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Ask Dr. Ed Wilfong Your Own Question

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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Its Margaret Douglas, again. I have just completed my 5th

Resolved Question:

It's Margaret Douglas, again. I have just completed my 5th week of Paxil and I feel just the same as when I started. So I give it 8 weeks or should I swith to Zoloft? If I swith do I have to wean from Paxil and at what dosage should I start ? What are the side effects? I suppose that's impossible to answer because everyone is different, but are side effects usually a problem?
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Ed Wilfong replied 2 years ago.

Dr. Ed Wilfong :

Hi Margaret. If I recall, you are on 20mg of Paxil. I would think that is enough time. Most of the drugs have potentially the same side effects. I would take 10mg of Paxil one day, skip the next and then start Zoloft. Since you seem sensitive to side effects, I would start at 25mg (usually is 50 to start) and increase by 25mg each week until get to therapeutic dosage (likely 75mg to 125mg). Side effects are most likely at beginning but usually are not as uncomfortable as Paxil. Most people don't have a problem with it and side effects on one drug doesn't always predict side effects on another. Start taking at night unless it makes you a little jittery (a temporary effect) in which case take in am and use ativan to help.

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 2 years ago.
How soon can I expect to feel a difference in myself after starting Zoloft? I really don't like the idea of going through another trial, but I'm pretty well convinced that Paxil isn't doing much for me, now. Can you do any harm by switching meds so often? (notice I spelled "switch" correctly this time!
Expert:  Dr. Ed Wilfong replied 2 years ago.
They are similar enough that switching meds should not hurt. If you want, you can let it "wash out" 3-5 days but there may be some benefit of actually having some of the paxil in system for transition. The Paxil should have helped by now. 10days to 2 weeks is the norm after starting zoloft, but since you are starting at low dose to avoid side effects (if you don't get side effects, you can go to 50mg after 3rd day and 75mg at 10th day). You should start feeling better after a week at 50 or 75 mg. After that, you need to see what response is to see what dose you need to be on longer term. I'll be glad to help as you see how it goes.
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 2 years ago.

I went to see my doctor today. She wanted to put me on Prestiq, but I requested Zoloft---which she said she prescribes often. She was concerned about my use of Ativan, because she said it will quit working if one uses it too often. I am still only using 2 halves during the day and one at night, although today I have been really shakey and would like to take another half at the moment!

She wasn't sure about the 25 mg., so she prescribed 50 and told me to cut them in half. This should be good because you said I will have to go up to 50mg. at some point.

So, I should start at 25 and if I have no side effects I can go up to 50 after 3 days? Then you said I should start at 25mg and go up 25 mg. each week until I reach a therapeutic dose. Which way should I do this? How will I know when I have reached the correct dosage? When I stop shaking?

I know you are not online right now, but I would appreciate an answer tomorrow, if possible, as we are leaving town, for a couple of months, on Saturday and will be on the road for 2-3 days, and I would like to know before we go what program I should use. I will be able to reach you, however, once we get to our house in Arizona.

Margaret

 

Expert:  Dr. Ed Wilfong replied 2 years ago.
50 mg is usual starting dosage, so I would try it for a day and see if you tolerate it well. If so, 50 will take effect sooner. If you have side effects that are intolerable, then cut in half then do 25 for a few days (exact number of days is not important. I suggested 25 because you are sensitive to side effects, but, pardon the complexity here, but sometimes starting too low is as bad as too much and 50 will get you to desired dose sooner). You should stay on 50mg until you are comfortable (10 days, even if you have no side effects) then go to 75 mg. You should check back with MD at that point, but usual end dosage is between 75-150mg. As we age, you metabolize drugs differently and may respond well to 75mg. You are at the age that we just have to see.
Don't worry too much about taking an extra half of Ativan. This is intended to be short term and you will likely lower dose or be able to just use occasionally once Zoloft works.
When Zoloft works you should essentially feel like you did when Paxil worked (if I remember, it did). You should have a sense of well being and less anxious. It is hard to describe but people typically know it when they get there.
Let me know if you have any questions or issues with it while in AZ. Enjoy the trip.
I think I'll go watch the world series.
Take care.
Ed
P.S. Pristiq is a good drug if Zoloft doesn't work out.
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 2 years ago.

Dear Ed,

I feel as though we have become Pen Pals!

Thank you for answering my question so promptly. I do have question: if Zoloft might make me jittery, would it be better if I took it at night along with a tranquilizer?

I have been putting up with this for so long, I feel as though I may never get over this. I hope that is not the case!

I think I will know when I get results. I will stop thinking about myself all the time and the shakes will be gone. Wish me luck!

Margaret

 

Did the team you were rooting for win the Series? We were kind of pulling for the Rangers.

 

Expert:  Dr. Ed Wilfong replied 2 years ago.
You can experiment with timing. I would try am w/ ativan, but pm is fine. Whichever works best. Just don't drive, especially with ativan. It is sometimes trial and error for right med. Hopefully trip will distract you.
Game was really good-one of best I have seen. I am rooting for Rangers, but St. Louis won in extra innings. Game 7 tonite. Should be fun.
Later,
Ed
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

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