Posted by bleauberry on December 16, 2009, at 17:19:16
In reply to Looking for a new AD, posted by Laney on December 16, 2009, at 11:00:18
With respect to how long you have been on Paxil, I would suggest being in no hurry to get off it. Instead, add something else to it, with the idea of slowly weaning off Paxil over a few months while the new med is taking over. You will likely shock your whole system bigtime if you just wean off Paxil to start something else. It's been over a decade and your body is going to freak out without that molecule, despite that it pooped out. So basically I am saying stay with Paxil for now, in very slowly lowered doses, to avoid destabilizing things so bad you'll never catch up.
You may find that a new med added to Paxil is all that is needed, and that the two together will work as good or better than Paxil ever did on its own.
For starters, I would try adding Nortriptyline to it, starting at 10mg and slowly increasing as you feel it out.
This might sound weird since it is a new drug in the USA and a true SNRI, but Milnacipran in low doses seems to me like it would have very good potential added to Paxil. In other parts of the world it is commonly added to Luvox or Paxil (Japan for example, where it is one of their top drugs). In USA it is called Savella. Heavy on norepinephrine, modest of serotonin, but with some binding sites that are different than other antidepressants which makes it unique as well.
I'm not impressed with Wellbutrin. In some countries it works so poorly in their clinical approval trials that they don't even approve it for depression. It is instead found useful for smoking cessation more than depression. Once in a while we see someone get remarkable improvement with Wellbutrin, but I can't think of any case where it lasted for any respectable amount of time. More than anything it seems to be good for energy, when and if it works. Mileage varies of course.
Another option is low dose Ritalin or Adderall added to Paxil. Either one of those should work within 1 to 3 days if they are going to work.
Some doctors like to spice up an antidepressant with an antipsychotic. In that arena, Abilify is probably the best bet, though any in low doses could be helpful. Or not. Sometimes they worsen the exact symptoms you are complaining about. Sometimes they help them. Hard to tell.
I like the idea of adding another antidepressant with a norepinephrine/dopamine angle to it, which means either Nortriptyline, Savella, Ritalin, or Adderall. I would not consider Wellbutrin until those had been exhausted first.
My two cents.