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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SLS on December 8, 2008, at 19:20:03
A friend of mine suffers from depression and generalized anxiety disorder (GAD). Right now, the only thing he is taking is Remeron. It might be helping the depression - it is hard to tell. But it is certainly not helping his GAD. I suggested that he look into taking Paxil or Effexor. He tells me that he already tried Paxil, and that it didn't help.
Which is a better drug for GAD?
Has anyone not responded to Paxil whom later responded to Effexor?
Are there any other drugs that are effective? Klonopin would probably be a good drug for him, except that there are substance abuse issues, and his doctor is reluctant to prescribe it.
If all else fails, I would like to see him give Nardil a shot. The special MAOI diet doesn't seem to be an issue for him.
Thanks.
- Scott
Posted by Phillipa on December 8, 2008, at 20:43:56
In reply to GAD - Paxil or Effexor - Other?, posted by SLS on December 8, 2008, at 19:20:03
First ad was paxil l0mg with lopressor 25mg but also took benzos. So that's no help. The paxil was low dose as pdoc said anything higher would increase anxiety. It did work for two years then went off it. Was fine. Still took the benzos though. Effexor for me couldn't tolerate. I know some people that liked effexor. Trial and error I guess. Love Phillipa
Posted by mav27 on December 9, 2008, at 2:22:07
In reply to GAD - Paxil or Effexor - Other?, posted by SLS on December 8, 2008, at 19:20:03
I've been on all the ssri's and the one that helped the most (and by far) was lexapro. It however made me unusually tired but i believe that isn't a normal reaction so he probably won't get that.
My experiance is klonapin helps with the anxiety of thinking about going out around people and the lexapro made me comfortable when actually around people. I've since switched to prozac, it hasn't helped as much yet but it's only been 3 weeks.
Posted by cactus on December 9, 2008, at 3:29:12
In reply to GAD - Paxil or Effexor - Other?, posted by SLS on December 8, 2008, at 19:20:03
Both Paxil and Efexor were of no help to me, efexor was for a very short time span in regards to SP, maybe 2 months max, but then it went weird for me. Paxil sent me mad but here's some other suggestions.
Modafinil, I suffer from anxiety but this doesn't seem to exacerbate it at all, maybe even 100mg might do the trick for him. Trial it at home before going out.
DA's ropinirol or mirapex, worked wonderes for SP, but the side effects were too much for me in the end, but not everyone gets them
Clonazepam is excellent, but if it's VERY closley monitered by a doctor they will know very quickly if it going to be problematic for him.
Valium is great too
I hope he finds something to help him, Peace c
Posted by softheprairie on December 9, 2008, at 4:00:19
In reply to GAD - Paxil or Effexor - Other?, posted by SLS on December 8, 2008, at 19:20:03
If first-line (or second-line) meds don't work, perhaps perphenazine and/or a beta blocker? Both of those are in my current med coctail.
Posted by raisinb on December 9, 2008, at 13:58:23
In reply to GAD - Paxil or Effexor - Other?, posted by SLS on December 8, 2008, at 19:20:03
My pdoc feels that Lexapro is very helpful for anxiety-related issues. It does seem to be helping mine, though I do not know if I'd quite qualify for a full diagnosis of GAD.
Posted by bleauberry on December 9, 2008, at 18:49:15
In reply to GAD - Paxil or Effexor - Other?, posted by SLS on December 8, 2008, at 19:20:03
Hi SLS,
Well, as you know, ask 10 different docs and get a variety of different answers.
Anyway, my personal opinion not being a doc would be neither Paxil or Effexor, but instead Lexapro. I agree with what someone else said about Mirapex, but at an extremely low dose either as monotherapy or ssri combination. I feel the same synergy could exist with ssri plus super low dose risperdal. I doubt he is the type to order meds from other borders, but Amisulpride would fit in the picture too.
Staying just within the SSRI category, Lexapro would be my first choice, based upon its efficacy, its lower burden of side effects, lower burden of withdrawal, and a slight edge of a few percentage points over other ssris in metastudies.
Posted by SLS on December 9, 2008, at 18:59:41
In reply to Re: GAD - Paxil or Effexor - Other? » SLS, posted by bleauberry on December 9, 2008, at 18:49:15
Thanks guys. You've all been helpful.
:-)
Is there a special dosage range of Lexapro that is more appropriate for GAD than for depression? With OCD, it often takes very high dosages of SSRIs and an excruciatingly long period of time before a positive response begins to manifest.
This friend of mine had been on Lexapro many years ago, but he doesn't remember the details. It is possible that he didn't use a high enough dosage or didn't wait long enough. It is also possible that unresolved psychological issues generated anxiety along with the GAD, and this was misinterpreted as a lack of pharmacological response.
- Scott
Posted by mav27 on December 10, 2008, at 0:59:43
In reply to Re: GAD - Paxil or Effexor - Other?, posted by SLS on December 9, 2008, at 18:59:41
I was taking 30mg of lexapro... i do remember though that it took a while to start working and started working in a more subtle wsy over time than the time i took nardil which just semed to kick in over night after a few weeks. The lexepro wasn't giving me any of the usual ssri side effects so i was on it for quite a few months.. normally i don't tolerate ssri's for more than a few weeks.
> Thanks guys. You've all been helpful.
>
> :-)
>
> Is there a special dosage range of Lexapro that is more appropriate for GAD than for depression? With OCD, it often takes very high dosages of SSRIs and an excruciatingly long period of time before a positive response begins to manifest.
>
> This friend of mine had been on Lexapro many years ago, but he doesn't remember the details. It is possible that he didn't use a high enough dosage or didn't wait long enough. It is also possible that unresolved psychological issues generated anxiety along with the GAD, and this was misinterpreted as a lack of pharmacological response.
>
>
> - Scott
>
>
This is the end of the thread.
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