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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by MattSanz on June 10, 2008, at 20:13:47
Hello,
I was hoping someone who has had experience with SSRIs can help me. I've been on Paxil CR for about 3 months now with varying doses. At the current time I am up to 50mg daily, which I've been taking for 2 and a half weeks. Unfortunately, I haven't felt any improvement in my depression or anxiety, both of which are pretty severe. I have an appointment with my pdoc on Thursday and I don't know if I should continue on the Paxil or switch to something else. He suggested that I should raise the dose up to 75mg, and possibly add something like Wellbutrin. I've tried Wellbutrin in the past, with little success. The only medication that has ever worked for me was Zoloft, which was great for 2 years but wore off about a year ago. I was thinking of possibly going back to that, but my doc said I would have to come off the Paxil first before starting on Zoloft, which would take about 4 weeks. I'm already feeling very badly as it is and I'm not sure if I should risk possible withdrawal from the Paxil, even though I don't feel like its working anyway. Can someone help me? Should I increase the Paxil and hope it will finally work or give up and try something else risk withdrawal? Thanks.
Posted by Phillipa on June 11, 2008, at 0:25:42
In reply to Paxil CR., posted by MattSanz on June 10, 2008, at 20:13:47
I'm just starting a tiny bit of paxil with luvox. Need benzos too. Does the cr come in doses that high? Love Phillipa
Posted by Phillipa on June 11, 2008, at 0:27:19
In reply to Paxil CR., posted by MattSanz on June 10, 2008, at 20:13:47
And I see you're new to babble welcome. A lot of knowledge here. Hopefully someone with more than me will read and answer your post. I have heard zoloft is good. Phillipa
Posted by MattSanz on June 11, 2008, at 0:57:48
In reply to Paxil CR., posted by MattSanz on June 10, 2008, at 20:13:47
Thanks for the welcome. Yes, the maximum daily dosage of CR is 75mg. My previous doctor told me that he usually only prescribes up to 62.5, but my current one said he goes up to 75.
Posted by bleauberry on June 11, 2008, at 14:55:24
In reply to Paxil CR., posted by MattSanz on June 10, 2008, at 20:13:47
Just wanted to comment that your doc is wrong about having to come off paxil for 4 weeks before starting zoloft. Kind of makes me wonder about his/her fluency with psych meds. Anyway, you could do one of several things.
One would be to do a cross taper. Cut the paxil in half and add in about 6mg zoloft to start (cut the pill in approximate chunks). Cut the paxil down a bit more and raise the zoloft another 6mg. Keep at it until paxil is gone, then begin the journey to your target dose of zoloft. The purpose of adding in zoloft at very low doses is to help minimize the withdrawals of paxil, and yet avoid serotonin sydrome at the same time.
Another method would be to wean off paxil over a period of several weeks. After it has been completely stopped for 2 days, start zoloft. This will likely involve some difficult paxil withdrawal symptoms. As soon as zoloft is started those symptoms should ease significantly.
With either of these approaches, there will be paxil withdrawals, there will be brain readjustments to the lack of paxil, there will be start-up side effects to zoloft. No way to predict, but the whole switch could go amazingly smooth or it could be a rough ride.
In any case, a 4 week wash out of paxil is, well, absurd. As an example, the drug that stays in your body the longest is prozac, with a halflife of about a week; and the most dangerous drug to start after prozac would be an maoi. The washout time for that switch is 4 weeks.
Generally a couple days to a week is all the washout needed, though you can avoid one completely by doing a modest crossover taper.
This is the end of the thread.
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