Psycho-Babble Medication Thread 1016071

Shown: posts 1 to 17 of 17. This is the beginning of the thread.

 

Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on April 20, 2012, at 21:00:15

I tried to post this earlier but I think it may have been lost in the interwebs. I've been taking Sertraline 200 mg and Tryptophan 8 grams for approximately three weeks. My psychiatrist recently recommended that I add imipramine 25 mgs three times daily in an attempt to overcome my treatment-resistant depression. Has anyone tried the combination of these three before? I've recently been reading interesting things about combining TCAs and SSRIs on this and other sites. Would this combination be generally safe and advisable to take?

 

Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist

Posted by SLS on April 21, 2012, at 12:37:08

In reply to Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 20, 2012, at 21:00:15

> I tried to post this earlier but I think it may have been lost in the interwebs. I've been taking Sertraline 200 mg and Tryptophan 8 grams for approximately three weeks. My psychiatrist recently recommended that I add imipramine 25 mgs three times daily in an attempt to overcome my treatment-resistant depression. Has anyone tried the combination of these three before? I've recently been reading interesting things about combining TCAs and SSRIs on this and other sites. Would this combination be generally safe and advisable to take?


Perhaps you can talk with your doctor about the advantages and disadvantages of using nortriptyline in place of imipramine. Nortriptyline has more mild side effects and is not too heavy on serotonin. It is possible that he wants to use imipramine for its more potent serotonin reuptake inhibitor properties. Of course, you already get that with sertraline. One might consider that adding imipramine places too much of a serotonin load on the system. You would need to screen for serotoinin syndrome. Either way, I hope adding a TCA produces a favorable response for you.

Good luck.


- Scott

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on April 21, 2012, at 14:03:39

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist, posted by SLS on April 21, 2012, at 12:37:08

Serotonin syndrome was my concern, as well. He tried to reassure me that it was highly unlikely and that imipramine would produce the most favourable response to treatment-resistant depression but I want to consider my options. I'm at a point where I'm so depressed that I'm practically mute but I can try articulating that to him. Thank you for your response.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on April 21, 2012, at 15:20:56

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist, posted by SLS on April 21, 2012, at 12:37:08

Serotonin syndrome was my concern, as well. He tried to reassure me that it was highly unlikely and that imipramine would produce the most favourable response to treatment-resistant depression but I want to consider my options. I'm at a point where I'm so depressed that I'm practically mute but I can try articulating that to him. Thank you for your response.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by bleauberry on April 22, 2012, at 7:52:59

In reply to Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 20, 2012, at 21:00:15

My first hunch was that if serotonin syndrome was a risk in this case, then it would have already happened. That's because zoloft is at a high dose and tryptophan is at a super high dose.

One thing for sure....your depression is not much related to serotonin. The inability of zoloft (serotonin) and tryptophan (serotonin) to make a big impact proves it. With that viewpoint, then a TCA makes very good sense. I like SLS suggestion of nortriptyline. I also like the general impression that imipramine might have more depression impact potential than nortriptyline. I wouldn't at this point put too much worry into which TCA to choose, just choose one and know going into it that it might be just one of 3 you will try. At this point the best choice it seems to me would be to go with the doc's hunch.

To counterbalance all that serotonin you've got going on you could also do a ritalin trial and an adderall trial....just a few days each....to sort of test it out and see if there is anything there for you. Unlike most other meds, these work fast good or bad.

The simple addition of rhodiola rosea is as worthy as any other choice. Its potential with your cocktail is at least as good as other med options but in my mind potential better than the meds and comes with wide spectrum stress tolerance/disease resistance mechanisms as well.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by gman22 on April 22, 2012, at 21:44:26

In reply to Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 20, 2012, at 21:00:15

I would just reduce sertraline and try imipramine at a decent dose. It has been proven successful and safe.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by creepy on April 23, 2012, at 7:57:52

In reply to Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 20, 2012, at 21:00:15

Is your doc old-school? They might be trying to gain some of the perceived effectiveness of imipramine without going to a full dose.
I would be careful of the dose too.. imipramine metabolizes into desipramine which can raise desipramine levels something like 300%, and zoloft 150% if I remember right. Might be worth checking if your doc is aware of that interaction.

 

Re: Imipramine, Tryptophan, Sertraline combination. » SLS

Posted by Alexei on April 23, 2012, at 9:30:21

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist, posted by SLS on April 21, 2012, at 12:37:08

> Perhaps you can talk with your doctor about the advantages and disadvantages of using nortriptyline in place of imipramine. Nortriptyline has more mild side effects and is not too heavy on serotonin. It is possible that he wants to use imipramine for its more potent serotonin reuptake inhibitor properties. Of course, you already get that with sertraline. One might consider that adding imipramine places too much of a serotonin load on the system. You would need to screen for serotoinin syndrome. Either way, I hope adding a TCA produces a favorable response for you.
>
> Good luck.
>
> - Scott


The TCA + SSRI mix is something my pdoc & I are likely to try. Specifically zoloft plus either nortriptyline or desipramine. Maybe "creating" your own SNRI might be better than these new ones ... pristiq, cymbalta, etc. I'm finding effexor to be way below average... Not helping.

Now, if we could just figure out whether to use abilify or seroquel to augment, maybe I'll start to feel better.

Good luck, essissentialist ...

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on April 23, 2012, at 14:22:04

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » SLS, posted by Alexei on April 23, 2012, at 9:30:21

Thanks for the replies, everyone. I've contacted my psychatrist about trying the nortriptyline instead of the imipramine initially. We'll see how that goes. I haven't completely ruled-out imipramine at this point, though. I hope that I won't have to experiment any further.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by creepy on April 25, 2012, at 7:14:36

In reply to Re: Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 23, 2012, at 14:22:04

Just make sure your doc is aware of the zoloft + desipramine combo raising the amount of both drugs in your system. If he is, the dose of desipramine would be on the low side. 25-75mg maybe?
I want to try this combo myself since I did so well on desipramine with celexa.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on April 26, 2012, at 14:39:09

In reply to Re: Imipramine, Tryptophan, Sertraline combination., posted by creepy on April 25, 2012, at 7:14:36

Day 3 of the nortriptyline addition at 25 mg and I'm feeling slightly hungover. I'm considering taking it in the morning instead of at night.

 

Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist

Posted by SLS on April 26, 2012, at 19:40:14

In reply to Re: Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 26, 2012, at 14:39:09

> Day 3 of the nortriptyline addition at 25 mg and I'm feeling slightly hungover. I'm considering taking it in the morning instead of at night.

The first few days can be difficult with respect to fatigue and somnolence. After being on it for several weeks, you may not experience these things at all.


- Scott

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on April 27, 2012, at 16:00:05

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist, posted by SLS on April 26, 2012, at 19:40:14

I'm actually grateful to at least be experiencing something in response to it even if that response isn't ideal. I seem to have lost my appetite entirely, too.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on May 2, 2012, at 16:18:14

In reply to Re: Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on April 27, 2012, at 16:00:05

I have a follow-up meeting with my psychiatrist tomorrow. I haven't had much difficulty in terms of side effects with the addition of nortriptyline to the sertraline and tryptophan, but I also haven't had much positive response, either. I'd like to try increasing the nortriptyline, though it's only been a little over a week and I'm wondering what the maximum safe dosage would be. From what I read on psychotropical, sertraline in high doses only increases nortriptyline levels by about 30% and the highest recommended dose is 150 mg, so I was thinking 100 to 125 mg would be safe, though I wouldn't immediately increase to that. THoughts?

 

Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist

Posted by SLS on May 2, 2012, at 17:52:51

In reply to Re: Imipramine, Tryptophan, Sertraline combination., posted by Exisessentialist on May 2, 2012, at 16:18:14

> I have a follow-up meeting with my psychiatrist tomorrow. I haven't had much difficulty in terms of side effects with the addition of nortriptyline to the sertraline and tryptophan, but I also haven't had much positive response, either. I'd like to try increasing the nortriptyline, though it's only been a little over a week and I'm wondering what the maximum safe dosage would be. From what I read on psychotropical, sertraline in high doses only increases nortriptyline levels by about 30% and the highest recommended dose is 150 mg, so I was thinking 100 to 125 mg would be safe, though I wouldn't immediately increase to that. THoughts?

It might be a good plan to test for blood levels of nortriptyline to help guide dosage decisions. Nortriptyline has a therapeutic window of blood concentrations of 50 - 150 ng/ml. Plasma levels outside this range result in a diminished antidepressant effect. It is possible to take too much, even if toxic levels are not reached.


- Scott

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on May 2, 2012, at 19:16:37

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist, posted by SLS on May 2, 2012, at 17:52:51

Okay. I'll look into that, thank you.

 

Re: Imipramine, Tryptophan, Sertraline combination.

Posted by Exisessentialist on May 3, 2012, at 17:52:23

In reply to Re: Imipramine, Tryptophan, Sertraline combination. » Exisessentialist, posted by SLS on May 2, 2012, at 17:52:51

We're going to try 75 mg of nortriptyline for two weeks and see how that goes. Apparently, 75 mg was supposed to be the initial dosage but there was a communication breakdown somewhere.


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