![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by SLS on November 1, 2004, at 10:30:04
Combining norepinephrine and serotonin reuptake inhibition mechanisms for treatment of depression: a double-blind, randomized study.
Nelson JC, Mazure CM, Jatlow PI, Bowers MB Jr, Price LH.
Department of Psychiatry, University of California-San Francisco, 401 Parnassus Avenue, Box 0984-5, San Francisco, CA 94143, USA
BACKGROUND: Although several antidepressants are now available, all have limited efficacy and a delayed onset of action. The current study was undertaken as a proof of the concept that combining norepinephrine and serotonin reuptake inhibition would be more effective and act more rapidly than either drug alone. METHODS: Inpatients with nonpsychotic unipolar major depression and a Hamilton Depression Rating Scale (HAMD) score of at least 18 after 1 week of hospitalization without antidepressant medication were randomized to 6 weeks of treatment with fluoxetine (FLX) 20 mg/day, desipramine (DMI) adjusted to an adequate plasma level, or the combination of FLX 20 mg/day and DMI, given under double-blind conditions. Twenty-four-hour DMI levels were used to rapidly adjust DMI dose to achieve a therapeutic level and to anticipate the enzyme-inhibiting effects of FLX. Treatment-resistant patients were stratified. Patients were rated with the HAMD and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Thirty-nine patients began treatment. One patient withdrew consent. The DMI-FLX combination was significantly more likely to result in remission on the MADRS than either FLX or DMI alone [53.8% vs. 7.1% and 0%, respectively; chi(2)(2) = 13.49, p =.001]. The advantage for combined treatment was not explained by history of treatment resistance or by drug plasma concentrations. Rapid response, at 1 or 2 weeks, was neither statistically nor meaningfully greater with combined treatment. CONCLUSIONS: This study supports the hypothesis that the combination of a noradrenergic and serotonergic agent is more likely to result in remission than either selective agent alone during a 6-week treatment period.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14744472 [PubMed - indexed for MEDLINE]
Posted by jboud24 on November 1, 2004, at 13:41:13
In reply to Combining SSRI + desipramine better than SSRI only, posted by SLS on November 1, 2004, at 10:30:04
Hmm, I wonder if we'll see those kind of success rates for TRD with Cymbalta. I bet not.
Justin
Posted by Emily Elizabeth on November 1, 2004, at 18:17:50
In reply to Combining SSRI + desipramine better than SSRI only, posted by SLS on November 1, 2004, at 10:30:04
Wow! Thanks for the post. My pdoc recently added Desipramine to my Lexapro b/c Lex just wasn't getting me through my current depressive episode. It seems like it has made a difference for me. This article helps me believe that we have actually found something more effective and it is not just a coincidence.
Was this just published? I want to tell my pdoc.
EE
Posted by ed_uk on November 2, 2004, at 7:37:04
In reply to Re: Combining SSRI + desipramine better than SSRI only, posted by Emily Elizabeth on November 1, 2004, at 18:17:50
I take the NRI lofepramine with the SSRI citalopram. It seems to be better than taking either drug alone.
Ed
Posted by jujube on November 3, 2004, at 19:31:12
In reply to Re: Combining SSRI + desipramine better than SSRI only, posted by ed_uk on November 2, 2004, at 7:37:04
Ed,
My pdoc just prescribed Anafanil for me, which I am to take with 20 mg of Celexa (citalopram). I am currently on only 40 mg of Celexa. I am hoping to achieve some relief with this combination. I am nervous, however, of the side effects, having never been on a TCA before and having never been on more than one AD at a time. Hopefully I will be able to tolerate any side effects. Do TCAs kick in faster than SSRIs in your experience?
I'm glad you are having success with your combination.Tamara
> I take the NRI lofepramine with the SSRI citalopram. It seems to be better than taking either drug alone.
> Ed
Posted by ed_uk on November 5, 2004, at 20:14:51
In reply to Re: Combining SSRI + desipramine better than SSRI only » ed_uk, posted by jujube on November 3, 2004, at 19:31:12
Hello Tamara.......
Since clomipramine and citalopram are both potent serotonin reuptake inhibitors it may be unwise to combine them. It would probably be safer to try the clomipramine on its own. In my experience, SSRIs and TCAs both seem to take ages to kick in!!!Ed
Posted by Iansf on November 6, 2004, at 1:01:44
In reply to Re: Combining SSRI + desipramine better than SSRI only, posted by ed_uk on November 2, 2004, at 7:37:04
> I take the NRI lofepramine with the SSRI citalopram. It seems to be better than taking either drug alone.
> EdDo you have any sexual dysfunction from the drugsf? Someone recently mentioned that low-dose tricyclics would reverse sexual problems caused by an SSRI alone. I'm just wondering if that's necessarily the case.
John
Posted by jujube on November 6, 2004, at 10:56:02
In reply to Re: Combining SSRI + desipramine better than SSRI only, posted by ed_uk on November 5, 2004, at 20:14:51
Thanks Ed. I have a call into the pdoc to confirm what exactly he wants me to do with the Celexa (I wasn't focussing particularly well at my appointment on Tuesday. Nerves and frustration I guess.). He had said to continue with the Celexa, but at a reduced dose. In a response I received from Sad Panda regarding my concern about the potential for serotonin syndrome when combining the two, he indicated something along the lines that Anafranil has a mechanism built into it so that serontonin syndrome would not be a concern (if I understood correctly. I'll re-read the response just to make sure).
Hopes things are getting better for you. Take care.
Tamara
> Hello Tamara.......
> Since clomipramine and citalopram are both potent serotonin reuptake inhibitors it may be unwise to combine them. It would probably be safer to try the clomipramine on its own. In my experience, SSRIs and TCAs both seem to take ages to kick in!!!
>
> Ed
Posted by ed_uk on November 6, 2004, at 15:51:27
In reply to Re: Combining SSRI + desipramine better than SSRI only » ed_uk, posted by jujube on November 6, 2004, at 10:56:02
Hello Jujube!
Like Sad Panda said, serotonin syndrome is very unlikely. I just thought I'd mention it since it is a possibility. BTW, if you do try the clomipramine and don't like it, there are plenty of other TCAs you could try.
Ed
Posted by ed_uk on November 6, 2004, at 15:56:33
In reply to Re: Combining SSRI + desipramine better than SSRI » ed_uk, posted by Iansf on November 6, 2004, at 1:01:44
Hello John,
No, I don't have any sexual dysfunction from the medication. I never had a problem with the SSRI on its own though!
It's been suggested that adding a low dose of nortriptyline to an SSRI may relieve the sexual side effects of the SSRI by blocking certain serotonin receptors. If this combination was used, it would be helpful to monitor the nortriptyline level in the blood to make sure that it didn't get too high.
Ed
Posted by jujube on November 6, 2004, at 16:12:24
In reply to Re: Combining SSRI + desipramine better than SSRI only, posted by ed_uk on November 6, 2004, at 15:51:27
Thanks Ed. I had actually hoped that the pdoc would give nort, but he prefers clominpramine (Anafranil). You're right, though, if it doesn't work or I can't tolerate it, there is always another one I can try.
Tamara
> Hello Jujube!
> Like Sad Panda said, serotonin syndrome is very unlikely. I just thought I'd mention it since it is a possibility. BTW, if you do try the clomipramine and don't like it, there are plenty of other TCAs you could try.
> Ed
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.