augmentation of SSRIs with Inositol (was: Your Inositol question)

[Guest guest]

I got these references off the internet about augmentation of SSRIs

with inositol. My son is on Anafranil, which is a tricyclic. Is

there as much worry about Serotonin Syndrome with Tricyclics? If we

stay well below the 18gm/day, are we ok?

http://www.homestead.com/westsuffolkpsych/OCDmeds.html

" ...Inositol, a B-vitamin available without prescription from most

health-food stores and many pharmacies, has shown effectiveness in

reducing OCD symptoms when taken with SSRIs, and, in some cases, even

when taken alone (although dosages had to be pushed to fairly high

levels)... "

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=105658\

02 & dopt=Abstract

" Inositol augmentation of serotonin reuptake inhibitors in

treatment-refractory obsessive-compulsive disorder: an open trial:

Ten OCD patients who had failed to respond to current and previous

trials of serotonin reuptake inhibitors participated in open-label

trial of inositol (18 gm/day) [corrected] augmentation for 6 weeks.

Symptoms were rated at 2-weekly intervals using the Yale-Brown

Obsessive-Compulsive Scale, the Montgomery-Asberg Depression Rating

Scale, and the Clinical Global Impressions (CGI) Scale. The majority

of patients (n = 7) did not respond to treatment with inositol

augmentation on the CGI improvement item. However, a small number of

patients (n = 3) did report a clinically significant response on the

CGI improvement item. OCD patients who fail to respond to a number of

trials of SRIs may be a particularly treatment-refractory group of

subjects. Unfortunately, inositol augmentation of a SRI did not lead

to significant improvement in the majority of such cases.

Nevertheless, further research on the mechanism of inositol efficacy

in some patients with anxiety and mood disorders is warranted. "

>

>

> >

> > Per an article I read on the Internet entitled " Inositol & OCD " by

> Federick Penzel, Phd, Inositol should never be taken with any

> prescription antidepressant (such as an SSRI) or herbal products such

> as St. 's Wort, as it can cause a very serious condition called

> serotonergic syndrome.

> >

[Guest guest]

,

From what I just read (I'll paste excerpt below), I would not take

much inositol with Anafranil since they both work on serotonin; so,

yes, you would still have worry about Serotonin Syndrome. With

inositol alone you could take up to 18 grams (even more I guess) but

with an SSRI you would keep inositol low, maybe try it as a " booster "

to the tricyclic. As to what " low " is, I would think maybe 3 grams,

6...? I'm just a mom. When my son took inositol, he was on that

alone, not with any other medication.

Excerpt: " The tricyclics have been used to treat depression for a

long time. They act on both serotonin and another neurotransmitter,

norepinephrine, and may also interact with other chemicals throughout

the body. "

Just my thoughts on the two together.

>

> I got these references off the internet about augmentation of SSRIs

> with inositol. My son is on Anafranil, which is a tricyclic. Is

> there as much worry about Serotonin Syndrome with Tricyclics? If we

> stay well below the 18gm/day, are we ok?

>

>

[Guest guest]

I figured I'd go to the source, so I wrote to Dr Penzel. He responded:

" ...You can take inositol with anything, without worry about there

being any kind of interaction. I have said in various articles that

you cannot take St. 's Wort with SSRI or tricyclic

antidepressants, or you will risk getting serotonergic syndrome. A

person taking inositol should lay off caffeine because it lowers

inositol levels, but that is the only thing to watch out for.... Go

ahead and use the inositol! Just remember that it is not a miracle

cure, and doesn't work for everyone. You just have to try it and see.

I wish your son success with his recovery. Keep pushing the CBT - it

is the most important part of the treatment. "

> >

> > I got these references off the internet about augmentation of SSRIs

> > with inositol. My son is on Anafranil, which is a tricyclic. Is

> > there as much worry about Serotonin Syndrome with Tricyclics? If we

> > stay well below the 18gm/day, are we ok?

> >

> >

>

[Guest guest]

Thanks for sharing that !

Still, respectfully to Dr. Penzel (who I also email with questions at

times and did email about 5-HTP recently), I'd start out low. Also a

reason to start low, go slow, is to avoid stomach upset.

If you try it, please let us know any good or no news! was

on inositol all thru middle school and it helped, I loved it. Tried

it again this year and nothing (BIG SIGH!). So we are trying 5-HTP.

Nothing there yet either but too soon to tell, just got up to a good

dose.

>

> I figured I'd go to the source, so I wrote to Dr Penzel. He

responded:

>

> " ...You can take inositol with anything, without worry about there

> being any kind of interaction. I have said in various articles that

> you cannot take St. 's Wort with SSRI or tricyclic

>

[Guest guest]

He also recommends starting at low doses. I asked him about dosage

timing also, since the bottle of inositol I have says to give it

" between meals or at bedtime " . It is much easier to be regular about

giving it if we can give it with meals, so I asked what would be the

disadvantage of doing that. This was his response:

-----Forwarded Message-----

From: Fred Penzel

Sent: Jun 24, 2007 7:16 AM

Eubanks

Subject: Re: augmentation of SSRIs with Inositol

Dear Ms. Eubanks -

Feel free to ignore whatever it says on the bottle. The people

who make up these labels don't have a clue. What they say isn't based

upon evidence of any kind. I would experiment and have your child

take it in whatever way best agrees with him. Some people find it

better with meals, some without.

Best - Dr. Penzel

>

> Thanks for sharing that !

>

> Still, respectfully to Dr. Penzel (who I also email with questions at

> times and did email about 5-HTP recently), I'd start out low. Also a

> reason to start low, go slow, is to avoid stomach upset.

>

> If you try it, please let us know any good or no news! was

> on inositol all thru middle school and it helped, I loved it. Tried

> it again this year and nothing (BIG SIGH!). So we are trying 5-HTP.

> Nothing there yet either but too soon to tell, just got up to a good

> dose.

>

>