Psychosomatics 5: 44-47, 1964
Copyright
© 1964 Academy of Psychosomatic Medicine
Some Experiences with a Combination Of Amitriptyline and Perphenazine In Severe Psychiatric Syndromes
H. ANGUS BOWES M.D.1
1 Director of the Institute of Neurology and Psychological Medicine, 1600 University, Grand Forks, North Dakota
In a private psychiatric clinic with facilities in the wards of a general hospital, we have treated 100 patients suffering from severe and intractable psychiatric syndromes characterized by severe anxiety, depression and with obsessional and paranoid ideation. We used a combination of amitriptyline (Elavil) 40-200 mg. daily and perphenazine (Trilafon) 4-32 mg. daily, and have had a recovery rate of 71 per cent in a mean of five out-patient therapeutic sessions. In those cases requiring hospitalization plus modified E.S.T., the patients were given two to five treatments daily for a mean of five days' hospitalization and of 10 modified E.S.T. and then seen in three follow-up therapeutic sessions.
No double-blind studies have been carried out. The patients acted as their own controls since the majority had received antidepressant drugs and tranquilizers from their referring physicians. Those who did not make recoveries reached a plateau of improvement with a lack of drive and retention of hypochondriacal or phobic symptoms requiring respectively the additional administration of opipramol (Ensidon) 50 mg. q.i.d. or diazepam (Valium) 5-10 mg. q.i.d. before a further improvement was obtained. Only 7 per cent did not appear to benefit from the regimen; these were patients with poor personalities and lifelong maladaptation who appeared reluctant to abandon their secondary neurotic gains from their illness though their condition appeared improved not only to their families but also to the examining psychiatrists. The patients included in this study were chosen as a result of their profiles on the Minnesota Multiphasic Personality Inventory and our own clinical observations. Many included in this study appeared to be classical cases of schizophrenia.
