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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Honore on June 30, 2007, at 16:29:01
I noticed recently that someone was asking for articles recommending or suggesting the appropriateness of stimulants with MAOIs for daytime sleepiness. This article, which addresses that issue, happened to be in a search I was doing on Medline.
Database Ovid MEDLINE(R)
Unique Identifier 15554766
Authors Feinberg SS.
Authors Full Name Feinberg, S Shalom.
Institution Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, USA. Shalomf@aol.com
Title Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication. [Review] [44 refs]
Source Journal of Clinical Psychiatry. 65(11):1520-4, 2004 Nov.
NLM Journal Name The Journal of clinical psychiatry
Abstract BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study. [References: 44]
Publication Type Case Reports. Journal Article. Review.Honore
Posted by KayeBaby on July 2, 2007, at 22:24:24
In reply to Article discussing use of stimulants w/MAOIs, posted by Honore on June 30, 2007, at 16:29:01
Thank you, Honore.
I am interested in the safety and efficacy of this combo.
Who has taken a stim+maoi? How is/did it work?
Kaye
Posted by linkadge on July 3, 2007, at 9:00:32
In reply to show of hands-who has tried this?, posted by KayeBaby on July 2, 2007, at 22:24:24
is combining a stimulant and a monoamine oxidase inhibitor.
Linkadge
Posted by Honore on July 4, 2007, at 22:15:34
In reply to Re: Anyone who smokes, posted by linkadge on July 3, 2007, at 9:00:32
I've used provigil, ritalin, and adderall, at different times. I haven't had problems with any of them.
Honore
Posted by sobeit on July 5, 2007, at 17:49:40
In reply to show of hands-who has tried this?, posted by KayeBaby on July 2, 2007, at 22:24:24
A few years ago I was prescribed methylphenidate (Focalin) with phenelzine, and then a short-course trial of dextroamphetamine (Adderall) with phenelzine to attempt to reduce the daily sleepiness/grogginess I experienced with the maoi alone. With both regimens I experienced greater insomnia and orthostatic hypotention, and no improvement in the hypersomnolance.
This is the end of the thread.
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