Anti-Depressants and Recreational Drugs

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DISCLAIMER: This drug interaction table is based on medical literature, anecdotal, and theoretical data gathered by author and is not necessarily accurate. The author can not be held responsible for possible inaccurate/incorrect data.

Contents

Introduction

Antidepressants (ADs) can be roughly categorized into five groups: Tricyclics, Heterocyclics, NARIs, SSRIs, and MAOIs.

Begin by looking at the #list of types of antidepressants below. Look for the brand name of the drug you are taking, and find out what group your antidepressant belongs to. Then go to the section for that group of antidepressants to learn about recreational drug interactions.

This FAQ also contains some background information about ADs.

See the #Glossary for a list of terms used in this FAQ.

Marijuana

General note: you can smoke weed/marijuan/cannabis on any antidepressant. This is almost always a safe combination. Of course, if you are suffering any bad effects from smoking weed while on your medication, STOP smoking the weed.

List of Types of Antidepressant

This lists the common drug and brand names of different classes of antidepressant, along with their half-life - how long it takes for half the drug to be cleared from your system.

Tricyclics (TCAs)

  • Amitripyline (Elavil, Endep, Tryptin(e,) Tryptanol)[31-46 hours]
  • Amitriptyline and Chlordiazepoxide (Limbitrol)
  • Amitriptyline + Perphenazine (brand name Etrafon, Triavil -- Perphenazine is an antispychotic)
  • Clomipramine (Placil, Anafranil)[22-84 hours]
  • Desipramine (Norpramin, Pertofran)[12-50 hours]
  • Dothiepin (Prothiaden, Dothep) [11-40 hours]
  • Doxepin (Adapin, Sinequan, Deptran)[8-24 hours]
  • Imipramine (Melipramine, Tofranil)[9-24 hours]
  • Lofepramine (Gamanil, Lomont) [extensively metabolized to Desipramine] [4-6 hours + ~24 hours for the desipramine metabolite]
  • Nortriptyline (Pamelor, Alledgron, Nortrilen, Sensival) [18-93 hours]
  • Protriptyline (Vivactil)[54-124 hours]
  • Trimipramine (Surmontil)[8-30 hours]

SSRIs (Selective Serotonin Reuptake Inhibitors)

  • Citalopram (Celexa, Cipramil,Seropram) [23-75 hours]
  • Fluoxetine (Prozac, Flux, Fluxil, Fluxine, Modipran, Oxetin. Prolert, Prozyn, Rize, Seronil, Ufrex,Vonder, Zauxit) [72-360 hours]
  • Fluvoxamine (Luvox, Faverin, Dumirox) [7-63 hours]
  • Paroxetine (Paxil, Aropax, Seroxat) [3-65 hours]
  • Sertraline (Zoloft, Lustral, Besitran) [10-35 hours]

Irreversible MAOIs

N.B.: half-lives not included because they mean very little in the case of irreversible MAOIs.

  • Chlorgyline [selective for MAO-A]
  • Isocarboxazid (Marplan) [nonselective]
  • Nialamide [nonselective]
  • Pargyline (Eutonyl) [nonselective]
  • Phenelzine (Nardil) [nonselective]
  • Rasagiline [selective for MAO-B]
  • Selegiline (Deprenyl) [selective for MAO-B]
  • Tranylcypromine (Parnate) [nonselective]

Reversible MAOIs

All are selective for MAO-A, thus RIMAs.

  • Befloxatone
  • Brofaromine (Consonar)
  • Harmaline + Harmine
  • Moclobemide (Aurorex, Aurorix, Arima, Manerix)

Heterocyclics

  • Amoxapine (Asendin, Asendas) [8-14 hours]
  • Bupropion (Wellbutrin, Zyban, Zyntabac) [8-24 hours]
  • Mianserin (Bolvidon, Lantanon, Lerivon, Lumin, Norval, Tolvon) [17 (6-40) hours]
  • Mirtazapine (Remeron, Avanza, Rexer Zipsin) [20-40 hours]
  • Nefazodone (Serzone) [2-18 hours]
  • Tianeptine (Ardix, Stablon) [2.5 hours]
  • Trazodone (Desyrel) [4-14 hours]
  • Venlafaxine (Effexor) [4-10 hours]

NorAdrenaline Reuptake Inhibitors (NARIs)/Selective NE Reuptake Inhibitors

  • Atomoxetine (Strattera) [~5 hours]
  • Maprotiline (Ludiomil, Loxapac) [21-58 hours]
  • Reboxetine (Edronax, Vestra, Norebox) [8-18 hours]

Recreational Drug Interactions

TCAs/Tricyclics

Alcohol, GHB, Benz=os, Opiates, Barbituates

Because TCAs have strong sedative effects, combining TCAs with central nervous system (CNS) depressants like the drugs listed above can potentiate (make stronger) the effects of those drugs: if you are taking a TCA, you will be MORE SENSITIVE to these drugs, and you won't need to take as much to get high. Therefore, please dose carefully; you will probably need a lower dose than a normal person. Otherwise, these drugs are fairly safe to combine with a TCA.

Ketamine

The effects of this drug should not be altered by TCAs and the combination is not known to be dangerous.

DXM (Dextromethorphan, Robotussin)

This can be a very DANGEROUS combination! Do not take DXM and TCAs together! Combining DXM with a TCA can lead to too much serotonin in your brain, which can cause the potentially FATAL serotonin syndrome.

MDMA/Ecstasy (includes MDA, MDEA etc)

TCAs will reduce the effects of taking MDMA, i.e. you won't roll very hard, if at all. Some people do roll on TCAs however, and find that TCAs do not inhibit the effects of MDMA as much as the SSRIs do. Still, you will find that rolling on TCAs is not NEARLY as fun as rolling without being on a TCA. It is not fatally dangerous to take MDMA while on TCA. However, as MDMA increases the risk of cardiovascular complications, and TCAs already have some negative effects on the cardiovascular system, it could be unsafe to combine these drugs. I have not heard of a case of cardiovascular problems resulting from MDMA and TCA, but it is still a possibility that you should be aware of. Consider the combination of MDMA and a TCA very carefully; you'll find that it's probably not worth it.

Stimulants: Amphetamines, Cocaine, Ritalin, 4-MAR

As with MDMA above, many people find that while they are on a TCA, they do not experience the full effects of these stimulants. However, you WILL still be able to get fairly high from these drugs; the impact of the TCA on your high will not be that great. The only danger here is the same as the danger above with MDMA; possible cardiovascular complications. If you combine stimulants and a TCA, watch your dosage and pay attention to any cardiovascular effects that seem unusual or disturbing.

Hallucinogens: LSD, mushrooms, Tryptamines, 2-ct-2,DPT, DMT, Salvia

TCAs can make the effects of hallucinogens stronger, therefore you should be careful about how much you take of a drug. You probably won't need as much to get high. Also, because hallucinogens have a number of cardiovascular effects, the same warning that applies to MDMA and stimulants applies here as well. Though fundamentally a safe combination, be careful and use moderation. Start with a LOW dose.

NOTE: Do not take 'ayahuasca' while on TCAs. This is a very dangerous combination.

SSRIs

Alcohol, GHB etc, Benzos, Opiates, Barbituates, Ketamine

All of these drugs can be safely combined with SSRIs. You might be slightly more sensitive to alcohol, benzos, and barbituates (i.e., you might get higher than usual from a particular dose). Otherwise, you should experience the drug as you would normally. Some people find that ketamine and opiates do not affect them as strongly.

DXM

This can be a very DANGEROUS combination! Do not take DXM and SSRIs together! Combining DXM with an SSRI can lead to too much serotonin in your brain, which can cause the potentially FATAL serotonin syndrome.

MDMA/MDA/MDEA

It is NOT POSSIBLE TO ROLL while taking an SSRI! It is a COMPLETE and UTTER WASTE OF YOUR MONEY! Basically, SSRIs 'block' the part of your brain where the MDMA needs to go in order to get you high; and since MDMA can't get in there, you won't be able to get high. You might experience some weak 'speedy' effects from high doses of MDMA, but you will not be able to truly 'roll'.

Do NOT stop taking your SSRI so that you can roll. First of all, even if you stop taking it for a few days, it is unlikely that you will fully be able to roll. It takes much longer than a few days for all the SSRI (and its metabolites and effects) to leave your body (see the SSRI page under 'metabolism'). Second, you can get VERY SICK (withdrawal symptoms, depression, etc) if you stop taking your medicine. I strongly suggest that you give up rolling while you are taking an SSRI.

Amphetamines, Ritalin, Cocaine, 4-MAR

The effects of these drugs on someone taking an SSRI will not be significantly different. With the amphetamines, especially methamphetamine, there will be less 'loveyness' but overall, the high will remain unchanged. This is a safe combination overall, and you should still be able to get high from these stimulants while on an SSRI.

Hallucinogens: LSD, mushrooms, Tryptamines, 2-ct-2,DPT, DMT etc, Salvia

These drugs can be safely combined with the SSRIs. Most people report that they need to take MORE of a hallucinogen to get normal effects. Thus, if you are taking an SSRI, you will probably need more of the drug to reach threshold effects. Some people find that they need to take more LSD, but that shrooms affect them normally. So be careful to start at a normal dose and only take more if you find that you need to.

NOTE: Do not take 'ayahuasca' while on an SSRI. Do not combine SSRIs with any kind of MAOI, such as harmaline.

MAOIs

Reversible MAOIs

If you are taking a RIMA, do not use recreational drugs that are warned against in this FAQ within SEVEN DAYS of going on or off your medication. I.e., if you get high on a contraindicated drug (this means a drug that you can't take on a RIMA), you should wait 7 days before starting to take your medicine. If you STOP taking your RIMA, you should be off the medicine for at least 7 days before you attempt to get high.

Irreversible MAOIs

If you are taking an irreversible MAOI, you need to abstain from drug for a week before starting your medication. If you are going OFF an irreversible MAOI, you need to avoid recreational drugs for THREE WEEKS. Please be careful and heed this advice, or severe medical problems and/or death are possible.

Alcohol

If you are taking a MAOI, it is best to avoid Chianti wine and vermouth, as well as imported beer and ale. Consumption of red, white, and port wine in quantities less than 120ml present little risk. Whisky and liqueurs such as Drambuie and Chartreuse have also caused reactions. Best to stick with drinks like vodka, gin, rum etc and to avoid imported beers and red wine.

GHB etc, Benzos and Barbiturates

While you can take these drugs while on a MAOI, please be very careful when doing so and take LOW DOSES. MAOIs cause hypErtension while benzos/barbs cause hypOtension, and thus you can confuse and upset your heart rate, blood pressure etc by combining the two drugs.

Opiates

Opiates can, in general, be used while taking MAOI's, with some notable exceptions. Meperidine (Demerol) can inhibit the reuptake of serotonin (acts like an SRI), taking it with an MAOI can result in serotonin syndrome, which is terrible and can be fatal.Tramadol (Tramal) is a serotonin and norepinephrine reuptake inhibitor, and should also be avoided with MAOI's. Most other opiates are quite clean drugs, acting only on opioid receptors, thus posing no danger to a person using MAOI's

Ketamine

It is safe to use ketamine while taking a MAOI.

DXM

This can be a very DANGEROUS combination! Do not take DXM and MAOIs together! Combining DXM with a MAOI can lead to too much serotonin in your brain, which can cause the potentially FATAL serotonin syndrome. If you are on a MAOI that is selective for MAO b, such as rasagiline or selegiline (l-deprenyl), then it is safe to use DXM.

MDMA/MDA/MDEA

A VERY DANGEROUS combination. Do not roll while you are taking a MAOI. This leads to serotonin syndrome, a hypertensive crisis, and eventually death. A number of people have DIED from combining MDMA and a MAOI. DO NOT DO THIS! If you are on a MAOI that is selective for MAO b, however, such as rasagiline or selegiline (l-deprenyl), then it is safe to use MDMA, and in fact the MAO b inhibitors have been shown to reduce MDMA-related neurotoxicity. The same goes for the stimulants discussed in the next paragraph.

Amphetamines, Ritalin, Cocaine, 4-MAR

Again, a DANGEROUS combination, pretty much like combining MDMA and a MAOI. Stay away from stimulants when taking a MAOI!

Hallucinogens: LSD, mushrooms, Tryptamines, 2-ct-2,DPT, DMT etc, Salvia

Apparently, people taking MAOIs are LESS sensitive to hallucinogens/tryptamines than normally. This is especially true with LSD. Interactions with the tryptamines and with salvia are not well established, so please be VERY CAREFUL when combining. Start out with a LOW DOSE and see how the drug affects you before proceeding.

Some tryptamines such as DMT and 5-MeO DMT are destroyed in the stomach and gut by the action of MAO. Concomitant use of an MAOI and DMT makes DMT orally active. This is why ayahuasca includes a source of DMT as well as a source of a naturally occurring MAOI

Amoxapine

Interactions are pretty much identical to the drug interactions for the tricyclics/TCAs, see above.

Bupropion

Alcohol, GHB etc, Benzos, Opiates, Barbituates, Ketamine

Some people taking bupropion have found that it does not combine well with alcohol, and that they are more sensitive to alcohol and to blacking out while drinking. Not all people on bupropion find that alcohol affects them differently, however. Your best bet is to drink cautiously when you first start taking buproprion, and observe how alcohol affects you. All other downers (opiates, benzos, barbiturates) and ketamine are safe for people taking bupropion.

DXM

Not much is known about the combination of bupropion and DXM, but it appears to be safe. Use caution until more is known; start with a low dose.

MDMA/MDA/MDEA

There is a lot of controversy about rolling on bupropion. Some people (especially people who have bipolar) find that they can roll normally. Some people find that they roll slightly less hard than normally. Some people find that they only roll a little bit. In general, most people find that they can still roll, but not quite as hard, and so they often need to take more MDMA than usual. However, until you know how MDMA affects you personally while you are on bupropion, take your normal dose of MDMA. If you are at all prone to seizures, you should avoid combining bupropion and MDMA as you are more likely to suffer a seizure with this combination.

Amphetamines, Ritalin, Cocaine, 4-MAR

Amphetamines and ritalin are safe to use and the high should be unaffected. Some people on bupropion find that they get more out of cocaine; the high is better and lasts longer. In general, all stimulants seem to be safe for people taking bupropion. Observe, however, that if you are at all prone to seizures, you should avoid combining bupropion and stimulants as you are more likely to suffer a seizure with such a combination.

Hallucinogens

There are no known dangers resulting from combining these drugs with bupropion.

NARIs/Noradrenaline Reuptake Inhibitors

Alcohol, GHB, Benzos, Opiates, Barbituates

If you are taking a NARI, then the effects of these drugs might be stronger than normal. This is especially true when using barbiturates. Go easy on these drugs and stick to low doses until you are sure how they interact with the NARI. Otherwise these drugs are safe to use while on a NARI.

Ketamine

The effects of this drug should not be altered by NARIs and the combination is not known to be dangerous.

DXM

Because NARIs and DXM are metabolized by some of the same enzymes, this combination is most likely quite dangerous. Avoid taking DXM and a NARI together!

MDMA

Not much is known about rolling on NARIs. Rolling is still possible, and appears to be safe. Some of MDMA's effects are intensified while other effects are absent or weakened. I was much hotter and more sedated than usual, and jaw clenching/grinding, which I normally don't suffer from much, was quite severe. I also felt more 'fucked up', I was more out of it, had trouble with motor control, walking, etc. I did not feel 'stimulated' and I did not experience body rushes and tingling like I normally do. I still felt a decent amount of euphoria, however, and was more social and talkative. The comedown from MDMA was unpleasant (which it has never been otherwise), and included headache and jaw pain.

Amphetamines, Ritalin, Cocaine, 4-MAR

While it is not particularily dangerous (according to current data, at least) combining NARIs and amphetamines/ritalin is not recommended. The stimulant effects of the drugs, i.e. feeling alert/awake/hyper etc, are almost completely blocked by the NARI. You can snort 3 fat lines of quality meth and fall asleep two hours later. Jaw clenching, headache, come down etc are all terrible. There are some fucked-up feelings but very little euphoria and the bad side effects override any pleasurable effects. Nothing is known about combining cocaine and a NARI but an interaction similar to the amphetamine/ritalin interaction is suspected. Interactions with 4-MAR would probably be milder and less worriesome, or possibly completely absent.

Hallucinogens

There are no known dangers resulting from combining these drugs with a NARI.

Mianserin

Alcohol, GHB, Benzos, Opiates, Barbituates

The effects of these drugs will be stronger than normal, as they will add to the sedative effects of mianserin. This is especially true of the benzos and opiates. BE CAREFUL and go easy on these drugs and stick to low doses until you are sure how they interact with the mianserin.

Ketamine

The effects of this drug should not be altered by mianserin and the combination is not known to be dangerous.

DXM

Because mianserin and DXM are metabolized by some of the same enzymes, this combination is most likely quite dangerous. Avoid taking DXM and mianserin together!

MDMA

There is some evidence that mianserin may reduce MDMA-related neurotoxicity by blocking some of MDMA's effects on 5HT2 receptors. Mianserin's effects on NE probably increases the stimulant effects of MDMA. Though probably a relatively safe combination, roll with caution; start with a low dose.

Amphetamines, Ritalin, Cocaine, 4-MAR

Mianserin seems to potentiates (increase) the effects of stimulants. This means that you should be VERY CAREFUL when using stimulants stick to low doses until you have a better understanding of how these drugs interact with mianserin

Hallucinogens

Hallucinogens seem to be stronger on mianserin, so please dose carefully. It is probably not wise to combine mianserin with a MAOI-like hallucinogen, though not much is currently known about such interactions.

Mirtazapine

Alcohol, GHB, Benzos, Opiates, Barbituates

The effects of these drugs will be stronger than normal, as they will add to the sedative effects of mirtazapine. CAREFUL and go easy on these drugs and stick to low doses until you are sure how they interact with the mirtazapine.

Ketamine

The effects of this drug should not be altered by mirtazapine and the combination is not known to be dangerous.

DXM

Because mirtazapine and DXM are metabolized by some of the same enzymes, this combination is most likely quite dangerous. Avoid taking DXM and mirtazapine together!

MDMA

Rolling on mirtazapine is relatively safe. Some people find that they do not roll quite as hard as they usually would, and that they need to take about 1/2 an extra pill to obtain normal effects.

Amphetamines, Ritalin, Cocaine, 4-MAR

Using stimulants while on mirtazapine seems to be relatively safe as well. The mirtazapine does not appear to affect the recreational effects of the stimulant (i.e. you will get just as high as you always did).

Hallucinogens

Hallucinogens seem to be MUCH stronger in combination with mirtazapine, so please be VERY CAREFUL! A dangerous interaction with shrooms has been observed in one person taking mirtazapine. Please avoid hallucinogens while taking mirtazapine or dose very carefully.

Nefazodone

Alcohol, GHB, Benzos, Opiates, Barbituates, Ketamine

These drugs can be safely combined with nefazodone. Of course, if you feel somewhat sedated from the nefazodone, it makes sense not to consume too much of a downer, so don't take more than you really need to.

DXM

Because nefazodone and DXM are metabolized by some of the same enzymes, this combination is most likely quite dangerous. Avoid taking DXM and nefazodone together!

MDMA

Rolling on nefazodone is relatively safe. Because of the serotonin reuptake inhibitor effects of nefazodone, you will probably not roll as hard as usual. Some people will stop taking nefazodone for a day or two in order to roll more effectively. While stopping your medication is never recommended, in this case stopping for a day or two seemed to improve people's rolls.

Amphetamines, Ritalin, Cocaine, 4-MAR

Using stimulants while on nefazodone seems to be relatively safe as well. The nefazodone does not appear to affect the recreational effects of the stimulant (i.e. you will get just as high as you always did).

Hallucinogens

Not much is known about combining hallucinogens with nefazodone, but it is very likely that nefazodone makes the effects of hallucinogens stronger. You should therefore be very careful about combining nefazodone with hallucinogens; start with a low dose and be careful!

Tianeptine

Alcohol, GHB, Benzos, Opiates, Barbituates, Ketamine

These drugs can be safely combined with tianeptine. Ketamine seems very slightly potentiated/stronger.

DXM

Not much is known about the combination of DXM and tianeptine. As it is somewhat likely that the combination is dangerous, use caution until more is known.

MDMA

Fairnymph may be the only person to have ever taken MDMA while taking tianeptine (37.5mg/day for a month). She says "The combination was a good one, and undoubtably the tianeptine potentiated (made stronger) the effects of the MDMA. Having rolled a dozen times, on a variety of doses, I can say that this was the strongest roll I have ever experienced. The dose of MDMA was average for me, and it was pure and tested. The tianeptine does not potentiate the MDMA enough to make the combination really dangerous, but nonetheless I recommend being cautious when using MDMA while taking tianeptine. You certainly would not need to take more than 1-2 pills."

Amphetamines, Ritalin, Cocaine, 4-MAR

Fairnymph writes "Again, the only reference I can provide here is my own. I have used all of these substances except 4-MAR while on tianeptine, and the amphetamines seemed to be noticeably, though not overhwelmingly stronger, while my experiences with methylphenidate and cocaine were normal. The combination does not seem dangerous, but most likely you will need only an average dose of an amphetamine in order to feel the effects quite intensely."

Hallucinogens

Tianeptine and hallucinogens seem to be a safe combination. Psychedelic drugs appear to be slightly stronger than usual, but not by much.

MAOIs

Do NOT take tianeptine with a MAOI of any sort! This is most likely a dangerous combination.

Trazodone

Alcohol, GHB, Benzos, Opiates, Barbiturates, Ketamine

Trazodone increases sensitivity to alcohol, benzos, opiates and barbiturates. It is likely that trazodone increases sensivity to ketamine as well, though this is a safe combination either way.

DXM

Because DXM and trazodone are metabolized by some of the same enzymes, this combination is likely to be quite DANGEROUS. It is NOT recommended that you take these drugs together.

MDMA

Trazadone appears to reduce the effects of MDXX slightly.

Amphetamines, Ritalin, Cocaine, 4-MAR

Trazodone and stimulants do not seem to interact in any way; thus combining these drugs is probably relatively safe.

Hallucinogens

Trazodone will probably reduce your sensitivity to hallucinogens.

MAOIs

Do NOT take trazodone with a MAOI of any sort! This is most likely a dangerous combination.

Venlafaxine

Alcohol, GHB, Benzos, Opiates, Barbituates, Ketamine

These drugs can be safely combined with venlafaxine, and there effects will not be significantly altered.

DXM

Because DXM and venlafaxine are metabolized by some of the same enzymes, this combination is likely to be quite DANGEROUS. It is NOT recommended that you take these drugs together.

MDMA

See SSRIs. It is not possible to roll on venlafaxine. UNDER NO CIRCUMSTANCES should you STOP TAKING YOUR VENLAFAXINE SUDDENLY. Venlafaxine has VERY SEVERE WITHDRAWAL SYMPTOMS including nausea, dizziness, and ELECTRIC SHOCKS!

Amphetamines, Ritalin, Cocaine, 4-MAR

Amphetamines can be used relatively safely in combination with venlafaxine.. You should get normal effects from these drugs. Cocaine use is also relatively safe; however some people find that while they are taking venlafaxine they are MORE SENSITIVE to cocaine and that the cocaine high lasts longer. Ritalin, when taken by a person on venlafaxine, has been known to cause seizures, so use extreme caution with this combination.

Hallucinogens

Hallucinogens and venlafaxine can be relatively safely combined, without any significant impact on the effects of the hallucinogen being used. Do NOT take venlafaxine with a MAOI of any sort! This is a VERY DANGEROUS combination that can lead to serotonin syndrome and death!

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Online Sources

Naunyn-Schmiedeberg's Archives of Pharmacology. Abstracts of articles on tianeptine. SpringerLink

Maprotiline Full Prescribing Information. Healthyplace.com

Mianserin. Dr-bob.org

MAOI Vault. Erowid

Rxlist.com - directory of prescription drugs.

[www.erowid.org Erowid]

Glossary

Serotonin = 5-HT (5-hydroxytryptamine) Noradrenaline = Norepinephrine = NE Dopamine = DA Neurotransmitter = NT A Reuptake Inhibitor= a drug which prevents the reuptake of a neurotransmitter (such as serotonin, dopamine, etc), resulting in higher levels of the NT in the synapse Agonist = a drug which STIMULATES the production or the uptake of an NT Antagonist = a drug which INHIBITS the production or the uptake of an NT Selectivity = refers to the ability of a drug to target only a certain kind of receptor. For example, Prozac is an SSRI (SELECTIVE serotonin reuptake inhibitor), which means that it ONLY inhibits serotonin reuptake, and does not affect other NTs. Effexor, on the other hand, is a SNRI ( a serotonin/norepinephrine reuptake inhibitor) � it is not �selective� because it affects more than one NT.

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