ace - a few questions....

1) Which MAOI would you be mixing with the Zyprexaª (olanzapine)? I have to say that I have seen only a couple of drug regimens where the combination of Zyprexa and Nardilª (phenelzine) was used. If I am not mistaken the Zyprexa doses were very low 1.25mg (half of a 2.5mg; - we had the patient break open the tablet with a pill cutter and drop into a glass of orange juice - stirred very well - ; drink half today and half tomorrow. The problem with phenelzine is that, in some people trigger manic states in those taking antipsychotics (both traditional - tAP; and newer agents - aAP).

Manerixª (moclobemide) has exacerbated (make worse) psychotic symptoms when given to those who had a schizoaffective component to their depression or a depressive component to their schizophrenia (two very different groups, with the former usually having the AP added to the AD, whereas in the later scenario the AD is usually added to the a regimen consisting of an AP already.

So, could it be that the "manic state" of phenelzine and the "increase in psychotic symptoms" of moclobemide when combined with an antipsychotic be the reason for Dr. Barbee's (don't personally know of him) loathing of this combination. I never say never to any drug combo, as it reduces the size and scope of the tools available to combat psychiatric illness ............. although ..............

2) NEVER combine Clonidine and an MAOI <lol>; the potential potentiation possibilities poses problems. The adverse effects associated with these drugs when taken individually are not for the squeamish; combine these side effects profiles into one drug regimen and Still, the monitoring of that lil ol' "BP issues" may become a full time job, as both classes of drugs directly affect the heart. Not a good combo, in my opinion.

Risperidone (Risperdalª) has little antihistaminergic action compared to that seen with Zyprexa anf Clozarilª (clozapine), so combining this with an MAOI may not be so bad.

I have seen several treatment resistant depressions and I did follow one guy with treatment resistant OCD who could not tolerate clomipramine (Anafranilª) any longer. We switched him to Zyprexa 2.5mg at bedtime; and Manerix 150mg twice daily. He lasted on the Zyprexa for about 2 days and was back in. The doc switched to Risperdal 0.25mg at bed, which was raised to 0.5mg at bedtime a week later. In two weeks his Manerix dose was titrated up to 300mg twice daily. After some initial jitteriness and nervousness, the combo began to work. This "blah" feeling, which I attributed to the medication change, did take about 2 months to go away. For the first month - to month and a half - he said he felt worse, not better (do you how hard it is to motivate someone to keep taking their medications when you yourself start doubting the treatment).

At the 2 month mark he was much improved, at 6 months he got his first job that he actually stayed at for more than a week. I don't know if he has the same job, but I talked to him while visiting Mental Health Services. He is still taking the same drug regimen for the last 5 years.

Just remember though, I have seen this combination fail in several other treatment resistant cases of OCD &/or depression.

I hope this helps - Cam
(Which of my posts do you keep?; my treatise on dating misogynistic architecture [no, not Jayne Mansfield]?)
You know, after I finally do go off the deep end in some silly but spectacular way, you could probably put together a book and make millions ..... cool!
I've never kept anything that I wrote. Can you find conflicting information, and stuff like that?