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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Catling on March 13, 2013, at 6:22:50
Hi guys,
I've used this site a long time as a reference regarding medications and I just want to start off by saying how much I appreciate you all sharing things here. It's really a help to others that you might not even know about.
I have been dealing with ptsd related major depression with suicidal ideation and bad anxiety for the past decade. I was on a stable med regimen for a while but my insurance situation changed and I can't afford the primary antidepressant that was working for me (brand name wellbutrin), so I've been getting help from the public mental health system here in New Orleans. I have a great shrink, but we've been having a hard time finding anything that will work over the past two years.
She started me on parnate (tranylcypromine) about four or five months ago for the depression, I am taking 20 mg 2x daily. While it has seemed to stabilize my mood and I am not having any suicidal ideation, the place it is stabilizing at I would still characterize as very depressed. I am also taking 100mg lyrica 3x daily for anxiety (which works well for me and I don't have any issues from it).
My shrink mentioned that she wanted to start me on an antipsychotic to see if it would augment the antidepressant effect of the parnate. We tried geodon first, which was not her first choice but mine, because I'd done some research online that suggested other patients had seen positive results from this combo. I did get incredibly positive results but one of the side effects I was having was unpredictable sleep. Even at the lowest dose of geodon taken at bedtime, I would sleep anywhere from 9-13 hours and then be groggy for a couple of hours after that. She said this response to the medication was very atypical and suggested that we try Perphenazine which she's had good results with adding in with an antidepressant for other patients. I didn't research it, I just took the medication because sometimes I just get tired of all the leg work, you know?
I remember from my prior research (but of course didn't bookmark it) that there has been some research which has shown that some of the older antipsychotics can cause diabetes. This is of particular concern to me as I am pre-diabetic. Did I make that up or is there actual research someone knows about?
The perphenazine even at the lowest dose is making me kind of groggy and out of it throughout the day. I'm needing a lot of naps and I am not getting any of the good moods/motivation that I had with the geodon. Yet I know one of my shrink's concerns is that she wanted to keep things more on the sedating side because of my sleep issues and my anxiety issues. So is there another anti-psychotic perhaps someone may be aware of that has similar properties to geodon and also shares a low side effect profile?
Sorry this got long guys, thanks for reading.
All the best,
Cat
Posted by Tomatheus on March 13, 2013, at 23:15:36
In reply to Perphenazine + diabetes + anti-psychotics, posted by Catling on March 13, 2013, at 6:22:50
Cat,
First of all I'd like to welcome you to Psycho-Babble. Unfortunately, I can relate to feeling groggy and to oversleeping on antipsychotic medications, and even though your doctor said that your response to Geodon was very atypical, I don't think that you'd have a difficult time finding others who respond to the medication in a similar way. I don't think that I'd say that any of the antipsychotics have a low side effect profile, but it's my understanding that the atypicals (the newer antipsychotics) are less likely to cause tardive dyskinesia and "extrapyramidal" side effects such as tremors and muscle rigidity than the older typical antipsychotics. However, two of the atypical antipsychotics (Zyprexa and Clozapine) come with an increased risk of diabetes as a side effect, as do the "low-potency" typical antipsychotics, if my understanding is correct. So, if you're looking for an atypical antipsychotic other than Geodon that doesn't significantly increase the risk of developing diabetes, I think that your options would include Risperdal, Seroquel, and Abilify. Saphris, Fanapt, and Latuda might also be options, but I don't know how likely they are to increase the risk of developing diabetes. Somebody else here might know more about that.
Well, I want to wish you luck on finding a medication combination for your PTSD-related major depression that will hopefully be both effective and at least relatively tolerable. Thanks for posting, and please feel free to post some more if you have any additional questions.
Tomatheus
Posted by Zyprexa on March 14, 2013, at 9:49:32
In reply to Perphenazine + diabetes + anti-psychotics, posted by Catling on March 13, 2013, at 6:22:50
Geodon gave me diabetes, which went away a few months after stoping it. Risperdal was about the most similar to geodon, about the same level of sedation, which is not that much. Perpehenazine has not given me diabetes, been on it for 5 years. Zyprexa, I take with the perphenazine has been the best AP for PTSD, anxiety, a lack of being able to eat and sleep and for my schitzoaffective disorder. Zyprexa did not give me diabetes either, I've been on that for 15 years. If you want an AP that does not make you tired, Abilify is the one, but I found it made my anxiety worse, along with my schitzoaffective. I had realy bad results with abilify. You could always try a lower dose of perphenazine, see if it works better.
Posted by Catling on March 14, 2013, at 10:23:23
In reply to Re: Perphenazine + diabetes + anti-psychotics, posted by Tomatheus on March 13, 2013, at 23:15:36
Tomatheus, thank you so much for the warmwelcome and for your suggestions. It's always good to have a couple other names to throw out there if the shrink comes up empty - although since we've just started toying around with the APs as an addon, I suspect she has a lot of suggestions left yet. :)
Best,
Cat
Posted by Catling on March 14, 2013, at 10:37:56
In reply to Re: Perphenazine + diabetes + anti-psychotics, posted by Zyprexa on March 14, 2013, at 9:49:32
Zyprexa,thank you so much for your detailed feedback, it is super helpful to me. I think I am going to discontinue the perphenazine because it is making me drowsy at all hours and is not helping my mood the way the geodon did. My shrink wanted me to stay open to dealing with the sleep issues the geodon was causing and I think part of it may be my inconsistent bedtime so maybe I need to give it a more fair shot. All I know is that on geodon I was able to go take an hour and a half walk, something I haven't been able to do in about two years. So I think if it can help me motivate to get off my butt that will go a long way to keeping the pre-diabetes under control. (Seriously, I can't find the motivation to even walk around the block, so it was like night and day to be waking my BFF up at 8 am! on a Saturday to go for a walk with her dogs.)
I have tried Abilify before, I gave it a couple month shot and it didn't do anything for me. I am on the lowest dose of perphenazine already, for some reason I seem to be really sensitive to this class of med.
All the best,
Cat
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