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Which Type Of Antidepressant Is Safest To Use While Using Methadone? What About TCAs Or TeCAs?

Posted on Sat, 16 Jun 2012

Question: I am trying to find out which type of antidepressant is safest to use on a person who is detoxing via methadone. Methadone level decreases 2 mg per week and is now at 14 or 16 mg. It seems SSRIs are too XXXXXXX to mix. What about TCAs or TeCAs?

Answered by Dr. Ashish Mittal (1 hour later)

Hello,
Thanks for your query.

Important aspects of your query are:
•     24 year old female
•     Known case of depression
•     On methadone programme of detoxification for opioid dependence

Choice of medicine depends on doctor preference and experience, past history of treatment response and co morbid illness. It is a complex decision.

In general SSRIs are newer and better anti depressants than TCAs considering side effects profile and patient compliance. So SSRIs are preferred over TCAs. But if patient has depression with insomnia than TCAs can be preferred as they have hypnotic action too.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wishing her good health.
Regards,

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ashish Mittal (58 minutes later)

My daughter does in fact have a great deal of insomnia and gets very little sleep. At times I have given her one of my ambien or clonazapam but I worry that this may not be good to mix with methadone. I suffer from major recurrent depression myself and take Wellbutrin but I read that isn't a good mix with methadone. I did a lot of online research (because my daughter has no medical insurance) and read several studies about imipramine with methadol and mertazapine (aka Remeron). Imipramine seems to have had the best success rate. But I am still concerned about the mix with methadone although my daughter is on a relatively low dose. She takes the methadone in the morning. So if she took the antidepressant at bedtime, would that be the best idea? Thank you so much for your advice.
XXXXXXX

Answered by Dr. Ashish Mittal (10 hours later)

Hello again XXXXXXX

Considering insomnia, imipramine is definitely good. It is better to take the whole dose in two divided doses (morning and night). I can understand your concern related to insurance. But I would not prefer to advice without prescription here.

Treatment with psychotropic medication always need to supervised by Psychiatrist considering illness, its severity, required dose, interaction with other medicines, individual variation for response and side effects, risk of switching into mania in presence or emergence of bipolar illness.

Hope I answered all your questions. Please accept my answer in case you do not have further queries.

Take care

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Above answer was peer-reviewed by : Dr. Shanthi.E