Posted by Joy on August 4, 2001, at 8:34:14
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Jackster, posted by Mitch on August 3, 2001, at 12:17:59
I am on 60 mgs of Prozac; and probably would be fine between 40 mgs and 60 mgs. I had a very bad anxiety attack starting a new job so I took a tiny dose of generic Xanax, and that took the edge off. I also am taking 1 mg Xanax at bedtime for sleeping. I will try Trazodone next week for sleeping, but I always find for people with panic attacks, Xanax on an 'as needed' basis only is fine with an SSRI. It works well. Just my humble opinon.
Joy
Joy
> > Thanks for the advice - but I guess I haven't given the full info. (at the risk of rabbling on). I tapered of 40mg Paxil because I was feeling so good I thought I could carry on without it. At 10mg I started having panic attacks again and went back up to 40mg. It no longer worked nearly as well. I tried Celexa, Imipramine and then Prozac (which I took only for a week because it gave me the worst panic attacks of my life. I started at 20 mg which was too high). That was when the PDoc put me on Xanax. I eventually went back onto the Paxil - which made me OK, but not back to where I was. I actually asked to try the Zoloft - kind of as a last resort. I don't think I can afford the dosage I would need for it to be effective, and each time I went up 25mg it would be hell. My PDoc has said that Prozac could help but I'm really scared of taking it again. I could either start it really low (with the liquid) or go back to Paxil at a higher does. In the meantime I'm on 75mg of Zoloft and Xanax 2 (micro? grammes).
>
> Jackie,
>
> No, I wouldn't retry the Prozac then (given that it set off your panic and it required the Xanax to control it). I couldn't tolerate more than 5mg/day! Obviously AD's that are fairly activating give you a lot of trouble. So now you are on Paxil, Zoloft, +Xanax.
>
> Here are four+ options you might consider(which really isn't bad!):
>
> 1) You could go ahead and continue playing with the Paxil up to 60mg like your pdoc suggested and keep your other doses the same and see how you do.
> And of course continue to help pay the pharmacy's bills! Also, you said the Paxil doesn't work like it used to and evidently the Zoloft doesn't sound like it is the "one" either, so I don't know if I would stay stuck in SSRi land in the longrun or not. SSRi's are notorious for "pooping-out" with subsequent switching, adding, etc.
>
> 2) You said you tried imipramine (a TCA) and then got rid of it. Have you ever tried amitriptyline (Elavil)? It is quite a bit more sedative and all of the metabolites are anxiolytic, AND it is dirt cheap. The imipramine breaks down into desipramine and can make people really jittery (I couldn't hack desipramine-but it was great for attention!).
>
> 3) You could withdraw/wash out all of your meds except the Xanax (which you would probably have to increase quite a bit!) and try an MAOI, phenelzine, for example. But, I don't know if you or your pdoc would like the hazards and diet restrictions of MAOI's. They are also quite inexpensive, however and can be quite effective for panic. You have had a lot of distress with PD
> and this might be an "ultimate" alternative.
>
> 4)Can you get Remeron (mirtazapine) where you live? If so, it could work quite well. It is pretty sedative-kind of like doxepin or amitriptyline. There have been reports of success for panic with it.
>
> 5) Have you tried clonazepam instead of Xanax for panic? It has a much longer half-life and may be more effective for you.
>
>
> I would suggest a trial of amitriptyline first, but with the other meds (zoloft+paxil) in the mix it could complicate the blood levels of all the meds and you could get "serotonin syndrome" if you are not careful.
>
> The MAOI sounds even better though,(IF it works and you tolerate it), mainly because you could wind up being on probably two inexpensive but quite effective meds: The MAOI+benzo.
>
> Now I see why your pdoc probably just wants to increase the Paxil. Any of these other options might be better, but would require "rocking the boat" a hell of a lot to find out. I guess if you are feeling adventurous and are willing to do a little "heavy surfing"...
>
> Mitch
poster:Joy
thread:72854
URL: http://www.dr-bob.org/babble/20010804/msgs/73474.html