Posted by med_empowered on August 29, 2006, at 14:56:45
In reply to Re: Paxil to TCA, anyone?, posted by Emily Elizabeth on August 28, 2006, at 23:21:57
hi. the ssri/TCA combo can work--I tried a cymbalta/Tofranil/Adderall combo that worked pretty well, except for the hellish side effects.
Personally, I'd try to keep the Paxil for now (especially since Paxil withdrawal sucks) and adding in low-dose TCA, as long as you dont have heart problems or a weight issue. Tofranil is pretty hardcore, and so is Elavil; plus, they're not too great for anxiety by themselves...you might want to try Pamelor in low doses with the Paxil. Have you tried BuSpar? Or a benzo? Benzos can be used long-term w/o being used daily..."as-needed" use a of benzos can be very helpful, and as long as you keep your usage minimal, you won't have to worry about withdrawal or needing to up the dose. Ativan is pretty good for as-needed use.
Mood stabilizers can also help anxiety/depression combos, but they can make you stupid. And fat. and lose hair. Personally, I like Trileptal--its not likely to make you fat or bald, but it can slow you down a bit at higher dosages. Keppra (I think) can help with anxiety, too, with pretty minimal side effects (for an anticonvulsant, anyway).
Surmontil (trimipramine, I think) might be a good TCA choice. Its odd b/c it doesnt do very much reuptake inhibition; it apparently acts like a very mild neuroleptic (at super-high doses it has been used experimentally for schizophrenia). Its sedating (and improves quality of sleep) and calming, so it might be good for your anxiety. Since its kind of neuroleptic-ish I imagine there's a risk of TD, etc., but since its so mild that might not be an issue at usual doses (your doc will know about that, and you can do a pub med search for cases studies, too).
Have a good day.
poster:med_empowered
thread:681045
URL: http://www.dr-bob.org/babble/20060825/msgs/681217.html