Azilect and Anti depressants

Having been prescribed the Anti depressant Citalopran i was advised by the pharmacist to read the leaflet.Having put off Anti depressants on a couple of occasions,and feeling they may be beneficial at this time.I was amazed to find they reacted with the Azilect.Not only the one i was given,but it seems like all of them are not recommended with Azilect.
Having taken Azilect for nearly 1 1/2 years,it would be a shame to stop.In order to take the Anti depressant the Azilect has to be discontinued for at least 2 weeks and can only be reinstated 2 weeks after completion of Anti depressant treatment.
Ironically one of the side effects of Azilect can be Depression.So imagine the scenario of developing depression because of the Azilect,stopping the Azilect to take the Anti depressant.In the Two weeks waiting time the depression lifts,so you go back on the Azilect only to become depressed again.
It would probably be best to forget the whole Anti depressant thing anyway.However does anybody know of an Anti depressant that does not have bad reaction with Azilect,or has taken Anti depressants with Azilect and maybe had a bad reaction.My doctor is at a loss and i have left a message with the pd nurse.
Any light shed on this conundrum would be much appreciated.
Many Thanks

I'm amazed. I've been taking Azilect for years, and Citalopram for at least 18 months. No problems whatsoever in combining the two.

"Baffled" of Hull.
Hi Ray,
Do me a big favour.Please google Serotonin,the first link gives all the info about Serotonin Syndrome,it can be fatal.Citalopram is in a list of five on the right hand side,if its the same link.Read into it and see.
All the best
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I also include Selagaline(not sure spelling)as well for concern.Both M A O I,s.This should not be taken with a long list of Anti depressants.
CHECK OUT,take care
titan, I think that you described it well - a conundrum. I had the same thoughts about this:
DA prescribed for PD symptoms
DA causes nausea & sickness
Domperidone prescribed for nausea & sickness
Domperidone can cause PD symptoms

My consultant , concerned about my insomnia is scratching her head to come up with a sleep aid that does not interact with my PD medication. In the meantime I stay awake All drugs interact to some extent, and the patient information
does tend to err on the side of caution.
I think that in the end it depends upon which is causing you most concern - your PD mobility difficulty or depression. I very much doubt that your consultant would prescribe an anti-depressant if he/she thought it would adversely affect the treatment of your PD. We moan about consultants (actually you don't) but they are not out to finish us off
I do understand your concern & think that you have done exactly the right thing in contacting PD nurse
Hi Annebernadette,
I read the leaflet and questioned the prescribing with Azilect.The chemist and doctor after looking into said definitely don,t take the Two together.I handed the Anti depressants back today,diden,t take any.Serotonin syndrome M A O Inhibitors and Anti depressants.It can be fatal.Thats quite a risk.My G.P is at a loss for an alternative and says go to neurologist to see what they say.
Concerned for others,including Ray of sunshine
All the best
Hi. I just found these on the web, dated 30 June 2010. Interesting?

"Citalopram is contraindicated in individuals taking MAOIs, due to potential for serotonin syndrome."

"Serotonin syndrome is a potentially life threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells."

"Serotonin syndrome most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time. The drugs cause too much serotonin to be released or to remain in the brain area."

Hi Ray,
Interesting yes,alarming definitely,scarey for all who are on these meds.Pleased you took a look Ray.For all you know,you could be having side effects now because of the combo and don,t realise.That dizzyness or unusual tiredness for example,may not be down to the meds you think,but these.Check it out properly with G.P for piece of mind.
I wonder how many more there are and just exactly how dangerous and prevalent the Serotonin syndrome is.But anything with FATAL,included in the heading must be heeded.
All the best
I agree, and I'll certainly be having a chat with "the team" about this very soon - thanks for the tip off! :smile:

Of course, as I've said before, I'm now prescribed so many different pills and potions that any change in symptoms is virtually impossible to pin down to any single drug or interaction.

I need to come off everything, and start again from scratch.

My current regime is:

Rasagiline 1mg x 1 daily
Tolterodene XL 4mg x 1 daily
Stalevo 100mg x 7 daily
Sinemet CR 250mg x 2 nightly
Gabapentin 300mg x 3 daily
Citalopram 20mg x 1 daily
Citalopram 10mg x 1 daily
Madopar dispersible 50mg x (up to) 4 daily
Solpadol x (up to) 8 daily
Sildenafil 100mg x (up to) 1 daily
Vitamins, various x 3 daily
Bowel thingies x 1 daily

Total: 33 daily.

Please note that the following is just one opinion (not necessarily mine) and not a medical guideline
It is generally considered that a citalopram dosage of up to 20mg daily can be safely taken with azilect (up to 60mg citalopram daily can be prescribed ) However, it is also considered prudent to avoid any combination of SSRI & MAOI. So it would seem it very much depends upon the level of need for an anti depressant .
Since the SSRI "revolution", the benzodiazepine drugs (eg valium)are far less widely prescribed & then on a short term basis & rather for anxiety than for depression
When my PD nurse added Citalopram to my daily concoction @ 20mg/day, and subsequently increased it to 30mg with the stated intention of going up to 40mg, why was I not told about this risk?

If the answer to this question is "well, there's a warning on the leaflet", that's just not good enough. The complexities of drug interactions are very hard to understand, and given that I for one was in a bit of a mess at the time. most patients will just trust their GP/consultant and take it - no questions asked.

The patient should be given a clear explanation as to the dilemma and be permitted to decline if they wish to, without feeling awkward.
Well it just goes to show the importance of cross examination of all medications.I was only prescribed Citalopram 10mg x 1 daily as a starting dose,but questioned it because of the M A O I/Serotonin link.I certainly would not like to play what seems like Russian roulette with them.
The obvious decision is to stop the Azilect or other M A O Inhibitor and take the citalopram or other Anti depressant,the debate still goes on about the benefits of Azilect anyway.However to stop something which COULD BE slowing down the progression for a feel good tab is not an option i wanted to take.
Ray,apologies for using yourself now as an example.Ray is on 10 mg above what is considered(possibly)safe,if you are correct Annebernadette.I have only read that they should not be combined,full stop.Combined with such a heady cocktail that Ray is taking,what is the accumulative effect,what if taking the Azilect and Citalopram together literally in the same mouthful.Surely there will be an even bigger surge in the serotonin level.
Surely putting the words FATAL has got to be heeded.This is the case all over when googled.I just am astounded at this medical minefield we tread.I apologise for being alarmist if this turns out to be the case.
Hope everyone on these combinations will at least look and check it out with their G.P.
All the best
This is a personal opinion.
I think that a Dr will prescribe for the presenting problem based on current research & also personal preference (eg he/she has seen good results).
Research cannot possibly test all drug interactions in one trial. They only come to light as more research is done and, sadly ,as problems are reported. Then things like dosage & timing have to be considered
And on a more down to earth level, if a Dr/nurse detailed every single risk that could possibly result from taking a drug, the patient will understandably be reluctant to make use of a drug that may alleviate the symptoms that brought them to the clinic.
I do agree, a service user is entitled to the most up to date & comprehensive information. But most of us will need help to make decisions based on that info. And where do we get that from?
titan - I think the 20mg/day safe limit is based on the fact that the azilect trials allowed inclusion of subjcts taking this dosage of citalopram Some other antidepressants were not permitted. I do not know what the researchers based their decision upon. But yes, to minimize risk 0mg is better. Also, don't eat cheese (I am not being flippant, the interaction between tyramine in cheese & MAOI's is well known)
hello again titan (& thank you)
Have you considered herbal remedies that may relieve depression? I asked a pal who runs a health food shop. She mentioned St John's Wort, but there are others. As always, best to check with GP/nurse/neuro (who cannot advise re herbal remedies!) A herbal remedy will not have the strength of a prescribed medication, but it may take the edge off?
Just a thought.
Hi Annebernadette,
and Ray of Sunshine,
I have just got off the phone with the pd nurse.Concerns over Citalopram combined with Azilect(rasagaline).The Neurologist overlooked the fact that i am on Azilect when prescribing it.Advised to try and go without Anti depressants,Seeing the pd nurse in 3 months anyway concerning other probs.
The simple fact is,Anti depressants should not be prescribed in conjunction with Azilect.Will anybody on this combination please check it out.Also MAOI Selegiline is in the same catagory as Azilect,so the same applies.

Ray of sunshine,
Have you sought advice on this matter.With the heady cocktail you take and the length of time,what is the effect this combination above possibly having on your body or mind,especially mixed with all the other meds.
All the best
Thanks,will look into the Herbal route.Either that or pop a valium when need be.:rolling_eyes:what else is there apart from getting drunk.:bulb::rolling_eyes:
This link explains about drug interaction

Hi Titan, what about CBT (Cognitive behavioural therapy)? Is the antidepressant for depression or sleep deprivation?

CBT is also known to help OCD's!
Hi Cutiepie,
Its for sitting there in front of the Neuro and having to stop for welling up when attempting to talk about nothing.For looking around and seeing what should be done,but don,t see the point.The grass grows long,if i cut it,it grows long again.The dust is removed,again it comes back,a blanket of misery which pervades the house.Wallpaper,2-3 years old,sat in a cupboard,a life on permanent hold.What is the point,a cosmetic finish to a living room,claustrophobic as a prison cell.The seconds turn mournfully into days as another week ticks by.Another week in a life redundant of all meaningful function.
Each attempt at happiness is knocked back,k.o'd,as one thing after another just pokes its scornful finger,like a school bully.Psychologist/councillors,best not go there,i star in my own video on Friday.That may make sense to some.Inside the catacombs which twist and turn,a sombre trapped soul gropes for light,as the cogs turn slowly in a mind which glosses over undercoat beyond removal.
Dried up long ago like the tears which sit there like a swell only to be sucked back in from whence they came.Parkinsons is just the final blow,a gladiatorial finish to what was insignificant anyway.A fly in a web,wrapped up tight,awaiting its fate.Nothing left,sucked dry,dry like the cracks in the barren desert of a sensitive mind.There an oasis holds out for hope,struggling to be fertile,but dyslexic,futile spells the mocking end of hope,to be snatched away ad infinitum.
But i,ll be okay,we just get by
my dear titan, that sounds like true clinical depression. I doubt that it is possible to talk yourself out of it & maybe a chemical solution is the only answwer ( I do not recommend valium or alcohol - addictive & nasty hangovers) But I know for certain that those who care for you will listen & do their best to try to help you climb out of what seems like a pit of depair