SHOULD TEGRETOL BE ADDED TO PROZAC? 
Ask The Doctor Dr. Leland Heller Biological Unhappiness 
SHOULD TEGRETOL BE ADDED TO PROZAC? 
Question: I’ve been using Prozac for about 10yrs but its not working as well. I just found your articles on adding Tegretol to the Prozac. In your opinion, is augmenting the Prozac with Tegretol the best way to go? Dr. Heller’s Answer: It depends on the underlying diseases and comorbidities. If an individual with just the BPD in my practice is doing well on Prozac and has a dysphoric episode, I prescribe a dose of Haldol, usually 2mg. If that doesn’t work, I’ll give a dose of Tegretol. If that doesn’t work, 3mg of Risperdal will stop the dysphoria 24 hours later. If the individual needs Haldol on a regular basis, is going through excessive stress, is having bad dreams or wakes up dysphoric, or has persistent mood swings, then I’ll prescribe a regular Tegretol dose. In my experience, the Prozac (fluoxetine) / Tegretol (carbamazepine) combination is by far the best medical treatment for the BPD. It’s also very inexpensive and rarely has significant side effects. There are other combinations that can work very well also, but I don’t usually use them. They are:
1) Prozac (fluoxetine) with Zyprexa (olanzapine). This works well, and has literature to back it up. Zyprexa is enormously expensive and can cause tremendous weight gain as well as diabetes. 2) High dose Effexor (venlafaxine) (usually 450-600mg daily) either by itself or with a weight neutral antipsychotic like Abilify (aripiprazole). Expense and severe withdrawal symptoms are a problem. Effexor (venlafaxine) can cause significant high blood pressure and side effects commonly limit its use. Some practitioners believe Effexor (venlafaxine) is the best medication for the BPD. I’d love to see a head to head study comparing Effexor (venlafaxine)–with or without an antipsychotic–with the combination of Prozac (fluoxetine) with and Tegretol (carbamazepine) at a therapeutic dose that stops the target symptoms.
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