Rifampicin + antidepressants

rifampicin speeds up liver processing through the CYP450 enzyme system - and its this that lowers the blood concentration of many drugs - as many drugs are processed through this pathway

macrolides can slow this pathway to some extent - clarithro in particular - counteracting this effect
so that might be another option in place of azithro - to avoid upsetting the anti-depressant medication as much (clarithromycin is in the same family of ABX as Azithro - and is often preferred by LLMD's for both Lyme and Bart).
however, this is theoretical on average - in practice the degree to which one effect counteracts another is probably highly variable from patient to patient - so this could be a large effect or a small one and no way to know for sure without trying it.

the other option would be to have blood levels of the antidepressant drug monitored and adjusted during treatment - but this could be a bit of a roller coaster as liver function can fluctuate over time on the drugs - esp in Bart - as bart itself effects the liver and its functions. So this could end up being a chasing your tail type exercise.

no easy answers i'm afraid

the third option would be to try to find a way off long term anti-depressants through alternative means

a few points that may be relevant or helpful in framing this approach
these drugs were actually never intended for long term ongoing use
they tend to be prescribed long term because people get stuck and doctors do not know what else to do
and patients press for something
but there is not good clinical evidence that they really help people in the long term
these drugs also have unwanted and potentially harmful side effects
and they may actually contribute to ongoing mental health issues -
both by unwanted biological side effects - but also by preventing or discouraging people from processing what is causing their mental health issues in the first instance.


hope this is of at least some help

MariaS74, You are very wise to assess your individual health needs. Please remember that no one here is a doctor and advice to go off of a medication which has proven helpful to you is unwise.

Regarding what Garzie said about clarithromycin, while clarithromycin does block the effects of CYP450 somewhat, I found this not helpful at all. It was very inconsistent, and made my blood pressure go up and down a lot. The elimination half life of clarithromycin is only a few hours, so it doesn't last all day and things get real unstable when it's messing with other things.

If you can't tolerate rifiampicin, atovaquone (mepron, wellvone) is often effective against bartonella and doesn't have the CYP450 effect. I eventually settled on treating bart with azithromycin + atovaquone. Atovaquone is a little pricey though.

Mepron or malarone being effective against bartonella is something that people have reported

https://www.healingwell.com/community/default.aspx?f=30&m=4296580
https://www.healingwell.com/community/default.aspx?f=30&m=4216994
https://www.healingwell.com/community/default.aspx?f=30&m=4231426

Theoretically, based on it's mechanism of action, it's fairly clear why this would be so. Bartonella, like malaria and babesia, takes heme from red blood cells, which it uses for its cytochrome bc1 complex. As atovaquone inhibits cytochrome bc1, it should work on bartonella as well as malaria.

I found that mepron alone wasn't enough to kill bart, but mepron plus azithromycin or clarithromycin worked well. I also found valproate plus minocycline quite effective, however that has a lot more side effects.

Things that aren't quite enough to kill bartonella can disturb the dormant bartonella causing it to become active. This can make the infection worse, but it can also make the bartonella more susceptible to other antibiotics. This is widely reported with disulfiram, but I also noticed it with valproate. Atovaquone didn't cause a huge problem for me, but in that other thread Wisco woman said malarone did cause a bart flare up, but adding azithromycin got rid of it.

Valproate is a mood stabilizer which was unexpectedly found to have antimicrobial effects. There have been several studies published on using it to treat toxoplasmosis. I found it quite effective on borrelia, but with bartonella it does have the risk that what doesn't kill bart can make it become more aggressive.

Obviously valproate does have neuro effects and if you need antidepressants then maybe you would be sensitive to this. Mostly it makes me tired and increases REM sleep, with a slight manic effect if I take too much. The usual dose is 1000 to 1500 mg, but I took only 250 to 500 mg and this caused such a severe herx that I would not recommend taking more than that.