading about combining these two classes of meds, and a problem with certain enzymes.
I'd appreciate some specific information about this. Which SSRIs and TCAs can be used together and are there web sites that would me to learn more? Thanks!
Posted by linkadge on October 31, 2004, at 9:57:00
In reply to Tricyclics and SSRI augmentation, posted by RetiredYoung on October 31, 2004, at 9:37:24
Oftentimes a TCA is added to a SSRI to augment the SSRI.
Clomipramine is very much like a SSRI in its actions. Ie, it mainly effects the serotonin pump.
Usually a noradrenic TCA is added to an SSRI to provide additional antidepressant responce.
If your problem is mainly depression, then perhaps you could add a bit of nortyptaliine to the clomipramine in order to get a greater effect on the norepinephrine neurotransmitter.
I think that adding a SSRI might not be beneficial in that your depression does not seem to be fully responsive to serotogenic medications.
You might even consider adding wellbutrin to the clomipramine.
You have to ask yourself which symptoms of depression are you still experiencing.
1. Sadness, anxiety, insomnia,
(responsive to additional serotonin)
or2. Anhedonia, low energy, low motivation, apathy, poor concentation etc.
(responsive to noradrenic medications)
Linkadge
Posted by RetiredYoung on October 31, 2004, at 10:28:40
In reply to Re: Tricyclics and SSRI augmentation, posted by linkadge on October 31, 2004, at 9:57:00
Actually, I'm finding the clomipramine to have somewhat strong effects on norepinephrine. My heart rate is way up, which has been the case with every medication I've taken that impacts NE (eg Straterra, Effexor, and Pamelor). Another side effect is frequent urination. Plus the tricyclic goodies like dry mouth.
Bottom line for me is that energy/motivation wise, I'm doing pretty good now. It's the sadness/hopelessness/worthlessness depression feelings that are at issue for me.
FYI, I was on Lexapro for two years until recently. It began pooping out and I was losing more and more energy, the longer I was on it. We tried augmenting with Provigil and Adderall with only short term good results. Basically, the stimulants worked great initially, but then they either stopped working (Provigil) or "overflowed" my norepinephrine/dopamine systems causing bad anxiety, nervousness, etc.
So, I started on the clomipramine in August. We wanted to try a pure tricyclic to see what it's effecys might be on my other (definitely related) health problem: daily tension headaches.
This is the end of the thread.
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