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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 David Hanifin on December 2, 2018, at 1:36:31
Hi folks,
I've been on Nardil 75mg (MAOI) for almost 5 years now with relatively good results for major depression and generalized anxiety. I have been experiencing frequent moderate to major insomnia though and my doctor at the last minute on my suggestion prescribed me Amitripyline 10mg which I could take before bed. I just wanted to double check is this combination reasonably safe as many websites state that serotonin syndrome maybe an issue with this interaction? Is this possible side effect overstated or should I rethink using it and ask for nortriptyline instead?
In more recent times I have been also diagnosed with aespergers syndrome and have moderate add symptoms also. I have used methamphetamine on past occasions which assisted me in small dosages with the add but I don't use meth frequently much anymore due to the long term toxicity it can cause both in the brain and on the body. Dex is a possible option I will consider when I see a psychiatrist in 2019. Im currently 40 yrs old. Any feedback to my question or ideas as to what I have put in this post would most highly be appreciated. Thanks heaps, David
Posted by atypical on December 2, 2018, at 20:14:45
In reply to Nardil 75mg + Amitripyline 10mg Combination, posted by David Hanifin on December 2, 2018, at 1:36:31
I would suppose that if a side effect of Amitriptyline is sedation and you are taking a small dose, that could work without a high risk of serotonin symdrome. Why not try Trazodone? I take Nardil and took a small dose of Trazodone (like 12.5 mg) for helping to get to sleep for a few months. Trazodone seems to be much more commonly used for insomnia.
Posted by adiaphora on January 16, 2019, at 19:57:26
In reply to Nardil 75mg + Amitripyline 10mg Combination, posted by David Hanifin on December 2, 2018, at 1:36:31
Hi David,
I don't think there's too much published on this topic, but here is the relevant section from a 2015 article in the journal Pharmacology reviewing some of the literature on combination treatment with MAOIs:
MAOI plus TCA
The literature on TCA-and-MAOI combination therapy is mixed. Small studies and case reports have demonstrated its safety, but the combination has generally been found to be less well tolerated than either agent alone.
In addition, there are studies that suggest that the combination is no more efficacious than either agent alone and should be reserved for individuals with high depression scores, TRD, or atypical depression. Our patients who received TCA and MAOI combination therapy show sustained tolerability and efficacy (Table 3, cases 1315;Table 4, cases 1013). Three of the seven patients remained on this regimen for at least 2 years, two of whom also received trazodone in combination with the TCA and MAOI. The combination was discontinued in four patients due to one case of hypotension (patient was also receiving trazodone), one case with suspicion of serotonin syndrome, one patient who experienced fatigue with the combination, and one patient who could not tolerate pruritis associated with the selegiline patch. These results support existing data that this combination is relatively safe, with variable efficacies. If this combination is used, the TCA should be initiated first or at the same time as the MAOI.
It should be noted here that clomipramine, a TCA, exhibits potent inhibition of serotonin and should not be used incombination with an MAOI.
https://deepblue.lib.umich.edu/bitstream/handle/2027.42/111275/phar1576.pdf?sequence=1&isAllowed=y
Hope that is of some help.
p.s. FWIW, I second the suggestion of Trazodone over Amitriptyline if you are just looking for help with sleep. The combination seems to be safer and Trazodone is better on the nasty anticholinergic side effects.
This is the end of the thread.
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