If I am right I think they both increase seratonin levels, both my doctor and the pharmacist know I take Lexapro.. is it safe for me to be taking both together?
I am only on 5mg of lexapro, and will begin on 15mg of Elavil to titrate to 25.

Thank you

Jess

Hi Jess,
Many people take more than one medication but you always have to way up the benefits vs side effects/risks.
Officially the combination is listed as "moderate interaction risk".
Most doctors won't recognize signs of interaction so it's good that you are taking some control of your treatment. The doctor titrated the Elavil slowly, that is normal practice when combining.
Was the Lexapro causing insomnia or other problems that requiring the addition of Elavil?
It's always safer if you only take one type of antidepressant or chemical that acts on the central nervous system. Your right, by using the same pharmacy for your medications, they should check not just presciption meds but also "over the counter" meds like cough/cold remedies, they to can interact.
Nick

Thanks Nick, actually my GI doctor prescribed Lexapro, as I was having colon spasms and he told me about the GI nerve-brain interaction and wanted to try Lexapro. i have had success on it for my IBS and spasms, haven't had any since. But my Neuro and PCP want me to try the Elavil for the nerve pain. I took it for the first time last night and didn't have problems, just slept like a log. I usually get up at 5:30, slept until 8:30. Thank you for your reply. I am hoping the Elavil works for the nerve pain.

But, there is another thing more serious with Elavil and that is prolonged QT potential.

One reason the SSRIs are so popular is that they are less QT affecting than Elavil. To get good antidepressant effects with Elavil one needs high doses. Elavil is very dangerous on overdose/suicide attempts, whereas SSRIs are not.

Mixing drugs that have potential to affect the heart however, is problematic.
I explain this on a Sticky in the Chronic pain forum.
http://neurotalk.psychcentral.com/thread1120.html
post #4

http://www.azcert.org/medical-pros/d...ts/list-04.cfm
I'd read the whole site there since it is very helpful.
Simple dehydration, with low potassium and/or magnesium will add to drug risk and even perhaps trigger a person with low risk to have an event.

Serotonin syndrome is not likely at doses of Lexapro at 5mg.
But as doses increase, or mixtures are used (or drugs that impair metabolism etc), then the risk goes up.

Thank you again , you are very helpful. I was aware of the " seratonin syndrome" and ask the pharmacist and my pcp about it. They told me that I could take the 2 together, but should monitor it. I will not be increasing my Lexapro dosage, as that dosage works for my IBs and spasms, therefore the only dosage I may raise is the Elavil. So I will pay attention to that. My GI issues are being helped by the Lexapro and Bentyl, I just need to get the nerve pain under control, so the dr prescribed Elavil.
Thank you for the links and info. What is QT?

QT at the chronic pain link.

It is the timing of the heart beat measured on paper.
The longer the timing, the longer the QT segment.
You can read more about it here:
http://www.mayoclinic.com/health/lon...ndrome/DS00434

Normal people may develop this from drug interactions, or you may be born with this tendency. Electrolyte disturbances make it worse, or may trigger it. Also strenuous physical activity may do it. Recreational drugs like X and Cocaine, Meth, may trigger it. Combinations of prescription drugs may trigger it.

It can be screened for with an EKG.

Thank you for the response. I do hope to be on it more shorter term than longer term, believe me, I don't want to be taking a myriad of drugs. But right now, I need to get this pain under some control and know that the tri cyclics and the anti-convulsants seem to be 1st and 2nd line treatment for neuro pain.
Should i get checked or monitored via EKG after a few months on the drugs?
I truthfully am hoping that the Elavil may help with the nerve pain at the dose I am on, without having to raise it.

Hi again Jess,
No you won't need an EKG unless it's for a routine medical. The worse side effects of the tricyclics are such things as sedation and dry mouth etc, you may have noticed. The tricyclics are more dangerous in the overdose scenario than the SSRI's eg:Lexapro.
Your 25mg dose is standard dose for pain relief. Adverse reactions can happen sometimes so If you notice any irregular heart rhythm/breathing problems seek medical help.
Look after yourself
Nick