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SSRI's and Tricyclics together!!

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  • SSRI's and Tricyclics together!!

    Started to see quite a few scripts for citalopram and amitriptyline prescribed on the same script. On questioning the patient there is no plan to reduce one and introduce the other.

    Anyone seen these two prescibed together?

    Any guidelines out there regarding different anti depressants prescribed together?

    I have some info from cks library about switching antidepressants but nothing regarding the use of two together?

    Does anyone have any info about the use of two together?

  • #2
    Re: SSRI's and Tricyclics together!!

    Yes, it's used frequently, despite the warnings for metabolic interaction which can increase the TCA levels in the blood that can lead to cardiac toxicity. My friend you'll see more and more things that don't always go by the book. clinical experience is better than all the theory. Usually the TCA is introduced in small amount then adjusted accordingly depending on the blood levels obtained. Add to that Citalopram is a very weak inhibitor and won't cause too much interactions.

    The idea behind prescribing the 2 is to get an additive action on a different receptor. SSRI block serotonin reuptake, while TCA block mainly noradrenaline reuptake. The other advantage of adding a TCA is helping with quality of sleep at night which is a core trait of depression and it's also disturbed by the SSRI use.

    Check this page from google books:,M1

    PS:You can't print or save from google books. The quickest way to print is to do a print screen, then paste into a word document and do some croppings, then increase the size of your picture. Not the best quality but the quickest.
    Last edited by Shwampa; 16, September 2008, 12:34 PM.


    • #3
      Re: SSRI's and Tricyclics together!!

      It could be a neuropathic pain patient, either being augmented with an SSRI or with a seperate diagnosis of depression. If its low doses of both, I wouldn't worry. Screening mental health prescriptions soon makes you less worried about this...!
      Band6 is a Band 6 no longer.. now 7/8a