Amphetamines SSRIs

AMPHETAMINES SSRIs t plasma concentrations of amphetamine, with risk of toxic effects Due to inhibition of CYP2D6-mediated metabolism of amphetamine Avoid concurrent use... 

Amphetamines SSRIs may increase the sensitivity to amphetamines amphetamines may increase the risk of serotonin syndrome. 

Recent evidence indicates that the 5-HT transporter is subject to post-translational regulatory changes in much the same way as neurotransmitter receptors (Blakeley et al. 1998). Protein kinase A and protein kinase C (PKC), at least, are known to be involved in this process. Phosphorylation of the transporter by PKC reduces the Fmax for 5-HT uptake and leads to sequestration of the transporter into the cell, suggesting that this enzyme has a key role in its intracellular trafficking. Since this phosphorylation is reduced when substrates that are themselves transported across the membrane bind to the transporter (e.g. 5-HT and fi -amphetamine), it seems that the transport of 5-HT is itself linked with the phosphorylation process. Possibly, this process serves as a homeostatic mechanism which ensures that the supply of functional transporters matches the demand for transmitter uptake. By contrast, ligands that are not transported (e.g. cocaine and the selective serotonin reuptake inhibitors (SSRIs)) prevent the inhibition of phosphorylation by transported ligands. Thus, such inhibitors would reduce 5-HT uptake both by their direct inhibition of the transporter and by disinhibition of its phosphorylation (Ramamoorthy and Blakely 1999). 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

Amphetamine, ephedrine and some SSRI can reduce appetite. 

Drugs that may affect amphetamines include furazolidone, MAO inhibitors, SSRIs, urinary acidifiers, and urinary alkalinizers. Drugs that may be affected by amphetamines include guanethidine. 

Antidepressants MAOIs, TCAs, SSRIs, SNRIs, mirtazapine, venlafaxine Amphetamines, phentermine, methylphenidate, sibutramine... 

Stimulants such as amphetamine and methylphenidate have been used to treat depression for many years. Stimulants should not be used alone, except perhaps in geriatric patients with prominent apathy, medically ill patients with depression, or patients with poststroke depression (Lingam et al. 1988). However, psychostimulants are useful for augmentation of antidepressant therapy in refractory depression, and they are generally safe, even for most patients with cardiac disorders. The nonamphetamine stimulant modafmil was found to be helpful in a recent placebo-controlled study involving 311 patients with partial response to SSRIs (Fava et al. 2005). 

In terms of the brain-mind paradigm and its 3-D map, the AIM model, SSRIs produce the equivalent of a stimulant effect as well as paradoxical sedation. The upward shift of the M dimension, caused by the elevation in aminergic drive, makes descent into deep sleep impossible, just as amphetamines make falling asleep at all more difficult. Because subjects spend much more time in light sleep at or near waking levels, they naturally experience more dreaming and they are more aware of it because they awaken more often. 

FIGURE 7—56. Heroic combo 12 SSRI plus stimulant. Here, 5HT and DA are single-boosted. The stimulants could include ( -amphetamine, methylphenidate, phentermine, or diethylpropion. The combo could also include direct-acting dopamine agonists such as pramipexole. 

Fourth, as an expert in criminal and civil cases, I have studied the lives of many individuals who—under the influence of psychoactive drugs such as SSRIs, nonselective serotonin reuptake inhibitors (NSRIs), and benzodiazepines—have committed acts of aggression that were wholly alien to their character and antithetical to their prior behavior. It is, of course, well known that the illegal use of stimulant drugs, such as meth-amphetamine and cocaine, can be associated with paranoid reactions and violence. 

The authors of the first report speculated that longterm therapy with methylphenidate could have desensitized the patient to the effects of amphetamines, since these drugs act in similar ways. It is also possible that amphetamine therapy interacted with the escitalopram. For this reason, they suggested caution when treating ADHD patients with amphetamines when they are also taking an SSRI. 

Clinically important, potentially hazardous interactions with acyclovir, alcohol, amphetamines, barbiturates, CNS depressants, fluoxetine, furazolidone, general anesthetics, glycopyrrolate, glycopyrronium, isocarboxazid, linezolid, lithium, MAO inhibitors, moclobemide, phenelzine, phenobarbital, phenothiazines, rasagiline, ritonavir, selegiline, sibutramine, SSRIs, tranquilizers, tranylcypromine, tricyclic antidepressants, val acyclovir... 

Some of the drugs that have been reported to cause rhabdomyolysis are salicylates, amphotericin, quinine, statin drugs, SSRIs, theophylline, amphetamines, and others. 

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