Venlafaxine has little effect on CYP2D6 and therefore should not have a significant impact on TCA levels; dose adjustments in combinations may not be necessary. Tell owners to watch for early signs of serotonin syndrome, which can be ambiguous, but include agitation, tremors, and seizures. These along with others have really helped me and I have had no side effects. Some people find that zoloft (sertraline) can interfere with sleep and trazodone oft. Liver diseaseEffects may be increased because of slower removal of the medicine from the body. Because trazodone, SSRIs, TCAs, and MAOIs boost serotonin levels, their use in combination (any 2 of these drugs together) may potentially trigger serotonin toxicity, or serotonin syndrome, a potentially fatal reaction. Do not use trazodone with buspirone (Buspar), fentanyl (Abstral, Duragesic), lithium (Eskalith, Lithobid), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova, Maxalt, Relpax . However, there is no evidence that this ratio is related in any way to clinical effectiveness. (2002). Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Moreover, even though the combination of Buspar and alcohol is not fatal, it does exacerbate the effects of alcohol. Adding onto that, there is incomplete remission of the symptoms and there are sexual side effects. Consult with the doctor on dietary habits upon the prescription of the medication, or search for alternatives to the drug, such as for example Buspar vs Xanax. McCauley, Mac Dara Nausea, headaches, nervousness with insomnia, urinary retention and periorbital oedema were reported, especially in combination with fluoxetine. Some mixtures of medications can lead to serious and even fatal consequences. Can BuSpar and Abilify be taken together? This means that some alcoholic patients may still consume alcohol despite the use of Buspar. 2023 eHealthMe.com. Muscle and joints mostly. Available for Android and iOS devices. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. For this medicine, the following should be considered: Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. include protected health information. All information is observation-only. However, when taking it with the latter, it is necessary to learn the foods and substances that cannot be consumed with this medication. Patients who are inadvertently exposed to this combination show a very high occurrence of the toxic serotonin syndrome. If that is unsuccessful, further strategies include the use of higher doses, switching to another antidepressant of the same or different class, augmenting the antidepressant with either psychotherapy or a medication which is not an antidepressant (such as lithium or antipsychotics), or combining with another recognised antidepressant. Side-effects included orthostatic hypotension, daytime sedation and mania in one patient with bipolar disorder. 118 people who take Trazodone hydrochloride and Buspar together, and have interactions are studied. Close this message to accept cookies or find out how to manage your cookie settings. Howland, R. H. (2015). Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position. You may opt-out of email communications at any time by clicking on
Call your doctor or 911 if you think you may have a medical emergency. According to a study of medical doctors from London, though rare, typical side effects of combining Buspar and grapefruit include dizziness, drowsiness, and blurred vision. Other side-effects are due to the synergism of the two drugs and include orthostatic hypotension, dizziness, headache, urinary retention, weight gain and nausea, all of which can be caused by either drug alone. Thus, Buspar effects sex drive and may have some discomforting withdrawal symptoms when discontinued. In this article, information about the effects of mixing Buspirone with other medications, substances, and food, and how to avoid dangerous Buspirone interactions will be provided. Because of this large number, it is important to understand that Buspar pills mixed with other drugs and substances can lead to major Buspirone interactions. Lastly, understand that the absence of major alcohol and Buspirone interactions does not mean the safety of combined use. Despite an increase in the number of available and effective antidepressants, many patients with depression respond poorly to drug treatment. Do not take other medicines unless they have been discussed with your doctor. This reduces the serotonergic effect expected from such heteroreceptor blockade. and This tool may not cover all possible drug interactions. Acute buspirone dosing enhances abuse-related subjective effects of oral methamphetamine. If we combine this information with your protected
After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals. Theoretically, this offers one of the most potent mechanisms of manipulating the monoamine system, leading to its nickname of California rocket fuel. The Journal of Clinical Pharmacology, 33(11), 1104-1109. I have been having sleeping problems and no over the counter medicine seemed to be helping me. What is buspirone? However, no pediatric-specific problems have been documented to date. Trazodone - Is there a huge difference between 50mg and 100mg of trazadone as my doc has doubled? Do not use trazodone with buspirone (Buspar), fentanyl (Abstral, Duragesic), lithium (Eskalith, Lithobid), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova, Maxalt, Relpax, Zomig). Besides that, literally zero side effects from either of them. The combination of a predominantly noradrenergic TCA such as nortriptyline and an SSRI may overcome this ceiling effect and produce a different sodium:5-HT reuptake blockade ratio. Arulsamy, Alina Posts: 7,368. Do not suddenly stop taking this medicine without checking first with your doctor. and Doctors typically provide answers within 24 hours. Citalopram, owing to its relative lack of CYP inhibition, may be a safer SSRI to use in combination with a TCA, although no clinical data are available to support this. He has been on advisory boards for Astra-Zeneca, Bristol-Myers Squibb, Eli Lilly and Servier in the past 2 years but has no consultancies with or pecuniary interests in any pharmaceutical company. Check for more interactions with the Drug Interaction Checker, Never use this combination of drugs because of high risk for dangerous interaction, Potential for serious interaction; regular monitoring by your doctor required or alternate medication may be needed, Potential for significant interaction (monitoring by your doctor is likely required), Interaction is unlikely, minor, or nonsignificant, Pill Identifier Tool Quick, Easy, Pill Identification, Drug Interaction Tool Check Potential Drug Interactions, Pharmacy Locator Tool Including 24 Hour, Pharmacies. This chapter seeks to review the complex literature on this topic scattered over a wide range of disciplines including anthropology, psychology, psychiatry and sociology. According to a study published in the American Journal of Medicine, effects stay for a couple of hours when it is paired with alcohol. With medical big data and AI algorithms, eHealthMe is running millions of phase IV trials and makes the results available to the public. It has been suggested that the safest option is to start MAOI and TCA simultaneously at low doses increasing slowly to a maximum of half that used with single-drug treatment (Reference White, Razani and SimpsonWhite 1982). The following drug could be potentially fatal if combined with an SSRI: 4 He develops hyperthermia, agitation and diarrhoea. Despite the positive reports of efficacy in case series (Reference White, Razani and SimpsonWhite 1982), the controlled trials are largely negative. WARNING: Please DO NOT STOP MEDICATIONS without first consulting a physician since doing so could be hazardous to your health. Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum. RA. Taking these two together is generally safe, and there are no known interactions with Wellbutrin. Recent meta-analyses have shown stronger data for switching to a drug in a different class (Reference Papakostas, Fava and ThasePapakostas 2008) or augmentation of antidepressants with psychotherapy (Reference Pampallona, Bollini and TibaldiPampallona 2004), lithium (Reference Bauer and DopfmerBauer 1999) or atypical antipsychotics (Reference Papakostas, Shelton and SmithPapakostas 2007), suggesting that these strategies should be logical next steps in the management of treatment-resistant depression before employing a combination strategy. Jaiswal, Yogini S Other drugs that have the same active ingredients (e.g. Apart from drug interactions, one must also be wary of certain foods. Check with your doctor immediately if any of the following side effects occur: Get emergency help immediately if any of the following symptoms of overdose occur: Some side effects may occur that usually do not need medical attention. Dosage of drugs is not considered in the study. We identified three RCTs (total n = 181), four open-label trials (total n = 85) and three case series (total n = 46) that used SSRITCA combinations (a full list of references is available on request). Consult your healthcare professional (e.g., doctor or pharmacist) for more in formation. With Buspar, it is imperative to disclose all medications and health issues to a doctor. Too much serotonin is a potentially life-threatening situation. 2020. This will help the victim of dependence to return to a previously healthy and meaningful life. Portions of this document last updated: Feb. 01, 2023, Original article: https://www.mayoclinic.org/drugs-supplements/buspirone-oral-route/precautions/DRG-20062457. Appropriate studies on the relationship of age to the effects of buspirone have not been performed in the pediatric population. On the other hand, Buspirone is an anxiolytic that generally treats mild and short-term anxiety symptoms. Fava and colleagues recommend using small doses of TCAs and plasma-level monitoring in such combinations (Reference Fava, Alpert and NierenbergFava 2002). Even regular foods can cause interactions with subsequent unpleasant effects. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. 2013. This medicine may cause some people to become drowsy or less alert than they are normally. It is not known exactly how buspirone works to relieve the symptoms of anxiety. Because of this, it is better to avoid consuming Buspirone and alcohol together. Grapefruitmedication interactions: Forbidden fruit or avoidable consequences?. The SSRImoclobemide combination has been tried with the same rationale as the SSRIMAOI combination. Napoliello, M. J., & Domantay, A. G. (1991). This is to decrease the chance of having withdrawal symptoms such as increased anxiety; burning or tingling feelings; confusion; dizziness; headache; irritability; nausea; nervousness; muscle cramps; sweating; trouble with sleeping; or unusual tiredness or weakness. Its effect on 2-heteroreceptors present in serotonin neurons is mitigated by its direct 1-blocking effect. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. Answer (1 of 2): https://www.drugs.com/interactions-check.php?drug_list=441-206,2228- No, no, no, NO!!!! These 2 drugs have . The decision to employ a particular combination must be based on evaluation of each patient's clinical status (including the severity of key target symptoms). However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. The American College of Physicians also does not recommend trazodone in its 2021 insomnia treatment guidelines. Is Buspar and Zoloft ok to take together ? Venlafaxine might be useful in achieving an antidepressant top-up effect for patients who require a higher TCA dose than they could tolerate, but there is no direct clinical evidence for this. According to a medical study, a Buspar tablet is an effective drug for treating weed / cannabis / marijuana dependence. Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly. Ghaffar, Yahya A. trazodone oral and buspirone oral both increase serotonin levels. Nonetheless, it is mandatory to carefully monitor such combinations and avoid the routine use of high doses of both drugs. It is unclear what happened to the brand or whether Colin Stuart is still designing shoes. Good response to the combination has been demonstrated in a small (n= 26) double-blind RCT involving a treatment-resistant sample defined using Thase & Rush criteria (Reference Maes, Vandoolaeghe and DesnyderMaes 1996). Kaye, Adam M. Is it ok to take 50mg of trazodone before bed and 10mg of buspirone twice daily and 20 mg of fluoxitine once daily? Is Anyone on this combination ? A placebo-controlled trial of buspirone for the treatment of marijuana dependence. Various open-label trials have been reported, involving reboxetine in doses of up to 8 mg/day (Reference Rubio, San and Lpez-MuozRubio 2004). Ram, Dushad Feature Flags: { Ott, Michael Case summary: A 37-year-old white man taking fluoxetine 20 mg/d for generalized anxiety disorder developed confusion, diaphoresis, incoordination, diarrhea, and myoclonus after buspirone was added to the drug regimen. 2 months later that went away. Several combinations have a low benefit:risk ratio and should be avoided, and most should only be used with a second opinion and/or specialist advice and support. Sujkowska, Ewelina 2021. (2013). Read and follow the instructions in the insert carefully. I wish you all the best with your current . Always consult with the doctor before taking a combination of drugs to get more information about the safety of combination drugs. Published online by Cambridge University Press: Drug information provided by: IBM Micromedex. This trial had been preceded by an open-label study by the same team, involving 30 newly admitted randomly assigned patients with depression, who were not necessarily treatment refractory. Yes they can , but these medication can cause sedation and therefore u need to start low and go slow and be careful when u drive until u see the effect of medication on u . drug interactions checker>trazodone oral and buspirone oral interactions. I started feeling a little better so i I laid off the buspirone. Two studies have reported on the use of trazodone for the treatment of insomnia in patients established on an MAOI. Langmaierov, Kateina Hi all, My family doctor recently prescribed me buspar 10 mg x 2 a day and 50 mg trazodone at night for sleep. According to a study, concomitant use of these medications causes cardiovascular health dangers and may exacerbate the side effects like blurred vision, dizziness, drowsiness, excitability, headache, lightheadedness, and nausea. I started taking buspirone about 3 months after I started the fluoxetine. The combination of mirtazapine and venlafaxine (n = 4) was also included in the Reference Carpenter, Yasmin and PriceCarpenter et al (2002) study discussed earlier. International Journal of Clinical Pharmacology and Therapeutics, Fluoxetinemirtazapine interaction may induce restless legs syndrome: report of 3 cases from a clinical trial, The safety and efficacy of combined amitriptyline and tranylcypromine antidepressant treatment, Combined antidepressants: clinical experience, Acta Psychiatrica Scandinavica Supplementum, Reboxetine adjunct for partial or nonresponders to antidepressant treatment, Clinical guidelines: developing guidelines, Combination of tricyclic antidepressants with moclobemide or tranylcypromine outcome data in therapy resistant MD, Moclobemide and amitriptyline, alone or in combination, in therapy resistant depression, Human Psychopharmacology: Clinical and Experimental, Fluoxetine added to non-MAOI antidepressants converts nonresponders to responders: a preliminary report, Fluoxetine-induced tricyclic toxicity: extent and duration, Combined MAOI-tricyclic antidepressant treatment: a controlled trial, Controlled trial of trimipramine, monoamine oxidase, and combined treatment in depressed outpatients, Clinically significant CYP450 interactions between antidepressants, Summary of studies considered in this review. However, an RCT involving patients had not responded to standard (20 mg/day) fluoxetine monotherapy failed to demonstrate significant benefits for this combination compared with high-dose (4060 mg/day) fluoxetine monotherapy (Reference Fava, Rosenbaum and McGrathFava 1994). This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Created for people with ongoing healthcare needs but benefits everyone. . Learn More Integer gravida Patients receiving busPIRone should preferably avoid the consumption of large amounts of grapefruits and grapefruit juice. Please note, we cannot prescribe controlled substances, diet pills, antipsychotics, or other commonly abused medications. Evidence is too scarce to comment further on this combination. An open-label study (n = 20) followed by a small RCT (n = 26) of mirtazapine 1530 mg in combination with other antidepressants (including SSRIs) at near-maximum doses revealed a significant response and good tolerance (Reference Carpenter, Yasmin and PriceCarpenter 2002). This is one of the most popular combinations and has been proposed on various grounds: rapid onset of effect is possible, owing to the receptor profile of noradrenergic and specific serotonergic antidepressants (NaSSAs) (see below); side-effects of the SSRI may be nullified by the NaSSA and vice versa; additive effects are possible because of different mechanisms of action; SSRIs can increase plasma levels of NaSSAs through CYP450 enzyme inhibition. trazodone oral brand names and other generic formulations include: buspirone oral brand names and other generic formulations include: trazodone oral and buspirone oral both increase affecting serotonin levels in the blood. There are no published data on duloxetine in combination with SSRIs. These medications may interact and cause very harmful effects. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Tell your doctor right away if you start to feel more depressed or have thoughts about hurting yourself or others. Gillard, Patrick Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. (2007). Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. Alprazolam is indicated for anxiety, but can cause sleepiness, memory impairment, and cognitive disorder. The phase IV clinical study analyzes what interactions people who take Buspar and Depakote have. This provides the basis for combining TCAs with MAOIs. Synthroid is FDA pregnancy category A - it is definitely secure for breastfeeding Synthroid or Levothyroxine in its generic form, is a a commonly used medication to treat Hypothyroidism, an underactive thyroid. This can lead to increased adverse effects such as drowsiness. In theory, combining these two drugs could result in enhanced serotonin transmission by an additive effect. However, Buspirone interactions may alter the cognitive functions of patients. Do not stop taking this medicine without first checking with your doctor. I take buspirone, trazodone and bromazepam together. Interaction Details. Lately i've lost interest in things things that i used to enjoy. If a person stops taking either drug, they could experience . As of 2021, there are around 1,312 approved drug interactions for this drug. Farooq A full reference list is available from the authors on request. Isaak Stotts is an in-house medical writer in AddictionResource. By the end of the night I was shaking and almost passed out twice. The combination was, however, found more likely to benefit women with severe depression lacking energy. Of course, one should always follow the correct directions from a doctor for such a combination. Combinations of SSRIMAOI and TCAMAOI have been considered in the previous sections. Re: Buspar and Trazodone anyone? This combination has been tried with a similar rationale to the SSRItrazodone combination. Mianserin predominantly blocks 2-autoreceptors, leading to increased noradrenergic transmission. Buspirone is an anxiolytic while Melatonin is an organic compound. Do not eat grapefruit or drink grapefruit juice while you are taking this medicine. SSRI with trazodone. The combination of an MAOI with a TCA might, at least theoretically, protect against the cheese reaction. For potential or actual medical emergencies, immediately call 911 or your local emergency service. All generic drug interactions for buspirone oral (lists will include brand and generic names): 4 contraindicated drug interactions. No one should assume the information provided on Addiction Resource as authoritative and should always defer to the advice and care provided by a medical doctor. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. buspar is a not very good tranquilliser that isnt effective against panic attacks. In the first of the two (Reference Lauritzen, Clemmesen and KlysnerLauritzen 1992), imipramine was started at a low dose (2550 mg/day depending on age), aiming for a plasma level of >200 nmol/l, and mianserin was given at a dose of 30 mg/day. Spencer, T., & Biederman, J. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. Responses to subsequent courses are also limited. Viswanath, Omar Comparison of SSRINaSSA combinations with other antidepressantNaSSA combinations has not been undertaken to date. While generally considered safe, CBD may cause drowsiness, lightheadedness, nausea, diarrhea, dry mouth, and, in rare instances, damage to the liver. Can these medications cause nosebleeds. Tricyclic toxicity can occur as a result of raised plasma levels. In the Buspirone and Caffeine interaction, the former is an anxiolytic while the latter is considered a stimulant substance. Using busPIRone together with traZODone can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking . The combination was better tolerated than the individual agents alone, with a significantly more rapid onset of action than with fluoxetine alone. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. It may be the most commonly combined antidepressant with SSRIs for this reason. All rights reserved. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements. Paroxetine can increase the anticholinergic side-effects of TCAs. eHealthMe is studying from 19,100 Buspar users for its effectiveness, alternative drugs and more. If you or anyone you know is undergoing a severe health crisis, call a doctor or 911 immediately. While the drug itself is slow acting and relatively safe, its concentration can be increased significantly with certain drug interactions. Answered in 20 minutes by: So overall your medication regimen is perfectly safe and there is relatively no chance for any major interaction effects to occur. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination. Nutrition Journal, 6(1), 1-9. and For temporary relief, use sugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute. Lyne, John Despite the risks of an increased burden of side-effects or drugdrug interactions with antidepressant combinations, such combinations are common in clinical practice. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Serotonin syndrome can lead to dangerous health events such as coma or death if left unattended. and Copyright 2023 IBM Watson Health. Thus, it could be predicted that a combination of both medications could induce a more rapid and robust antidepressant effect than each medication administered alone. All rights reserved. This medicine is available only with your doctor's prescription. Joshi, Shivang I have been taking the buspar ever day and started with the 50 trazodone at night. Tung, Amy Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Can i get a general doctor to prescribe lamictal, trazodone and Buspar (buspirone) for me? The following combination has been shown superior to the others listed in the management of patients with treatment-resistant depression: TABLE 1. Haddad, Peter M. To learn more, please visit our. One small RCT (n = 58) (Reference Tanghe, Steeman and BollenTanghe 1997), one open-label trial (n = 14) (Reference Knig and WolfersdorfKnig 1997) and a short report (n = 18) have published on this combination (Reference Steinberg, Jost and WeessSteinberg 1994). Trazodone is used in combination with SSRIs for: 5 To provide you with the most relevant and helpful information, and understand which
In a pooled analysis of placebo-controlled trials of antidepressants (n = 4,500 pediatrics and 77,000 adults), there was an increased risk for suicidal thoughts and behaviors in patients 24 years of age and younger receiving an antidepressant versus placebo . eHealthMe is studying from 20,180 Trazodone hydrochloride users for its effectiveness, alternative drugs and more. This may be mediated through increased 5-HT1A transmission. A controlled pilot study. Yesterday I took my two buspar as directed. The dose of this medicine will be different for different patients. Advertising revenue supports our not-for-profit mission. Psychiatry 36 years experience. Mannchen, Julie K. UNABLE TO DISPLAY ANY INTERACTIONS AT THIS TIME. With regards to Buspirone and Melatonin uses, the former is used to treat mild symptoms of anxiety while the latter is used to treat insomnia, preoperative anxiety, shift-work disorder, circadian rhythm disorders, and nicotine withdrawal. The following combination has a plausible neurochemical basis: 3 It has high affinity for type 1 serotonergic receptors (5HT-1). It is often used in insomnia. Can I take pristiq and Buspar together with trazadone at. This is supported by Reference Weilburg, Rosenbaum and BiedermanWeilburg et al (1989), who showed that fluoxetine alone could not sustain remission in a significant number of patients who initially responded to the combination of a TCA and fluoxetine. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. The following information includes only the average doses of this medicine. Copyright 2023 IBM Watson Health. Trazodone may cause a serious condition called serotonin syndrome if taken together with some medicines. All rights reserved. Rapid metabolisers of TCAs may show a good response when combining a TCA with an SSRI that inhibits CYP2D6 (Reference Conus, Bondolfi and EapConus 1996). Drug interaction checkers will often list the interaction between hydrocodone containing products and Buspar (buspirone) as 'moderate' to 'major'. Restless legs syndrome has been reported in three patients from an RCT sample receiving fluoxetine 20 mg/day in combination with mirtazapine 15 mg/day (Reference Prospero-Garcia, Torres-Ruiz and Ramirez-BermudezProspero-Garcia 2006). Phase IV trials are used to detect adverse drug outcomes and monitor drug effectiveness in the real world. Our phase IV clinical studies alone cannot establish cause-effect relationship. Learn about side effects, dosage, alternatives, interactions, and more. . As an anxiolytic medication, it is common to find Buspirone drug combined with other drugs to treat anxiety disorders. Too much serotonin is a potentially life-threatening situation. Yes, this combination can lead to false-positive results on a urinary drug test. Free & Confidential 24/7 Treatment Hotline. How buspirone interacts with trazodone? With medical big data and proven AI algorithms, eHealthMe provides a platform for everyone to run phase IV clinical trials. Talk to your doctor or pharmacist if you have any questions or concerns. However, in a fourth RCT (n = 295), the combination of sertraline and mianserin was only as efficacious as 100 mg sertraline alone in patients previously unresponsive to 6 weeks of sertraline alone. Call Us Today (616) 675-4675. Although these two can be taken together as a Buspar tablet also seems to improve ADHD symptoms, this interaction can elevate the risk of serotonin syndrome as they both affect serotonin levels. This is one of the Buspirone interactions that could even result in a coma or death. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Hello in2sharpei. Of the sample, 82% responded, with 64% achieving full remission which in the majority was maintained at 2 years. The best evidence is for the combination of an SSRI with an NaSSA or trazodone this combination received some support in the NICE guidelines (National Institute for Health and Clinical Excellence 2004).