Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T00:42:35.636Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants in Combination

Interactions and Therapeutic Uses

Published online by Cambridge University Press:  02 January 2018

David Taylor
David Taylor*
Affiliation:
Principal Clinical Pharmacist, Maudsley Hospital, London SE5 8AZ
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The selective serotonin reuptake inhibitors (SSRIs) are now widely used in the treatment of depressive illness. Interest has grown in the use of SSRIs as alternatives to tricyclic antidepressants (TCAs) and in the therapeutic use of combinations of SSRIs and TCAs in refractory depression.

Method

MEDLINE and PSYCLit literature searches were conducted. Reference sections from papers retrieved were scrutinised for other relevant reports.

Results

Of 41 relevant articles identified, 35 were selected for review.

Conclusions

Fluoxetine, fluvoxamine, paroxetine and sertraline may substantially increase TCA plasma levels when given concurrently. Such interactions may give rise to adverse effects. The effect of sertraline may be less profound than that of fluoxetine, fluvoxamine and paroxetine. Limited data suggest that citalopram may not affect TCA serum levels. There is scant literature evidence to support the use of SSRIs in combination with TCAs as a treatment for refractory depression.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 167 , Issue 5 , November 1995 , pp. 575 - 580
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alderman, J., Greenblatt, D. J., Allison, J., et al (1994) Desipramine pharmacokinetics with serotonin reuptake inhibitors, paroxetine or sertraline. Data on file, Pfizer Ltd. Google Scholar
Aranow, R. B., Hudson, J. I., Pope, H. G., et al (1989) Elevated antidepressant plasma levels from addition of fluoxetine. American Journal of Psychiatry, 146, 911–913.Google Scholar
Baron, B. M., Ogden, A. M., Siegel, B. W., et al (1988) Rapid down regulation of beta adrenoreceptors by co-administration of desipramine and fluoxetine. European Journal of Clinical Pharmacology, 154, 125–134.CrossRefGoogle ScholarPubMed
Barros, J. & Asnis, G. (1993) An interaction of sertraline and desipramine. American Journal of Psychiatry, 150, 1751.Google ScholarPubMed
Bauman, P. & Bertschy, G. (1993) Pharmacodynamic and pharmacokinetic interactions of selective serotonin re-uptake inhibiting antidepressants (SSRIs) with other psychotropic drugs. Nordic Journal of Psychiatry, 47 (suppl. 30), 13–19.CrossRefGoogle Scholar
Bell, I. R. & Cole, J. R. (1988) Fluoxetine induces elevation of desipramine levels and exacerbation of geriatric non-psychotic depression. Journal of Clinical Psychopharmacology, 8, 447–448.Google Scholar
Benazzi, F., Bartolini, F. & Mazzoli, M. (1994) Medical complications of polydipsia in non-psychotic depression. Canadian Journal of Psychiatry, 39, 185.Google Scholar
Bergstrom, R. F., Peyton, A. L. & Lemberger, L. (1992) Quantification and mechanism of the fluoxetine and tricyclic antidepressamt interaction. Clinical Pharmacology and Therapeutics, 51, 239–248.CrossRefGoogle ScholarPubMed
Brosen, K., Otten, S. V. & Gram, L. F. (1986) Imipramine demethylation and hydroxylation: impact of sparteine oxidation phenotype. Clinical Pharmacology and Therapeutics, 40, 543–549.Google Scholar
Brosen, K., & Skjelbo, E. (1991) Fluoxetine and norfluoxetine are potent inhibitors of P450IID6 – the source of the sparteine/debrisoquine oxidation polymorphism. British Journal of Clinical Pharmacology, 32, 136–137.Google Scholar
Cavanaugh, S. V. (1991) Drug-drug interactions of fluoxetine with tricyclics. Psychosomatics, 31, 273–276.Google Scholar
Cowen, P. J. & Power, A. C. (1993) Combination treatment of depression. British Journal of Psychiatry, 162, 266–267.Google Scholar
Crewe, H. K., Lennard, M. S. & Tucker, G. T., et al (1991) The effect of paroxetine and other specific 5-HT re-uptake inhibitors on cytochrome P450IID6 activity in human liver microsomes. British Journal of Clinical Pharmacology, 32, 658–659P.Google Scholar
Crewe, H. K., Lennard, M. S. & Tucker, G. et al (1992) The effect of selective serotonin reuptake inhibitors on cytochrome P4502D6 (CYP2D6) activity in human liver microsomes. British Journal of Clinical Pharmacology, 34, 262–265.Google Scholar
Dollery, C. (1991) Therapeutic Drugs. Edinburgh: Churchill Livingstone.Google Scholar
Downs, J. M., Downs, A. D., Rosenthal, T. L., et al (1989) Increased plasma tricyclic antidepressant concentrations in two patients concurrently treated with fluoxetine. Journal of Clinical Psychiatry, 50, 226–227.Google ScholarPubMed
Extein, I. L. (1991) Recent fluoxetine treatment and complications of tricyclic therapy. American Journal of Psychiatry, 148, 1601–1602.Google Scholar
Fava, M., Rosensbaum, J. F., McGrath, P. J., et al (1994) Lithium and tricyclic augmentation of fluoxetine treatment for resistant major depression: a double-blind, controlled study. American Journal of Psychiatry, 151, 1372–1374.Google Scholar
Faynor, S. M. (1989) Fluoxetine inhibition of imipramine metabolism. Clinical Chemistry, 35, 1180.Google Scholar
Goodnick, P. J. (1989) Influence of fluoxetine on plasma levels of desipramine. American Journal of Psychiatry, 146, 552.Google Scholar
Gram, L. F., Hansen, M. G. J., Sindrup, S. H., et al (1993) Citalopram: Interaction studies with levomepromazine, imipramine, and lithium. Therapeutic Drug Monitoring, 15, 18–24.Google Scholar
Hahn, S. M. & Griffin, J. H. (1991) Comment: fluoxetine adverse effects of drug interactions. DICP – The Annals of Pharmacotherapy, 25, 1273–1274.Google Scholar
Hartter, S. H., Wetzel, H., Hammes, E., et al (1993) Inhibition of antidepressant demethylation and hydroxylation by fluvoxamine in depressed patients. Psychopharmacology, 110, 302–308.Google Scholar
Kahn, D. C. (1990) Increased plasma nortriptyline concentration in a patient co-treated with fluoxetine. Journal of Clinical Psychiatry, 51, 36.Google Scholar
Lydiard, R. B., Anton, R. F. & Cunningham, T. (1993) Interactions between sertraline and tricyclic antidepressants. American Journal of Psychiatry, 150, 1125–1126.Google Scholar
Maskall, D. D. & Lam, R. W. (1993) Increased plasma concentration of imipramine following augmentation with fluvoxamine. American Journal of Psychiatry, 150, 1566.Google Scholar
Montgomery, S. A., Henry, J., McDonald, G., et al (1994) Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. International Journal of Psychopharmacology, 9, 47–53.Google Scholar
Nelson, C., Mazure, C. M., Bowers, M. B., et al (1991) A preliminary open study of the combination of fluoxetine and desipramine for rapid treatment of major depression. Archives of General Psychiatry, 48, 303–307.Google Scholar
Preskorn, S. H., Beber, J. H., Faul, J. C., et al (1990) Serious adverse effects of combining fluoxetine and tricyclic antidepressants. American Journal of Psychiatry, 147, 532.Google Scholar
Preskorn, S. H., Alderman, J., Chung, M., et al (1994) Pharmacokinetics of desipramine co-administered with sertraline or fluoxetine. Journal of Clinical Psychopharmacology, 14, 90–98.Google Scholar
Schraml, F., Benedetti, G., Hoyle, K., et al (1989) Fluoxetine and nortriptyline combination therapy. American Journal of Psychiatry, 146, 1636–1637.Google Scholar
Seitfritz, E., Holsboer-Trachsler, E., Hemmeter, U., et al (1994) Increased trimipramine plasma levels during fluvoxamine co-medication. European Neuropsychopharmacology, 4, 15–20.Google Scholar
Seth, R., Jennings, A. L., Bindman, J., et al (1992) Combination treatment with noradrenaline and serotonin reuptake inhibitors in resistant depression. British Journal of Psychiatry, 161, 562–565.Google Scholar
Vandel, S., Bertschy, G., Bonin, B., et al (1992) Tricyclic antidepressant plasma levels after fluoxetine addition. Neuropsychobiology, 25, 202–207.Google Scholar
Vaughan, D. A. (1988) Interaction of fluoxetine with tricyclic antidepressants. American Journal of Psychiatry, 145, 1478.Google Scholar
von Moltke, L. L., Greenblatt, D. J., Cotreau, B., et al (1994) Inhibition of desipramine hydroxylation in vitro by serotonin-reuptake-inhibitor antidepressants, and by quinidine and ketoconazole: a model system to predict drug interactions in vivo. Journal of Pharmacology and Experimental Therapeutics, 268, 1278–1283.Google Scholar
Weilburg, J. B., Rosenbaum, J. F., Biederman, J., et al (1989) Fluoxetine added to non-MAOI antidepressant converts nonresponders to responders: a preliminary report. Journal of Clinical Psychiatry, 50, 447–449.Google ScholarPubMed
Wilens, T. E., Biederman, J., Baldessarini, R. J., et al (1992) Fluoxetine inhibits desipramine metabolism. Archives of General Psychiatry, 49, 752.Google ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.