Posted by europerep on August 5, 2011, at 16:28:09
Hello there..
I have another question about neuropharmacology, I hope someone can help me with it...
My last posts were about phenelzine (Nardil), which I tried in another attempt to find a solution to treatment-resistant depression. This was a failure just like tranylcypromine (Parnate), i.e. it actually made me feel worse. It did not give me insomnia the way Parnate did, but the effects on my mood were largely the same.
The two drugs which gave me some benefit so far were high-dose venlafaxine and amitriptyline. Seeing that I tried all kinds of combinations with venlafaxine without success (adding lithium, amitriptyline, bupropion, mirtazapine, aripiprazole, and even buprenorphine), my first idea was to go back on amitriptyline to get some relief and try adding something else to it. Simultaneously, I found a new paper on tramadol as an antidepressant, and I decided to ask my doc whether he would give it to me. Surprise, he did! I now have a box of 50mg slow-release tramadol sitting here :). I'm very excited, but also somewhat scared... but mostly excited.
So, anyhow, the situation is the following: I started amitriptyline less than two weeks ago, I am now at 50mg and I notice an improvement. I conclude from that, that it's the norepinephrine reuptake inhibition that has this effect on me. Amitriptyline's inhibits mostly NE reuptake, and venlafaxine does that as well, but only at higher doses, which would explain why I only responded to high-dose venlafaxine. (Ami has a range of other effects, but I assume these neuroadaptive effects wouldn't "kick in" so quickly, as it would take a little more time for these changes to take place.)
Tramadol also has SNRI properties. So right now I'm not sure what to do: keep on taking amitriptyline and "augment" it with tramadol, or go off amitriptyline and then take tramadol instead. I don't want to lose the partial improvement I have gotten so far, but there is a chance that I would get the same NE reuptake inhibition from tramadol and hence wouldn't need amitriptyline.
So, my question is basically this: what happens when there are two NE reuptake inhibitors in my system (in this case, amitriptyline and tramadol)? With agonistic agents, the stronger agent would replace the agonist with weaker affinity at the receptors, but how does it work with reuptake inhibitors? WOuld the two RI's exert their action simultaneously, or would only the stronger one be active and replace the weaker one? In other words, would there be an additive effect?
I'm tending towards taking tramadol only, and eventually adding amitriptyline if tramadol produces a response, but not remission. Would anyone agree that that is the better strategy?
Any other advice or anything? I'd appreciate any comment!
Thanks,
ER
poster:europerep
thread:992904
URL: http://www.dr-bob.org/babble/20110728/msgs/992904.html