Psycho-Babble Medication Thread 13272

Shown: posts 1 to 14 of 14. This is the beginning of the thread.

 

Need to drop Paxil & trazadone, any suggestions?

Posted by Aylse on October 16, 1999, at 14:32:04

I have been on 30mg of Paxil in the morning and 100 mgs of trazadone at bedtime for several years. I itch constantly (am allergic to lots of simple things, even tylenol!) and feel sure it is the Paxil. I have been tapering down, starting with the trazadone. (It has given me real fits with bladder problems.) I am curious about Celexa. Any of you folks have suggestions about dosage of Celexa, and if I should take something at night for the insomnia? Has Celexa made any of you itch? How about having to get up at night for bathroom trips? Information would be so appreciated.

 

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.


 

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

Posted by S. Suggs on October 17, 1999, at 6:19:26

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

Aylse, I'm a little long winded here, so please forgive me. I have taken both Paxil and trazadone at different times, but w/o the itch. My guess is that of the two it probably could be the Paxil. If you feel it is a good idea and your doctor agrees, go ahead and change. I would suggest that you keep your trazadone where it is, since it functions very much like your Paxil. With your doctors help, look at other ssri's and pick one. Zoloft and Celexa are two good meds to look at. Working in a TCA (in place of the trazadone)has worked wonders for some folks. It is a great sleep aid and augments the ssri. In my opinion (based on personal experience), Prozac with a TCA is too much to handle. I felt like I wanted to crawl out of my skin, but could'nt. It's (Prozac) half-life is very long and interfered with the metabolisim of the TCA. I have just switched over to Celexa a couple of days ago. I feel it is way too early to say if it will work or not, we'll see (no itch for me, but I do know one person who did get a mild rash which lasted a couple of weeks and went away).
Good luck!

S. Suggs

 

To: JohnL re. TCA choice & Lamictal question

Posted by Susan on October 17, 1999, at 6:26:30

In reply to Re: Need to drop Paxil & trazadone, any suggestions?, posted by JohnL on October 17, 1999, at 3:45:43

>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.
>
Is there any reason for choosing Nortriptyline over Sinequan or Elavil which are also both quite sedating? I have tried Sinequan and Elavil in the past but never Nortriptyline. Does it have fewer side effects? I have been using Xanax for sleep and am not getting more than 6 hours a night (unless I take more at 4 am) and want to consider going back to a TCA. Trazodone did not work for some reason. The Xanax does not cause the anticholineric side effects which Sinequan and Elavil caused. I suppose I could up the dose of Xanax from .50 to .75 for longer sleep. What do you think? Actually, now that I am writing this question I remember that the reason I liked the Xanax over the TCA's is because I do not wake up with a drugged, groggy feeling as I did with the TCA's.

Also, have you ever heard of Lamictal causing severe nightmares? What dose/combo are you on? I tried it for 2 weeks and kept my husband awake with my moaning from terrible dreams. I was also taking 150 mg Effexor XR and .50 Xanax. Could it have been a serotonin syndrome reaction? Any way, I stopped the Lamictal. Tried it again 10 days later and the nightmares resumed. I know that Lam. is a promising new medication but it did not work for me. Thanks for your input. Dr.'s appointments go so fast even though I am always given extra time. The questions on this board are even a puzzle at times for the experts!

 

Re:TCA choice & Lamictal question

Posted by JohnL on October 17, 1999, at 7:03:20

In reply to To: JohnL re. TCA choice & Lamictal question, posted by Susan on October 17, 1999, at 6:26:30


> >
> Is there any reason for choosing Nortriptyline over Sinequan or Elavil which are also both quite sedating?

It's the one I know most about. And it, along with Desipramine, have the lowest side effects of TCAs. It isn't overly sedating. I actually don't sleep as sound or as long with it as with Remeron, but I think the sleep structure is much better because I awake feeling refreshed. That drugged hangover feeling goes away quicker in a.m. than Remeron for me.

>
> Also, have you ever heard of Lamictal causing severe nightmares? What dose/combo are you on?

One of Lamictal's possible side effects is disturbed sleep or insomnia, usually at higher doses though. Could certainly have contributed to the nightmares, though it is likely that could have subsided with time. Current dose is 125mg, still slowly working upward until I feel the onset of side effects. I especially like the way it quiets my tinnitus. Unbelievable. Also Prozac 30mg. Naltrexone 25mg. Remeron 7.5mg for sleep. I am considering lowering the Prozac down to 10mg and potentiating with Nortriptyline, ditching the Remeron. If Naltrexone hasn't provided much benefit in another couple weeks, I'll ditch it too. But I like Lamictal and from previous experience I liked the Nortriptyline.

The questions on this board are even a puzzle at times for the experts!

Yep! It really is an art sometimes. While an expert oil painter has an instinctive knack with colors and strokes, so does the expert doc with drugs and doses.

 

Re: Aylse-Celexa

Posted by LD on October 18, 1999, at 7:52:19

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

> I have been on 30mg of Paxil in the morning and 100 mgs of trazadone at bedtime for several years. I itch constantly (am allergic to lots of simple things, even tylenol!) and feel sure it is the Paxil. I have been tapering down, starting with the trazadone. (It has given me real fits with bladder problems.) I am curious about Celexa. Any of you folks have suggestions about dosage of Celexa, and if I should take something at night for the insomnia? Has Celexa made any of you itch? How about having to get up at night for bathroom trips? Information would be so appreciated.

Aylse,

I was allergic to Paxil- horrible rash and itching, and eventually found my way to Celexa. I love it. I started with 20 mg. for 2 weeks then up to 40 mg. I also take trazadone 50mg at night to sleep. The celexa has been somewhat stimulating and I've needed the traz to sleep. Let me know if you have any other questions on Celexa. Oh- no problem with a rash or itching on the Celexa (for me).

 

Re: Aylse-Celexa

Posted by Aylse on October 18, 1999, at 21:42:49

In reply to Re: Aylse-Celexa, posted by LD on October 18, 1999, at 7:52:19


LD

Do you have to get up frequently and visit the bathroom at night with Celexa and traz? How about appetite stimulation? And sweating? I sweat a lot with Paxil. Did you? Any one else? Thanks for you post. Aylse

 

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

Posted by Aylse on October 18, 1999, at 22:46:28

In reply to Re: Need to drop Paxil & trazadone, any suggestions?, posted by JohnL on October 17, 1999, at 3:45:43

What good advice one gets on this board! The lloonngg posts were most helpful. There is a lot to consider, and that is why I am still in the thinking stages of switching. I have not gained any weight on Paxil, and it has been excellent for my depression. My itching, however, is much worse than I may have described. VERY BAD. Every inch of my bod, from head to toe itches. Severely. Also, sweating, rash, joint pain and the dreaded insomnia. Fearing depression more than anything, I have SORT of tolerated it for several years. The challenge test was what I was wanting to try, didn't know what to call it, though. So I am 3 days off Traz now, still itching and still running to the bathroom all night.(Awake, too. No traz.) Is this enough time to rule out traz as the culprit? I suspect the Paxil or both are causing my DISCOMFORT. Thanks for the detailed advice on the weaning process. Very helpful. I will use it to slow taper to 20 mgs Paxil for a while, and see if that alleviates some of my ickies. You have all given me excellent advice, and yes, there is lots to consider. I am not doing this lightly. I am scared to death and hoping something works without too much decline in my status. Thanks All!

 

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

Posted by Aylse on October 18, 1999, at 23:02:06

In reply to Re: Need to drop Paxil & trazadone, any suggestions?, posted by S. Suggs on October 17, 1999, at 6:19:26

I can follow some of this, I am afraid I am not as educated with all these terms as most of you. TCA is like Elavil? Are you suggesting a TCA for the insomnia? Is Celexa an SSRI? If I decided to switch my Paxil and trazadone, are you suggesting something like Celexa and Elavil? Sorry, I am from a tiny town in the west. We have no Psychiatrist here. I am trying to figure out what to "suggest" to my GP. He LOVES it when I "suggest" to him what I want him to do. ;(

 

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

Posted by Aylse on October 18, 1999, at 23:06:34

In reply to Re: Need to drop Paxil & trazadone, any suggestions?, posted by JohnL on October 17, 1999, at 3:45:43

P.S.
HOW DID YOU ALL GET SO SMART? Where is everybody getting all this wonderful information?

 

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

Posted by JohnL on October 19, 1999, at 3:03:25

In reply to Re: Need to drop Paxil & trazadone, any suggestions?, posted by Aylse on October 18, 1999, at 23:02:06

> I can follow some of this, I am afraid I am not as educated with all these terms as most of you. TCA is like Elavil? Are you suggesting a TCA for the insomnia? Is Celexa an SSRI? If I decided to switch my Paxil and trazadone, are you suggesting something like Celexa and Elavil? Sorry, I am from a tiny town in the west. We have no Psychiatrist here. I am trying to figure out what to "suggest" to my GP. He LOVES it when I "suggest" to him what I want him to do. ;(

Yes, TCAs are tricyclics, like Elavil, Nortriptyline, Desipramine, Imimpramine, Amitriptyline, Protriptyline, and more. Most are rather sedating while some are very sedating. Not just good for insomnia, but excellent add-ons to an SSRI for better response. SSRIs are serotonin reuptake inhibitors, like Celexa, Prozac, Zoloft, Paxil, Luvox. And yes, I was thinking of something like Celexa and Elavil (or other TCA) The only one I have experience with is Nortriptyline, which gave me good sleep. Normal dose Celexa with small dose TCA. It will be interesting to see what happens with the itch when you're off the Paxil. If it's that bad, you might want to ween off the Paxil more aggressively, but expect some flu-like symptoms for a few days if done quickly.

 

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

Posted by S. Suggs on October 19, 1999, at 7:36:05

In reply to Re: Need to drop Paxil & trazadone, any suggestions?, posted by Aylse on October 18, 1999, at 22:46:28

Aylse, just a thought - I did have trouble (a couple of years ago) with trazadone increasing my trips to the bathroom at night. Also, have you considered trying 25-50mg of benadryl at night. It could help counter the itching and should help with the insomnia. Buy the generic form, it is all over the place - diphenhydramine hcl. Same stuff in tylenol pm - but no need to pay the high price. You should be able to get a box of 24 otc for a couple of bucks. Best wishes

 

Re: Aylse-Celexa

Posted by LD on October 19, 1999, at 11:11:06

In reply to Re: Aylse-Celexa, posted by Aylse on October 18, 1999, at 21:42:49

>
> LD
>
> Do you have to get up frequently and visit the bathroom at night with Celexa and traz? How about appetite stimulation? And sweating? I sweat a lot with Paxil. Did you? Any one else? Thanks for you post. Aylse

Aylse,

I do get up occasionally at night for the bathroom, but I drink tons of water, so i've always done that. I actually do it less now because i'm so asleep from the trazodone. Sweating on Celexa, yes. Especially at night. Increased appitite? yes and no, at first yes, but it is tapering off. I also just quit smoking so I think i'm eating more because I can finally taste food!

I hope this helps.

 

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

Posted by dove on October 19, 1999, at 14:08:44

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

My daughter also had a real problem with the itchies when she took paxil. It would let-up and then get worse. She had insomnia big time with paxil, although this was dxed as a manic reaction, which concluded our trial of paxil. She also hated the heat-flashes and the sweating, made her feel even more itchy and confined.

She switched to Buspar and has had no rashes or heat-flashes. She is sleeping well, I guess I should say she's actually sleeping for the first time ever.

Anyway, the Tri-Cyclic-Antidepressants in even minimal amounts can really help with the sleep problems. Combining a TCA and a SSRI is supposedly safe and augments the SSRI well. I will be adding Prozac shortly to my regimen which includes Amitriptyline (elavil) So, let us know what you end up doing and how it works out. Good Luck!

Extra Question: Has anyone noticed increased bladder problems or infections with specific med combo's? (i.e. TCA+SSRI)


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