# Prozac and Amitriptyline



## ladylore (Jul 8, 2008)

I have been taking 25mg of Amatripyline for a couple of months now. Because of major depression symptoms coming back my doctor also prescribed 20mg of Prozac to be taken in the morning and I take the Amatripyline at night.

I started the meds on Friday. I am not experiencing trembling or really any of the more physical symptoms of the Prozac my doctor told me about. What I am feeling is a boxed in feeling. I feel like my mind is in a box - can't think forward or backwards into the past. I could barely speak this morning and it took me forever it felt like to get going. "Boxed in" is the best way I can describe it. I can write but person to person interactions are hard.

Is this suppose to happen with the combination of prozac and amatripyline? Anyone know? Thanks for any help.


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## Halo (Jul 8, 2008)

*Re: Prozac and Amatripyline*

I don't know anything specific about the two medications together that you mention but I would think that it is still pretty early for your system on the Prozac and the "boxed in" side effect that you are feeling may go away once your system becomes use to it.  I know that sometimes when I start new medication and it is combined with my others that it does give me different side effects but they generally go away after about a week.

Hang on and lets hope that it diminishes.

Take care
:hug: :hug:


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## Halo (Jul 8, 2008)

*Re: Prozac and Amatripyline*

I did a search on DrugDigest for possible interactions between the two medications and this is what came up:

Check Interactions

2 potential interactions were found for the drugs you selected.

You searched for interactions between the following drugs: 

Amitriptyline
Fluoxetine Capsules 

_(Note: Not all drug interactions are known or reported in the literature, and new drug interactions are continually being reported. This information is provided only for your education and for you to discuss with your personal healthcare provider. )_

FLUOXETINE may interact with AMITRIPTYLINE

Both fluoxetine and amitriptyline have an effect on serotonin, a chemical that is found in the brain. Excess levels of serotonin in the brain may cause serious or potentially life-threatening side effects. Early signs of this problem include increased confusion and restlessness. Other possible symptoms may include weakness, fever, nausea, and anxiety. In rare cases, high levels of serotonin in the brain may cause severe complications like seizures, stroke, and even death. If these drugs are used together, your doctor may want to monitor you closely when therapy with fluoxetine is started or stopped. If you are experiencing problems, it may be necessary to adjust the dose of amitriptyline or to stop therapy with either drug. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.

This interaction is well-documented and is considered moderate in severity.

Last Updated: December 2003

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FOOD may interact with AMITRIPTYLINE

Foods that have a high fiber content may interfere with the absorption of amitriptyline from the stomach. As a result, less amitriptyline would be available for the body to use and blood levels could become too low. This could make the drug less effective. High fiber foods include fruits, vegetables, and grains (bread, cereal, rice, and pasta). Let your doctor know if you have recently changed your diet to include more high fiber foods while you are taking amitriptyline. If the amitriptyline does not seem to be working properly, it may be helpful to adjust your diet. You may want to ask your healthcare provider about this potential interaction if you think you are having problems.

This interaction is poorly documented and is considered moderate in severity.

Last Updated: December 2003


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## ladylore (Jul 8, 2008)

*Re: Prozac and Amatripyline*

Thanks for the search Halo.  I wouldn't say its confusion - more of its an effort to interact with anyone.


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## Retired (Jul 8, 2008)

*Re: Prozac and Amatripyline*

I would certainly suggest reporting the way you feel to your doctor.  Do you have an arrangement where you can contact your doctor to report side effects after staarting a new prescription?



> Excess levels of serotonin in the brain may cause serious or potentially life-threatening side effects.



This is called _seretonin syndrome_ and should not be treated lightly.  Only your doctor can determine if you are experiencing the symptoms of this interaction, which is why it should be reported.

Also fluoxetine (Prozac) impairs the clearance and metabolism of amitriptyline. 

All good reasons to have a conversation with your doctor, to ask if you may be experiencing effects of either a drug / drug or drug / food interaction.

At best it may just require a dosage adjustment and at worst, the fluoxetine (Prozac) may have to be substituted by a different SSRI.


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## ladylore (Jul 8, 2008)

*Re: Prozac and Amatripyline*

We haven't formally talked about it but I could get an appointment and ask - its just such a low dose but I guess the two could be having a negative effect. Thanks


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## David Baxter PhD (Jul 8, 2008)

*Re: Prozac and Amatripyline*

People starting Prozac may experience a feeling of detachment or derealization which usually dissipates within a few days to a week.


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## ladylore (Jul 9, 2008)

*Re: Prozac and Amatripyline*

Thanks Dr. B - that is a relief to know.  
My doctor didn't tell me obout that side effect.


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## Retired (Jul 9, 2008)

*Re: Prozac and Amatripyline*



> People starting Prozac may experience a feeling of detachment or derealization which usually dissipates within a few days to a week



Is this effect specific to fluoxetine or to all SSRI's?


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## David Baxter PhD (Jul 9, 2008)

*Re: Prozac and Amatripyline*



TSOW said:


> Is this effect specific to fluoxetine or to all SSRI's?



I expect it's possible with other SSRIs but it's not uncommon with Prozac.


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## ladylore (Jul 9, 2008)

*Re: Prozac and Amatripyline*

I didn't experience this with the other medication. That one left me groggy for about a week. What your talking about feels more of what is happening. Its uncomfortable but at least I know it won't last too much longer.


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