Posted by bleauberry on May 11, 2009, at 16:55:02
In reply to clomipramine plus milnacipran, posted by uncouth on May 10, 2009, at 13:49:34
> is this combo safe?
>
> i know some TCAs plus SSRIs are OK, but not sure about clomipramine, as it supposedly hits serotonin a bit harder than nortriptyline or desipramine (which to my knowledge are safe with an SNRI).
>
> anyone?All I know is that in Japan it is fairly common to combine either Paxil or Luvox with Milnacipran. Milnacipran's strong action on NE I think maybe gives it some elbow room for safety when combined with other serotonin meds. Not sure how or why. But it is combined with potent SSRIs.
In your case I think it makes sense to reduce the meds to as few as possible...one or two...and stay on those meds for at least 8 to 12 weeks without changing anything. Jumping in with another med before that timeframe has been met just screws up the whole process and significantly lowers any hope of progress.
It is actually very similar to how my doctor treats my Lyme and yeast issues. One thing at a time, and a full month at each new thing. There is no way otherwise to know what is doing what, good or bad.
As a sidenote, in a clinical trial it was shown that most of the patients who had not responded to Milnacipran at 100mg (your dose, right?), did respond significantly to 150mg. In another small study, 4 of 5 treatment resistant patients went into remission when Risperdal .25mg-1mg was added to Milnacipran. In a case study, a woman with delusional treatment resistant depression went into remission with Milnacipran and Zyprexa.
Milnacipran and Clomipramine? Who knows. I would be more inclined to try to duplicate what worked for others first. In those trials however, their only meds before adding a new one were Milnacipran and sometimes a sleep aid. The more meds in the cocktail, well, it gets real hard to make any progress. One at a time.
Someone else here recently had failed all kinds of meds and combos, and yet was feeling a lot better with a simple combo of Nortriptyline and Zoloft. Ya know? More is not usually better. Keep it simple, give each med a good long time to know if it is worth keeping or not. If it isn't doing a lot of good, ditch it. Don't add something to a loser med.
I think clomipramine and milnacipran would be safe, but it would be wise to creep up in dose cautiously. Both meds could be synergistic, especially considering Clomipramine's 5ht2 antagonism, which is sort of similar to the antipsychotics. But as I've mentioned, I think there are better options.
poster:bleauberry
thread:895040
URL: http://www.dr-bob.org/babble/20090505/msgs/895210.html