The most effective AD I've tried was the MAOI phenelzine (Nardil). Unfortunately, dietary issues were a problem back in the 1980s which became a real pain in the posterior, but these days much less so because modern food processing techniques create significantly less tyramine, plus we now know that adjunct doses of a NRI like desipramine and nortriptyline will pretty much block the response if a high tryramine dose food is eaten. However, should I need to go back onto a MAOI then it would be tranylcypromine (Parnate) as seems to provide a smoother 'ride' than the rocket fuel derive phenelzine.
Because I think it is less important than switching the AD, might still be having a positive effect on anxiety and it could speed up neurogenesis a little by accelerating the maturation of the new cells.
Imipramine is a fairly potent serotonin reuptake inhibitor, in fact slightly more so than vortioxetine, so there may be a small risk of triggering serotonin syndrome/toxicity when taking both. Nortriptyline is a much weaker SRI, so much so that before SNRIs were readily available it was quite common to prescribe it and a SSRI, usually sertraline, at highish doses to create a bespoke SNRI. Some old time psychiatrists still prefer the combo to a SNRI.
Understood, which is why I think it preferable to not leave you untreated while switching if possible as you would be when stopping the vortioxetine before starting a TCA, John.
Tsk, tsk.
Never a good idea, mate, not even if someone like me suggests it. Your GP, or psychiatrist should always be the gatekeeper as they have both the expertise, and even more importantly, a better grasp of your mental and physical state and the meds you are and have taken.