Posted by Christ_empowered on June 14, 2011, at 14:35:23
In reply to Re: Prozac+Amitriptiline+Perphenazine !! Scared, posted by Vasilis on June 14, 2011, at 6:38:36
Perphenazine+amitrip sounds like the most mind-numbing combo ever. Is it?
Anyway, there are a couple different approaches you can take to psychotic depression. Lithium+an antidepressant (I think TCAs are the most studied) can sometimes work. Amoxapine (sold as Asendin here in the US) is a TCA that partly breaks down into loxapine, an old school antipsychotic. It works quickly on mood symptoms in a lot of people and its often used for psychotic depression. You have to watch out for TD, EPS, and all your usual TCA side effects, but I think it'd be easier to tolerate than your current combo, and probably less mind numbing.
Some people respond to fluvoxamine (Luvox here in the US) without anything else. I don't know why, but there's some indication that it does something unique in the brain to make psychotic depression better. That would spare you being exposed to an antipsychotic, if it works.
And there are newer antipsychotics than perphenazine. I don't know that they're "better," b/c they still have side effects,but some of them seem to have anti-depressant properties in their own right, so they might be better suited for this situation. I'd personally try Abilify if I were you--minimal weight gain, minimal sedation, fewer drug-induced cognitive problems than other antipsychotics, possibly some built-in antidepressant action.
Sorry you're going through this. I've had psychotic depression as part of my Bipolar I, and taking abilify+celexa cleared that up. I read somewhere that Lamictal can help prevent a future episode of psychotic depression, so maybe lamictal+an antipsychotic, then drop the antipsychotic once the psychosis clears up? I don't know...I just would hate to have to take an old school antipsychotic and a TCA for any extended period of time, unless absolutely necessary.
poster:Christ_empowered
thread:987960
URL: http://www.dr-bob.org/babble/20110610/msgs/988084.html