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Promethazine for depression/antipsychotic when needed?


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Hello all! What's this? MM making a thread about medication?  :o

 

Yep!

 

Well, sort of.

 

I went to my GP and asked if there was anything I could take only as needed for depression and paranoia (the two often coincide for me) and she has suggested a prescription of promethazine. I've done a bit of research and from what I gather the main thing it does is make you tired. The psychoactive effects include a mild antipsychotic effect but apparently it's pretty weak. I've also found very little information about it being used to treat bipolar depression, or any kind of depression really, in particular.

 

So with little information to be found already online, I come here to ask you guys what you think. Do you think this will do the job of taking the edge off depression (mainly suicidal thoughts and the like) and paranoia? Or do you think there are other things that are more likely to work? Me and my GP are talking about options right now basically.

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Using drugs as a prn for depression and psychosis is a hit or miss anyway, especially the depression part. I've never seen or heard of any drug treating depression that doesn't take days to weeks to work. Treating paranoia is less so, but still, I don't know that a dose here and there would necessarily cover you.

Promethazine is primarily an antiemetic, and I don't know if it's used as an antipsychotic, ever. It's definitely not something that's used often for psych reasons.

What else are you taking? Why aren't you under the care of a psychiatrist? Most, if not all, GPs are unequipped to treat mental illness apart from very simple depression and anxiety.

Edited by dianthus
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first things first, you have to meet a psychiatrist who has a broader awareness of medications and their utility. Most of the atypicals whould remove the paranoia within week of using it, and they also have additional benefit of elevating mood, therefore treating depressive symptoms. A typical antipsychotic should be used, then one atypical doesn't work to the fullest and some more d2 receptor blockade is needed, however usually the augmenting agent should be a temporar thing, because of some nasty side effects they bring to the user

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I would love to get a proper pdoc but on the NHS they don't give you one of those until you are in crisis and I don't have the money to see one privately. So it's GP or nothing right now.

Promethazine has weak antipsychotic effects but yeah primarily it just sedates. That's why I'm asking about it. Seems like a strange thing to recommend.

The reason I don't want meds 24/7 is because I need my creativity. I am a writer so it's vital. That's why I'm interested in PRN.

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I don't think all meds dull creativity. I have had previous times of being highly creative while on meds. Right now I'm in a dry spell, but in the past meds didn't stop me. In depression I am not creative anyway. Just saying you don't have to discard them all.

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I've heard a lot of mixed reviews about the effects of mood stabilisers on creativity. But the overwhelming theme seems to be they often do impact creativity, especially since, for me, a lot of my creativity happens during hypomania. Besides, most of the time I'm stable, I don't think I need to be on something all the time.

Anyway, I'm not here to discuss the pros and cons of mood stabilisers. I've made my decision on that already for now. So since I think we can all agree promethazine isn't ideal, does anyone have recommendations for other PRN stuff?

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It is often used in the Uk instead of benzo's as sedatives, often to calm down anxiety and agitation. I get it after I leave IP to help me sleep and keep me sedated. It is not as habit forming as a benzo or a z med (zopiclone etc) but it's not going to have much use beyond short term PRN. If it helps, I am on two mood stabilisers, I am really prolific with with writing and art. They lessen my epsiodes and keep me stable, AAP's I couldn't tolerate, I took risperidone for a few years but it was never that good for me. I think depression stunted my creativity more than Lithium or Lamictal.

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Yeah in the UK they do seem very reluctant to prescribe benzos from what I've read and heard. But would those help for this use anyway? I've heard a lot of mixed things about that. Because I do know people who have been prescribed diazepam PRN for bipolar for this very reason, and I've read it doesn't get rid of bad thoughts but it helps you not to focus on them and not to let them bother you which sounds ideal, but other stuff I've read suggests it can make depression worse and my GP said the same, so I'm unsure what to think.

 

Regarding promethazine, are you saying it could be useful for my needs?

 

Depression sure stunts creativity but hypomania triples it (in my experience at least).

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Anyway, I'm not here to discuss the pros and cons of mood stabilisers. I've made my decision on that already for now. So since I think we can all agree promethazine isn't ideal, does anyone have recommendations for other PRN stuff?

 

There isn't a prn for mania/paranoia/psychosis/depression.  You're looking for something that doesn't really exist.  Sure, you can choose to not medicate yourself between episodes, but if you don't prevent the episodes in the first place, you're going to spend a lot of time recovering from them.  Your choice, of course, but it's not the most efficient way of treating bipolar I disorder.

 

AAPs and some mood stabilizers can knock down mania and psychosis in a few days or so, but full recovery from mania typically takes longer than that.  Depression relief is typically measured in weeks, not days.  You can also choose the middle road-- to be minimally medicated between episodes which may help space them out, and then only use the heavy duty stuff once an episode hits.  

 

I work full-time and make a living at being an artist, so it is possible to be creative on the right meds.  

Edited by dianthus
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I'm not really looking for something that will magically make depression disappear, but rather, something to take the edge off when it gets really bad. Like if I'm sitting there one night and get a strong urge to off myself, having something I can take to just calm me down and distract me from those thoughts I think would be helpful. I know it won't make the depression go away, that's not what I'm asking for, but when it gets really bad it'd be nice to have something to help out a little.

 

Edit: plus, I hate getting paranoid and I don't want to risk it turning into delusions as it has in the past.

Edited by Manic Maverick
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I will tell you what works for me, but you may not like it because it is a mood stabilizer. I find that the chewable 100 mg Tegretol tablets are great PRN to bail me out when I really need something to pull me out of the abyss. For me, it works within minutes. I know that many doctors believe that it is a blood level thing, but I swear that it works on me regardless of whatever the exact level is in my blood. And it worked from my first dose on day one. Now just because my brain likes Tegretol doesn't necessarily mean that it will work for you. It's just my two cents.

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I'm not really looking for something that will magically make depression disappear, but rather, something to take the edge off when it gets really bad. Like if I'm sitting there one night and get a strong urge to off myself, having something I can take to just calm me down and distract me from those thoughts I think would be helpful. I know it won't make the depression go away, that's not what I'm asking for, but when it gets really bad it'd be nice to have something to help out a little.

 

Edit: plus, I hate getting paranoid and I don't want to risk it turning into delusions as it has in the past.

 

Benzos, promethazine, a real AP will "take the edge off" for you, or at least put you to sleep.  They're all sedatives of some sort, so they will calm you down a bit.

 

An AAP/AP might help you with the paranoia turning into delusions, but again, that's going to be something you need to take for days/weeks, not just one here and there.  

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I've heard of Zyprexa being used as a PRN type med because its quick acting and knocks symptoms down fast, But thats mainly for psychosis (delusions, paranoia, hallucinations, etc) not mood episodes. It still might be an effective option if you just want to end the episode quickly though. Even then it can take days to take effect, And generally with mood episodes as stated they take weeks to fully resolve. There is no medication you can just take to make your problems go away.

 

In regards to the creativity I have had no loss at all on both lithium and Saphris, Other medications had a blunting effect however this was not as bad as a depressive episode. I found initially on lithium I had word finding problems, but that faded within a few months.

The best upside for lithium for me though is the almost complete lack of suicidal thoughts, Once I got to a theraputic level they evaporated even when very depressed which makes it easier to bear.

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Technically some AAPs like Abilify, Saphris etc should be effective against all 3 components eg. depression, mania, psychosis and they ought to work at least somewhat a bit on the first day. But I am not a pdoc and I dont know if theyll actually work that way.

Edited by konings
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The most effective thing I find for taking the edge of is distress tolerance and distraction skill, therapy skills taught me more about how to handle these long term than meds could provide.

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I am prescribed promethazine for nausea with headache, and it is sedating/calming, but I don't know if it would be a great option for what you are after. It would probably just put you to sleep. It has no effects on depression one way or another, to the best of my knowledge. I find compazine very helpful for anxiety. I have it prescribed as an antiemetic, but use it occasionally for severe anxiety, and it really helps. It isn't as sleep inducing as promethazine (at least for me) and makes my brain feel quiet. Stops almost all of the racing thoughts. You might want to look into that.

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I am prescribed promethazine for nausea with headache, and it is sedating/calming, but I don't know if it would be a great option for what you are after. It would probably just put you to sleep. It has no effects on depression one way or another, to the best of my knowledge. I find compazine very helpful for anxiety. I have it prescribed as an antiemetic, but use it occasionally for severe anxiety, and it really helps. It isn't as sleep inducing as promethazine (at least for me) and makes my brain feel quiet. Stops almost all of the racing thoughts. You might want to look into that.

 

Compazine has the exact opposite effect on me, oddly enough.  We think it's because it gives me akathisia, but I'm not willing to take it again to really figure it out.

 

To address the general topic (again):

 

There's just nothing out there that's going to treat bipolar disorder on a prn basis.  I think that's what everyone with bipolar would like.  I'd love to not take meds until I start having symptoms, and then take the meds for a day or so and everything is fine.  You can't treat bipolar disorder like the common cold.  I wish you could, but there's nothing out there that does that.  If there was, we'd all be treated that way and would be living much easier lives.   I don't think anyone particularly wants to be medicated all the time.  Maintenance meds aren't exactly fun.

 

Keep in mind that people who are talking about using things like Zyprexa, other AAPs, and mood stabilizers on a more prn or temporary basis are already medicated to some degree or another and the prn is only for breakthrough symptoms.  Comparing that scenario to someone trying to treat bipolar disorder strictly on a prn basis while maintaining hypomanias is like comparing apples to oranges.  As well, meds like lithium, ACs, and ADs that have been mentioned can't be used much at all on a prn basis.  You have to maintain certain blood levels of those drugs and then add more if it's needed because you're showing breakthrough symptoms.

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Just to update this, I set up another appointment to talk to the GP about Seroquel since I've read a lot of good stuff about it being used as a PRN for not only depression but also paranoia (obviously, it's an antipsychotic :P) and anxiety, and apparently it works well as a mood stabiliser for bipolar too. From my research it seems pretty much perfect. The only issue I see is weight gain, that means I'll actually have to exercise. Pfft.

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