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Dr. Bob is Robert Hsiung, MD,
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Posted by Jedi on August 13, 2005, at 2:51:36
In reply to Re: I don't hate amitriptyline (Elavil) anymore......., posted by Tom Twilight on July 27, 2005, at 9:54:30
> Could/would you take 10mg amitriptyline (with 10mg Parnate) for sleep? You reckon Zolpidem would be better? Any other suggestions?
> > Declan
>
> Hey Declan
>
> I'm not Ed, but I'm on 30mgs of Marplan, last night I took 20mgs of Amitryptaline for sleep
> I felt fine the next day
>
> I imagine that the major risk from this combination is serotonin syndrome, but at low doses I don't imagine this would be a problem
> Still its early days
>Hi,
Though officially contraindicated the MAOI/tricyclic combination has been well studied. I have used phenelzine with nortriptyline (the active metabolite of amitriptyline) with no problem. The usual method is to add the MAOI to an established dosage of tricyclic or start the two simultaneously. Some people have been able to go the other way, but it is more risky. At the small dosage your describing, I don’t know.
JediHere is an abstract of a long-term combination study:
J Affect Disord. 1995 Jun 8;34(3):187-92.
A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.Berlanga C, Ortega-Soto HA.
Division of Clinical Research, Mexican Institute of Psychiatry, Mexico, DF.Treatment-resistant depression is a clinical complication that not infrequently affects a certain number of patients. Within the treatment strategies proposed for this condition, the association of a MAO inhibitor (MAOI) with a tricyclic antidepressant has gained reputation both for its unusual efficacy, as for its potential toxicity. However, when cautions are taken, it may be safely administered. Most reports on this combination have been carried in nonresistant patients and, when resistant patients are included, only the acute phase of the treatment is reported. In this study, a group of well-defined resistant patients received an open trial with the association of isocarboxazide and amitryptiline (n = 25). Those who responded were followed during the next 3 years (n = 12) and every 6 months an attempt was made to discontinue the MAOI and continue only with amitryptiline. At the end of the study, 4 patients maintained response with single medication, 6 still required both drugs and 2 relapsed. No clinical differences were apparent between the outcome groups, except that those who maintained their response only with the 2 combined drugs had more previous depressive episodes than the others. The isocarboxazide/amitryptiline combination may be a good treatment option for at least some forms of resistant depression. The safety of this treatment modality is confirmed, even when given for long periods of time. The study also suggest that there are no clinical characteristics in resistant depression that may predict the treatment outcome but, perhaps in some patients, a combined treatment is required to obtain a broader biochemical effect that could convert them from nonresponders to responders.
PMID: 7560546 [PubMed - indexed for MEDLINE]
Posted by darkhorse on August 13, 2005, at 3:57:50
In reply to MAOI combined with tricyclic, posted by Jedi on August 13, 2005, at 2:51:36
I tried Amitriptyline 25mg with Tranylcypromine 60mg with no ill effects.
Not all TCA's are containdicated with MAOIs;the more serotonergics are more dangerous, so apart from Clomipramine,Imipramine,all SSRIs,Venlafaxine,Duloxetine(and maybe Milnacipran),any other Antidepressant would not cause a problem(e.g all other TCAs,Maprotiline,Reboxetine,Trazodone,Mirtazapine..etc)
Posted by KaraS on August 13, 2005, at 15:09:15
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 12, 2005, at 1:17:24
> Hi K!
>
> Have you ever tried amitriptyline?
>
> ~Ed xOnly once. The first doctor I went to for anxiety/depression gave me a 75 mg. sample of amitriptyline to take. I was out for a couple of days. I know it was way too big a starting dose but still I've never gone near it again!
K
xx
Posted by ed_uk on August 13, 2005, at 18:15:58
In reply to Re: Amitriptyline is ok » ed_uk, posted by KaraS on August 13, 2005, at 15:09:15
Arghhhhhhh! Start at 10mg if you want to try it - I'd expect you'd like it.
~Ed
Posted by KaraS on August 13, 2005, at 19:06:24
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 13, 2005, at 18:15:58
> Arghhhhhhh! Start at 10mg if you want to try it - I'd expect you'd like it.
>
> ~Ed
Probably but what's the advantage over doxepin? They're very similar, aren't they?L
Posted by Jedi on August 13, 2005, at 19:09:27
In reply to Re: MAOI combined with tricyclic » Jedi, posted by darkhorse on August 13, 2005, at 3:57:50
> I tried Amitriptyline 25mg with Tranylcypromine 60mg with no ill effects.
>
> Not all TCA's are containdicated with MAOIs;the more serotonergics are more dangerous, so apart from Clomipramine,Imipramine,all SSRIs,Venlafaxine,Duloxetine(and maybe Milnacipran),any other Antidepressant would not cause a problem(e.g all other TCAs,Maprotiline,Reboxetine,Trazodone,Mirtazapine..etc)Hi,
Obviously the US prescribing information provided by Pfizer for phenelzine is overly conservative. What this does is make it very difficult for people to know what is really dangerous and what is not. I have eaten many of the foods and taken many of the medications that are warned about in the prescribing information for phenelzine and tranylcypromine. However, I will not advise another person to do the same. I do my own research and take my own chances. I have been burned in the past listening to advice from pharmacists and MDs. Once a supermarket pharmacist told me a cough syrup I asked them about would be fine with phenelzine as long as it didn’t contain dextromethorphan. That should have been my clue right there that she didn’t know what she was talking about. I had misplaced my reading glasses or I could have seen the microscopic print, 30mg pseudoephedrine hydrochloride. That was a $1000 mistake: a mild hypertensive crisis, a trip to the ER, and a CT scan later. It could have been much worse. If she didn’t know the answer for sure, that’s what those computer terminals are for.The best source for actual MAOI food restrictions I’ve found:
http:/www.dr-bob.org/babble/20010814/msgs/75408.html
This list was compiled by Elizabeth; “the guru of treatment resistant depression”. In my experience with MAOIs, I’ve found it to be very accurate. Does anyone know what Elizabeth is doing now? She was a wealth of knowledge in the earlier days of babble.
JediPrescribing information for phenelzine:
http://www.pfizer.com/pfizer/download/uspi_nardil.pdf… “CONTRAINDICATIONS
NARDIL should not be used in patients who are hypersensitive to the drug or its
ingredients, with pheochromocytoma, congestive heart failure, a history of liver disease,
or abnormal liver function tests.
The potentiation of sympathomimetic substances and related compounds by MAO
inhibitors may result in hypertensive crises (see WARNINGS). Therefore, patients being
treated with NARDIL should not take sympathomimetic drugs (including amphetamines,
cocaine, methylphenidate, dopamine, epinephrine, and norepinephrine) or related
compounds (including methyldopa, L-dopa, L-tryptophan, L-tyrosine, and
phenylalanine). Hypertensive crises during NARDIL therapy may also be caused by the
ingestion of foods with a high concentration of tyramine or dopamine. Therefore, patients
being treated with NARDIL should avoid high protein food that has undergone protein
breakdown by aging, fermentation, pickling, smoking, or bacterial contamination.
Patients should also avoid cheeses (especially aged varieties), pickled herring, beer, wine,
liver, yeast extract (including brewer’s yeast in large quantities), dry sausage (including
Genoa salami, hard salami, pepperoni, and Lebanon bologna), pods of broad beans (fava
beans), and yogurt. Excessive amounts of caffeine and chocolate may also cause
hypertensive reactions.NARDIL should not be used in combination with dextromethorphan or with CNS
depressants such as alcohol and certain narcotics. Excitation, seizures, delirium,
hyperpyrexia, circulatory collapse, coma, and death have been reported in patients
receiving MAOI therapy who have been given a single dose of meperidine. NARDIL
should not be administered together with or in rapid succession to other MAO inhibitors
because HYPERTENSIVE CRISES and convulsive seizures, fever, marked sweating,
excitation, delirium, tremor, coma, and circulatory collapse may occur. ...
Posted by Jedi on August 13, 2005, at 19:19:17
In reply to Nardil - US Prescribing Information from Pfizer, posted by Jedi on August 13, 2005, at 19:09:27
The link to Elizabeth's "MAOI Short List" of food restrictions didn't convert for me. Copy and paste to your address line and it will take you there.
Jedi
Posted by ed_uk on August 14, 2005, at 9:20:27
In reply to Re: Amitriptyline is ok » ed_uk, posted by KaraS on August 13, 2005, at 19:06:24
Hi K,
>Probably but what's the advantage over doxepin?
I've always believed that amitriptyline was probably more effective. It's a much more potent serotonin and NE reuptake inhibitor than doxepin. It's a better established AD. It's probably more likely to cause tachycardia though........ but not much as desipramine.
Ed xx
Posted by ed_uk on August 14, 2005, at 9:22:43
In reply to Nardil - US Prescribing Information from Pfizer, posted by Jedi on August 13, 2005, at 19:09:27
Hi,
>This list was compiled by Elizabeth; “the guru of treatment resistant depression”.
Wasn't she just!
>Does anyone know what Elizabeth is doing now?
I tried to find out but I couldn't, no one seems to know for sure.
Kind regards
~ed
Posted by darkhorse on August 14, 2005, at 12:05:42
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 14, 2005, at 9:20:27
Hi ED :
> I've always believed that amitriptyline was probably more effective. It's a much more potent serotonin and NE reuptake inhibitor than doxepin. It's a better established AD. It's probably more likely to cause tachycardia though........ but not much as desipramine.Me too. In my opinion Doxepin is a powerful anti-histamine medican, with very mild 5ht/ne uptake as a bonus!
However I agree that Amit. is a potent NE/5ht,5ht2 antagonist,and anti- histaminic as a bonus!
Yes, desipramine gave me the 2nd worst tachycardia ever (after the pro-aggression/depressive Sibutramine).
Posted by KaraS on August 14, 2005, at 15:50:06
In reply to Re: Amitriptyline is ok » KaraS, posted by ed_uk on August 14, 2005, at 9:20:27
> Hi K,
>
> >Probably but what's the advantage over doxepin?
>
> I've always believed that amitriptyline was probably more effective. It's a much more potent serotonin and NE reuptake inhibitor than doxepin. It's a better established AD. It's probably more likely to cause tachycardia though........ but not much as desipramine.
>
> Ed xx
Thanks. Maybe someday I'll try it again. Right now, since it is more likely to cause tachycardia, then I think I'll stay away from it. I don't want to be combining it with the Dex.K xx
Posted by KaraS on August 14, 2005, at 15:54:34
In reply to Re: Amitriptyline is ok » ed_uk, posted by darkhorse on August 14, 2005, at 12:05:42
> Hi ED :
>
> > I've always believed that amitriptyline was probably more effective. It's a much more potent serotonin and NE reuptake inhibitor than doxepin. It's a better established AD. It's probably more likely to cause tachycardia though........ but not much as desipramine.
>
> Me too. In my opinion Doxepin is a powerful anti-histamine medican, with very mild 5ht/ne uptake as a bonus!
> However I agree that Amit. is a potent NE/5ht,5ht2 antagonist,and anti- histaminic as a bonus!
> Yes, desipramine gave me the 2nd worst tachycardia ever (after the pro-aggression/depressive Sibutramine).
>
Yes, doxepin's anti-histamine effect has been great for me for a number of reasons.I'm surprised that you're calling sibutramine "pro agression/depressive". I know of two people who have mentioned recently that they really want to try it as an AD (one of them being SLS).
k
Posted by KaraS on August 14, 2005, at 17:45:33
In reply to Re: Amitriptyline is ok, posted by KaraS on August 14, 2005, at 15:54:34
Posted by Phillipa on August 14, 2005, at 18:28:48
In reply to Re: Amitriptyline is ok, posted by KaraS on August 14, 2005, at 15:54:34
Hi Kara, Just wondering if you'd heard from Scott SLS. Last time I saw a post he wasn't doing well at all with his trileptal. Fondly, Phillipa
Posted by KaraS on August 14, 2005, at 18:36:32
In reply to Re: Amitriptyline is ok » KaraS, posted by Phillipa on August 14, 2005, at 18:28:48
> Hi Kara, Just wondering if you'd heard from Scott SLS. Last time I saw a post he wasn't doing well at all with his trileptal. Fondly, Phillipa
Hi,He posted a couple times recently further down on the board. You may have seen his posts already by the time you read this.
K
Posted by darkhorse on August 15, 2005, at 7:09:37
In reply to Re: Amitriptyline is ok, posted by KaraS on August 14, 2005, at 15:54:34
> I'm surprised that you're calling sibutramine "pro agression/depressive". I know of two people who have mentioned recently that they really want to try it as an AD (one of them being SLS).
>
> kHello Kara :
When Sibutramine came out,I was so excited by it: a theoraticaly AD (5ht/Ne/Da action)+ Weight loss!Sadly I tried it several times and for relativly long periods with diff. doses (10-15-20-30),but all I got from the 2nd day onwards is an increase in hostility,aggresion and agitation.I was frowning all the time.
I tried to tame this by adding Fluoxetine& benzoz but to no avail.
I could have tolerated the Tachycardia and the sweating and insomnia,but this aggressive effect was too much for me and everybody else who came my way.When I stopped it I felt such a huge relief.
I also asked 2 other people who had no psyc. history and tried it to lose weight and told me they could not tolerate it because of its hostile irritable depressive effect.
Sibutramine is not alone:
Milnacipran did the same,and it is supposed to be an official AD!
Also Bupropion had an irritable/dysphoric effect on me.
And last,but not least, Reboxetine,though did not make me hostile, within a couple of days I was the most miserable person on earth.
It triggered a terrible depression that rapidly makes you wondee if life is worth living.When I stopped Sibutramine,Milnacipran,Bupropion and Reboxetine, within a day or 2 I was back to normal.
I've tried many many ADs,but the ones mentioned stand out as being the worst ever,as they effect you in the opposite direction.
Just my experience.
P.S. note that Sibutramine , Milnacipran and Reboxetine are not popular medications,even though they are new,so there must be an explanation to this??
All the best!
Dark Horse.
Posted by ed_uk on August 15, 2005, at 7:19:36
In reply to Re: Amitriptyline is ok » KaraS, posted by darkhorse on August 15, 2005, at 7:09:37
Hi DH!
I know you like imipramine. How did desipramine and nortriptyline affect your mood?
~ed
Posted by darkhorse on August 15, 2005, at 8:15:46
In reply to Re: Amitriptyline is ok » darkhorse, posted by ed_uk on August 15, 2005, at 7:19:36
Hi ED!
>
> I know you like imipramine. How did desipramine and nortriptyline affect your mood?
>
> ~edI still think that imipramine is the most balanced AD ever, with 50+ years of proven efficacy for Major depression,PD,GAD ..etc.
I took desipramine only with sertraline and later with Fluoxetine. I do not think it made a difference,except tachycardia.
Nortriptyline is different.When I took the first few doses,I felt everything was more colourful (vision-wise)really!- Nefazodone did the same but with headeache and apathy-.Anyway,after a few days this effect was overcome by more concentration,but not so much anxiolytic effect.I just stopped it since I did not feel great benefit from it,but at least had some effect,unlike desipramine.
BTW, I notice that Venlafaxine is talked about a lot in PB.There is a lot of talk about its withdrawal . I do not know, but I think that Venlafaxine was a very very good medication for me,and,except sweating, it was a clean drug.I have not experienced the withdrawal at all!
I rank it aon top of best AD (along with imip.,Amit,&fluox).Also it is very different from the other so-called SNRIs :
- Milnacipran is a totally different one with pro aggresive action.
-Duloxetine is totally the opposite with full-blown apathy,but Venlafaxine has the same anxiolytic effect of SSRIs + better concentration and a little activation,even in a tiny dose (25mg a day).
Opinion?Dark Horse
Posted by KaraS on August 15, 2005, at 10:03:56
In reply to Re: Amitriptyline is ok » KaraS, posted by darkhorse on August 15, 2005, at 7:09:37
Good to know. You're probably right - if it were such a great AD and well as weight loss drug, then it would probably be a lot more popular by now.
K
Posted by ed_uk on August 15, 2005, at 11:01:45
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » ed_uk, posted by darkhorse on August 15, 2005, at 8:15:46
Hi DH!
>I do not think it made a difference,except tachycardia.
It's interesting that it didn't make you depressed or agressive like reboxetine - another NRI.
>Nortriptyline is different.When I took the first few doses,I felt everything was more colourful (vision-wise)really!- Nefazodone did the same but with headeache and apathy........
They both block 5-HT2 receptors, perhaps that could have something to do with it. Do you get the same 'colour' effect from other 5-HT2 antagonists, like amitripyline?
>Venlafaxine
It was very similar to an SSRI for me. The withdrawal wasn't too bad.
>Duloxetine is totally the opposite with full-blown apathy.......
It's interesting how many babblers switched from Effexor to Cymbalta, expecting Cymbalta to cause less apathy....... and then it caused more!
>Milnacipran
It sounds like sibutramine!
mfg :-)
~ed
Posted by SLS on August 15, 2005, at 18:09:14
In reply to Re: Sibutramine » darkhorse, posted by KaraS on August 15, 2005, at 10:03:56
> Good to know. You're probably right - if it were such a great AD and well as weight loss drug, then it would probably be a lot more popular by now.
>
> K
Peter Mueller, MD (one of the discoverers of seasonal affective disorder) swears by sibutramine. I still have it on my list of things to try.
- Scott
Posted by KaraS on August 15, 2005, at 22:01:29
In reply to Re: Sibutramine, posted by SLS on August 15, 2005, at 18:09:14
> > Good to know. You're probably right - if it were such a great AD and well as weight loss drug, then it would probably be a lot more popular by now.
> >
> > K
>
>
> Peter Mueller, MD (one of the discoverers of seasonal affective disorder) swears by sibutramine. I still have it on my list of things to try.
>
>
> - Scott
Hi Scott,I knew if I changed the title of the post to "Sibutramine" that I'd get a response from you and get a different opinion. :-)
Actually after I posted my response I thought about it some more and realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
Kara
Posted by darkhorse on August 16, 2005, at 3:59:01
In reply to Re: Sibutramine » SLS, posted by KaraS on August 15, 2005, at 22:01:29
realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
>
> KaraHi Kara :
I tried Desipramine,Nortriptyline and Maprotiline (The most selective NE inhibitor),and non of them made me irritable.
Dark Horse.
Posted by darkhorse on August 16, 2005, at 4:14:44
In reply to Re: Amitriptyline is ok/Venlafaxine/SNRIs » darkhorse, posted by ed_uk on August 15, 2005, at 11:01:45
> Hi ED
> It's interesting that it didn't make you depressed or agressive like reboxetine - another NRI.There must be something odd about Reboxetine.I'm sure of it!
>
> >Nortriptyline is different.When I took the first few doses,I felt everything was more colourful (vision-wise)really!- Nefazodone did the same but with headeache and apathy........
>
> They both block 5-HT2 receptors, perhaps that could have something to do with it. Do you get the same 'colour' effect from other 5-HT2 antagonists, like amitripyline?No.Maybe the strong antihistaminic effect makes ones vision more foggy than colourful!
>
> >Venlafaxine> It's interesting how many babblers switched from Effexor to Cymbalta, expecting Cymbalta to cause less apathy....... and then it caused more!
Yes,it is true.Duloxetine made me a vegetable from the 1st dose!but not Efexor.
DH
Posted by darkhorse on August 16, 2005, at 4:17:26
In reply to Re: Sibutramine, posted by darkhorse on August 16, 2005, at 3:59:01
> realized that any drug with significant NE reuptake or increase may be contraindicated for darkhorse given the list of meds that made that poster irritable and more aggressive. So my mind is open on this one again.
> >
> > Kara
>
> Hi Kara :
>
> I tried Desipramine,Nortriptyline and Maprotiline (The most selective NE inhibitor),and non of them made me irritable.
>All the best!
> Dark Horse.
>
>
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