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Re: Need to drop Paxil & trazadone, any suggestions?

Posted by JohnL on October 17, 1999, at 3:45:43

In reply to Need to drop Paxil & trazadone, any suggestions?, posted by Aylse on October 16, 1999, at 14:32:04

Hi Aylse. This seems fairly simple on the surface but I think is actually kind of tricky. So I apoligize in advance for what will likely be a long post addressing your questions.

To begin, I am always wary of stopping a treatment that has been working for so long. That can open a whole can of worms. You may not want to go there. You may find other drugs don't work as well or give other troublesome side effects. And then if you return to Paxil after some time, it may not work like it did the first time. Of course you could find a drug that's wonderful to you, but it really is like venturing into the unknown.

It would be helpful to know for sure which drug, if either, is actually causing the itch. Only a challenge test would tell. That is, drop each drug one at a time to isolate which one, if either, is at fault. It's possible neither is related to the itch, which would make the whole switch to a new drug even more questionable.

Paxil can and does cause bladder problems in women in the 30mg to 40mg range. I know several women who had bladder problems on Paxil. The problems completely went away when the Paxil was reduced or stopped. I would tend to think in your case the bladder problems are more Paxil's fault than Traz. I could be wrong, but that's just what I've seen. Again, a challenge test would tell.

Considering how long you've been on Paxil it would be wise to consider weening off it very slowly if your decision is to abandon it. Something like this...alternate daily 30mg one day, 25mg the next, 30, 25, and so on for a week. Then alternate daily between 20mg and 25mg back and forth for a week. Then 15, 20. Then 10, 15. Then 5, 10. Then 0,5. And finally 0. Your body is used to the Paxil, so slow taper will ease or eliminate any withdrawal effects.

So let's assume for a moment that you know for sure one or both of these drugs is causing intolerable side effects. That would warrant a complete switch. I think it is not possible to predict what response or side effects you will have to a drug based on other peoples' experiences. We can draw general expectations in advance, but you may end up with one, all, or none of the expected side effects. Maybe even unexpected ones. Maybe opposite of expected. Opposite of what others experienced on the same drug. You just never know.

With that in mind, choosing Celexa or Zoloft or Prozac is a flip of the coin. Each has its own unique characteristics and each will likely be different for you. But I think it's impossible in advance to know how you will respond to which one. So again, the hesitancy of switching until we know more for sure what's going on.

Now let's assume for a moment that you have discovered neither drug is causing the itch. In that case, you may want to lower the Paxil dosage to relieve common bladder problems. And/or replace the Traz. In this situation, I would favor dropping the Paxil down to 20mg and taking a small-medium dose of a TCA instead of Traz. That would turbocharge the Paxil and allow you good sleep. TCAs might also be good for allergies because of their histamine effects. As a sidenote, Paxil caused me terrible sleep. I think that is common. Insomnia is actually common with all the SSRIs, though not with everyone. Paxil+Nortriptyline (a TCA) has been cited as being a very good combination. I just think tweeking with what has been working makes more sense than a complete switch. But again, we need to know for sure if either drug is actually causing the problems you're dealing with.

In summary, I was right....this is a loonngg post! :) Sorry. Just seems to me there are a lot of things to consider here.



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poster:JohnL thread:13272
URL: http://www.dr-bob.org/babble/19991016/msgs/13302.html