Psycho-Babble Medication Thread 527060

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Anyone Tried a MAOI - A with an SSRI

Posted by Denise1966 on July 13, 2005, at 7:00:12

Hi,

I was just wondering if anyone on here had tried an MAOI such as Manerix with an SSRI and if so how effective was it?

I was discussing this with my psychiatrist yesterday and we are thinking about maybe trying this out if all else fails.

Denise

 

Re: Anyone Tried a MAOI - A with an SSRI Denise1966

Posted by gardenergirl on July 13, 2005, at 10:15:23

In reply to Anyone Tried a MAOI - A with an SSRI, posted by Denise1966 on July 13, 2005, at 7:00:12

I would imagine it would be very risky given the bump in serotonin you would get. Serotonin Syndrome is not to be messed with.

gg

 

Re: Anyone Tried a MAOI - A with an SSRI Denise1966

Posted by SLS on July 13, 2005, at 12:04:11

In reply to Anyone Tried a MAOI - A with an SSRI, posted by Denise1966 on July 13, 2005, at 7:00:12

> Hi,
>
> I was just wondering if anyone on here had tried an MAOI such as Manerix with an SSRI and if so how effective was it?
>
> I was discussing this with my psychiatrist yesterday and we are thinking about maybe trying this out if all else fails.
>
> Denise


I have not tried this combination, although I had once considered it.

Medline is littered with cases of fatal serotonin syndrome when these drugs are combined in overdose. There are only a few cases where overdose was not a consideration. However, there are those doctors in Canada who advocate its use. Try to get a hold of a guy named R. T. Joffe if you can. Apparently, he's currently at Department of Psychiatry, UMDNJ-New Jersey Medical School, Newark, NJ, USA. Also, you can try D. Bakish at Ottawa Psychopharmacology Clinic, Ontario, Canada.

---------------------------------------


J Clin Psychiatry. 1994 Jan;55(1):24-5. Related Articles, Links


Combined SSRI-moclobemide treatment of psychiatric illness.

Joffe RT, Bakish D.

Mood Disorders Program, Clarke Institute of Psychiatry, Toronto, Ontario, Canada.

BACKGROUND: To determine the efficacy and safety of a serotonin selective reuptake inhibitor (SSRI) combined with moclobemide in the treatment of 11 patients with various DSM-III-R diagnoses. METHOD: Subjects received moclobemide in doses of 150 to 800 mg/day together with sertraline (N = 5) in doses of 25 to 200 mg/day or fluvoxamine (N = 6) in doses of 50 to 200 mg/day. Patients were carefully monitored for side effects and for clinical response at the end of the trial, which lasted a minimum of 5 weeks. RESULTS: The combination was tolerated extremely well. Insomnia was the most common side effect, occurring in 5 of 11 subjects. A marked or complete therapeutic response was noted in 8 of 11 subjects. CONCLUSION: This open clinical trial suggests that combined SSRI-moclobemide treatment appears to be safe and well tolerated. It may also have therapeutic effects in treatment-refractory patients.

Publication Types:
Clinical Trial
Controlled Clinical Trial

PMID: 8294388 [PubMed - indexed for MEDLINE]


--------------------------------------------


CNS Drug Rev. 2003 Spring;9(1):97-140. Related Articles, Links


Comment in:
CNS Drug Rev. 2004 Spring;10(1):83-5; author reply 86-8.

Moclobemide: therapeutic use and clinical studies.

Bonnet U.

Department of Psychiatry and Psychotherapy, University of Essen, Germany. udo.bonnet@uni-essen.de

Moclobemide is a reversible inhibitor of monoamine-oxidase-A (RIMA) and has been extensively evaluated in the treatment of a wide spectrum of depressive disorders and less extensively studied in anxiety disorders. Nearly all meta-analyses and most comparative studies indicated that in the acute management of depression this drug is more efficacious than placebo and as efficacious as tricyclic (or some heterocyclic) antidepressants or selective serotonin reuptake inhibitors (SSRIs). There is a growing evidence that moclobemide is not inferior to other antidepressants in the treatment of subtypes of depression, such as dysthymia, endogenous (unipolar and bipolar), reactive, atypical, agitated, and retarded depression as with other antidepressants limited evidence suggests that moclobemide has consistent long-term efficacy. However, more controlled studies addressing this issue are needed. For patients with bipolar depression the risk of developing mania seems to be not higher with moclobemide than with other antidepressants. The effective therapeutic dose range for moclobemide in most acute phase trials was 300 to 600 mg, divided in 2 to 3 doses. While one controlled trial and one long-term open-label study found moclobemide to be efficacious in social phobia, three controlled trials subsequently revealed either no effect or less robust effects with the tendency of higher doses (600 - 900 mg/d) to be more efficacious. Two comparative trials demonstrated moclobemide to be as efficacious as fluoxetine or clomipramine in patients suffering from panic disorder. Placebo-controlled trials in this indication are, however, still lacking. A relationship between the plasma concentration of moclobemide and its therapeutic efficacy is not apparent but a positive correlation with adverse events has been found. Dizziness, nausea and insomnia occurred more frequently on moclobemide than on placebo. Due to negligible anticholinergic and antihistaminic actions, moclobemide has been better tolerated than tri- or heterocyclic antidepressants. Gastrointestinal side effects and, especially, sexual dysfunction were much less frequent with moclobemide than with SSRIs. Unlike irreversible MAO-inhibitors, moclobemide has a negligible propensity to induce hypertensive crisis after ingestion of tyramine-rich food ("cheese-reaction"). Therefore, dietary restrictions are not as strict. However, with moclobemide doses above 900 mg/d the risk of interaction with ingested tyramine might become clinically relevant. After multiple dosing the oral bioavailability of moclobemide reaches almost 100%. At therapeutic doses, moclobemide lacks significant negative effects on psychomotor performance, cognitive function or cardiovascular system. Due to the relative freedom from these side effects, moclobemide is particularly attractive in the treatment of elderly patients. Moclobemide is a substrate of CYP2C19. Although it acts as an inhibitor of CYP1A2, CYP2C19, and CYP2D6, relatively few clinically important drug interactions involving moclobemide have been reported. It is relatively safe even in overdose. The drug has a short plasma elimination half-life that allows switching to an alternative agent within 24 h. Since it is well tolerated, therapeutic doses can often be reached rapidly upon onset of treatment. Steady-state plasma levels are reached approximately at one week following dose adjustment. Patients with renal dysfunction require no dose reduction in contrast to patients with severe hepatic impairment. Cases of refractory depression might improve with a combination of moclobemide with other antidepressants, such as clomipramine or a SSRI. Since this combination has rarely been associated with a potentially lethal serotonin syndrome, it requires lower entry doses, a slower dose titration and a more careful monitoring of patients. Combination therapy with moclobemide and other serotonergic agents, or opioids, should be undertaken with caution, although no serious adverse events have been published with therapeutic doses of moclobemide to date. On the basis of animal data the combined use of moclobemide with pethidine or dextropropoxyphene should be avoided. There is no evidence that moclobemide would increase body weight or produce seizures. Some preclinical data suggest that moclobemide may have anticonvulsant property.

Publication Types:
Review
Review, Tutorial

PMID: 12595913 [PubMed - indexed for MEDLINE]

 

Re: To SLS

Posted by Denise1966 on July 14, 2005, at 5:37:59

In reply to Re: Anyone Tried a MAOI - A with an SSRI Denise1966, posted by SLS on July 13, 2005, at 12:04:11

Hi Scott,

This is a great help, I'm going to send this to my new Psychiatrist.

The reason I asked is that about two years ago Seroxat started working for me a bit after failing at another time previously. Anyway, after the Christmas the Seroxat hasn't been working.

I was trying to rack my brains thinking of what to do next and it ocurred to me that the Seroxat had worked after I'd been on a months trial of Nardil and the normal two weeks washout period and was wondering if there could have been anything in that. I also remembered that when I started the Seroxat I didn't get all of the horrible anxiety start up affects I got before.

So I mentioned to this to my psychiatrist and asked if I could try this again, i.e. take Nardil for a month come off and then go back on Seroxat. She thought about it and speculated that perhaps the Nardil had still been exerting its effects, even though it was no longer in my system and maybe that's what helped the Seroxat to work.

Anyway, we are going to give this a try again but failing that working she mentioned it might be an idea to try Moclobemide with an SSRI and asked me to do some research whilst she looks into the ECT option. She's a new psychiatrist I've been seeing as she's really nice in that she considers my suggestions without batting them straight out the window.

How is it going with the Trileptal?

Denise


 

Re: To SLS Denise1966

Posted by SLS on July 14, 2005, at 7:05:22

In reply to Re: To SLS, posted by Denise1966 on July 14, 2005, at 5:37:59

Hi Denise.

Scenario 1:
The possibility exists that what you experienced upon the discontinuation of Nardil was a neurochemical rebound of sorts that was potentiated by the addition of Seroxat within the first few weeks. I think it depends how long you continued to respond to Seroxat as to the possibility that this is what happened. For me, the rebound improvement from discontinuing Nardil can last for up to four weeks. It is mild, but there. To add another antidepressant during this time can work better if its effects act synergistically with the rebound. It might be that the Seroxat unmasked this neurochemical rebound that remained occult, resulting in the improvement you experienced. If this is true, the combination of moclobemide with an SSRI will likely fail.

Scenario 2:
The other mechansism that might contribute to a synergism is that there was a residual amount of MAO inhibition when you began taking the Seroxat. This is what you and your doctor are betting on. One thing that argues for this possibiility is that MAO activity does not return quickly after discontinuing Nardil. The system recovers more slowly after Nardil discontinuation than Parnate discontinuation. Perhaps you and your doctor are right about how the Seroxat worked the last time you tried.

How long did the Seroxat work for?

If it was for less than a month, I would guess that the first scenario is true. If it lasted for several months, I would look more towards the second scenario as being accurate, in which case the moclobemide + SSRI combination remains an exciting proposition.


- Scott

 

Re: Anyone Tried a MAOI - A with an SSRI Denise1966

Posted by darkhorse on July 14, 2005, at 8:52:11

In reply to Anyone Tried a MAOI - A with an SSRI, posted by Denise1966 on July 13, 2005, at 7:00:12

Hi,
Yes I have tried Moclobemide with :

1- Citalopram : very bad effects from first dose.Stopped immediately.

2- Fluoxetine : One side effect : restless legs during sleep.Had to take a benzo with them.

3- Fluvoxamine 50mg : no side effects at all.This was the better combination,but unfortunatly it did not give positive results for me.

Regards,
Dark Horse.

 

Re: Anyone Tried a MAOI - A with an SSRI

Posted by SLS on July 14, 2005, at 10:32:23

In reply to Re: Anyone Tried a MAOI - A with an SSRI Denise1966, posted by darkhorse on July 14, 2005, at 8:52:11

Hi.

What dosage of moclobemide were you on?


- Scott


> Yes I have tried Moclobemide with :
>
> 1- Citalopram : very bad effects from first dose.Stopped immediately.
>
> 2- Fluoxetine : One side effect : restless legs during sleep.Had to take a benzo with them.
>
> 3- Fluvoxamine 50mg : no side effects at all.This was the better combination,but unfortunatly it did not give positive results for me.
>
> Regards,
> Dark Horse.

 

Re: Anyone Tried a MAOI - A with an SSRI

Posted by darkhorse on July 15, 2005, at 2:35:32

In reply to Re: Anyone Tried a MAOI - A with an SSRI, posted by SLS on July 14, 2005, at 10:32:23

> Hi.
>
> What dosage of moclobemide were you on?
>
>
> - Scott
>
>
> > Yes I have tried Moclobemide with :
> >
> > 1- Citalopram : very bad effects from first dose.Stopped immediately.
> >
> > 2- Fluoxetine : One side effect : restless legs during sleep.Had to take a benzo with them.
> >
> > 3- Fluvoxamine 50mg : no side effects at all.This was the better combination,but unfortunatly it did not give positive results for me.
> >
> > Regards,
> > Dark Horse.
>
>
Hi,
With citalopram 20 + Moclobemide 150mg
Fluoxetine20 + Moclobemide 150 increased to 300mg + bromazepam 9mg
Fluvoxamine 50mg + Moclobemide 150mg.

Dark Horse.

 

Re: To SLS

Posted by Denise1966 on July 15, 2005, at 15:14:04

In reply to Re: To SLS Denise1966, posted by SLS on July 14, 2005, at 7:05:22

Hi Scott,

Re possibility number one, I know what you mean about rebound improvements as I've experienced this in the past when initially stopping SSRIs, it's like you feel better than before you took them and when you were taking them but you know the feeling is not going to last. I don't remember experiencing a rebound improvement with Nardil so I don't think this is a viable option. Mindyou I hated Nardil so much maybe psychologically I was just relieved to have come off them. Don't have much forward to when I start the months trial again really do I :-)

I'm hoping it's option two but having said that the whole fact that the Seroxat worked 50% after the Nardil could just be pure fluke. I guess I'll have to wait and see.

The Seroxat worked about 50% for about two years with the odd bad week here and there but maybe because I'd had that lift in the depression after two years of hell psychologically it sort of kept me going. Since Christmas the rot has set in. I've just been made redundant from IBM and you know what? I really didn't care much when they told me.

If this experiment doesn't work I'm definately going to go with ECT and if that doestn't work then I'll try either VNS or deep brain stimulation because I'm sick of this whole drug merry go round. This whole cycle of going a drug for six weeks and then upping the dose if it doesn't work and then adding something else for weeks if that doesn't work and then finally having to go through the awful withdrawal in order to start again from scratch, and there goes another 3 months of your life down the drain.

Because I have to go through the two week washout period before taking the Nardil I stopped taking anything almost two weeks ago and I'm starting to feel really morose and morbid, flat and just generally creepy, although no anxiety anymore. Even the Zyprexa which actually used to help my depression doesn't seem to do much these days, it only seemed to help when I had the anxiety.

I was just reading the stiff neck thread and can really relate to what you say about your jaw getting tense and your neck being stiff when the drugs aren't working and then when they do work all that goes, I've experienced this myself in the past. I also know from my experience of SSRIs working really well years ago that when they do work I always used to get a sensation just behind my eyes and top of my nose, I could actually feel things happening in my brain. I've never felt that sensation in the last four years and they've never worked that well.

I saw your notes on the trileptal and I'm really sorry it's no longer working, I spose it's time to try out the RU486.

I don't think I'm in a position to give you any advice but after seeing the list of all the drugs you've had to tried and from seeing your posts over the years, if I were you I wouldn't put all my eggs into the drugs basket, I think you should be looking at VNS or DBS in parallel to trying the drugs but then that's just my opinion. I guess it all depends on how desperate you feel.

Denise


 

Re: To Darkhorse

Posted by Denise1966 on July 15, 2005, at 15:15:18

In reply to Re: Anyone Tried a MAOI - A with an SSRI Denise1966, posted by darkhorse on July 14, 2005, at 8:52:11

Thanks Dark Horse,

Have you ever tried Nardil or Parnate and if so how did they compare with Moclobemide?

Also, what are you taking now and is it working?


Denise

 

Re: To Darkhorse Denise1966

Posted by ed_uk on July 16, 2005, at 8:12:15

In reply to Re: To Darkhorse, posted by Denise1966 on July 15, 2005, at 15:15:18

Hi!

Parnate made darkhorse eat like a real horse LOL! It also made him rather too assertive I believe :-O Sorry DH if I'm getting mixed up!

~Ed

 

Re: To Darkhorse

Posted by Declan on July 16, 2005, at 16:06:37

In reply to Re: To Darkhorse Denise1966, posted by ed_uk on July 16, 2005, at 8:12:15

Moclobemide was agitating for me, much more so than Parnate. Some people don't get any effect from moclobemide but I noticed it straight away and had to keep reducing the dose to avoid agitation (75mg/d was OK). I was also taking 400mg SAMe which probably potentiated it.
Declan


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