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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by canyon17 on August 28, 2006, at 22:55:51
It seems like Paxil is the only SSRI that works for me. I am afraid after a couple years its not as effective. Anyone gone to a TCA that was a nice transition? Pamelor? Tofranil?
Please let me know, Zoloft, Lexapro, and Prozac have all been bad for me....
I suffer 75% general anxiety, 25% depressionthanks!
Posted by Emily Elizabeth on August 28, 2006, at 23:21:57
In reply to Paxil to TCA, anyone?, posted by canyon17 on August 28, 2006, at 22:55:51
Desipramine helped my anxiety/depression. (Not completely, but it helped some) You might want to consider adding a TCA rather than completely switching. That way you can get the benefits of both and perhaps fewer side effects b/c you'll need a lower dose of the TCA.
Best,
EE
Posted by med_empowered on August 29, 2006, at 14:56:45
In reply to Re: Paxil to TCA, anyone?, posted by Emily Elizabeth on August 28, 2006, at 23:21:57
hi. the ssri/TCA combo can work--I tried a cymbalta/Tofranil/Adderall combo that worked pretty well, except for the hellish side effects.
Personally, I'd try to keep the Paxil for now (especially since Paxil withdrawal sucks) and adding in low-dose TCA, as long as you dont have heart problems or a weight issue. Tofranil is pretty hardcore, and so is Elavil; plus, they're not too great for anxiety by themselves...you might want to try Pamelor in low doses with the Paxil. Have you tried BuSpar? Or a benzo? Benzos can be used long-term w/o being used daily..."as-needed" use a of benzos can be very helpful, and as long as you keep your usage minimal, you won't have to worry about withdrawal or needing to up the dose. Ativan is pretty good for as-needed use.
Mood stabilizers can also help anxiety/depression combos, but they can make you stupid. And fat. and lose hair. Personally, I like Trileptal--its not likely to make you fat or bald, but it can slow you down a bit at higher dosages. Keppra (I think) can help with anxiety, too, with pretty minimal side effects (for an anticonvulsant, anyway).
Surmontil (trimipramine, I think) might be a good TCA choice. Its odd b/c it doesnt do very much reuptake inhibition; it apparently acts like a very mild neuroleptic (at super-high doses it has been used experimentally for schizophrenia). Its sedating (and improves quality of sleep) and calming, so it might be good for your anxiety. Since its kind of neuroleptic-ish I imagine there's a risk of TD, etc., but since its so mild that might not be an issue at usual doses (your doc will know about that, and you can do a pub med search for cases studies, too).
Have a good day.
Posted by vainamoinen on August 29, 2006, at 16:12:01
In reply to Paxil to TCA, anyone?, posted by canyon17 on August 28, 2006, at 22:55:51
Your going to hate the side effect profile of TCAs compared to Paxil, constipation, dry mouth, sedation.
As an aside if you have allergies Tofranil works better than Benadryl.
You can add the TCA to the Paxil too. I took Tofranil and Prozac. Fairly high doses of both.
I found desipramine too stimulating. If you have anxiety that may not be a good choice.
This is the end of the thread.
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