Can moclobimide be taken with mirtazipine?

[JohnBoy2000]

ive read they don't mix, but then other sources suggest they are a potent combo for resistant depression.

insights?

1 hand typing, so shorthanding

 

[Weltmeister]

Apparently mirtazipine isnt an a releaser or reuptake inhibitor for neither serotonin, dopamine or norepinephrine. It indirectly increases dopamine and norepinephrine in specific brain regions by interacting with certain receptors. I dont know if that could be a problem.

The best course of action would be talking to a doctor obviously.

 

[serotonin2A]

MAOI use is listed as a contraindication for mirtazepine. There may be rare situations where they are used in combination but that would require intensive monitoring.

 

[JohnBoy2000]

even being a reversible maoi?

 

[serotonin2A]

even being a reversible maoi?

Oh yes, definitely. The reason for using reversible MAOIs is to avoid interactions with tyramine and other dietary amines. Reversible MAOIs can still produce serotonin syndrome if combined with serotonergics. There have been a number of cases of serotonin syndrome when moclobemide is combined with SSRIs or other serotonin uptake inhibitors.

http://www.ncbi.nlm.nih.gov/pubmed/11300508
http://www.ncbi.nlm.nih.gov/pubmed/8443525
http://www.ijccm.org/text.asp?2005/9/3/173/19684
http://jat.oxfordjournals.org/content/25/2/147.full.pdf
http://www.thelancet.com/journals/lancet/article/PII0140-6736(93)92774-N/abstract

 

[asecin]

moclobemide seems more potent than selegiline, anyone noticed this

 

[Limpet_Chicken]

I'd avoid it. Mirtazepine is an antagonist at alpha2 adrenergic autoreceptors, like yohimbine is, as well as its more well known extraordinarily potent antihistaminic effect.
Awful shit too IMO, made me just about ready to have thrown myself off a bridge, had there been one to do it with, dreadful, dreadful akathisia. One of the worst experiences in my life. Right up there with the likes of benzo, barbiturate or GHB withdrawal in terms of foulness, although of of a different nature.

Moclobemide does seem to be somewhat forgiving. Infinitely more than the old noncompetitive MAOIs like the hydrazines, (not like a hydrazine moiety is a good sign in anything you might put in your mouth to be honest), a girl I know of on one of another forum I frequent takes (and has for long enough to be stable on the combination) moclobemide/dexamphetamine along with haldol and benztropine. Seems to like the combination, as it helps her well seemingly.

Although mixing moclobemide and dexphet would make me nervous as hell.

 

[asecin]

wow she tolerates that? moclo and dexies, that would make most people itchy and angsty as fuck. but it makes sense she also takes haldol and benzotropine so... there is that

 

[MeDieViL]

Mirtazepine is entirely safe to combine with moclobemide and even the more powerfull older generation maois like nardil, it has been proposed as a treatment for serotonin syndrome too but personally i am skeptical as i think its affiinity for 5ht2a is lower then that of serotonin, eg it also doesnt block any psychedelics.

 

[Limpet_Chicken]

I REALLY disagree in the case of the older MAOIs. Mirtazepine is an antagonist at the alpha2 adrenoreceptor. Clonidine, xylazine, (dex)medetomidine, inverse thereof. Adrenergic secretagogue. Pressors and irreversible MAOIs are bad, bad fucking news. With moclobemide, theres a fair bit of wiggle room at least with adrenergics, I know someone prescribed both moclobemide and d-amphetamine, who is and has been for a while, stable on the combination. Prescribed by her headshrinker. I did a doubletake when I heard that one, But so far so good, apparently.

 

[MeDieViL]

mate its such a weak antagonist it wont be any danger at all, you can safely take low doses of amphetamine with maois, nardil with amphetamine was commenly prescribed back in the day for treatment resistant depression, its really weak man..

 

[MeDieViL]

ill find some old papers on that combo, also know someone that combined nardil with mirtazepine completely fine, prescribed by hes pdoc

 

[serotonin2A]

Mirtazepine is entirely safe to combine with moclobemide and even the more powerfull older generation maois like nardil, it has been proposed as a treatment for serotonin syndrome too but personally i am skeptical as i think its affiinity for 5ht2a is lower then that of serotonin, eg it also doesnt block any psychedelics.

If you read through the literature on Pubmed there are a few reports of serotonin syndrome associated with mirtazapine. The prescribing info for mirtazapine states that use with an MAOI is absolutely contraindicated.

http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020415s023s024.pdf

ill find some old papers on that combo, also know someone that combined nardil with mirtazepine completely fine, prescribed by hes pdoc

That doesn't mean they are actually safe. There have certainly been attempts to combine antidepressants and MAOIs for treatment resistant depression, sometines with impressive results. The problem is that there are often complex pharmacokinetic interactions between the drugs due the CYP450 inhibition, meaning that the antidepressant blood levels can be raised to unusually high levels. Any change in dosing (taking an extra pill by accident) or adding another drug that inhibits CYP450 can push the patient into a toxic reaction.

 

[MeDieViL]

Those reports of serotonin syndrome dont report any hyperthermia, and are this non dangerous side effects.

 

[Limpet_Chicken]

Perhaps I am unusually sensitive to adrenergic autoreceptor agonists then. Good god, they are utter poison, to me. The ONLY thing with such effects at a clinically significant or even perceptible effect I have EVER been able to tolerate without wanting to shoot myself in the face to just make it end, was piribedil. And THAT I was taking alongside clonidine and a fairly large daily dose of tizanidine. Dropped it like a red hot dog turd the moment I had access to pramipexole although it was ok in combination with clonidine to suppress the adrenergic activity.


Serotonin syndrome doesn't even NEED an MAOI. It can happen solely from combining antidepressants. I know someone it happened to. She thought at the time she was going to die that very day, collapsed and immobilized, severely hyperthermic and displaying muscle rigidity. Thankfully she recovered, because its someone I care dearly for.

 

[morphine-dreams]

I'd avoid it. Mirtazepine is an antagonist at alpha2 adrenergic autoreceptors, like yohimbine is, as well as its more well known extraordinarily potent antihistaminic effect.
Awful shit too IMO, made me just about ready to have thrown myself off a bridge, had there been one to do it with, dreadful, dreadful akathisia. One of the worst experiences in my life. Right up there with the likes of benzo, barbiturate or GHB withdrawal in terms of foulness, although of of a different nature.

Moclobemide does seem to be somewhat forgiving. Infinitely more than the old noncompetitive MAOIs like the hydrazines, (not like a hydrazine moiety is a good sign in anything you might put in your mouth to be honest), a girl I know of on one of another forum I frequent takes (and has for long enough to be stable on the combination) moclobemide/dexamphetamine along with haldol and benztropine. Seems to like the combination, as it helps her well seemingly.

Although mixing moclobemide and dexphet would make me nervous as hell.

While drugs affect everyone differently, I had a similar experience on mirtazapine. I never felt that I had clinical depression (just bouts of it as a result of stress) but when I was on that shit, I sure did. Wanted to die every single day because I felt so dead. According to wiki, it's also a D1 antagonist. It acts on a lot of other receptors too. I know this doesn't help answer the OP, just wanted to say that I had the same experience as you.

 

[palmanita]

Perhaps I am unusually sensitive to adrenergic autoreceptor agonists then. Good god, they are utter poison, to me.

Oh yes, me too. This appears to be particularly strong when one has, or has had tolerance to opioids, or dissociatives (maybe a subset of them, ketamine for sure), obviously clonidine.

This incredible tension, headache, anxiety, pulse and BP increase is so bad (like with yohimbine, something I'll never take again even I'd get paid for). Don't know why they prescribe it for drug withdrawal, when clonidine is available and safer/better antidepressants. Even venlafaxine, with its NRI component, is better by far. Also the latter has an actual antidepressant effect to me while mirtazapine fails for almost everyone I heard of taking it.

Also moclobemide did next to nothing for me, but this is just my experience.

Amphetamine or methylphenidate becomes very strong and hard to the body with moclobemide, 2.5mg of d-amphetamine raised my BP to around 160/120 when I usually have below 120/90. Clonidine (sublingual) reversed this within 15 minutes. Problem is that there is potentiation of norepinephrine but not dopamine (or am I wrong here?). Dopamine is much less of a pressor than NE.

How can amphetamine be effective when taken with such a strong antipsychotic as haldol? This looks like a potentiation of the above potentiation because you'll get even less DA vs. NE...

 

[polymath]

My dad was once prescribed a combo of moclobemide and mirtazapine for depression, but it made him see colorful "visuals" as a side effect, and he had to stop taking those meds almost immediately. His description of those visual disruptions sounded similar to what psilocybin and similar drugs cause. Note: this is not a recommendation to try the combination.

 

[Limpet_Chicken]

That figures, i'm tolerant to all three plus a fourth, tizanidine. Used to have way too much of a love affair with dissociatives, mxe and 4-methoxy, 3-methoxy and 3-hydroxyPCP and 3-MEO-PCE, diphenidine/methoxphenidine and memantine, which was...different, but very very much rewarding, at least, theres just something about it that makes me feel human again. damn strong priming effect, just thinking about it fired me up in a strange kind of way.

And currently on longter morphine/oxy pain meds for childhood injury of my knee.