Posted by johnsmith12345 on January 19, 2005, at 15:20:37
In reply to PAXIL POOP OUT??, posted by CK1 on January 18, 2005, at 17:41:38
This is a common experience, to have a medicine helping a lot and then just stop working. There are several options at this point.
1. Augment the paxil with buspirone:
One study on Medline supports this, another shows no effect. You may want to search for case reports on dr-bob or search harder on Medline.
2. Augment the paxil with wellbutrin:
Some evidence on Medline to support this.
3. Augment the paxil with lithium:
I know this sounds scary, but it is the most studied, and probably the most likely option to work as an augmentation strategy. In fact it will probably work as well as option number 7. But to my knowledge you must have your lithium blood levels monitored, so you should ask your psychiatrist.
4. Switch to effexor:
Medline says this shows promise. Be careful when reading the studies, though. Many of them will say "70% of people responded to this medicine" but define response as only a partial response, which in my opinion is unacceptable.
5. Switch to a different SSRI:
You have already done this, and it did not work. I do not see any reason to continue trying, unless you have a lot of time on your hands.
6. Switch to a tricyclic:
I haven't looked it up on medline, but I remember seeing some evidence pointing to its effectiveness. At worst, it would be a more promising option than switching to a different SSRI.
7. Switch to an MAOI:
These have the highest success rates of any antidepressant, both in the likeliness of a full response, and the length of time until "poop-out". But there is one major caveat. There is a special diet you must go on, a diet which forbids beer from the tap, aged cheeses (including cheddar), and various other foods. Most people reject this choice in favor of newer, less restrictive (and also less effective) medications. But if you truly do *need* to be better by the summer, and are willing to make the sacrifices to do so, this would be one of your best bets.
>I have another internship this summer in New York and NEED to be better by then.
I hate to break it to you my friend, but the days of having a social and consistent personality are probably over. It would be a good idea to stop taking this for granted and planning your future around it, at least until you have definitely found something that works as well as the Paxil used to.
poster:johnsmith12345
thread:443837
URL: http://www.dr-bob.org/babble/20050119/msgs/444277.html