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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by CK1 on January 18, 2005, at 17:41:38
Hi all,
I started Paxil 10mg in high school for social anxiety with no depression and found it to be a wonderful drug for me! I no longer had any problem talking to girls or being sociable. It worked for a year and a half, but I decided to get off because I didn't think I needed it. bad idea. When I came back to college and lived in the fraternity house, I became extremely anxious in front of everyone and tried Serzone, Paxil CR, and Lexapro to no avail. Finally, last February, I went on Paxil 10mg again and, once again, it worked up wonderfully for 8 months. I was interning for a major advertising firm in New York and was doing great!
For the past month, I have been anxious around people again and depressed (sleeping 10-11 hours day) and still fatigued.
I upped the Paxil to 20mg and this simply made me more sedated and made the sexual SE's worse so I'm going back down.
Has anyone out there experienced this problem where the medicine that has been a wonder drug just stops working?! I'm scared because I have no desire to go through the process of weaning off Paxil and starting the search to find another SSRI that works. I have another internship this summer in NEw York and NEED to be better by then. Any opinions as to what I should do? Augment with Buspar, get off Paxil and try another SSRI, etc?? I just bought a SAD bright light but I'm afraid to complicate things right now. The excessive sleepiness might be worse than the anxiety!
Posted by johnsmith12345 on January 19, 2005, at 15:20:37
In reply to PAXIL POOP OUT??, posted by CK1 on January 18, 2005, at 17:41:38
This is a common experience, to have a medicine helping a lot and then just stop working. There are several options at this point.
1. Augment the paxil with buspirone:
One study on Medline supports this, another shows no effect. You may want to search for case reports on dr-bob or search harder on Medline.
2. Augment the paxil with wellbutrin:
Some evidence on Medline to support this.
3. Augment the paxil with lithium:
I know this sounds scary, but it is the most studied, and probably the most likely option to work as an augmentation strategy. In fact it will probably work as well as option number 7. But to my knowledge you must have your lithium blood levels monitored, so you should ask your psychiatrist.
4. Switch to effexor:
Medline says this shows promise. Be careful when reading the studies, though. Many of them will say "70% of people responded to this medicine" but define response as only a partial response, which in my opinion is unacceptable.
5. Switch to a different SSRI:
You have already done this, and it did not work. I do not see any reason to continue trying, unless you have a lot of time on your hands.
6. Switch to a tricyclic:
I haven't looked it up on medline, but I remember seeing some evidence pointing to its effectiveness. At worst, it would be a more promising option than switching to a different SSRI.
7. Switch to an MAOI:
These have the highest success rates of any antidepressant, both in the likeliness of a full response, and the length of time until "poop-out". But there is one major caveat. There is a special diet you must go on, a diet which forbids beer from the tap, aged cheeses (including cheddar), and various other foods. Most people reject this choice in favor of newer, less restrictive (and also less effective) medications. But if you truly do *need* to be better by the summer, and are willing to make the sacrifices to do so, this would be one of your best bets.
>I have another internship this summer in New York and NEED to be better by then.
I hate to break it to you my friend, but the days of having a social and consistent personality are probably over. It would be a good idea to stop taking this for granted and planning your future around it, at least until you have definitely found something that works as well as the Paxil used to.
This is the end of the thread.
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