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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by F_minor on May 30, 2013, at 11:03:40
Hello all, i need your help...
I am taking for years amitriptyline 25mg and Perphenazine 4 mg. I have depression and my family doctor wants to add effexor XR 150 mg to amitriptyline and perphenazine. Is it safe to mix all these drugs? What about serotonin syndrome?
Thank you in advance for your response!P>S: The reason i asked my family doctor is because i dont have money to go to a psychiatrist (too expensive most of them here in Greece)
Posted by vbs on May 30, 2013, at 11:31:00
In reply to Amitriptyline, Perphenazine and Effexor XR, posted by F_minor on May 30, 2013, at 11:03:40
Hi, welcome to Babble. I think you'll be okay. Serotonin syndrome/toxicity is a rare condition; possible but unlikely. I take both Cymbalta and trazodone and I feel fine. Talk to your family doctor about the risks and benefits of adding Effexor XR to your medication regimen.
Posted by Phillipa on May 30, 2013, at 11:53:49
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » F_minor, posted by vbs on May 30, 2013, at 11:31:00
welcome also to babble. Have you had a blood level test for the amitriptyline? That should tell you and your doc if safe. But you are on a low dose and agree with vbs that things should be fine. Phillipa
Posted by ed_uk2010 on May 30, 2013, at 18:22:30
In reply to Amitriptyline, Perphenazine and Effexor XR, posted by F_minor on May 30, 2013, at 11:03:40
>I am taking for years amitriptyline 25mg and Perphenazine 4 mg.
Are these meds helping at all? Amitriptyline is an antidepressant but perphenzine is an antipsychotic. Perphenazine is normally only recommended for long-term use in schizophrenia. For depression and anxiety, it is only recommended for short-term use. This is because long-term use can eventually cause a movement disorder called tardive dyskinesia, even when used at low doses. Tardive dyskinesia usually causes uncontrolled movements of the tongue/mouth/face but can affect other parts of the body too. Hopefully, you might be able to reduce perphenazine gradually and stop.
Tardive dyskinesia...
http://www.youtube.com/watch?v=W_3bbpFjI68
Rather than trying a different antidepressant, you could consider increasing amitriptyline. Most patients need more than 25mg to help their depression.
>What about serotonin syndrome?
Serotonin syndrome is very unlikely with this combination.
I assume you've already tried one or more SSRI antidepressants such as citalopram or sertraline? Although Effexor can be effective, it tends to cause more side effects than SSRIs and more severe withdrawal symptoms when it's stopped. For this reason it is not a drug of first choice. Among the SSRIs, sertraline might be a good choice because it can be combined with your current meds without an interaction. Some SSRIs interact with amitriptyline and so would not be suitable.
Posted by jono_in_adelaide on May 30, 2013, at 21:43:58
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » F_minor, posted by ed_uk2010 on May 30, 2013, at 18:22:30
25mg of amitriptyline is a subtheraputic dose for depression
Posted by F_minor on June 1, 2013, at 4:10:12
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » F_minor, posted by ed_uk2010 on May 30, 2013, at 18:22:30
> >I am taking for years amitriptyline 25mg and Perphenazine 4 mg.
>
> Are these meds helping at all? Amitriptyline is an antidepressant but perphenzine is an antipsychotic. Perphenazine is normally only recommended for long-term use in schizophrenia. For depression and anxiety, it is only recommended for short-term use. This is because long-term use can eventually cause a movement disorder called tardive dyskinesia, even when used at low doses. Tardive dyskinesia usually causes uncontrolled movements of the tongue/mouth/face but can affect other parts of the body too. Hopefully, you might be able to reduce perphenazine gradually and stop.
>
> Tardive dyskinesia...
>
> http://www.youtube.com/watch?v=W_3bbpFjI68
>
> Rather than trying a different antidepressant, you could consider increasing amitriptyline. Most patients need more than 25mg to help their depression.
>
> >What about serotonin syndrome?
>
> Serotonin syndrome is very unlikely with this combination.
>
> I assume you've already tried one or more SSRI antidepressants such as citalopram or sertraline? Although Effexor can be effective, it tends to cause more side effects than SSRIs and more severe withdrawal symptoms when it's stopped. For this reason it is not a drug of first choice. Among the SSRIs, sertraline might be a good choice because it can be combined with your current meds without an interaction. Some SSRIs interact with amitriptyline and so would not be suitable.
>
>
>Thank you all for your responses!
I am on day 2 of effexor 75mg. I have tried escitalopram for some years and fluoxetine... i see on drug interactions that sertraline increases plasma concentrations of phenothiazines,like perphenazine... so i am not taking the risk.
Perphenazine helps keep me calm from my phobias, amitriptyline i dont know.
i had a very expensive psychiatrist, who was considered very good, and gave me fluoxetine with amitriptyline, 40mg of fluoxetine and 50mg of amitriptyline... when i told him to check for interactions he said i was stupid....
Anyway, i cant up the dose of amitriptyline cause here in Greece it is sold as a combo with perphenazine and i dont want to take more of the antipsychotic.
Posted by ed_uk2010 on June 1, 2013, at 8:49:09
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » ed_uk2010, posted by F_minor on June 1, 2013, at 4:10:12
>I am on day 2 of effexor 75mg. I have tried escitalopram for some years and fluoxetine... i see on drug interactions that sertraline increases plasma concentrations of phenothiazines,like perphenazine... so i am not taking the risk.
Sertraline, citalopram/escitalopram and venlafaxine minimally effect the plasma levels of phenothiazines, there may be a slight change but nothing more. Fluoxetine and paroxetine may produce large increases in plasma levels and combinations with tricyclic antidepressants and phenothiazines are not a good idea. Since you have previously tried more than one SSRI, venlafaxine is probably slightly more likely to be effective than sertraline.
>Anyway, i cant up the dose of amitriptyline cause here in Greece it is sold as a combo with perphenazine
Really, how surprising! Amitriptyline is available on its own almost everywhere. Did you check with a pharmacist?
Posted by F_minor on June 1, 2013, at 9:57:14
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » F_minor, posted by ed_uk2010 on June 1, 2013, at 8:49:09
>
> Really, how surprising! Amitriptyline is available on its own almost everywhere. Did you check with a pharmacist?
>Yes, of course... you know, i think that here in Greece we didnt even have generics... the previous year started to appear!
Posted by F_minor on June 1, 2013, at 10:09:41
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » F_minor, posted by ed_uk2010 on June 1, 2013, at 8:49:09
Well, fluoxetine with amitr was a nice combo, but i was afraid to continue. Escitalopram made me extremely apathetic and no emotions, i was in a terrible car crash, inside the car and was like 'oh! that crash was awesome!'. I am an artist and extremely emotional and i couldnt create anything good. I ll give effexor a shot. let's see...
Posted by ed_uk2010 on June 1, 2013, at 12:27:47
In reply to Re: Amitriptyline, Perphenazine and Effexor XR » ed_uk2010, posted by F_minor on June 1, 2013, at 10:09:41
I hope Effexor works for you! If not, perhaps you could consider trying fluoxetine on its own. You could gradually reduce your current medication eg. to half a tablet first and then switch over to fluoxetine. It might work well for you.
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