Posted by SLS on July 8, 2004, at 7:52:21
In reply to Re: Disappearance of chronic pain with Effexor? » flipsactown, posted by Sad Panda on July 8, 2004, at 4:27:09
FST:
> Another idea would be to ask my pdoc to Rx Nortriptyline or Amitriptyline to augment Lexapro. I probably will try this first before I try Effexor again because of my previous terrible experience with Effexor's SEs.
I agree with you. I think augmenting the Lexapro makes sense, especially since you are expereriencing a partial response to it. If you opt for nortriptyline instead of desipramine, be sure to use blood levels to help determine proper dosing.
Panda:> Looks like Nort & Effexor raise each others levels somewhat, so I have to be carefull with the dosages.
According to my reference, they do, but not to a large degree. However, since dosage is so critical with nortriptyline when treating depression, you should test for blood levels. It will make things easier.
> Prozac & Paxil look to be bad choice for combination with TCA's because they are inhibitors of CYP2D6 which is the enzyme that is responsible for the metabolism of a lot of drugs.
I don't think they are necessarily bad choices so much as they are choices that require knowledge of pharmocokinetic interactions and appropriate adjustment of dosages. You can pretty much cut the dosage of the TCA in half. Prozac or Paxil + desipramine makes for a reasonable combination. I combined Paxil with desipramine with no trouble at all. Again, blood tests are available to make this a viable option.
I'm surprised that I found the following abstract so easily. It is important to consider that the blood concentrations of desipramine were controlled. Many previous reviews of such combinations offered as discussion the possibility that the increased rate of antidepressant response observed was due to increased blood levels of TCA produced by the CYP2D6 inhibition produced by the SSRI.
Good luck with your new combo!
- Scott
poster:SLS
thread:363567
URL: http://www.dr-bob.org/babble/20040704/msgs/363963.html