Posted by Peter Jay on February 6, 2002, at 3:41:33
In reply to Re: How do I safely augment SSRIs with anafranil?, posted by petters on February 5, 2002, at 11:17:45
Jane
Thanks for your reply.
You are quite right that an new psychiatrist might be the answer but we are in the UK and have to use the public National Health Service. Changing psychiatrists can take a very, very long time. Nor can we afford to pay for the doctor privately. We are kind of stuck with the doc we have. He is not a bad doc it's just that he is not familiar with some of the med combos.
> The problem with combining these particular drugs (Anafranil/clomipramine
> and Prozac), as Petters has said, is that each of these drugs hasthe
> potential to increase the level of the other one by effecting the enzyme
> system that breaks the drugs down.(1) I can not pretend to be an expert on the complexities of the Cytochrome P450 system but I am aware that there are several sorts of interactions possible here of the enzymes involved. I gather that the P450 system sometimes makes two meds may act synergistically and sometimes the P450 system makes them start to cancel each other out.
(2) In addition to these possible Cytochrome P450 interactions, there is the question of the two meds involved here (Prozac and Anafranil) working together so successfully on raising serotonin levels that the serotonin level because too high. It may be that my friend is partly resistant to one or the other of these two meds and specifically she may be resistant to the specific way in which one prevents the re-uptake of anafranil.
It is mainly the second of the two things above which I am concerned by. Of course (2) may be caused by (1) which makes it even more complicated!
However, I understand that such augmentation is often practised for refractory patients. So I was hoping not to have to delve into the science of it but just to understand what is common clinical practise in approaching such augmentation. I don't want to find that adding a tiny amount of one of these two meds suddenly raises the level of serotonin with the result that we end up with a serotonin overdose!
I am sure that somebody here will either have experienced this augmentation and/or will know about it. Here to hoping tat they will reply!
Peter Jay
poster:Peter Jay
thread:92851
URL: http://www.dr-bob.org/babble/20020131/msgs/93051.html