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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by house on July 30, 2002, at 13:04:56
I've tried all the SSRI's(except paxil), a couple of tri's and nardil. Paxil is my last hope of treating, treatment resistant GAD/Social Anxiety and mild OCD disorders. Can anyone relate or give a success story regarding paxil and anxiety, it would be much appreciated. Make one up if you have to(just joking) thanks, House
Posted by LLL on July 30, 2002, at 13:42:06
In reply to Paxil and Anxiety, posted by house on July 30, 2002, at 13:04:56
>I've tried all the SSRI's(except paxil), a couple of tri's and nardil. Paxil is my last hope of treating, treatment resistant GAD/Social Anxiety and mild OCD disorders. Can anyone relate or give a success story regarding paxil and anxiety, it would be much appreciated. Make one up if you have to(just joking) thanks, House
As someone with panic disorder and agoraphobia (can't get much more anxious than that) I found none of the SSRI's to be helpful - actually made everything much, much worse. The MAOI's were a God send. I started first on Nardil and for the first time in my life felt normal. I eventually switched to Parnate. I attempted to get back on Parnate just last week (after a 4 yr. break with few symptoms) and responded adversely to it physically. I'm on my way to the doc to try Nardil again. How long did you try it? Would you consider other MAOI's? Although they're not as popular and don't have the big pharmaceutical companies promoting them I believe they do the best job for anxiety disorders. They also work wonders on the phobic response as well.
Good Luck
Lisa
Posted by CamW. on July 30, 2002, at 14:08:58
In reply to Paxil and Anxiety, posted by house on July 30, 2002, at 13:04:56
House - PaxilŸ (paroxetine) has been used quite extensively for a variety of anxiety disorders (eg. panic disorder, GAD, social phobia, etc.). Paxil is thought to have much more anti-anxiety activity than the other SSRIs. This is thought to be due to it's greater affinity for blocking muscarinic-M1 receptors.
I have seen much success in the use of Paxil in panic/phobic disorders, such as in the fear of flying. The success rate seems to be greatly enhanced when Paxil is combined with cognitive &/or behavior therapies. This is mostly from my personal observations, so it may be tainted with my subjective feelings.
In panic-type anxiety treatment, I see doses that are higher than normally would be used in a majority of major depressions (eg. 20mg to 30mg of Paxil daily for depression, as opposed to 30mg to 40mg generally used in panic disorders).
This is in contrast to Effexor XRŸ (venlafaxine) which tends to be recommended in lower dosages for GAD, than are normally prescribed. Whether Effexor XR is actually prescribed in lower dosages for GAD, I am not absolutely certain what is prescribed in other areas, aside from where I live. Here the pdocs tend to write approximately equivalent doses for anxiety disorders (all types) and depression; with a wide range of dosages used in both disorders (generally 75mg to 225mg daily, but I have seen dosages slightly outside this range - sometimes 37.5mg or 300mg daily are prescribed).
I have noticed that, in general, people with anxiety disorders are more sensitive to the side effects (especially the start-up side effects) of both Paxil and Effexor XR, and also require a longer period of time on these drugs before a therapeutic effect is noticed. For example, 8 to 10 weeks of treatment at the target dose is usually required in anxiety disorders (especially panic disorder) as opposed to depressive disorders where the 4 to 6 weeks of treatment at the target dose is generally required before full effect of the treatment is attained. I find that this holds true for any SSRI (and Effexor XR) used in the treatment of anziety disorders.
Again, the above are generalizations that I have noticed, and not backed by any hard data.
I hope that this is of some help - Cam
Posted by house on July 30, 2002, at 14:14:18
In reply to Re: Paxil and Anxiety, posted by LLL on July 30, 2002, at 13:42:06
> >I've tried all the SSRI's(except paxil), a couple of tri's and nardil. Paxil is my last hope of treating, treatment resistant GAD/Social Anxiety and mild OCD disorders. Can anyone relate or give a success story regarding paxil and anxiety, it would be much appreciated. Make one up if you have to(just joking) thanks, House
>
> As someone with panic disorder and agoraphobia (can't get much more anxious than that) I found none of the SSRI's to be helpful - actually made everything much, much worse. The MAOI's were a God send. I started first on Nardil and for the first time in my life felt normal. I eventually switched to Parnate. I attempted to get back on Parnate just last week (after a 4 yr. break with few symptoms) and responded adversely to it physically. I'm on my way to the doc to try Nardil again. How long did you try it? Would you consider other MAOI's? Although they're not as popular and don't have the big pharmaceutical companies promoting them I believe they do the best job for anxiety disorders. They also work wonders on the phobic response as well.
> Good Luck
> Lisa>>>I'm on my third day of paxil so I will probably give it some time. I tried Nardil for about 6 weeks. First two weeks made me very depressed, next week were great and then it seemed to poop out and I was at the max. dosage level. I probably should of stayed with it or tried to augment it with something else. The problem with trying nardil or another maoi would be the wash out period. The ssri's are useless to me except for the fact that keep my panic disorder at bay. I have to ride the subway everday for work and if I'm not taking one of the SSRI's I get situation panic attacks. I would load up on klonopins but they effect my short term memory and make me depressed. Did you find parnate to work as well as Nardil? The reason I ask is because our conditions sound very simular.
Thanks for the response
Posted by house on July 30, 2002, at 14:35:32
In reply to Re: Paxil and Anxiety » house, posted by CamW. on July 30, 2002, at 14:08:58
Thanks for the great info.. One point that strikes me a little odd is that the panic side of my disorder is usually help by an ssri within a matter of days. The rest of my condition has never been remoted effected, except when nardil relieved me of all symptoms for about two week. Do you think that another MAOI or even nardil is worth another shot since it had the best results of anything I've ever taken. By the way I only took nardil for 6 weeks. The two weeks in the middle were good and the rest where miserable. Should I have stayed with it for a little longer?
>
House - PaxilŸ (paroxetine) has been used quite extensively for a variety of anxiety disorders (eg. panic disorder, GAD, social phobia, etc.). Paxil is thought to have much more anti-anxiety activity than the other SSRIs. This is thought to be due to it's greater affinity for blocking muscarinic-M1 receptors.
>
> I have seen much success in the use of Paxil in panic/phobic disorders, such as in the fear of flying. The success rate seems to be greatly enhanced when Paxil is combined with cognitive &/or behavior therapies. This is mostly from my personal observations, so it may be tainted with my subjective feelings.
>
> In panic-type anxiety treatment, I see doses that are higher than normally would be used in a majority of major depressions (eg. 20mg to 30mg of Paxil daily for depression, as opposed to 30mg to 40mg generally used in panic disorders).
>
> This is in contrast to Effexor XRŸ (venlafaxine) which tends to be recommended in lower dosages for GAD, than are normally prescribed. Whether Effexor XR is actually prescribed in lower dosages for GAD, I am not absolutely certain what is prescribed in other areas, aside from where I live. Here the pdocs tend to write approximately equivalent doses for anxiety disorders (all types) and depression; with a wide range of dosages used in both disorders (generally 75mg to 225mg daily, but I have seen dosages slightly outside this range - sometimes 37.5mg or 300mg daily are prescribed).
>
> I have noticed that, in general, people with anxiety disorders are more sensitive to the side effects (especially the start-up side effects) of both Paxil and Effexor XR, and also require a longer period of time on these drugs before a therapeutic effect is noticed. For example, 8 to 10 weeks of treatment at the target dose is usually required in anxiety disorders (especially panic disorder) as opposed to depressive disorders where the 4 to 6 weeks of treatment at the target dose is generally required before full effect of the treatment is attained. I find that this holds true for any SSRI (and Effexor XR) used in the treatment of anziety disorders.
>
> Again, the above are generalizations that I have noticed, and not backed by any hard data.
>
> I hope that this is of some help - Cam
Posted by CamW. on July 30, 2002, at 17:43:55
In reply to Re: Paxil and Anxiety/Cam , posted by house on July 30, 2002, at 14:35:32
House - It is always a good idea to give an antidepressant a trial of 8 weeks, unless the is absolutely no change at 5 weeks.
Since meds for panic disorder seem to always need a longer trial to take effect, perhaps any partial response, no matter how early that response is, should be given at least an 8 week trial. Perhaps 10 weeks amy even be better.
The rationale for this comes from studies of Prozac™ (fluoxetine) in obsessive-compulsive disorder (OCD) in which this SSRI can take 26 weeks to show a 50% improvement in symptoms.
Also, it can take 8 to 10 months for Clozaril™ (clozapine) to cause any noticeable improvement in when used for tardive dyskinesia (TD).
I guess when using medication to treat mental disorders, patience can be a virtue. The problem didn't develop overnight (in a vast majority of cases), therefore I guess we shouldn't expect the medications to work that quickly. Most of the medications used in psychiatry require one or more of the body's subsystems.
Realignment of the neurotransmitter/receptor concentrations leading to a recoupling of body's stress defense system (the HPA axis) in depressive disorders is a good example of the body needing to make adjustments to itself before relief from the depression is attained. People with chronic depression may need to take antidepressants for life because they need to artificially maintain their neurotransmitters (and thus their receptors) at certain concentrations to allow their flight-or-fight system working (again, the HPA axis)
Another case where neurotransmitter adjusting is needed is the downregulation of dopamine receptors and the upregulation of endogenous dopamine output in the nucleus accumbens in controlling a drug addiction; be it due to prescription drugs, nonprescription drugs, smoking, and alcohol. I guess we could go one step further with this and say that neurotransmitter adjustment must occur in other addictions as well (eg. eating disorders, sexual disorders, and internet porn addictions, to name a few).
Just thinking out loud. - Cam
Posted by LLL on July 30, 2002, at 17:50:44
In reply to Re: Paxil and Anxiety/LLL, posted by house on July 30, 2002, at 14:14:18
Yes both Nardil and Parnate worked beautifully. I've been highly anxious, with phobia's and obsessive intrusive thoughts since childhood. Although my symptoms wax and wane (now waxing!)the MAOI's were the only thing that made me feel like a normal person. The panic stopped, the anticipatory anxiety was greatly diminished as was the agoraphobic response. I was still restricted in my life (wouldn't fly or take a car trip alone - at least not for a long trip) but was MUCH, MUCH, MUCH more functional and at peace. That inner voice of "what if" was silenced. I switched off the Nardil because of the weight gain (vanity) and some other symptoms (nothing major) and found Parnate to just pick up where I left off but with a bonus of weight loss, increased energy and increased libido. Unfortunately this time around I couldn't handle the Parnate but my new doc said to start it again but VERY slowly (1/2 tablet/day for 7 days increasing by 1/2 table every 7 days) provided there's no more tachycardia. It's also good to have on hand some xanax (I use only 1/2 of .25) or low dose Klonopin to get you through the initial energizing effects of the Parnate. However, if you feel you'd be succesful on a SSRI then go for it - they're certainly better undertood and accepted by the medical community. I happen to not only be sensitive to the side effects of ALL types of med's I'm frightened of them, so it's double hard for me to handle what the SSRI's do initially to anxiety and panic. My new doc said she'd never recommend Paxil, Prozac, Effexor or Remeron for someone like me. She did recommend if the Parnate bites me once again to consider Zoloft or Celexa, combined with Klonopin. My plan though is to switch back to the Nardil if the Parnate causes the tachycardia again since it's less energizing.
Hope I helped.
Good Luck,
lisa
Posted by timmy4 on July 30, 2002, at 19:27:01
In reply to Re: Paxil and Anxiety/LLL » house, posted by LLL on July 30, 2002, at 17:50:44
Hey House,
I have social anxiety as well and have been back and forth between medicating and not. 4 weeks ago I decided on Paxil CR and after 4 weeks the side effects have been miminal to none, the confidence has been strenghening, and my hope for the anxiety is more promising. I am up to 37.5 now. I am very pleased with the Paxil CR...I think the difference is the Controlled Release takes 4-5 hours to be emptyed thru the body. Which apparently makes for smoother toleration and lower side effects.
Anyone else have experience with this?
I am really happy at this point with the medication.
Good luck House.
Timmy
Posted by katekite on July 30, 2002, at 21:18:01
In reply to Re: Paxil and Anxiety » house, posted by CamW. on July 30, 2002, at 14:08:58
You need to post more. This board needs you.
-- kate
Posted by CamW. on July 30, 2002, at 23:24:39
In reply to Re: Paxil and Anxiety » CamW., posted by katekite on July 30, 2002, at 21:18:01
Thanks katekite; I think that it is time for me to return. I may not be able to spend as much time as I would like here, though, as I have moderator responsibilities on another website, - Cam
This is the end of the thread.
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