TCA and SSRI

[pharmacology888]

I know MAOI's cannot be combined with either TCA's and SSRI's, but what about the combination of TCA's and SSRI's? Won't concomitant use of these two increase Serotonin and can therefore lead to serotonin syndrome and hypertensive crisis? I used an interaction checker and I put in imipramine and cymbalta, and no interactions popped up so I am kind of confused.

Also, should one restrict tyramine containing foods when on anyone of these antidepressants or just with the MAOI's?

thanks

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[njac]

just MAOIs and Linezolid as far as I know on the tyramine foods.

I have seen TCA + SSRI used. I think it requires further monitoring and a higher potential for serotonin syndrome but I think it can be done.

I would try the interaction checked with a pure SSRI, like citalopram rather than duloxetine.

 

[RogerWilco]

Generally tertiary amines like amitryptiline and imipramine affect serotonin and norepi whereas secondary amines like desipramine and nortryptiline are more potent for preventing norepi re-uptake. (tertiary amines are eventually metabolized to secondary amines)

 

[slaitken]

The combination of an SSRI and TCA can lead to serotonin syndrome, but it doesn't often result in as severe a condition as the SSRI/MAOI combination would.

On a side note, some drugs in the SSRI class are strong inhibitors of the CP450 system, which can lead to toxic levels of a TCA when used in combination. This might not necessarily cause serotonin syndrome, but it can lead to other toxicities resulting from excessive levels of a TCA.

 

[twester]

Additionally, TCAs have broad side effect profiles, which limits their use. Patients just don't tolerate them very well. If they are used together it is not usually for depression alone. The TCAs are used for a lot of other reasons, like peripheral neuropathy migraine prophylaxis and fibromyalgia.

 

[Pharmavixen]

Where I work, TCAs and SSRIs are used together all the time. Theoretically, there's an increased risk of serotonin syndrome, but I've personally never seen it.

A common combination is citalopram with trazodone. Citalopram doesn't have the CP450 issues of, say, fluvoxamine. Usually the SSRI is used as an antidepressant while the trazodone is for sleep (and also it boosts the SSRI).

I was a bit taken aback when I first saw this combination (ten years ago, maybe?), but it's popular amongst psychiatrists.

 

[FruitFly]

Where I work, TCAs and SSRIs are used together all the time. Theoretically, there's an increased risk of serotonin syndrome, but I've personally never seen it.

A common combination is citalopram with trazodone. Citalopram doesn't have the CP450 issues of, say, fluvoxamine. Usually the SSRI is used as an antidepressant while the trazodone is for sleep (and also it boosts the SSRI).

I was a bit taken aback when I first saw this combination (ten years ago, maybe?), but it's popular amongst psychiatrists.

Yeah, I see that all the time...