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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by jujube on October 31, 2004, at 15:28:06
I had been on Paxil for a number of years with great success in treating anxious depression and panic. I went off Paxil to try something else, which I never really got around to using. Last fall, I began experiencing anxiety and low mood again, so my doctor presribed Paxil again. After 3 months at the same dose I had been at previously, I found that it didn't work effectively. Since that time, I have been put on 3 other ADs, with no noticable improvement. Has anyone else experienced this? Would trying a higher dose or trying Paxil CR be worth a try after having tried 3 other ADs? I am currently looking at options, including TCAs. If there may be chance that Paxil will work again, then before trying a TCA, I will re-try
Anything anybody can tell me would be greatly appreciated.
Thanks.
Tamara
Posted by RetiredYoung on October 31, 2004, at 15:50:56
In reply to Anybody else experience this?, posted by jujube on October 31, 2004, at 15:28:06
I would think that trying the Paxil at higher dosages would certainly worth a shot, given it's positive history for you...
Posted by jujube on October 31, 2004, at 15:57:54
In reply to Re: Anybody else experience this?, posted by RetiredYoung on October 31, 2004, at 15:50:56
Thanks. I think, at this point, I am leaning that way. Perhaps after now having been on three other ADs, the Paxil may work. I am so afraid of the side effect profile of TCAs, but I will not discard them as an option. My depression this time is a bit different than previously 8 years ago, at which time I experienced what was more of an anxious depression - high on anxiety and panic. In the past few months, I am experiencing a more andhedonic depression with anxiety. The anhedonia is pretty scary. Oh well, I have to continue to have faith that things will get better, and that this too shall pass.
Tamara
> I would think that trying the Paxil at higher dosages would certainly worth a shot, given it's positive history for you...
Posted by karaS on October 31, 2004, at 16:50:33
In reply to Re: Anybody else experience this? » RetiredYoung, posted by jujube on October 31, 2004, at 15:57:54
> Thanks. I think, at this point, I am leaning that way. Perhaps after now having been on three other ADs, the Paxil may work. I am so afraid of the side effect profile of TCAs, but I will not discard them as an option. My depression this time is a bit different than previously 8 years ago, at which time I experienced what was more of an anxious depression - high on anxiety and panic. In the past few months, I am experiencing a more andhedonic depression with anxiety. The anhedonia is pretty scary. Oh well, I have to continue to have faith that things will get better, and that this too shall pass.
>
> Tamara
>
>
> > I would think that trying the Paxil at higher dosages would certainly worth a shot, given it's positive history for you...
>
>Tamara,
I don't think that the SSRIs tend to be very good for anergic type depressions. They may have a depressive effect on dopamine. I think that serotonin and dopamine work like a see saw with one of them on each side. If increasing Paxil doesn't work for you, then I think you are wise to look at other options. If I were you I'd look into medications that target norepineprhine and/or dopamine. Have you ever considered Wellbutrin? I'm sure that Sad Panda and some of the others here who know a lot about the TCAs will give you more information on them. Targeting dopamine alone is more complicated and probably not your next step.
Kara
Posted by jujube on October 31, 2004, at 17:03:55
In reply to Re: Anybody else experience this? » jujube, posted by karaS on October 31, 2004, at 16:50:33
> > Thanks. I think, at this point, I am leaning that way. Perhaps after now having been on three other ADs, the Paxil may work. I am so afraid of the side effect profile of TCAs, but I will not discard them as an option. My depression this time is a bit different than previously 8 years ago, at which time I experienced what was more of an anxious depression - high on anxiety and panic. In the past few months, I am experiencing a more andhedonic depression with anxiety. The anhedonia is pretty scary. Oh well, I have to continue to have faith that things will get better, and that this too shall pass.
> >
> > Tamara
> >
> >
> > > I would think that trying the Paxil at higher dosages would certainly worth a shot, given it's positive history for you...
> >
> >
>
> Tamara,
>
> I don't think that the SSRIs tend to be very good for anergic type depressions. They may have a depressive effect on dopamine. I think that serotonin and dopamine work like a see saw with one of them on each side. If increasing Paxil doesn't work for you, then I think you are wise to look at other options. If I were you I'd look into medications that target norepineprhine and/or dopamine. Have you ever considered Wellbutrin? I'm sure that Sad Panda and some of the others here who know a lot about the TCAs will give you more information on them. Targeting dopamine alone is more complicated and probably not your next step.
>
> KaraThanks Kara. I would love it if the Paxil would work again, but I am thinking that this second depression is a different beast than the first. Since I have bad anxiety which can lead to agoraphobia at times, I am a little nervous about Wellburtrin. I have heard that many people experience increased anxiety while on it. But it is an option to discuss with the pdoc. Maybe a TCA is the way to go. I'm just so scared of all the side effects, particularly the fatigue since I am so tired all the time already. Well, there has to be something out there that will help me. I am just hoping that my next drug trial will be the one that helps so that I can start doing all the things that have kept me depression-free in the past - exercising, socializing and having the energy to make a decent meal.
Thanks again, and take care.
Tamara
Posted by banga on October 31, 2004, at 17:26:43
In reply to Re: Anybody else experience this? » karaS, posted by jujube on October 31, 2004, at 17:03:55
I was on clomipramine (Anafranil), a tricyclic, and I actually had a lot less side effects than with others...it seemed to help a little with anxiety too. So I wouldn't necessarily let that worry me much. The only side effect was my weight would start creeping up with it, otherwise it was actually the best single AD I've experienced. But as soon as I gain a little weight, my back goes out, so it's not a side effect I can tolertate. Currently switching from Lexapro (due to sexual side effects) to Cymbalta (hoping for anxiety relief too)....
Posted by jujube on October 31, 2004, at 17:31:54
In reply to Re: Anybody else experience this?, posted by banga on October 31, 2004, at 17:26:43
Thanks. Anafranil is on my list to discuss with the pdoc. I don't particularly want to gain weight, but I definitely don't want to feel like this anymore. So, maybe I have to make a short-term trade-off.
Tamara
> I was on clomipramine (Anafranil), a tricyclic, and I actually had a lot less side effects than with others...it seemed to help a little with anxiety too. So I wouldn't necessarily let that worry me much. The only side effect was my weight would start creeping up with it, otherwise it was actually the best single AD I've experienced. But as soon as I gain a little weight, my back goes out, so it's not a side effect I can tolertate. Currently switching from Lexapro (due to sexual side effects) to Cymbalta (hoping for anxiety relief too)....
Posted by banga on October 31, 2004, at 17:41:06
In reply to Re: Anybody else experience this? » banga, posted by jujube on October 31, 2004, at 17:31:54
That's actually what Iv'e done in the past....got stabilized with Anafranil, then augmented/switched it with something else. the weight gain wasn't as bad as with Paxil....
Posted by jboud24 on October 31, 2004, at 17:49:28
In reply to Anybody else experience this?, posted by jujube on October 31, 2004, at 15:28:06
I have had this effect occur. The first AD I ever took was Paxil. Since then been on Remeron, Lexapro, Celexa, and Zoloft, but I've never had the same level of relief as when I was on Paxil that first time. Others have reported similar results in regard to it only working once.
Justin
Posted by jujube on October 31, 2004, at 18:04:20
In reply to Re: Anybody else experience this-jujube?, posted by banga on October 31, 2004, at 17:41:06
Thanks. Can you tell me how long the side effects lasted when you were on Anafranil? I am a bit of wimp, and, after four AD trials in the past 10 months, I don't know if I can handle too much in terms of long-term side effects. I, too, gained some weight on Paxil, but didn't mind since I really wasn't eating before I went on it.
Tamara
> That's actually what Iv'e done in the past....got stabilized with Anafranil, then augmented/switched it with something else. the weight gain wasn't as bad as with Paxil....
Posted by jujube on October 31, 2004, at 18:06:25
In reply to Re: Anybody else experience this?, posted by jboud24 on October 31, 2004, at 17:49:28
That seems to be the trend. I had read somewhere that Paxil is a very unforgiving AD. Once you give it up, there is no going back. I wonder if trying the CR version the second time around might work? Just a thought.
Tamara
> I have had this effect occur. The first AD I ever took was Paxil. Since then been on Remeron, Lexapro, Celexa, and Zoloft, but I've never had the same level of relief as when I was on Paxil that first time. Others have reported similar results in regard to it only working once.
>
> Justin
Posted by banga on October 31, 2004, at 18:19:06
In reply to Re: Anybody else experience this-jujube? » banga, posted by jujube on October 31, 2004, at 18:04:20
You know, I really didn't experience much in the way of side effects other than eventual weight. I don't remember dizziness, fatigue, anything like that. For me, I actually had one of those miracle moments while on this drug---I saw my life go from black and white to vivid color. But we're each so different, the process of finding something that works....and keeps on working...with tolerable side effects is so hard. I had taken Prozac, stopped it, and restarted only to find it no longer worked. I'm still looking for that right combo...
Posted by jujube on October 31, 2004, at 18:30:12
In reply to Re: Anybody else experience this-jujube, posted by banga on October 31, 2004, at 18:19:06
Thanks. I would love to experience the "miracle moment" at this point. I have only been through a depression once before in the months leading up and when I finally quit drinking. I had made so many positive changes in my life, and didn't think I would go through something like that again. But, given my "oholic" personality, I remained a workaholic, and suffered somewhat of a burn out (after 15 years of burning the candle at both ends) and had to deal with iron deficiency at the same time. Well, I need to continue to have faith that there is something out there that will help me get through this. I hope it is true that whatever doesn't kill us makes us stronger.
Take care.
Tamara
> You know, I really didn't experience much in the way of side effects other than eventual weight. I don't remember dizziness, fatigue, anything like that. For me, I actually had one of those miracle moments while on this drug---I saw my life go from black and white to vivid color. But we're each so different, the process of finding something that works....and keeps on working...with tolerable side effects is so hard. I had taken Prozac, stopped it, and restarted only to find it no longer worked. I'm still looking for that right combo...
Posted by karaS on October 31, 2004, at 18:37:56
In reply to Re: Anybody else experience this? » karaS, posted by jujube on October 31, 2004, at 17:03:55
> > > Thanks. I think, at this point, I am leaning that way. Perhaps after now having been on three other ADs, the Paxil may work. I am so afraid of the side effect profile of TCAs, but I will not discard them as an option. My depression this time is a bit different than previously 8 years ago, at which time I experienced what was more of an anxious depression - high on anxiety and panic. In the past few months, I am experiencing a more andhedonic depression with anxiety. The anhedonia is pretty scary. Oh well, I have to continue to have faith that things will get better, and that this too shall pass.
> > >
> > > Tamara
> > >
> > >
> > > > I would think that trying the Paxil at higher dosages would certainly worth a shot, given it's positive history for you...
> > >
> > >
> >
> > Tamara,
> >
> > I don't think that the SSRIs tend to be very good for anergic type depressions. They may have a depressive effect on dopamine. I think that serotonin and dopamine work like a see saw with one of them on each side. If increasing Paxil doesn't work for you, then I think you are wise to look at other options. If I were you I'd look into medications that target norepineprhine and/or dopamine. Have you ever considered Wellbutrin? I'm sure that Sad Panda and some of the others here who know a lot about the TCAs will give you more information on them. Targeting dopamine alone is more complicated and probably not your next step.
> >
> > Kara
>
> Thanks Kara. I would love it if the Paxil would work again, but I am thinking that this second depression is a different beast than the first. Since I have bad anxiety which can lead to agoraphobia at times, I am a little nervous about Wellburtrin. I have heard that many people experience increased anxiety while on it. But it is an option to discuss with the pdoc. Maybe a TCA is the way to go. I'm just so scared of all the side effects, particularly the fatigue since I am so tired all the time already. Well, there has to be something out there that will help me. I am just hoping that my next drug trial will be the one that helps so that I can start doing all the things that have kept me depression-free in the past - exercising, socializing and having the energy to make a decent meal.
>
> Thanks again, and take care.
>
> Tamara
I'm in a similar situation trying to find something that will work and that I'll be able to tolerate. Come to think of it, almost everyone on this board is in that same situation. The fact that you were able to find something that worked for you for so many years bodes well for you. Hopefully we'll all find something(s) sooner or later! I'll keep my fingers crossed for you.
Kara
Posted by jujube on October 31, 2004, at 18:45:34
In reply to Re: Anybody else experience this? » jujube, posted by karaS on October 31, 2004, at 18:37:56
> > > > Thanks. I think, at this point, I am leaning that way. Perhaps after now having been on three other ADs, the Paxil may work. I am so afraid of the side effect profile of TCAs, but I will not discard them as an option. My depression this time is a bit different than previously 8 years ago, at which time I experienced what was more of an anxious depression - high on anxiety and panic. In the past few months, I am experiencing a more andhedonic depression with anxiety. The anhedonia is pretty scary. Oh well, I have to continue to have faith that things will get better, and that this too shall pass.
> > > >
> > > > Tamara
> > > >
> > > >
> > > > > I would think that trying the Paxil at higher dosages would certainly worth a shot, given it's positive history for you...
> > > >
> > > >
> > >
> > > Tamara,
> > >
> > > I don't think that the SSRIs tend to be very good for anergic type depressions. They may have a depressive effect on dopamine. I think that serotonin and dopamine work like a see saw with one of them on each side. If increasing Paxil doesn't work for you, then I think you are wise to look at other options. If I were you I'd look into medications that target norepineprhine and/or dopamine. Have you ever considered Wellbutrin? I'm sure that Sad Panda and some of the others here who know a lot about the TCAs will give you more information on them. Targeting dopamine alone is more complicated and probably not your next step.
> > >
> > > Kara
> >
> > Thanks Kara. I would love it if the Paxil would work again, but I am thinking that this second depression is a different beast than the first. Since I have bad anxiety which can lead to agoraphobia at times, I am a little nervous about Wellburtrin. I have heard that many people experience increased anxiety while on it. But it is an option to discuss with the pdoc. Maybe a TCA is the way to go. I'm just so scared of all the side effects, particularly the fatigue since I am so tired all the time already. Well, there has to be something out there that will help me. I am just hoping that my next drug trial will be the one that helps so that I can start doing all the things that have kept me depression-free in the past - exercising, socializing and having the energy to make a decent meal.
> >
> > Thanks again, and take care.
> >
> > Tamara
>
>
> I'm in a similar situation trying to find something that will work and that I'll be able to tolerate. Come to think of it, almost everyone on this board is in that same situation. The fact that you were able to find something that worked for you for so many years bodes well for you. Hopefully we'll all find something(s) sooner or later! I'll keep my fingers crossed for you.
>
> Kara
>
> Thanks Kara. What's frustrating for me is that I responded so well to my first AD when I experienced depression 8 years ago. But, then again, I was younger, and maybe hormonal changes effect how women respond to ADs (who know?). Anyways, I know that, with the help of the pdoc, I will find something that will work (I have to keep telling myself that). I will keep my fingers crossed for you too as well as for the others on the board who are in a similar situation.Enjoy the rest of your evening.
Tamara
>
Posted by woolav on October 31, 2004, at 19:24:08
In reply to Re: Anybody else experience this? » karaS, posted by jujube on October 31, 2004, at 18:45:34
Hey, just wanted to say I took paxil years ago and it worked wonders for my social anxiety, but i had a bad pdoc and ended up on like 5 diff. meds at 25 yrs old and got freaked out and stopped taking all of them. Then years later, tried paxil again and it didnt work. My pdoc said that does happen to ppl..so after many diff. ssri's and snri's that failed. I have finally found a good combo (for now) its prozac, lamictal and klonopin. I feel better than i have in a long time....
Good Luck
S
Posted by jujube on October 31, 2004, at 19:31:14
In reply to Re: Anybody else experience this?, posted by woolav on October 31, 2004, at 19:24:08
Thanks. I tried Prozac and it made me crazy. I only lasted two weeks because I was having serious thoughts of death (not really suicide, just wanting to die). I wish it had worked because I hear a lot of people have success on it. I'm glad that you have found a combo that works for you. It makes life, with all its ups and downs, that much easier to deal with. Take care of yourself. At my pdoc appointment next week I will be raising options for a new AD. I may also ask about the possibility of adding something like Modafinil or Adrafinil. He probably won't go for it though. He has been practicing for many, many years, but is a bit conservative and seems to be not too keen on augmenting. Well, only time and discussion will tell.
Have a nice evening.Tamara
> Hey, just wanted to say I took paxil years ago and it worked wonders for my social anxiety, but i had a bad pdoc and ended up on like 5 diff. meds at 25 yrs old and got freaked out and stopped taking all of them. Then years later, tried paxil again and it didnt work. My pdoc said that does happen to ppl..so after many diff. ssri's and snri's that failed. I have finally found a good combo (for now) its prozac, lamictal and klonopin. I feel better than i have in a long time....
> Good Luck
> S
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