How Do Psychotherapeutic Combos Work?

Psychotherapeutic combos are combinations of psychiatric medications for treating depression associated with psychiatric disorders such as schizophrenia and bipolar disorder. Typically, psychotherapeutic combos are formulations of an antidepressant medication combined with an antipsychotic or antianxiety agent.

Psychotherapeutic combos work in multiple ways to improve symptoms of psychiatric disorders and depression associated with them. Psychotherapeutic combos primarily work by regulating the levels and activity of neurotransmitters such as serotonin, norepinephrine, dopamine and gamma-aminobutyric acid (GABA).

Neurotransmitters are chemicals that nerve cells (neurons) release to communicate with each other. Neurotransmitters regulate most of the body’s functions including breathing, heart rate, digestion, cognition, sleep, emotions and behavior. Dysregulation of neurotransmission is thought to play an important role in psychiatric disorders.

Neurotransmitters bind to specific types of receptors, protein molecules on neuronal surfaces, which initiate downstream action in response. The action may be excitatory or inhibitory depending on the neurotransmitter, the type of receptor and the feedback from the body.

Psychotherapeutic combos regulate neurotransmission by enhancing the levels and activity of inhibitory neurotransmitters and blocking excitatory neurotransmission. Following are some of the ways in which the components of psychotherapeutic combo formulations work:

• Tricyclic antidepressants (TCAs): TCAs increase the levels of serotonin and norepinephrine by preventing their reabsorption (reuptake) by neurons, a natural process in the brain.
• Selective serotonin reuptake inhibitors (SSRI) antidepressants: SSRI antidepressants increase serotonin availability in the brain by blocking their reuptake.
• Antianxiety agents: Antianxiety agents bind to GABA receptors and increase the inflow of chloride ions, which enhances GABA’s effects. GABA inhibits electrical activity in the brain and produces a sedative effect.
• First generation antipsychotics: First generation antipsychotics block D2 dopamine receptors, which initiate excitatory action when stimulated by dopamine.
• Second generation antipsychotics: Second generation antipsychotics block D2 dopamine receptors and 5-HT2A serotonin receptors, both of which are excitatory and believed to be involved in psychosis.

Psychotherapeutic combos are oral tablets or capsules administered in the treatment of the following conditions:

• Anxiety or agitation with depression
• Schizophrenia with depression
• Depression with anxiety
• Depression associated with bipolar I disorder
• Treatment-resistant depression

Side effects of psychotherapeutic combos may include the following:

• Drowsiness
• Dry mouth
• Constipation
• Blurred vision
• Dizziness
• Bloating
• Vivid dreams
• Impotence
• Tremor
• Confusion
• Memory impairment
• Violent behavior
• Nasal congestion
• Cataract
• Optic neuritis (inflammation of the optic nerve)
• Edema
• Syncope (fainting)
• Ataxia (impaired coordination, balance and speech)
• Stuttering
• Salivary hypersecretion
• EEG abnormalities
• Atrial fibrillation
• Heart arrest
• Cerebrovascular accident
• Pulmonary hypertension
• Hypersensitivity reactions such as:
  • Pruritus (itching)
  • Urticaria (hives)
  • Erythema multiforme (round lesions like bullseye)
  • Erythematous nodosum (painful bumps under the skin)
  • Angioedema (swelling in the tissue under the skin or mucous membranes)
  • Stevens-Johnson syndrome (a rare medical emergency with flu-like symptoms and a painful rash)
  • Toxic epidermal necrolysis (a severe skin condition with widespread redness, skin cell death and exfoliation which can lead to sepsis)
  • Drug rash with eosinophilia and systemic symptoms (DRESS)
  • Anaphylaxis (severe allergic reaction)
• Eosinophilic pneumonia
• Menstrual irregularities
• Blood dyscrasias (disorders) such as:
  • Agranulocytosis (low granulocytes, immune cells with granules)
  • Aplastic anemia (anemia due to reduced red cell production)
• Liver dysfunction
• Jaundice
• Cholestatic jaundice (jaundice due to impaired bile flow)
• Liver failure
• Hypoglycemia (low glucose level in the blood)
• Diabetic ketoacidosis (complication from diabetes that causes excessive blood acids known as ketones)
• Diabetic coma
• Drug withdrawal reactions such as:
  • Diaphoresis (excessive sweating)
  • Nausea
  • Vomiting
• Increase in triglyceride levels
• Kidney failure
• Deep vein thrombosis (blood clot in the vein)
• Pulmonary embolism
• Restless leg syndrome
• Rhabdomyolysis (breakdown of skeletal muscle cells)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of psychotherapeutic combo drugs include:

• amitriptyline/perphenazine
• chlordiazepoxide/amitriptyline
• fluoxetine/olanzapine
• Symbyax