[rmae990]

I am currently on 30mg of Paxil for GAD. I am constantly tired and have gained 20 pounds. While Paxil works well for my anxiety, I can't tolerate the side effects anymore. I have a 1 year-old and 5-year old to keep up with. Does anyone have a med that works well for their GAD without these side effects? Thanks:)

[Alden]

By reputation, Prozac has fewer of those side effects and they are milder. It is the mildest of the SSRIs. It is also a good stepping stone off of Paxil because its long half-life (its persistence between doses) minimizes withdrawal symptoms. It is often used as an interim medication for people trying to quit Paxil.

Depending on how you arrived at the 30 mg dose, it is possible that a lower dose of Paxil would give you less of the side effects, but Paxil is famous for being the SSRI with the most prominent side effects. It also has the reputation of being the hardest one to quit.

Almost all of the antidepressants (possibly not Wellbutrin) tend to be effective for GAD -- even the old, cheap tricyclics. (Among the antidepressants, those old, neglected tricyclics tend to be the most effective, in fact.) Extra-low-dose antipsychotics also tend to work well for GAD but the side effects tend to be even more pronounced. Some people get good results for GAD with benzodiazepines like Klonopin or Ativan but many do not. The benzodiazepines are better for physical anxiety like chronic panic attacks, but in tolerably low doses they don't necessarily do much for mental worry (unless it's worry about physical symptoms).

Since you're on Paxil, I'm guessing it was likely prescribed by your primary care physician rather than a psychiatrist. It might be worth consulting a psychiatrist to find something more compatible with your individual case.

[rmae990]

I am seeing a psychiatrist and I gave him a call today. He wants me to stop the Paxil cold turkey, which is making me a little nervous as I have come off of it before and know it can be very difficult. He wants me to start Lexapro right away. He did not mention Prozac as an option. I am hoping that the Lexapro will relieve some of the Paxil withdrawal symptoms. I also am hoping that it will help with my anxiety and depression. Any thoughts on my docs decision would be greatly appreciated! Thanks so much for your response Alden.

[Alden]

Well, it isn't really cold turkey when you're switching from one SSRI to another. I wouldn't expect the switch to present any problems as long as the dosage of the Lexapro is adequate. Of course there's never 100% certainty.

It's possible you'll have better results with the Lexapro than the Paxil. People do sometimes have different results between different SSRIs. And among the SSRIs, Paxil is the most notorious fattener.

Is your insurance covering all of it? Despite the marketing hype to physicians, there's minimal difference between Lexapro and Celexa. To make Lexapro, they simply remove a (mostly) biologically inactive form of the molecule from the Celexa. The differences in clinical trial results are almost entirely the result of selective publication (doing multiple instances of the same trial and only publishing the ones with the best results) and getting more clever at selecting participants as time goes by. The most important difference between Lexapro and Celexa is that Lexapro is still under patent and makes a lot more money for the manufacturer. Lexapro is an example of the phenomenon known as Evergreening, wherein insignificant-to-minor changes are used to extend the profitable lifecycle of a product over a longer period.

Just remember that Internet forum advice may not be worth what you're paying for it. I don't even play a doctor on TV.

This post has been edited by Alden: 26 July 2010 - 04:21 PM

[rmae990]

Well I have been on 10 mg of Lexapro and no more Paxil for about 3 days now. I am having the MOST HORRIBLE VIVID dreams ever. I cannot sleep at night as I am afraid to. I also am getting the very "pleasurable" electric shocks. On top it all my memory is shot! Hoping to get through this soon.... :cry:

[Alden]

I'm hesitant to say anything more given the excessive optimism in my previous post.

But I have read where people have said they've successfully self-treated brain zaps by taking an antihistamine like Benadryl.

Now before considering that, it would be good to know what your past reactions to older drowsy-making antihistamines like Benadryl have been. Some people get agitated and you wouldn't want to add that on top of what you're already experiencing. The Benadryl I have is in pink tablets, not indestructible little plastic capsules like they had when I was recently in the hospital. I sometimes take half a tablet to get to sleep.

I haven't taken Lexapro or Paxil, by the way, so I'm mostly speculating and repeating experiences others have related.

The Lexapro dosage seems middle-of-the-range, as did your previous Paxil dosage. If anything, you were maybe taking a little more Paxil than you are now taking of Lexapro if you translate to equivalencies.

All serotonin receptors in the body are not created equal. In a way it's a positive sign that you're having some symptoms, as long as they stay within a tolerable range. It means the Lexapro is talking to different serotonin receptors than the ones Paxil was interacting with, which suggests you will not have the same side effects you were getting from the Paxil.

Don't be a stoic sufferer. You can always call your doctor back, tell him about these symptoms, and ask about doing a cross-taper. It does require his knowledge and advice so that you don't take too much in combination, but cross-tapers are often possible with drugs like these. I don't know the specifics with Lexapro and Paxil but your doctor should.

[Wildflower]

rmae990, on 29 July 2010 - 07:47 PM, said:

Well I have been on 10 mg of Lexapro and no more Paxil for about 3 days now. I am having the MOST HORRIBLE VIVID dreams ever. I cannot sleep at night as I am afraid to. I also am getting the very "pleasurable" electric shocks. On top it all my memory is shot! Hoping to get through this soon.... :cry:

Hi rmae,

I was on 37.5 mgs of Paxil CR, and I had a horrible time on it. My doc had me quit cold turkey too (she said I needed to get off the stuff as soon as possible). I switched to Buspar, not another A/D, but I had a really, really hard time with the withdrwawal effects.

I talked to a pharmacist, who had me take dramamine for the naseau/dizziness. I also found that exercise seemed to help the brain zaps.

hang in there...it wasn't easy for me, but I got through it. (((rmae)))

[rmae990]

Thanks for the responses. I have gone off of Paxil before, but not with two kids to take care of :( The brain zaps continued today but a little less. I slept HORRIBLE last night. I have not slept that poorly since my 1 year old was a newborn. I feel like throwing in the towel and going back on the Paxil. I miss sleep so badly. Thanks for the hugs wildflower, it means a lot. Also, Alden thanks for the advice, I'll talk over the cross taper with my pdoc. Here's hopping for the best!

[rmae990]

Can't take the zaps and lack of sleep anymore.....going back on Paxil. I feel like a looser. :cry:

[Alden]

Treat this as temporary and don't cancel your plans.

You're not the "loser" here. Your doctor is, who showed poor medical judgment in switching you directly without a cross-taper period. (And I am, who blabbed that there shouldn't be any problem when I didn't have direct experience of that particular switch, nor had I read first-hand accounts of that particular switch.)

The reasons to get off Paxil are still there for you. And the fact that Lexapro didn't immediately prevent Paxil withdrawal still strongly suggests that whatever side effects of its own it might one day create for you, it will not be a duplicate of what you are experiencing on Paxil.

Many doctors still don't believe these meds cause withdrawal symptoms at all. And the drug companies changed the word in 1998 from "withdrawal" to "discontinuation syndrome" (but only in North America) to trick doctors into thinking the symptoms are much milder than "real" withdrawal. But if you get them, they aren't. Biologically it is classic withdrawal -- not just in how it feels but in the biochemical mechanisms causing it. It doesn't mean you can't quit. It just means you can't quit cold turkey. But you suspected that to begin with. You were right and your doctor and the anonymous Internet guy (me) were wrong.

Be persistent. Talk to your doctor about doing a proper cross-taper of 2-3 months. You're not doomed to be suffering through Paxil side effects forever. Getting off Paxil just has to be done in a medically appropriate manner.

[rmae990]

Alden, thanks so much for all of your advice. It really does help to know there is support out there. I refilled my Paxil and took a half of one today and the relief is immense. I am going to call my pdoc again. He thought I could handle it w/o the cross tapir because I have gone off of it before. But that was before I had two kids to take care of and I have been a horrible, irritable mother this past week. I think my husband has had it with my mood swings as well. I need to be there for my family. I will push for the cross tapir again. Thanks so much Alden for all your advice and support. I will stick to the plan....just needed to be reminded of that!

[Wildflower]

Rmae, how are you doing?

I understand what you mean about not needing to function to support your family. Do whatever you need to do in order to get off the Paxil and still function.

I don't have kids, but I was really lucky I didn't get fired from my job when I went off Paxil. I absolutely was so sick I couldn't function for probably a month. And the weight gain continued for 3 months after I was off it. I remember suddenly I just woke up one day and FINALLY felt better. It was around this time that the weight stopped coming on and I started losing instead.

You'll get there too, just go slower with the new drug added in, I am sure that will make it much more bearable that CT.