Posted by Rick on November 3, 2001, at 19:08:11
In reply to Back to meds for ANXIETY - Advice PLEASE!!! :), posted by dannyboy on November 3, 2001, at 17:02:30
dannyboy -(Please note -- I've only read your last post, so I apologize in advance if some of what I say here has already been covered.)
Given what you're dealing with, I'd be shocked if you haven't been given a benzo like Klonopin or Xanax, at least on a temporary or as-needed basis. If you're not familiar with benzos, they act very fast and do a great job on anxiety. I've been taking low-dose Klonopin for two years for non-depressive severe Social Anxiety (Xanax wasn't even in the same league for me), with great success. (I round it out with Provigil and Serzone -- a mostly non-SSRI yet serotonergic antidepressant particularly known for its anti-anxiety benefits, with low incidence of sexual dysfunction, and no tendency toward weight gain. In fact, dieting has been easier than ever for me on Serzone.)
Benzos probably aren't the best *longer-term* for *generalized* anxiety or OCD, but for panic sufferers in particular, nothing helps them live normal lives more than daily benzos. Of course, you'd get strong disagreement from the AD manufacturers with their big marketing budgets, as well as the multitude of benzophobic doctors who don't realize that most people who need them theraputically rarely abuse them. For people with anxiety, even when a doc doesn't want them on *long-term* benzos, they'll still often be used as a supplement to an AD in the early weeks of treatment since AD's can take awhile to kick in, and because -- as you have noted -- SSRI's can paradoxically cause quite an INCREASE in anxiety during the first few weeks.
Unless benzo usage is contradicted in your case for some reason (sometimes due to a history of substance abuse, although even this "rule" is has lately ben shown to be misguded in many cases), you REALLY should be taking a benzo now. As I said, I'm partial to Klonopin, one reason being because its effect is longer lasting and smoother. Just avoid the trap some people fall into that "more is better"; a too-high dose can actually be *less* effective, can lead to side effects, and can make the weaning-off process harder when you want to discontinue the med. When used properly, benzos are very safe (except perhaps in the frail or elderly). In truth, they're safer and more "time tested" than SSRI's, despite the $$$'s SSRI makers spend convincing patients and doctors that their antidepressants have superior safety and anti-anxiety effects and should be the prescriptions of choice for anxiety.
As for you specific question at the end, 'm guessing that combining Wellbutrin with Paxil *might* help with the weight gain (and possibly with any sexual dysfunction, but you don't mention that as a problem), but it also might add back some anxiety. Maybe adding a *low dose of Wellbutrin would work out OK.
I hate to belabor the point, but none of the meds you mentioned are "anti-anxiety" meds, they're antidepressants that can sometimes help anxiety.
Since Paxil has a slightly adrenergic effect while Celexa has virtually none, it sounds as if another med with some adrenergic action might help. Serzone, Effexor, and Remeron would all fall in this category, but Remeron -- while good for anxiety -- has weight gain as one of its primary side effects.If you didn't suffer much fatigue with Paxil -- AND you don't want to try a solo benzo -- even though you're not depressive -- it sounds like Serzone may be your best bet. It works great for many, while others hate it. YMMV. But just give it time. I *can* tell you that it's not very likely to *increase* your anxiety like the Celexa did.
Good Luck,
Rick> Hey Everybody -
>
> I've placed a couple of posts over the last several weeks due to treating my anxiety. I mentioned that I had been prescribed Celexa about a month ago, which I took (10 mg) for 2 weeks. It made my anxiety much worse... I began to have very severe panic attacks on a daily basis, usually at public places but not necessarily. I stopped the Celexa, but the anxiety remains. I've become totally agoraphobic, and have great difficulty functioning. I force myself to go outside every day, but I feel acute distress going anywhere. This has had, needless to say, a depressive effect - I'm beginning to feel more and more hopeless and sad that I can't live my life and do the things that I want to do (and I have big plans for my future -I'm very much in love with life and want to live it!)
>
> I entertained the idea of overcoming my anxiety med-free, with just therapy and developing relaxation techniques, but I think that it will take much too long, and with my anxiety at the levels it now is, it's damn near impossible to focus on therapy of any kind.
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> I took Paxil for four months about 10 months ago, (only 10 mgs. a day), and had great success. My anxiety was completely held at bay, I felt calm and confident.... however, I stopped because of weight gain (20 lbs in 4 months).
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> I recognize that I need to take medication again. I am not functional, and need to be able to tackle life again soon. I've taken a week off from work (I'm a third grade teacher) and even without the stresses of my job, my anxiety has not abated.
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> So, I've been shopping for anti-anxiety medications that might have less weight-gain potential, but they all seem to be even worse offenders than Paxil (i.e. Tofranil, Pamelor, Norpromine, Nardil, Remeron). I've come to the conclusion that, weight gain be damned, I'll have to tolerate that in order to begin living again. It's not as if I'm enjoying my slim body (nor is anybody else :), shut in at home, in a constant state of dread!
>
> Soooooo, after my long rant, here's the question... has anyone had success combining an anti-anxiety med with another agent that has counterbalanced the weight gain of the former? I'm considering just doing Paxil again (as someone here said "If it ain't broke, why fix it?"). Has ANYONE combined anything with Paxil to halt or at least slow the weight gain from this drug and had success? Or taken another antianxiety med with another agent to counter weight gain? I believe that just about anything will cause me to gain weight, as I already have a pretty slow metabolism...
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> BTW - I really don't have depression, just terrific anxiety - that's what I need help with...
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> Thanks everybody,
>
> Daniel
poster:Rick
thread:83102
URL: http://www.dr-bob.org/babble/20011025/msgs/83117.html