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Dr. Ed Wilfong
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience:  Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
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Because of your specializing in psychopharmacology, I want

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Because of your specializing in psychopharmacology, I want to tell you what I have been through over the past 7 months and get your advice. I had been trying to wean myself from Paxil 20 mg (which I had been on for 10 years or so) when I had a health scare. My anxiety came back because they made me wait 28 days for a test to see what was wrong with me (I am fine; test was negative) and very likely because I had not been taking my Paxil regularly. I went back on 20 mg Paxil daily, but I still had terrible shaking when I got up in the morning. Lorazapam took care of that. I was on the 20mg when my doctor had me try Paxil e.r. to see if it would help the shaking in the morning. It did get somewhat better. Then I saw a doctor who switched me to Celexa 20mg. I took it for a week and felt okay, but was still shaking, so I went up to 40 mg., which gave me the most horrible depression, borderline suicidal. So, my doctor put me on 40mg. of Paxil. I felt awful. So I saw a psychiatrist who put me back on 20mg of Paxil, and Lorazapam (2mg. a day) I have been on the 20 mg. of Paxil for 4 weeks now. I still shake, but not nearly as bad as in the beginning of this, but I feel kind of sick to my stomach all the time, and I still have no interest in anything much. You answered my question about switching back to Paxil 25 mg. e.r. and I think I will try it again. Now, my question is: do you think I have waited long enough for results from the Paxil? Should I give it 8 weeks to see if it will work? I am about at the end of my very frayed rope. Did switching medication so often interfere with the regime I am on now to work more quickly, or is 6 to 8 weeks standard for acheiving relief? I went through terrible anxiety/depression (anxiety was the worse of the two) 10 years ago and it took about 2-3 months to get completely over it. I was doing great for 10 years until I decided to see if I needed medication anymore. Huge mistake, and I seem to be paying for it now. So, should I give the Paxil more time? I know you are not available right now, but would appreciate an answer as soon as you re available. Thank you.


I want to mention that I am not feeling any better.  I feel the same lousy way every day, and the anxiety is still with me---I just don't shake quite as much as when this started.  It seems as though I should start feeling some improvement after 4 1/2 weeks, or am I wrong?  Do I just suddenly feel better after 6-8 weeks, or should there be some gradual progression toward feeling better.  I feel pretty good at night, and when I was on the Paxil 25 e.r. I would fell completely normal by around dinner time.  I would also have brief moments when I would feel normal, usually at night.  Is it possible that Paxil simply isn't working for me anymore?  Did I not give Celexa 20mg. enough time.  I was only on it for a week and went to 40 mg, which as I mentioned made me much worse. 

Submitted: 3 years ago.
Category: Mental Health
Expert:  Pauline replied 3 years ago.
After 4 weeks then you should be feeling some benefit but we would not normally expect a sustained improvement just yet. It can take some time to get to a state where good days outnumber bad days so I would stick with this for at least another 4 weeks.

You have had a lot of change in a short time, so it is worth sticking with this until sustained benefit is seen.

Do try to minimise the lorazepam use as this is great for short term relief but people can develop dependence on it .

Do ensure that you have some counselling too, to help with getting through the bad days.
Expert:  Dr. Ed Wilfong replied 3 years ago.
Sorry it took so long to get to you. My computer broke and it took 5 days to fix.
Sometimes when you discontinue a specific anti-depressant, it may not work when restarted. 4 weeks should give some relief and side effects should should be subsiding. Is there any chance it is related to other medical problem??
The celexa should take about 14-21 days to do anything except side effects. The FDA has also issued a warning that clexa can cause cardiac arythmias and Q-wave changes, but there have only been about 100 case, yet they issue the warning so I pass it along. It is difficult to tell how much the multiple changes in meds is making it difficult to get back on track. If you are no better after 6wks. of Paxil (not my favorite drug anyway), I would consider asking to be changed to Zoloft, Pristiq, Cymbalta or something similar.
The Lorazepam is fine. Although prolonged use may develop tolerence, 1 mg is minimal. It is OK to get you through this short time. It lasts about 8 hours, so you may want to split it and take 1/2 twice a day or OCCASIONAL 2mg/day. The research on dependence (to address Paulines concern) suggests that unless you exceed small dosages (don't increase because it becomes less effective) you should be OK. Also the research is finding actual dependence usually in people with pre-existing dependency problems of some sort in their history and keep increasing dosage. I do agree you should be cautious of overuse but don't be afraid to use it properly.
Let me know if you need clarification.
Customer: replied 3 years ago.

Thank you for your answer. I am just starting my 5th week of the Paxil e.r. Because of all the changes I have been through, I am willing to give the Paxil more time. The first time I had this problem it took about 2-3 months to get over it.

I can take up to 2 mg. of Lorazapam. I take 1/2 in the morning, and 1/2 in the afternoon, if I need it, and I take 1mg. when I go to bed. I'm not really sure I need to do that. I don't have trouble sleeping, but maybe it's because I take the Lorazapam.

I'm pretty sure this is not related to another medical problem, except the need for a hip replacement, which I'm not too thrilled about. But I had the hip problem before this started, although I didn't know I needed a new hip until this summer.

You mentioned Zoloft, Pristiq, Cymbalta, or something similar. What is "something similar" and what do all of these drugs have in common?

 

The psychiatric nurse I saw seemed to be a big fan of Prozac, but I wasn't willing to change drugs again at that time, so we went with the Paxil e.r., which seemed to be working for me until I tried the other things. I tried the others to see if they would stop the anxiety. The other things being 40mg. of Celexa and Paxil. The doses were too high. The psychiatrist I saw put me back on Paxil 20mg. and Lorazapam

You say that Paxil is not your favorite drug. What is your favorite drug?

I started with Xanax, went off of it immediately. It made me feel wired. Then I went on Paxil. Then a colleague of my doctor put me on Effexor. Quit that very soon because it gave me horrible headaches and raised my blood pressure. I went back to Paxil for 8- 10 years and did great, until my weaning trial!

The psychiatric nurse I saw seemed to be a big fan of Prozac, but I didn't want to change drugs again, so she put me on Paxil e.r. which I was doing pretty well on until I tried other things to see if they would stop the anxiety: 40 mg of Paxil and Celexa. The doses were too high, so the psychiatrist put me back on Paxil 20 mg. and Lorazapam.

If the Paxil e.r. doesn't fix me completely in another 2-4 of weeks, do you have any idea what might be the best drug for me to try?

 

 

 

Expert:  Dr. Ed Wilfong replied 3 years ago.
Giving Paxil more time is good idea and your lorazepam dose is fine. I am not a fan of Paxil because it usually comes with weight gain, but you would know by now, after the years of it working.
All the other drugs are very similar. Sometimes just switching to a different drug helps. Some have more of an action of Norepinephrine which sometimes helps. Celexa is Serotonin only. Zoloft is good with anxiety and Pristiq seems to have less side effects. Effexor is very complex - it acts differently depending on dosage. Cymbalta is very good if you also have any pain. Prozac is very good drug, but since you have anxiety, it usually increases anxiety for first 2-3 weeks. If you make it through that, it will reduce anxiety. I like Prozac a lot. Lexapro may be a good try. It is almost identical to Celexa but no FDA warning. I do like Cymbalta a lot, but responses are very individualized so it may not be right drug for you. You also seem to be very sensitive to these medications, so they key is to start at low dose and increase slowly. Hopefully the Paxil will work.

If I had to guess, which is all I can do not knowing you, I would likely try zoloft, cymbalta, or prozac (in that order of preference). It is impossible to predict which you will get side effects from or be able to tolerate since you have had a tough time.
Dr. Ed Wilfong, Psychologist
Category: Mental Health
Satisfied Customers: 1528
Experience: Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.
Dr. Ed Wilfong and other Mental Health Specialists are ready to help you
Customer: replied 3 years ago.

Thank you very much for all the information. I am very impatient I'm afraid, but I will continue on the Paxil. I am feeling a little bit better,except I just don't feel like doing anything---very frustrating. Perhaps I would feel better if I forced myself to do something, whether I feel like it or not!

I will keep your recommendations in mind, and tell my doctor, if Paxil doesn't come through for me this time.

 

Sincerely,

 

Margaret Douglas

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Dr. Ed Wilfong
Dr. Ed Wilfong
Licensed Psychologist
1524 Satisfied Customers
Twenty-five years treating all ages; Specialities: psychopharmacology & diagnosis, MMPI-2, testing.