![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Jackster on August 1, 2001, at 4:17:54
40mg Paxil has pooped out on me for Panic Disorder. Is 60mg safe? And is Prozac used for Panic Disorder - I hear so much that it can bring on panic attacks.
Jackie
Posted by Mitch on August 1, 2001, at 9:10:09
In reply to Is 60mg Paxil safe? Or should I switch to Prozac?, posted by Jackster on August 1, 2001, at 4:17:54
> 40mg Paxil has pooped out on me for Panic Disorder. Is 60mg safe? And is Prozac used for Panic Disorder - I hear so much that it can bring on panic attacks.
>
> JackieYour pdoc probably would suggest an increase to 60mg although the manufacturer suggests that dosage increases above a certain level aren't particularly helpful. I think a read a "tip" in here once about simply switching SSRi's when they poopout (assuming of course that they were effective when they worked). Jumping from Paxil to Prozac might be a little too "buzzy" for you, though, though for some it works quite well for panic.
This is a little of a stretch but you might try a "cross-taper" with Zoloft and see how you do with that. You could add 12.5mg of Zoloft to your 40mg of Paxil and see how you do for a week, and if you aren't seeing any worsening or you see an improvement reduce your Paxil from 40mg >30mg and increase the Zoloft to 25mg for example the following week until you are just on the Z and off the Paxil. If you are currently taking a benzo as well you may need to increase it a little while you do this. Zoloft is fairly activating, but generally not near as much as Prozac.
Mitch
Posted by KAK on August 1, 2001, at 9:46:31
In reply to Is 60mg Paxil safe? Or should I switch to Prozac?, posted by Jackster on August 1, 2001, at 4:17:54
> 40mg Paxil has pooped out on me for Panic Disorder. Is 60mg safe? And is Prozac used for Panic Disorder - I hear so much that it can bring on panic attacks.
>
> JackieI have been on Paxil for almost 2 years....My pdoc raised me from 40-60mg back in Nov I believe. I was very depressed, and the Paxil did help....I have been trying to wean down for the past 5 months. From what I was told, 60mg is pretty much the highest dose that people can go up to on Paxil.
~KAK
Posted by lrc on August 1, 2001, at 16:08:58
In reply to Is 60mg Paxil safe? Or should I switch to Prozac?, posted by Jackster on August 1, 2001, at 4:17:54
> 40mg Paxil has pooped out on me for Panic Disorder. Is 60mg safe? And is Prozac used for Panic Disorder - I hear so much that it can bring on panic attacks.
>
> JackieI felt horrible on paxil but it did take away my panic attacks. I thought that 10mg was more for depression. I think I would have died on 60mg. I, by the way, don't think paxil is safe at all. The side effects and the withdrawal symptoms. I'm still trying to get off of it after 3 months (weaning slowly). Good luck
Posted by Jackster on August 2, 2001, at 5:25:39
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Jackster, posted by Mitch on August 1, 2001, at 9:10:09
> > 40mg Paxil has pooped out on me for Panic Disorder. Is 60mg safe? And is Prozac used for Panic Disorder - I hear so much that it can bring on panic attacks.
> >
> > Jackie
>
> Your pdoc probably would suggest an increase to 60mg although the manufacturer suggests that dosage increases above a certain level aren't particularly helpful. I think a read a "tip" in here once about simply switching SSRi's when they poopout (assuming of course that they were effective when they worked). Jumping from Paxil to Prozac might be a little too "buzzy" for you, though, though for some it works quite well for panic.
>
> This is a little of a stretch but you might try a "cross-taper" with Zoloft and see how you do with that. You could add 12.5mg of Zoloft to your 40mg of Paxil and see how you do for a week, and if you aren't seeing any worsening or you see an improvement reduce your Paxil from 40mg >30mg and increase the Zoloft to 25mg for example the following week until you are just on the Z and off the Paxil. If you are currently taking a benzo as well you may need to increase it a little while you do this. Zoloft is fairly activating, but generally not near as much as Prozac.
>
> Mitch
I am actually on Zoloft (75mg) at the moment after the Paxil pooped out. But I can't afford any higher because it's not subsidised here. (NZ). I could afford 100mg, but I feel if I've had no effect from 75mg, I'd probably need at least 150mg.My PDoc has suggested that perhaps I could go up to 60mg of Paxil (to kick start it again, I guess) and then gradually go down to 40mg again. Any thoughts on if this would work?
Posted by KAK on August 2, 2001, at 8:18:50
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Mitch, posted by Jackster on August 2, 2001, at 5:25:39
you said, "...and then gradually go down to 40mg again. Any thoughts on if this would work?"My main concern is the withdrawl from the Paxil...It is very difficult to lower your dose of Paxil without having some kind of a side effect. Like I had mentioned, I was up to 60 mg not so long ago....and I am now down to 7mg...I am cutting my 30mg pills in quarters...And every time I lower my dose, I suffer for weeks from the withdrawl symtptoms. NOW....That said....I have to say that when I was upped to 60mgs, from 40mgs....I was very depressed....And going up that high on Paxil, *did* help me....My depression was knocked out. I supose, you will need to weigh the positives and the negatives very carefully before you decide.
Wishing you much luck with your decision.
~KAK
Posted by Mitch on August 2, 2001, at 9:10:09
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Mitch, posted by Jackster on August 2, 2001, at 5:25:39
> > > 40mg Paxil has pooped out on me for Panic Disorder. Is 60mg safe? And is Prozac used for Panic Disorder - I hear so much that it can bring on panic attacks.
> > >
> > > Jackie
> >
> > Your pdoc probably would suggest an increase to 60mg although the manufacturer suggests that dosage increases above a certain level aren't particularly helpful. I think a read a "tip" in here once about simply switching SSRi's when they poopout (assuming of course that they were effective when they worked). Jumping from Paxil to Prozac might be a little too "buzzy" for you, though, though for some it works quite well for panic.
> >
> > This is a little of a stretch but you might try a "cross-taper" with Zoloft and see how you do with that. You could add 12.5mg of Zoloft to your 40mg of Paxil and see how you do for a week, and if you aren't seeing any worsening or you see an improvement reduce your Paxil from 40mg >30mg and increase the Zoloft to 25mg for example the following week until you are just on the Z and off the Paxil. If you are currently taking a benzo as well you may need to increase it a little while you do this. Zoloft is fairly activating, but generally not near as much as Prozac.
> >
> > Mitch
>
>
> I am actually on Zoloft (75mg) at the moment after the Paxil pooped out. But I can't afford any higher because it's not subsidised here. (NZ). I could afford 100mg, but I feel if I've had no effect from 75mg, I'd probably need at least 150mg.
>
> My PDoc has suggested that perhaps I could go up to 60mg of Paxil (to kick start it again, I guess) and then gradually go down to 40mg again. Any thoughts on if this would work?
Jackie,This may be beating a dead horse, but given your dosage requirements (of SSri) and the expense, have you been adequately controlled with just clonazepam or alprazolam for your PD?? I just wonder if you have a pdoc that is anti-benzo and is wasting a lot of time (and *your* money) trying to get you controlled on just antidepressants when a benzo could work a lot better and be a HELL of a lot cheaper (and in my opinion not addictive either).
Perhaps you also have some depression problems as well, then maybe a lower dose of SSri *combined* with some clonazepam would be the answer. I know that generic Prozac should be available any time now(fluoxetine) which could save you a lot of money. You just said you are taking 75mg of Zoloft (assuming you are tolerating it ok). Given that I doubt if you would find Prozac too activating.
Yep, my suggestion is keep some money in your pocket, swap the Zoloft for 10-20mg/day of generic fluoxetine (don't bother trying to taper withdraw the Zoloft vis a vis the fluoxetine), keeping your Paxil at 40mg/day.
Then if you aren't already on some clonazepam or alprazolam-see if you can get your pdoc to add it.
THEN try to taperdown the Paxil and maybe increase the fluoxetine with the benzo in place.
Hopefully you can be taking just two generic meds-say clonazepam and fluoxetine (much less expensive!).Mitch
Posted by Jackster on August 3, 2001, at 1:27:28
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Jackster, posted by Mitch on August 2, 2001, at 9:10:09
>
>
> Jackie,
>
> This may be beating a dead horse, but given your dosage requirements (of SSri) and the expense, have you been adequately controlled with just clonazepam or alprazolam for your PD?? I just wonder if you have a pdoc that is anti-benzo and is wasting a lot of time (and *your* money) trying to get you controlled on just antidepressants when a benzo could work a lot better and be a HELL of a lot cheaper (and in my opinion not addictive either).
>
> Perhaps you also have some depression problems as well, then maybe a lower dose of SSri *combined* with some clonazepam would be the answer. I know that generic Prozac should be available any time now(fluoxetine) which could save you a lot of money. You just said you are taking 75mg of Zoloft (assuming you are tolerating it ok). Given that I doubt if you would find Prozac too activating.
>
> Yep, my suggestion is keep some money in your pocket, swap the Zoloft for 10-20mg/day of generic fluoxetine (don't bother trying to taper withdraw the Zoloft vis a vis the fluoxetine), keeping your Paxil at 40mg/day.
>
> Then if you aren't already on some clonazepam or alprazolam-see if you can get your pdoc to add it.
> THEN try to taperdown the Paxil and maybe increase the fluoxetine with the benzo in place.
> Hopefully you can be taking just two generic meds-say clonazepam and fluoxetine (much less expensive!).
>
> Mitch
Thanks for the advice - but I guess I haven't given the full info. (at the risk of rabbling on). I tapered of 40mg Paxil because I was feeling so good I thought I could carry on without it. At 10mg I started having panic attacks again and went back up to 40mg. It no longer worked nearly as well. I tried Celexa, Imipramine and then Prozac (which I took only for a week because it gave me the worst panic attacks of my life. I started at 20 mg which was too high). That was when the PDoc put me on Xanax. I eventually went back onto the Paxil - which made me OK, but not back to where I was. I actually asked to try the Zoloft - kind of as a last resort. I don't think I can afford the dosage I would need for it to be effective, and each time I went up 25mg it would be hell. My PDoc has said that Prozac could help but I'm really scared of taking it again. I could either start it really low (with the liquid) or go back to Paxil at a higher does. In the meantime I'm on 75mg of Zoloft and Xanax 2 (micro? grammes).
Posted by Mitch on August 3, 2001, at 12:17:59
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Mitch, posted by Jackster on August 3, 2001, at 1:27:28
> Thanks for the advice - but I guess I haven't given the full info. (at the risk of rabbling on). I tapered of 40mg Paxil because I was feeling so good I thought I could carry on without it. At 10mg I started having panic attacks again and went back up to 40mg. It no longer worked nearly as well. I tried Celexa, Imipramine and then Prozac (which I took only for a week because it gave me the worst panic attacks of my life. I started at 20 mg which was too high). That was when the PDoc put me on Xanax. I eventually went back onto the Paxil - which made me OK, but not back to where I was. I actually asked to try the Zoloft - kind of as a last resort. I don't think I can afford the dosage I would need for it to be effective, and each time I went up 25mg it would be hell. My PDoc has said that Prozac could help but I'm really scared of taking it again. I could either start it really low (with the liquid) or go back to Paxil at a higher does. In the meantime I'm on 75mg of Zoloft and Xanax 2 (micro? grammes).
Jackie,
No, I wouldn't retry the Prozac then (given that it set off your panic and it required the Xanax to control it). I couldn't tolerate more than 5mg/day! Obviously AD's that are fairly activating give you a lot of trouble. So now you are on Paxil, Zoloft, +Xanax.
Here are four+ options you might consider(which really isn't bad!):
1) You could go ahead and continue playing with the Paxil up to 60mg like your pdoc suggested and keep your other doses the same and see how you do.
And of course continue to help pay the pharmacy's bills! Also, you said the Paxil doesn't work like it used to and evidently the Zoloft doesn't sound like it is the "one" either, so I don't know if I would stay stuck in SSRi land in the longrun or not. SSRi's are notorious for "pooping-out" with subsequent switching, adding, etc.2) You said you tried imipramine (a TCA) and then got rid of it. Have you ever tried amitriptyline (Elavil)? It is quite a bit more sedative and all of the metabolites are anxiolytic, AND it is dirt cheap. The imipramine breaks down into desipramine and can make people really jittery (I couldn't hack desipramine-but it was great for attention!).
3) You could withdraw/wash out all of your meds except the Xanax (which you would probably have to increase quite a bit!) and try an MAOI, phenelzine, for example. But, I don't know if you or your pdoc would like the hazards and diet restrictions of MAOI's. They are also quite inexpensive, however and can be quite effective for panic. You have had a lot of distress with PD
and this might be an "ultimate" alternative.4)Can you get Remeron (mirtazapine) where you live? If so, it could work quite well. It is pretty sedative-kind of like doxepin or amitriptyline. There have been reports of success for panic with it.
5) Have you tried clonazepam instead of Xanax for panic? It has a much longer half-life and may be more effective for you.
I would suggest a trial of amitriptyline first, but with the other meds (zoloft+paxil) in the mix it could complicate the blood levels of all the meds and you could get "serotonin syndrome" if you are not careful.The MAOI sounds even better though,(IF it works and you tolerate it), mainly because you could wind up being on probably two inexpensive but quite effective meds: The MAOI+benzo.
Now I see why your pdoc probably just wants to increase the Paxil. Any of these other options might be better, but would require "rocking the boat" a hell of a lot to find out. I guess if you are feeling adventurous and are willing to do a little "heavy surfing"...
Mitch
Posted by Joy on August 4, 2001, at 8:34:14
In reply to Re: Is 60mg Paxil safe? Or should I switch to Prozac? » Jackster, posted by Mitch on August 3, 2001, at 12:17:59
I am on 60 mgs of Prozac; and probably would be fine between 40 mgs and 60 mgs. I had a very bad anxiety attack starting a new job so I took a tiny dose of generic Xanax, and that took the edge off. I also am taking 1 mg Xanax at bedtime for sleeping. I will try Trazodone next week for sleeping, but I always find for people with panic attacks, Xanax on an 'as needed' basis only is fine with an SSRI. It works well. Just my humble opinon.
Joy
Joy
> > Thanks for the advice - but I guess I haven't given the full info. (at the risk of rabbling on). I tapered of 40mg Paxil because I was feeling so good I thought I could carry on without it. At 10mg I started having panic attacks again and went back up to 40mg. It no longer worked nearly as well. I tried Celexa, Imipramine and then Prozac (which I took only for a week because it gave me the worst panic attacks of my life. I started at 20 mg which was too high). That was when the PDoc put me on Xanax. I eventually went back onto the Paxil - which made me OK, but not back to where I was. I actually asked to try the Zoloft - kind of as a last resort. I don't think I can afford the dosage I would need for it to be effective, and each time I went up 25mg it would be hell. My PDoc has said that Prozac could help but I'm really scared of taking it again. I could either start it really low (with the liquid) or go back to Paxil at a higher does. In the meantime I'm on 75mg of Zoloft and Xanax 2 (micro? grammes).
>
> Jackie,
>
> No, I wouldn't retry the Prozac then (given that it set off your panic and it required the Xanax to control it). I couldn't tolerate more than 5mg/day! Obviously AD's that are fairly activating give you a lot of trouble. So now you are on Paxil, Zoloft, +Xanax.
>
> Here are four+ options you might consider(which really isn't bad!):
>
> 1) You could go ahead and continue playing with the Paxil up to 60mg like your pdoc suggested and keep your other doses the same and see how you do.
> And of course continue to help pay the pharmacy's bills! Also, you said the Paxil doesn't work like it used to and evidently the Zoloft doesn't sound like it is the "one" either, so I don't know if I would stay stuck in SSRi land in the longrun or not. SSRi's are notorious for "pooping-out" with subsequent switching, adding, etc.
>
> 2) You said you tried imipramine (a TCA) and then got rid of it. Have you ever tried amitriptyline (Elavil)? It is quite a bit more sedative and all of the metabolites are anxiolytic, AND it is dirt cheap. The imipramine breaks down into desipramine and can make people really jittery (I couldn't hack desipramine-but it was great for attention!).
>
> 3) You could withdraw/wash out all of your meds except the Xanax (which you would probably have to increase quite a bit!) and try an MAOI, phenelzine, for example. But, I don't know if you or your pdoc would like the hazards and diet restrictions of MAOI's. They are also quite inexpensive, however and can be quite effective for panic. You have had a lot of distress with PD
> and this might be an "ultimate" alternative.
>
> 4)Can you get Remeron (mirtazapine) where you live? If so, it could work quite well. It is pretty sedative-kind of like doxepin or amitriptyline. There have been reports of success for panic with it.
>
> 5) Have you tried clonazepam instead of Xanax for panic? It has a much longer half-life and may be more effective for you.
>
>
> I would suggest a trial of amitriptyline first, but with the other meds (zoloft+paxil) in the mix it could complicate the blood levels of all the meds and you could get "serotonin syndrome" if you are not careful.
>
> The MAOI sounds even better though,(IF it works and you tolerate it), mainly because you could wind up being on probably two inexpensive but quite effective meds: The MAOI+benzo.
>
> Now I see why your pdoc probably just wants to increase the Paxil. Any of these other options might be better, but would require "rocking the boat" a hell of a lot to find out. I guess if you are feeling adventurous and are willing to do a little "heavy surfing"...
>
> Mitch
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.