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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 celticmom on December 18, 2004, at 15:01:06
DH was on 20 mg of Lex after switching from 40mg of Paxil. He was doing well on Paxil, except he had become forgetful, so pdoc switched him to Lex.
He had very little withdrawal from Paxil to Lex, but 5 weeks later started experiencing headaches and break through panic attacks. Pdoc increased the Lex 5 mg and a week later he is still getting the headaches. He also has chills and night sweats. This morning he woke up with a sense of despair. He knew there was no reason for it, but he was overwhelmed. After moving about for a while he felt better. But he is still more anxious than he used to be on Paxil and he's still clammy.
He has been taking motrin an sudaphed daily to help with the chills and fogginess and that seems to work. However, DH is at the end of his ropes. He has been sleeping all day. Pdoc isn't very helpful. Doesn't believe that the symptoms have anything to do with the medication - but I don't believe in coincidence.
She said to go ahead and wean off of Lex and then he can try Zoloft. Should he just give it more time? Has anyone experienced symptoms that didn't start until weeks after being on the med?
Any thoughts or suggestions are appreciated!
Posted by Ritch on December 18, 2004, at 16:20:53
In reply to Where should we go from here?, posted by celticmom on December 18, 2004, at 15:01:06
> DH was on 20 mg of Lex after switching from 40mg of Paxil. He was doing well on Paxil, except he had become forgetful, so pdoc switched him to Lex.
>
> He had very little withdrawal from Paxil to Lex, but 5 weeks later started experiencing headaches and break through panic attacks. Pdoc increased the Lex 5 mg and a week later he is still getting the headaches. He also has chills and night sweats. This morning he woke up with a sense of despair. He knew there was no reason for it, but he was overwhelmed. After moving about for a while he felt better. But he is still more anxious than he used to be on Paxil and he's still clammy.
>
> He has been taking motrin an sudaphed daily to help with the chills and fogginess and that seems to work. However, DH is at the end of his ropes. He has been sleeping all day. Pdoc isn't very helpful. Doesn't believe that the symptoms have anything to do with the medication - but I don't believe in coincidence.
>
> She said to go ahead and wean off of Lex and then he can try Zoloft. Should he just give it more time? Has anyone experienced symptoms that didn't start until weeks after being on the med?
>
> Any thoughts or suggestions are appreciated!
It may be possible that the Paxil was providing an antipanic effect that the Lexapro can't provide. Paxil has a fairly strong norepinephrine reuptake blockade effect compared to the rest of the SSRI drugs. Many folks that have panic (myself included) find that the norepi effect is what truly blocks the panic attacks, the serotonergic activity of the drugs acts more as a general anxiolytic. It might be a good idea to add a low dose (maybe more later) of a non-sedating TCA (nortriptyline or desipramine, i.e.) to the Lexapro to see if that gets his breakthrough panic under control. Hope this helps.
Posted by banga on December 18, 2004, at 18:06:49
In reply to Re: Where should we go from here? » celticmom, posted by Ritch on December 18, 2004, at 16:20:53
Certainly Lexapro doesn't seem to agree with him, I don't think it is too early to say this regimen is not going well. I would push the pdoc towards some changes--adding a tricyclic? for now? Not being a pdoc I can't give you specific recommendations, except I am also definitely inclined to believe the symptoms are due to the effects (or lack thereof) of the medication.
It is so frustrating when pdocs don't believe something is not going right.
And if you begin to feel your doc is not listening, consider switching docs if your circumstances allow for it. I actually wasn't particularly dissatisfied with my pdoc--until I went for a second opinion to another pdoc and was SO impressed, and I realized I had been missing out with my previous doctor.
Good luck. For me it sometimes help to remind myself when things get worse that it is not *me* that's off
, my biochemistry is off and causing me to see everything in life (including myself) in a negative way, to give some time for the meds to be straightened out and things will change for the better.
Posted by celticmom on December 19, 2004, at 7:33:21
In reply to Re: Where should we go from here?, posted by banga on December 18, 2004, at 18:06:49
Thanks Ritch and Banga for the replies. I'm going to discuss your thoughts with DH. I don't think he is interested in adding anything though. When he went on Paxil it was a pretty easy transition. Couple of weeks of vivid dreams was the worst of it. The only reason he switched was to help with his memory. I think now he is seriously considering going back to Paxil and then adding a stimulant to help him focus.
His pdoc wants to try Zoloft first, but I'm a little concerned after what he's been through with the Lex.
This is the end of the thread.
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