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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by Laney on April 5, 2010, at 14:54:41
ledge of meds. I'm currently trying out buproprion and take 10 mg. paxil. Depression/anhendonia/complete flat feelings. What is a med that works for most people most of the time? Someone who may not be treatment resistant? I have been on paxil for like 13 or so years and at a dose of 10mg. for about a year and a half because it stopped working and I can't get off of the crap. Would another SSRI like Zoloft or Lexapro work or something like Abilify? I don't know. That's why I'm asking. I trust your opinions more than Pdocs. It sounds like quite a few of you study this stuff and understand it quite well or at least better than average.
Thanks. I'm looking forward to your responses.
P.S. Something I may be able to take along with 10mg. paxil. I'm not completely afraid to combine SSRI's when being careful.
Laney
Posted by ed_uk2010 on April 5, 2010, at 16:44:54
In reply to Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 5, 2010, at 14:54:41
> ledge of meds. I'm currently trying out buproprion and take 10 mg. paxil. Depression/anhendonia/complete flat feelings. What is a med that works for most people most of the time? Someone who may not be treatment resistant? I have been on paxil for like 13 or so years and at a dose of 10mg. for about a year and a half because it stopped working and I can't get off of the crap. Would another SSRI like Zoloft or Lexapro work or something like Abilify? I don't know. That's why I'm asking. I trust your opinions more than Pdocs. It sounds like quite a few of you study this stuff and understand it quite well or at least better than average.
>
> Thanks. I'm looking forward to your responses.
>
> P.S. Something I may be able to take along with 10mg. paxil. I'm not completely afraid to combine SSRI's when being careful.
>
> LaneyYou shouldn't need to combine SSRIs. You can use paroxetine liquid to gradually taper off paroxetine, if necessary. If you switch to another SSRI it will probably block paroxetine's withdrawal symptoms but it might not be any better than paroxetine for your depression. Having said that, some people do benefit more from one SSRI than another, so you could try sertraline. You might feel less 'flat' on sertraline.
Personally, I feel a bit numb on all SSRIs. Tricyclic antidepressants such as nortriptyline do not seem to have the same numbing effect. Nortriptyline is not normally combined with bupropion though.
Posted by Phillipa on April 5, 2010, at 18:59:38
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by ed_uk2010 on April 5, 2010, at 16:44:54
Laney I bit tiny pieces off my 10mg of paxil and off in about two weeks. Was med free other than benzos for about six months. Then tried celexa didn't work, and luvox then to 250mg and it pooped after about two weeks. I curse the day that doc had me switch from paxil as it was working fine as had continued with it. Same dose. Last night an RN with severe anxiety that does take an occasional klonopin now said she went on lexapro at l0mg then went off and needed 20mg but she said in about two weeks like a light switched on and she felt fine. So maybe lexapro? Phillipa
Posted by manic666 on April 6, 2010, at 3:28:10
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by Phillipa on April 5, 2010, at 18:59:38
if you want another med //just tapper like edd said to another ssri //no withdrawl an no start up pain////that would be my fist choise//unless you fancy a wash out with withdrawl an start up sh*t for 6 months
Posted by ace on April 6, 2010, at 9:17:57
In reply to Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 5, 2010, at 14:54:41
> ledge of meds. I'm currently trying out buproprion and take 10 mg. paxil. Depression/anhendonia/complete flat feelings. What is a med that works for most people most of the time?
MAOI Nardil. Parnate and Marplan is very good too for a great deal of people.
Also the newer MAOI's.
Clomipramine is a great med too - also the other TCA's can help.
Someone who may not be treatment resistant? I have been on paxil for like 13 or so years and at a dose of 10mg. for about a year and a half because it stopped working and I can't get off of the crap.All SSRI's can be very hard to stop: all have the potential for bad withdrawal syndromes.
Would another SSRI like Zoloft or Lexapro work or something like Abilify?
I would try another class of AD.
Abilify I would stay clear off unless you have a psychotic problem, TR-OCD, or all other agents (other than antipsychotics) fail.
I don't know. That's why I'm asking. I trust your opinions more than Pdocs. It sounds like quite a few of you study this stuff and understand it quite well or at least better than average.
>
> Thanks. I'm looking forward to your responses.
>
> P.S. Something I may be able to take along with 10mg. paxil. I'm not completely afraid to combine SSRI's when being careful.
>
> LaneyHmmm....I would not recommend you stay on paxil simply cause it is too hard to get off. Instead I would switch to a TCA or an MAOI......
Wouldn't be too keen on combining SSRI's....Ace
Posted by ace on April 6, 2010, at 9:19:59
In reply to Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 5, 2010, at 14:54:41
PS- Remeron is not a bad med either. Bit of weight gain usually....unfortunately
Posted by Laney on April 6, 2010, at 9:38:49
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know » Laney, posted by ace on April 6, 2010, at 9:19:59
Thanks for your replies. So why the warning against Abilify? What's the deal with those types of meds? What are the symptoms of psychosis? Which one of the MAO's can you take and still be ok diet wise?
Thanks!
Laney
Posted by Laney on April 6, 2010, at 9:51:23
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know » Laney, posted by ace on April 6, 2010, at 9:17:57
Could I switch to a TCA or an MAOI and not have to taper the paxil? Could I just swap them out?
Thanks!
Laney
Posted by ace on April 6, 2010, at 9:54:42
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 6, 2010, at 9:38:49
> Thanks for your replies. So why the warning against Abilify?
It is a potent medication and I have seen it cause akathisia (an inner restlessness which is very bothersome) even at low doses in a lot of patients. It has a myriad of other s/effects throughout all systems of the body.
What's the deal with those types of meds?
They should be used for psychosis or Treatment resistant depressive or anxiety problems. Always last line here.
There are two types, generally
1. Neuroleptics- older....2. Atypicals- newer- I disagree with these medications being used as much as they are for non-psychotic problems. For example, instead of a benzo, many MD's would prescribe Zyprexa or Seroquel: not very smart I think.
What are the symptoms of psychosis?
Imaging that you are receiving messages from Mars, that you are in the birthplace of Christ.
Hearing things that are not actually happening....
......etc
Which one of the MAO's can you take and still be ok diet wise?None. Except the newer ones, although they have shown to be not as effective! The diet is really not so bad.........
> Thanks!
>
> Laney
Posted by ace on April 6, 2010, at 10:02:38
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 6, 2010, at 9:51:23
> Could I switch to a TCA or an MAOI and not have to taper the paxil? Could I just swap them out?
I would first taper to 5mg for one week, then 2.5mg for one week.
With a TCA- you could commence the TCA at a low dose. You may have elevated TCA blood levels for several weeks due to effects of the SSRI.
With the MAOI, you would absolutely need a 2-week washout period.
> Thanks!
>
> Laney
Posted by Laney on April 6, 2010, at 10:16:09
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know » Laney, posted by ace on April 6, 2010, at 10:02:38
Thanks Ace! So you think these AP's are bad stuff huh? Is it only because of the akathsia?
Thanks! Laney
Posted by ace on April 6, 2010, at 10:41:47
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 6, 2010, at 10:16:09
> Thanks Ace! So you think these AP's are bad stuff huh? Is it only because of the akathsia?
>
> Thanks! LaneyNot a problem. I don't think they are 'bad stuff', per se. I think they are extremely beneficial in some patients, but, they do have so many possible side-effects, possibly long-term and irreversible. They can knock you 'dead out', like a zombie, to put it crudely. They can cause akinesia, blood disorders, tremendous weight gain, diabetes....I could go on and on.
In people who take them in high doses for long periods of time, they can develope tardive dyskenisia, tardive akathisia....I have seen this and it is not pretty....However, when used at low doses in the right patient they can be great, even for depression and anxiety problems.
But they should be used with caution and discretion for these problems.......better to try AD's and anxiolytics first..even mood-stabilizers.....etc
Large doses should be all but reserved for those with bona-fide psychosis.Hope this helps!
Ace:)
Posted by conundrum on April 6, 2010, at 12:57:16
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 6, 2010, at 10:16:09
A friend of my mom's was given risperdal for depression. Risperdal is an AP and even though it works for her treatment resistant depression she has started to develop tardive dyskinisia a muscle movement disorder, like pseudo parkinsons. I would try to save APs for last.
Posted by Brainbeard on April 6, 2010, at 14:47:18
In reply to Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 5, 2010, at 14:54:41
How come my name wasn't in your title's post?!
;)
I'm only kidding.
IMPORTANT THOUGH: I learned from Dr. Preskorn that Paxil's half-life actually becomes shorter on the lowest doses, something in the range of only six hours. That's probably one of the main reasons why Paxil's such a bitch to wean off from. So, when reaching 5mg or less, it may be necessary/better to dose it twice a day.
I have some Abilify on the shelf, but I'm not touching for the reasons mentioned above. Lower doses seem more prone to lead to akathisia.
Posted by bleauberry on April 6, 2010, at 17:28:29
In reply to Scott, Bleauberry, Ed, anyone with some good know, posted by Laney on April 5, 2010, at 14:54:41
The biggest issue here is the 13 years on paxil. That is huge. The weaning process is going to be long and troublesome, and you already know that. The longstanding adaptations during and after it are going to overlap into whatever else you do, causing some confusing times.
Is that right? 13 years? Or was it 13 months? Either way, paxil is a tough one.
If I were you, I would try adding a noradrenergic agent to it. A common top choice would Wellbutrin, which you are doing, but I personally disagree with that choice. I see that drug used far too often and I don't know why. I don't know how it ever got past the FDA, because in other countries it performs so poorly as an AD they won't approve it for that. Only for smoking cessation, not depression.
My top choice would be adding Savella, which is what they do in Japan. Paxil+Savella. Another option is Paxil+Nortriptyline. Paxil+Ritalin. Paxil+low dose abilify. Paxil+Zyprexa. Paxil+low dose Risperdal. All viable options.
I do not believe even a little bit that switching to a different SSRI is going to work. Not after that long of a time period on one.
You might consider taking 10mg doses of Prozac 2 or 3 times a week if you want to continue weaning off paxil. It will help buffer things, with its long halflife.
Posted by Phillipa on April 6, 2010, at 20:02:56
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by bleauberry on April 6, 2010, at 17:28:29
Laney I absolutely didn't have a problem getting off l0mg of paxil after two years. Just tiny pieces for two weeks that was it. And I've done many direct switch overs to another SSRI. And SNRI's no problems just that they had bad side effects except for the luvox. That one had none for me Phillipa
Posted by Laney on April 7, 2010, at 20:49:55
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by Phillipa on April 6, 2010, at 20:02:56
So you don't like it. So far all it's doing is making me tense. My muscles like my neck, back, head, etc. feel tight and like I'm stressed out. I don't at all feel any better mood wise. I just can't imagine that this will change. Maybe I'm wrong. So you really don't think any SSRI will work for me? Are you saying don't even try one? Don't bother?
Thanks again,
Laney
Posted by Laney on April 7, 2010, at 22:02:58
In reply to Re: Scott, Bleauberry, Ed, anyone with some good know, posted by bleauberry on April 6, 2010, at 17:28:29
Bleauberry,
Could you elaborate more on what you know about the "confusing times" that I would have going onto something else from paxil. I have been taking it for 13+years. Why don't you think another SSRI will work. They are different aren't they?
Thanks,
Laney
Posted by Justherself54 on April 7, 2010, at 22:21:57
In reply to Bleauberry - Tell me more about Wellbutrin please, posted by Laney on April 7, 2010, at 20:49:55
Hi Laney..if you responded well to Paxil for a long time, I would try another SSRI..you could cross-taper over to Zoloft or Lexapro.
I had a pretty bad response to Wellbutrin..it's not that uncommon. It raised my anxiety pretty drastically.
Before I became treatment resistant I did very well for long periods of time on Zoloft and also Lexapro combined with Ritalin.
There are many different schools of thought here on Babble regarding what posters feel is the best med or best combo. It can be very confusing and stressful and you have to keep in mind that a lot of us are treatment resistant.
My advice would be to tell your doctor that you're feeling awful on Wellbutrin and discuss a cross taper over to another SSRI. I found when I was responding the last SSRI I was on, adding modafinil or Alertic as it's called here, really gave me a boost of energy, focus and motivation.
I hope you hit on the right combo that will work for you.
Wouldn't it be wonderful if you could get another 13 years mileage out of another med. That would be a dream come true for me and I'm sure many others here.
Best of luck and keep posting.
Posted by Laney on April 7, 2010, at 23:36:52
In reply to Re: Bleauberry - Tell me more about Wellbutrin please, posted by Justherself54 on April 7, 2010, at 22:21:57
Thanks everyone who responded to my request for info and help. It's just hard to know what to do. I'm new to trying out meds. Lamictal back in December or January was the first med change or anything in 13-14 years. Of course it didn't work for me at the time. I was way too irritable on it.
Thanks again.
Laney :)
Posted by morganator on April 7, 2010, at 23:39:04
In reply to Bleauberry - Tell me more about Wellbutrin please, posted by Laney on April 7, 2010, at 20:49:55
I would try out another SSRI like Zoloft, Lexapro, or Prozac instead of staying on Paxil. I don't see the point in staying on Paxil whatever you do. If you add some of the things Blueaberry suggested to the mix, you may as well get off Paxil and try another, better, cleaner SSRI.
Posted by morganator on April 7, 2010, at 23:43:39
In reply to Re: Bleauberry - Tell me more about Wellbutrin please, posted by morganator on April 7, 2010, at 23:39:04
I would try Zoloft and then add something if you don't feel better after a few months, but I am very biased towards it's use.
Posted by bleauberry on April 8, 2010, at 17:40:22
In reply to Bleauberry - Tell me more about Wellbutrin please, posted by Laney on April 7, 2010, at 20:49:55
You really just need to be candid and straight forward with your doc and let him know what is happening. If you are not confident with how he handles it, then it is wise to get a second opinion from another doctor. The whole time, keep in mind who is the boss. You. We are the paying customers. I think there is way too much "reverence" for doctors. They are just humans with a little more knowledge of physiology and disease than you and me. They do not have all the answers, and actually very few answers. The most important thing they can do is listen to the patient closely and try to put the clues together without any preconceived biases, egos, or outside influences (as in pharm reps).
I don't know what your side effects from wellbutrin mean. The doctor needs to know.
My comments about ssri's were based purely on anecdotal observations over the years. That is, once someone has been on an ssri for a long time, and then they get off of it, it is most common that the entire class of medication just will not perform any more. I don't know why.
I could dig up a few examples to prove that observation wrong, but they are very very few.
Right now I feel this way, but I bet it will take the medical profession 20 to 50 years to feel the same way, in that focus on enhancing purely and solely only serotonin at the synapse via reuptake blockage creates in the longterm some bizarre things.
Since TCAs and MAOIs are not used nearly as often as SSRIs, it would be hard to extrapolate any comparison. My guess is that the poopout thing, the drug sensitivity thing, the treatment resistant thing, and all that, are probably a lot less of an issue with multiple neurotransmitter drugs than the pure serotonin ones.
Back to Wellbutrin. For some people it is a great drug. Loved by many. It didn't pass the test in a few countries, but whatever. Startup restlessness, anxiety, and such is common. Muscle pain and joint tightness and all that can happen on any drug. It may go away and it may not. Wellbutrin made me feel horribly depressed, much worse that before. So I am personally not a fan, but certainly respect it has been a miracle for some other people.
Its mechanism is said to be DA and NE reuptake inhibition. I'm sorry, I just don't see that. Maybe it does those things a little bit. I've dug deep trying to find out what it really does, and the fact is, nobody knows. The best I can tell is that it somehow gets involved with the nitric oxide systems and the nicotinic receptor systems. Any DA or NE reuptake probably takes a backseat to that stuff.
But, and a big but, this is all my own personal totally unsupported stuff. So take it with a grain of salt. The most important thing is, have a good relationship with the doctor. Have his interest and cooperation. Have your wellbeing as his laser-like focus.
With a very long history of primarily ssris, it is overdue to be doing something else. Just my opinion.
> So you don't like it. So far all it's doing is making me tense. My muscles like my neck, back, head, etc. feel tight and like I'm stressed out. I don't at all feel any better mood wise. I just can't imagine that this will change. Maybe I'm wrong. So you really don't think any SSRI will work for me? Are you saying don't even try one? Don't bother?
>
> Thanks again,
>
> Laney
Posted by Phillipa on April 8, 2010, at 19:12:06
In reply to Bleauberry - Tell me more about Wellbutrin please, posted by Laney on April 7, 2010, at 20:49:55
Laney have you considered doubling the dose of paxil and seeing if it will work once again. That's great to get 13 years out of a med. Wellbutrin for me increased my anxiety and ended up in hospital and was taken off. Love Phillipa
Posted by Laney on April 9, 2010, at 11:13:47
In reply to Re: Bleauberry - Tell me more about Wellbutrin please » Laney, posted by bleauberry on April 8, 2010, at 17:40:22
Bleauberry, what do you mean by "With a very long history of primarily ssris, it is overdue to be doing something else. Just my opinion".
Thanks!
Laney
Phillipa, I tried that. It didn't work. Thanks!
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