Posted by SLS on October 28, 2005, at 7:42:47
In reply to Re: meds for psychotic depression, posted by med_empowered on October 28, 2005, at 5:38:49
Hi.
I guess the majority opinion is to combine an antidepressant with a neuroleptic antipsychotic. The problem is, which ones?
I would look first to choose the antipsychotic. If psychotic symptoms are prominent, I think a stronger atypical AP like Risperdal 3.0 mg might do the job. I do know someone for whom Seroquel 800mg is working well.
In the past, the tricyclic antidepressants have been thought of as being more efficacious than the SSRIs for psychotic depression. I have seen Wellbutrin be helpful as well. I would have a difficult time guessing as to which tricyclic to choose, but imipramine is the standard by which others are judged. Perhaps you can start with imipramine and switch over to desipramine or nortriptyline if you do not tolerate the side effects well. I am not a big fan of amoxapine. The incidence of EPS side effects with this drug seems to be equivalent to that of the older neuroleptics.
I would be wary of Geodon. Although it can exert mild antidepressant effects, it has also shown that it can precipitate mania and psychosis.
Good luck.
- Scott
poster:SLS
thread:572602
URL: http://www.dr-bob.org/babble/20051024/msgs/572642.html