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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by TriedEveryMedication on February 20, 2015, at 16:03:12
strattera? Yeah, I know the prescribing info says this is a no-no.
I've seen some studies with moclo and other TCAs.
Has anyone personally tried this combo or read anything about it?
I like the mood boost and sociability moclo gives me, but I need the focus desipramine gives me.
Thank you.
Posted by Christ_empowered on February 20, 2015, at 16:47:23
In reply to can moclobemide be combined with desipramine or, posted by TriedEveryMedication on February 20, 2015, at 16:03:12
I dunno. I think desipramine has been combined with old school MAOI drugs w/o too many problems. I could be wrong though..maybe its Pamelor I'm thinking of? Anyway, MAOI+TCA combos aren't unheard of.
Important thing is...what does your shrink have to say?
Posted by TriedEveryMedication on February 20, 2015, at 17:54:10
In reply to Re: can moclobemide be combined with desipramine or, posted by Christ_empowered on February 20, 2015, at 16:47:23
> I dunno. I think desipramine has been combined with old school MAOI drugs w/o too many problems. I could be wrong though..maybe its Pamelor I'm thinking of? Anyway, MAOI+TCA combos aren't unheard of.
>
> Important thing is...what does your shrink have to say?he's heard of doctors doing it. He considers it advanced for his skill level.
Posted by Christ_empowered on February 20, 2015, at 18:16:45
In reply to Re: can moclobemide be combined with desipramine or, posted by TriedEveryMedication on February 20, 2015, at 17:54:10
could you try something more traditional, like the tca+ a stimulant?
Posted by TriedEveryMedication on February 20, 2015, at 19:08:45
In reply to Re: can moclobemide be combined with desipramine or, posted by Christ_empowered on February 20, 2015, at 18:16:45
> could you try something more traditional, like the tca+ a stimulant?
see my user name :)
I should change it to TriedEveryCombination :D
Posted by linkadge on February 20, 2015, at 21:05:29
In reply to Re: can moclobemide be combined with desipramine or, posted by TriedEveryMedication on February 20, 2015, at 19:08:45
I think one of the metabolites of desipramine is more selective towards serotonin. Nortriptyline might be safer (?) although I don't know for sure. I would start very low and go very slow.
Linkadge
Posted by ed_uk2010 on February 22, 2015, at 16:21:07
In reply to Re: can moclobemide be combined with desipramine or, posted by linkadge on February 20, 2015, at 21:05:29
>I think one of the metabolites of desipramine is more selective towards serotonin.
I read that too, but I'm unsure if it's produced in clinical relevant amounts.
>Nortriptyline might be safer (?) although I don't know for sure.
Nortriptyline also gives some 5-HT receptor blockadge. On the other hand, it's less selective for NET than desipramine.
Moclobemide is much less powerful than classical MAOIs with respect to elevating serotonin. As such, some people can even tolerate it in combo with SSRIs! Small clinical trials have looked at this combination. Although it did not produce the life-threatening serotonin toxicity reliably induced by the SSRI + classical MAOI combination, intolerable serotonergic side effects were frequent.
My opinion of the moclobemide + desipramine combination is that it's unlikely to produce serotonin syndrome. Any side effects are likely to be typical of each individual drug. As you say, the initial dose of desipramine should be very low because the combination is untested. The combination probably isn't a good idea in someone who hasn't tried and tolerated each drug separately.
Posted by TriedEveryMedication on February 22, 2015, at 18:51:11
In reply to Re: can moclobemide be combined with desipramine or » linkadge, posted by ed_uk2010 on February 22, 2015, at 16:21:07
According to the article below, NRIs like desipramine completely block tyramine update and the pressor effect.
that is a good thing when dealing with MAOIs, right?
Do you think it is preferable to start one of the drugs first then add the other? Which order?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014120/
interesting - found this - SLS said he was on parnate and desipramine at much higher doses of desip than I plan on going on (me, like 10-20mg works for adhd)
Posted by ed_uk2010 on February 23, 2015, at 11:54:57
In reply to Re: can moclobemide be combined with desipramine or, posted by TriedEveryMedication on February 22, 2015, at 18:51:11
> According to the article below, NRIs like desipramine completely block tyramine update and the pressor effect.
>
> that is a good thing when dealing with MAOIs, right?Yes, it is. I doubt that very low doses of desipramine would be enough to completely block the effect, but it might be reduced.
> Do you think it is preferable to start one of the drugs first then add the other?
It used to be claimed you should add an MAOI to a TCA, rather than the other way around. I'm unsure of the rationale for this, and it might not apply to low dose desipramine anyway.
Posted by Escapee on March 25, 2015, at 4:57:36
In reply to Re: can moclobemide be combined with desipramine or, posted by ed_uk2010 on February 23, 2015, at 11:54:57
> It used to be claimed you should add an MAOI to a TCA, rather than the other way around. I'm unsure of the rationale for this, and it might not apply to low dose desipramine anyway.
>You're right Ed. My docs have mentioned that a couple of times but gone ahead and added the TCA to MAOI anyway. NRIs I've added to the full MAOIs phenelzine and isocarboxazid are the NRI lofepramine up to 210mg (metabolite of desipramine), the NDRI bupropion up to 450mg and the SNRI amitriptyline 100mg.
This is the end of the thread.
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