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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Vasilis on June 13, 2011, at 16:26:36
Hello and thank you in advance for your reply.
I want to ask a question about the drugs i am prescribed for psychotic depression.
At first i was prescribed daily 75mg of amitriptilyne and 12mg Perphenazine, but this combination made me way more tired so the doctor switched me to Prozac 40mg/ Amitriptiline 50mg/ Perphenazine 8 mg.
I am reading so many things on the net for the interactions and i am worried that this is a very bad combination.
What are you saying about this?
Posted by Christ_empowered on June 13, 2011, at 17:33:03
In reply to Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Vasilis on June 13, 2011, at 16:26:36
hey. Using a TCA antidepressant (the older ones, like amitrip) and an antipsychotic (perphenazine) in combo for psychotic depression used to be common. Then the SSRI drugs (such as Prozac) and the "atypical" antipsychotics" (such as zyprexa) came out and, in the US at least, its become more common to use the newer drugs (SSRI+atypical instead of your combo, TCA+old-school antipsychotic).
I don't understand why you're on 2 antidepressants. Is the idea to boost your energy levels? It strikes me as a kind of risky combo. What are your symptoms? I mean, I know you've been diagnosed with psychotic depression, but what's really bothering you--agitation, voices, insomnia...??
I'd personally try just one antidepressant and the perphenazine for a couple months and then if they psychosis is gone drop the perphenazine, or at least get the dose lower (in low doses it acts as a tranquilizer, not so much an antipsychotic agent).
Sorry you're going through a rough patch.
Posted by desolationrower on June 13, 2011, at 17:38:56
In reply to Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Vasilis on June 13, 2011, at 16:26:36
> Hello and thank you in advance for your reply.
> I want to ask a question about the drugs i am prescribed for psychotic depression.
> At first i was prescribed daily 75mg of amitriptilyne and 12mg Perphenazine, but this combination made me way more tired so the doctor switched me to Prozac 40mg/ Amitriptiline 50mg/ Perphenazine 8 mg.
> I am reading so many things on the net for the interactions and i am worried that this is a very bad combination.
> What are you saying about this?that seems like a weird combination. i don't think it is 'very bad' but the use of prozac instead of switching to a less hypnotic TCA is odd. and the dose is low enough you might be on the edge of it not doing anything *except* make you tired.
there may be some cyp450 interaction, i don't have those in memory.
-d/r
Posted by Vasilis on June 13, 2011, at 17:56:55
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Christ_empowered on June 13, 2011, at 17:33:03
> hey. Using a TCA antidepressant (the older ones, like amitrip) and an antipsychotic (perphenazine) in combo for psychotic depression used to be common. Then the SSRI drugs (such as Prozac) and the "atypical" antipsychotics" (such as zyprexa) came out and, in the US at least, its become more common to use the newer drugs (SSRI+atypical instead of your combo, TCA+old-school antipsychotic).
>
> I don't understand why you're on 2 antidepressants. Is the idea to boost your energy levels? It strikes me as a kind of risky combo. What are your symptoms? I mean, I know you've been diagnosed with psychotic depression, but what's really bothering you--agitation, voices, insomnia...??
>
> I'd personally try just one antidepressant and the perphenazine for a couple months and then if they psychosis is gone drop the perphenazine, or at least get the dose lower (in low doses it acts as a tranquilizer, not so much an antipsychotic agent).
>
> Sorry you're going through a rough patch.I am on two antidepressants because here in Greece perphenazine is sold only as a combo Amitriptiline-perphenazine. The doctor is perfect but i am unsure of his knowledge of pharmakokinetics.
Posted by jono_in_adelaide on June 13, 2011, at 18:12:16
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Christ_empowered on June 13, 2011, at 17:33:03
Prozac inhibits the metabolism of amitriptyline, so can increase blood levels in an unpredictable way - would make much more sense to take your amitriptyline/perphenazine in combo with Zoloft or Celexa than Prozac - speak to your doctor or pharmacist about the interaction
Posted by phillipa on June 13, 2011, at 19:00:08
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by jono_in_adelaide on June 13, 2011, at 18:12:16
Might also google med checker on internet and put in the meds and see what interractions come up. Done it lots of times myself. Is this a psychiatrist? Welcome to babble. Phillipa
Posted by jono_in_adelaide on June 13, 2011, at 19:54:47
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by phillipa on June 13, 2011, at 19:00:08
The combo of prozac and amitriptyline can be quite dangerous (the amitriptyline can build up to toxic blood levels) - I would speak to your doctor before taking it.
You can safely take amitriptyline/perhoenazine with Zoloft, Celexa or Lexapro, but not with Paxil or Prozac
Posted by Vasilis on June 14, 2011, at 6:38:36
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by jono_in_adelaide on June 13, 2011, at 19:54:47
I manually took for the past two days 4mg of Perphenazine/ 25mg amitriptilyne. I am a little scared because i have diarrhea and tachycardia. Could this be from withdrawal or amitriptilyne poisoning? What should i do? Ask him to prescribe me another antipsychotic?
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.
Posted by desolationrower on June 14, 2011, at 19:10:25
In reply to Re: Prozac+Amitriptiline+Perphenazine !! Scared, posted by Christ_empowered on June 14, 2011, at 14:35:23
I assume the combo is because hte TCA is a 5ht2 antagonist, so they are hoping to mimic the lower (at least in terms of classic) side effects of 2nd gen neuroleptics, though that may not totally work.
-d/r
Posted by phillipa on June 14, 2011, at 20:13:38
In reply to Re: Prozac+Amitriptiline+Perphenazine !! Scared, posted by Christ_empowered on June 14, 2011, at 14:35:23
CE what's this about luvox being unique in the brain? Please let me know as the one my brain seems to want. I'm not psychotic? Phillipa
Posted by Christ_empowered on June 14, 2011, at 23:45:05
In reply to Re: Prozac+Amitriptiline+Perphenazine !! Scared » Christ_empowered, posted by phillipa on June 14, 2011, at 20:13:38
hey, phillipa. I'm no expert, but apparently luvox has been used with some success all by itself in the treatment of psychotic depression. I've only read a wiki and some online psychiatric articles about it, so I don't know why your brain seems to need it, sorry.
Posted by Phillipa on June 15, 2011, at 19:17:46
In reply to Re: Prozac+Amitriptiline+Perphenazine !! Scared, posted by Christ_empowered on June 14, 2011, at 23:45:05
Thanks CE guess it's google search time!!!!! Love Phillipa
Posted by Peter Heuer on June 16, 2011, at 6:03:20
In reply to Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Vasilis on June 13, 2011, at 16:26:36
Hi,
Prozac and amitriptyline don't mix well.
That's a very bad combination of drugs.I have been on this combo myself.
That was the worst time in my life.I'm afraid that your doctor is ignorant.
You should get yourself a new doc.Best regards,
Peter Heuer
Posted by Vasilis on June 18, 2011, at 11:26:07
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Peter Heuer on June 16, 2011, at 6:03:20
> Hi,
>
> Prozac and amitriptyline don't mix well.
> That's a very bad combination of drugs.
>
> I have been on this combo myself.
> That was the worst time in my life.
>
> I'm afraid that your doctor is ignorant.
> You should get yourself a new doc.
>
> Best regards,
> Peter HeuerThank you all for your answers! I didn't have time to respond.
Peter, please give me details, what were the dosages of prozac and amitriptiline you were on?
Posted by Peter Heuer on June 20, 2011, at 10:02:04
In reply to Re: Prozac+Amitriptiline+Perphenazine Need to be sure, posted by Vasilis on June 18, 2011, at 11:26:07
Hi,
I don't remember the dosage of Prozac, but I probably took the standard dose.
I was on 50 mg of amitriptyline for many years.
I had a miserable time before I realized that this combination of drugs was inappropriate.
I fired my psychiatrist because the man was obviously incompetent.
Best regards,
Peter Heuer
This is the end of the thread.
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