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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5210
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have been on Paxil for about 10 years. As for the past 5

Resolved Question:

I have been on Paxil for about 10 years. As for the past 5 years I am on 40 mg. my dr feels the Paxil had pooped out. I have started Viibryd tonight. The taper and up load are as follows. Week 1 - 40 mg Paxil and 10 mg of viibryd.
Week two - 20 mg Paxil and 20 mg viibryd.
Week three- no Paxil and 40 mg of viibryd. What do you think if this plan. Worried due to all bad reports on stoping Paxil. I have not had a problem going on Paxil or while taken other than it is not working anymore.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

DoctorZ :

Hello I believe I can help you with your concern over weaning off the paxil

DoctorZ :

Typically the weaning of schedule that you have for the paxil is not what I have seen with the psychiatrists I work with

DoctorZ :

Also you have taken the Paxil for a considerable long time and your body is dependent on it physically

DoctorZ :

What psychiatrists and myself have done for patients on paxil is to reduce the dosage in half per week.

DoctorZ :

So the first week for you would be 40mg (I suspect your physician kept you on the original dose to see how you adjusted to Vibryd). The second week you would go to 20mg, third week 10mg, fourth week 5mg, and the fifth week you would be off the paxil

DoctorZ :

Typically the withdrawal effects of Paxil are not as serious or severe when compared to the withdrawal effects of other medications (roughly 20 percent of individuals have withdrawal effects to the discontinuation of paxil)

DoctorZ :

Also are you using the generic version of paxil or the brand name version? The generic version has a shorter half life and thus are known to cause more withdrawal effects for individuals.

DoctorZ :

The withdrawal effects that you want to look out for regarding paxil are dizziness, sensory disturbances, anxiety, irritability/agitation, and symptoms that resemble the flu. The symptoms usually last for one to two weeks on average.

DoctorZ :

And I think the gradual increase of Vibryd is fine and should not effect you negatively at all.

Customer: Will I still feel W/D doing taper and up load of Viibryd.
Customer: i have a trip to take in two week. My dr said start taper and up load now. Because due
DoctorZ :

It really depends on your body chemistry actually, if you are very sensitive to the paxil then you might have some withdrawal effects, but like I said only 20 percent of people get withdrawal effects when going off paxil cold turkey.

DoctorZ :

The upload of viibryd could negate any withdrawal effects you have from the paxil decrease because they are both SSRIs

DoctorZ :

That is a strong possibility and most likely what your doctor is thinking as well. The psychiatrists I work with and I tend to go on the conservative route and recommend a slower taper off method, but that is just our preference

DoctorZ :

There really is not wrong way to taper between your doctor's method and the method I mentioned because everyone's body chemistry is different. If you feel yourself having withdrawal effects, you can always slow the taper off method

DoctorZ :

I personally think you will not have any withdrawal effects from tapering off the paxil and increasing the dosage of viibryd because many studies believe that the side effects associated with paxil withdrawal is because of the increased serotonin. But since you are using viibryd there most likely will not be a significant increase of serotonin.

Customer: What do you feel about going to the Viibryd when it seems the pa il has stopped working. I don't want to get on something new that is going to be hard to stop at some point. I guess what I am asking is what you feel about the viibryd drug choice for anxieties and depression?
Customer: One last thought. Tonight I took them both at the same time is that ok. The Pa/dr have me klapin if I do have a problem. If I have trouble sleeping can I take on of those or melatoning to sleep. While my body adjusts. Or is that to much at one time?
DoctorZ :

Viibryd is a relatively new SSRI designed for depression and anxiety, i believe it came on the market in 2011. I worked at a state hospital where I learned psychopharmacology so we did not prescribe Viibryd that often because when new medications come on the market, they are very expensive and a state hospital budget is not as high as we would like. But with patients I saw it used on, they loved it. They mostly complained about the weigh gain from other SSRIs like Paxil, but Viibryd seemed to work effectively for anxiety and depression and also did not have the side effect of weight gain.

DoctorZ :

Taking both is fine, often individuals are prescribed two antidepressants at the same time, so I see now worries about taking both. You said "The Pa/dr have me klapin if I do have a problem." What is klapin? Do you mean Klonopin?

Customer: Yes I did mean klonopin.
DoctorZ :

Klonopin is fine if you are having trouble sleeping, but klonopin can be physically and psychologically addictive, which is why most physicians like it to be used at a low dose for a short term

DoctorZ :

I would use the melatonin first and if you are still not sleeping well then go to the klonopin as directed by your physician.

Customer: Thank you so much just had questions since what I have read kinda scared me. Not having to take either would be nice but right now that does not be the case. Been having racing thought, sadness all the time and nothing seems to feel good. So I need to feel better and this seems to be my choice since the Paxil is not working any more. Thanks again I feel better hear your thoughts on this.
DoctorZ :

Anytime I am always glad to help

DoctorZ :

If you have any other questions or concerns please feel free to contact me anytime

DoctorZ :

I hope I provided you with excellent service today

Customer: I will only use the klonopin if I really feel I need it. I would rather take
DoctorZ :

I agree the klonopin should be only if you feel you really need it because of the physical and psychological dependence effects with it.

Customer: Ok thanks again for you help.
DoctorZ :

Anytime, always happy to help

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5210
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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