Catwoman

Increasing Zoloft / sertraline to 200 mg

31 posts in this topic

6 hours ago, browri said:

@Catwoman I actually have an idea that you might be interested in. And @mikl_pls check my work on this one because I know I can count on you ;)

Clomipramine and fluvoxamine may both be the answer here if you're finding that anxiety and OCD-like symptoms are difficult to treat along with your depression:

https://www.ncbi.nlm.nih.gov/pubmed/8666564

Clomipramine (as a molecule hereby referred to as CMI) is extensively metabolized by CYP1A2 to desmethylclomipramine (DCMI). While CMI is a strong serotonin reuptake inhibiter, DCMI is mostly a norepinephrine reuptake inhibitor. CMI has a shorter half-life ranging from 19 to 37 hours while DCMI ranges from 54 to 77. This means clomipramine as a whole at steady state has a higher affinity for the norepinephrine transporter.

Luvox happens to be a strong CYP1A2 inhibitor (as well as an SSRI of course) and by taking it with clomipramine, you can increase the levels of CMI in your system and this fluvoxamine/clomipramine combination would be a much stronger serotonin reuptake inhibitor combined with the potency of fluvoxamine's sigma receptor properties.

In fact, Stephen Stahl goes into this combination in some detail in his Essential Psychpharmacology PDR.

Thoughts?

Great article! The only thing I foresee is increased levels of clomipramine from coadministration with fluvoxamine, so low doses of clomipramine would need to be used, and probably even routine blood work to monitor the levels of clomipramine to make sure they're within therapeutic range and not in toxic range.

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17 hours ago, mikl_pls said:

Apparently, they've used up to 400 mg sertraline before in treatment-refractory patients.
https://www.ncbi.nlm.nih.gov/pubmed/16426083

Yes, I found that article earlier. I've been on 250 mg for about two weeks, but it seemed to make my intrusive thought(s) more frequent....Not sure if 400 mg does the trick when 20 mg of ecitalopram and 200 mg of fluvoxamine did...
I think I could handle 400 mg (though I should not take it before bed, because it irritates my stomach and esophagus) but I don't think my doctor would approve.

I wonder about the role of those sigma recepters, since sertraline is an antagonist and fluvoxamine and fluoxetine are angonists at that site.

Edited by Catwoman

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7 hours ago, mikl_pls said:

Great article! The only thing I foresee is increased levels of clomipramine from coadministration with fluvoxamine, so low doses of clomipramine would need to be used, and probably even routine blood work to monitor the levels of clomipramine to make sure they're within therapeutic range and not in toxic range.

I found a Dutch article on that combo:

http://www.dejongepsychiater.nl/onderzoek/842-fluvoxamine-clomipramine-ocd-depressie

Maybe Google Translate will work. The writers of the article aren't quite sure if there's enough clinical evidence of the addition of clomipramine to fluvoxamine.
But they do think it can be useful for refractory OCD....

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3 hours ago, Catwoman said:

I found a Dutch article on that combo:

http://www.dejongepsychiater.nl/onderzoek/842-fluvoxamine-clomipramine-ocd-depressie

Maybe Google Translate will work. The writers of the article aren't quite sure if there's enough clinical evidence of the addition of clomipramine to fluvoxamine.
But they do think it can be useful for refractory OCD....

Makes me wonder what the difference between combining clomipramine and fluvoxamine and just administering supratherapeutic doses of fluvoxamine is (> 300 mg/day).

As for the interaction between CYP1A2, luckily most of the population are rapid CYP1A2 metabolizers.

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17 hours ago, Savannah said:

There are many books by Stahl including several that say "Essential Psychopharmacology ".

 

which o you recommend?

The one I have is the 5th Edition of his Prescriber's Guide, but the 6th Edition just came out. I've gotta get it.

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