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Mirtazapine+Moclobemide?

A

Abject

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Dec 14, 2012
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I've read reports on Mirtazapine being augmented with SSRI/SNRI's and TCAs, but what about a RIMA?
I remember seeing a study showing Mirtazapine being used to treat Serotonin Syndrome, so are there any risks here?
 
This is interesting, but I wouldn't undertake it. Depending on dosage level, the mirtazapine will cause increased serotonergic and norepinephrinergic activity via adrenal autoreceptor antagonism, and then the moclobemide will inhibit catabolism of 5ht and NE. So there could be a strong synergy, but some of the relevant mechanisms are indirect, so who knows. On the other hand, mirtazapine is an antagonist at many 5ht subreceptors, reducing the risks of serotonin syndrome from the combination.

I dunno...this combination sounds too complicated to me. :p

ebola
 
Thanks for the input ebola

I stopped taking my Moclobemide a week or two ago, so if I were to dose some moclobemide now (with my mirtazapine) the half-life would be quite short, so thanks to it's reversibility any ill effects would be short lived and I'd know better next time.

What worries me is that in a few weeks once there's a steady state and it lingers in my system for longer, is it possible something negative could happen without me being aware of it until it's too late?
of course i'd check on my heart beat as one sign.

I'm staring at both these meds as I type, contemplating the worth of playing with fire..
here's to not getting SS
 
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Don't do it.

Serotonin syndrome, if it doesn't kill you, will make you wish you were dead many times over.
 
Can you elaborate on why you think SS will occur?
I dosed 300mg moclobemide with 45mg mirtazapine yesterday, and again just then.
I will take another 300mg moc if I feel comfortable later on, it's what might happen in a weeks time that worries me.

Also, I took 45mg of Mirtazapine 90 minutes ago and I'm feeling much drowsier than 15mg or 30mg doses.
I was under the impression lower doses were meant to be more sedating?
I guess not.
 
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Moclobemide is a reversible inhibitor which should act comparatively quickly. I think that you would have noticed problems by now, if they're to manifest. but what are you trying to accomplish with this combo?

ebola
 
ebola? said:
what are you trying to accomplish with this combo?
Click to expand...

Affect.

I was on moclobemide at 600mg previous to starting mirtazapine, and I'm hoping being messy as fuck and doing a combo like this might have a higher chance of helping than either on their own.
 
I'm not sure if extremely complex pharmacological cocktails are suitable treatments for depression, at least not reliably so.

ebola
 
Well if you look here you'll see that moclobemide was used at massive dosages (1.6g) with trazodone, which is a SARI.
Mirtazapine is also an antagonist/inverse agonist, and augmentation seems to be my best bet for the moment.
Hopefully a new psych will put me on something neater- but that talk is irrelevant at the moment.
I'm on 900mg Moclobemide at the moment, but I may go up to 1.2g
I have 2 more repeats for my moclobemide, but hopefully I'll find someone to work with properly before I use them.
 
Anti-depressants focusing on serotonergic transmission tend to take 6-8 weeks to manifest efficacy. I think that this rapid-fire tinkering will prove counter-productive.

ebola
 
I'm going to bump this, as I'm looking into this combination myself.

I have read that, contraindications with aurorix do not really exist, at or below doses of 600mg, though.
 
Back when MAOIs were in common use they would sometimes add amphetamine to help with sedation and hypotension. Possibly a TCA combo with desipramine or nortriptyline? I do not think combining mirtazapine with moclobemide would be an issue. At higher dosage its like an NRI with some serotonin receptor antagonism. Doesnt mess with SERT.
 
ebola? said:
Anti-depressants focusing on serotonergic transmission tend to take 6-8 weeks to manifest efficacy. I think that this rapid-fire tinkering will prove counter-productive.

ebola
Click to expand...

Not mirtazapine. Blocking the 5-HT2C receptor can elicit an antidepressant can begin to precipitate itself within only a few days. Alpha 2 and 5-HT2 2A antagonism augments this.

I think what you are thinking of is serotonin transporter blockage which then indirectly waits on serotonin to naturally downregulate 5-HT 2A 5-HT2C and 5-HT 1A presynaptic 1A receptors.

This therapeutic delay isn't needed with direct antagonistis.
 
cr33py said:
Back when MAOIs were in common use they would sometimes add amphetamine to help with sedation and hypotension. Possibly a TCA combo with desipramine or nortriptyline? I do not think combining mirtazapine with moclobemide would be an issue. At higher dosage its like an NRI with some serotonin receptor antagonism. Doesnt mess with SERT.
Click to expand...

Um, no an amphetamine and an MAOI would CAUSE a preciptious hypertensive (quite possibly death) crisis and require hospitalization. and moclobemide and mirtazapine isn't dangerous. remeron doesn't cause serotonin syndrome with any serotonergic. It actually treats it. It blocks the excitatory 5-HT 2A receptors that release glutamate - the receptor responsible for the behavior syndrome.
 
^^ Does that mean remeron may detract from the efficacy of moclobimide in some capacity?

I'm guessing ritalin would be off the table with the introduction of moclobimide...?
 
Actually its not wrong, I'm not entirely sure if the sanity of the girl's shrink but I know someone who is on moclobemide and dex, albeit carefully dosed. Moclobemide is somewhat more forgiving than the older irreversible MAOIs, due to it being, like the harmala alkaloids for instance (the beta-carboline MAOI type that is, ignoring vasicine, vasicinone etc) reversible, and able to be displaced from the bound enzyme complex by monoamines needing to be mopped up.
 
If I was the doctor, I sure as hell wouldn't risk it combining those two medications in my patient.

No remeron certainly wouldn't detract from the efficacy. You want your 5-HT 2 receptors to have diminished activity. Overactivity of these receptors causes depressive and anxiogenic symptoms, so if anything it would augment the efficacy of the other AD.
 
theGirlWithBlueHair said:
Um, no an amphetamine and an MAOI would CAUSE a preciptious hypertensive (quite possibly death) crisis and require hospitalization. and moclobemide and mirtazapine isn't dangerous. remeron doesn't cause serotonin syndrome with any serotonergic. It actually treats it. It blocks the excitatory 5-HT 2A receptors that release glutamate - the receptor responsible for the behavior syndrome.
Click to expand...
It isn't true that mirtazepine is free from the risk of serotonin syndrome. Although rare, cases have been reported in patients on mirtazepine who are not taking any other serotonergics:
http://m.aop.sagepub.com/content/36/4/641.abstract

The other thing to consider is that serotonin syndrome is probably not due to glutamate release. 5-HT2A-driven glutamate release primarily occurs in cortex and from cortical-subcortical projections. Serotonin syndrome is probably mediated by 5-HT receptors in regions such as the hypothalamus and brain stem -- regions that regulate motor reflex activity and body temperature.
 
It shouldn't be forgotten though that mirtazepine is also an alpha2 adrenoreceptor antagonist, which will result in noradrenaline release.
b
 
MAOI would only be an issue in a hypertensive crisis if someone had consumed tyramine. in the case of moclobemide not even an issue. MAOIs if taken with amphetamine at a really high dose maybe you could have serotonin toxicity. And a possible hypertensive crisis can be addressed by giving the patient some nifedipine to keep on hand. Also people on MAOIs generally have failed everything else and as such the risk to benefit ratio is weighed a little differently from someone without treatment resistant depression.
 
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