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Major Depressive Disorder Severe With Psychotic Features


My daughter is in detention, and to my surprise they diagnosed her with major depressive disorder severe with psychotic features, audio and visual hallucinations, and anxiety disorder. They have her on 6 meds and when I visit her she seems so sedated and her eyelids are partially closed, but they tell me she’s not over medicated. The meds they are giving her are: Prozac 80 mg, Paxil 40 mg, Celexa 10 mg, Geodon 60 mg, Trazidone 400 mg, and Vistaril 200 mg. Her appetite ahs increased and she is gaining weight, as well as sleeping a lot. Is this combination of meds safe for her? Would it be harmful if she quit taking these meds? She stays so drowsy and is not functioning on all these meds. Prior to this detention she was on mental health meds, Clonazepam 1 mg, Seroquel 400 mg, and Effexor 150 mg.

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Usually the word "detention" refers to some type of jail. However, I am assuming that your daughter is hospitalized for her illness.

Anyway, I want to urge you to speak with her doctors about her treatment. They are the professionals who are in charge of her case and her treatment. They can answer all of your questions as well as provide reassurance for you. The only thing I can say is that each of the medications you refer to has a specific purpose. Ask the doctors about what each medicine does. In fact the psychiatric hospitals or the hospitals with psychiatric wards are always keenly interested in working with concerned parents. They want to see parental and family involvement.

Besides the psychiatrists assigned to your daughter’s case, there is also a social worker whose job it is to work with you and your daughter. The work of the social worker has several purposes in that setting. The purposes range from being a liason or communication network between doctors, who cannot always be easily available, and parents and patient all the way to helping patient and family prepare for a discharge program that will enable everyone adjust to post hospital life. Post hospital life can be stressful for all involved.

I will say that a severe case of Major Depression with Psychotic Features is very serious and not to be taken lightly. That is why the discharge plan for your daughter will be extremely important. In fact, I would guess that a meeting with the patient and the entire family will be called for to do an efficient type of planning. I am certain that your daughter will continue to need a lot of treatment and support when she is discharged.

I know that this is a very difficult time for you and your family. Please use the professional support systems available to all of you at the hospital. Speak to her Psychiatrists and meet with the social worker. Learn all you can from them about this illness and the medications.

I want to wish you, your daughter and your family the very best of luck.

More "Ask Dr. Schwartz" View Columnists

  • Michelle

    willing to make him/herself some time to spend talking with a parent of a child a diagnosis, especially considering the severity of both the diagnosis as well as the concerns of this parent should not have the case.

    I would start looking for a transfer as well as an attorney. Sounds as if the child is being kept 'out of the way' in a sense. The quality of care is at the bottom.

    If I were this childs parent I would find out if there are any classes for a parent, like 'homecare nursing. It is always best for a child to be with the person who has the childs best interest at heart (not the paycheck they receive for inadeqate "care".

  • Heath

    I was just discharged from the VA hospital today for that same illness, MDD with psychotic features.

    Im 37 yrs old. And I think Ive had this illness most of my life. Off and on.

    One thing I can say is dont let her spend too much time alone. Always be there. Even when she doesnt want you there.

    I think what helps me the most is having people around me. I had a sever case of social isolation. Went about 2 1/2 yrs without any social interaction with anyone and didnt go outside. My guess is ive had major depression at least 3 yrs constant. Suicidal thoughts for later 2 yrs or so.

    Im only on two meds though. Bupropion and Risperidone. And two others for blood pressure.

    You may consider hospitalization for awhile so the doctors can monitor her in my opinion.

  • Psychiatrist

    meet my standard for rational polypharmacy.

    From what you wrote:

    Prozac 80 mg, Paxil 40 mg, Celexa 10 mg, Geodon 60 mg, Trazidone 400 mg, and Vistaril 200 mg.

    I see 3 SSRI antidepressants (Prozac, Paxil, and Celexa), the first at very high dosage, the second at moderately high dosages, and the third at a starting dose, essentially doing the same thing (serotonin reuptake inhibition). Prozac and Paxil can have drug-drug interactions due to their inhibitory effects on the CYP450 system of liver metabolism, effectively boosting the levels of other medications. Plus, there is no sound evidence that using 3 SSRI's would be more effective than using 1 dosed at the proper dosage range, for a sufficient period of time. Geodon at 60mg, if used for the primary treatment of bipolar disorder or schizophrenia, is severely underdosed. Usually, the medication is given twice per day, with food (to get better absorption), and in my clinical experience, only really works at proper dosage ranges (usually 120mg per day). Finally, it appears that she is on Trazadone and Vistaril, both used for insomnia? Trazadone is another type of antidepressant, and at the dosage range used, it can be very sedating, as well as an effective antidepressant, provided that people can actually tolerate its side effect of sedation. Definitely sounds like your daughter can not. Therefore, I'm not sure why Vistaril at 400mg (an antihistamine, like Benadryl), which is a pretty high dosage has been added to her regimen. I am a psychiatrist, but I haven't examined your daughter, or gotten her past clinical history, so you must take what I say with a grain of salt. But, at the very least, you can be asking the treatment team the same questions I've raised here. Best of luck.

  • April

    I was just recently, additionally diagnosed with Major Depressive Disorder with Psychotic Features and Mood Disorder ontop of my Post-Traumatic Stress Disorder. I am researching to find out what information I can about the disorder. My doctor also just changed one of my medications which has me fearing the same issue will result being unable to function. I have stressed to her the doses of medication cause me to be out of it and unable to stay awake. She never addresses my concerns or makes any changes to the dosage. She says in time it will pass once I've become use to the dosage. I was on 160 mg of Geodon and 225 of Effexor. Once the Geodon took effect which seemed to be 6-7 hours after taking it, I'd be out of it and be groggy once I'd come to. I tried taking the Effexor during the day and the Geodon at night but couldn't get the one at night to coinside with my sleep pattern waking up and having it hit later or be groggy. I have now been taken off the Geodon and placed on Seroquel 200 mg. I took it on friday evening and slept through almost the entire day of Saturday and didn't do much better on Sunday (with not even taking a dose). My mother asks like I'm lazy even with me explaining to her it is the medicine. So either I take it and be out for the count or take it, be knocked out, and have my mother give me attitude because I'm asleep longer than she'd like. There is such a thing as too much medicine and not enough. Where is the line of just right?

  • Anonymous-1

    I don't know if this helps, but my own experience was with GAD (generalized anxiety disorder) with psychotic features back in the 1980s as a teenager. The hospital I was in had a very minimalistic approach to medications, and only put me on the absolute minimum needed to ensure I could participate in other therapies. So, all I got was a medicine used as an anti-psychotic at the time called Melleril. Even that was tapered down and taken away after a few years and when my overall function increased. When it was taken away, nothing bad happened, and they continued to follow me for awhile. Back then, in patient stays were longer, though. It sounds like the place does not have the same philosophy. Where I was, you relied on the medicine until you could learn other mechanisms of coping, and got off as soon as possible to avoid risks of the medicine.

  • Concerned

    The previous comments (patient and psychiatrist) and the original psychiatrist's comments are right on target. It is so important to do your own research and there is a wealth of information online -- good and bad, so you have to weed through it. Write down questions to address with your daughter's doctor. If you are not getting answers, then you need to find another on! It is so important because these are very serious medicines that can have long-term side-effects (tardive dyskinesia, liver damage, etc) that cannot be reversed. Sometimes, a doctor will put you on one med and it may result in another, so-to-say, symptom and then they'll put you on another. My daughter had that happen to her (in a residential facility) and wound up on six different meds. I have Tardive dyskinesia (there are videos on YouTube showing what a person experiences with this) from risperidon, something I have to live with the rest of my life. So, please, be very proactive in your own research and insist that the doctors give you answers. Also, find out if you can have an outside psychiatrist evaluate your daughter to ensure the accuracy and safety of their treatment. Best of luck to you and your daughter.


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