Psycho-Babble Medication Thread 80446

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Do I need to go on PAXIL again ??

Posted by Janelle on October 6, 2001, at 12:58:20

Hi -- I urgently need feedback and opinions here -- my situation is: I was on Paxil for about 7 years with GREAT SUCCESS - it kicked in very soon, no noticeable side effects, took me out of depression, eased anxiety, got rid of repeated racing thoughts, and now that I am in a position to look back on things and compare how I felt while on it to how I feel now, I also see that it helped me become more outgoing, assertive and comfortable in social situations. However, it was mostly life circumstances (a bad relationship) which caused my obsessive nature to barrel out of control and I became hypomanic, which my pdoc thinks the Paxil may also have contributed to.

So, after getting off it too rapidly (horrible withdrawaly symptoms), I tried a couple of other SRI's (Celexa, Effexor) neither of which worked for me. My current cocktail is 100 mg of Lamictal (50 mg twice a day) plus Zyprexa & Klonopin at night for sleeping. My pdoc firmly believes that I'll be okay WITHOUT any SSRI, because she thinks the primary problem is the hypomania stuff.

I have been leery from the start about this idea, and now I'm starting to think I may be right, and I may indeed need to be on an SRI a-d. I say this because it has been about 3 weeks since I've been completely off any SSRI for years, and the first couple of weeks I was feeling just fine BUT now this past week (#3 without any SSRI a-d), I've been feeling increasingly *cruddy* - more anxious, more social phobic, nervous, jittery, cannot concentrate, plus very lightheaded, rubbery legged, more tired than usual ...

In fact, I'm starting to feel so *desparate* for some relief from these disturbing symptoms (I'm anxious about feeling anxious!) that next week when I have my next pdoc appointment, I'm going to not only tell her about all of this, but ask if I should try the Paxil again, perhaps at a slightly lower dose than in the past. I'm not worried about the hypomania anymore because the Lamictal is definitely controlling that and I figure it would balance out any hypomania tendencies that Paxil might cause.

HELP! What do people out there think? What should I do? Does it sound like I'm depleted of serotonin or something and I need to get back on Paxil, or perhaps some other SSRI? Thanks for any input here.
-worried Janelle

 

Re: Do I need to go on PAXIL again ?? Janelle

Posted by SalArmy4me on October 6, 2001, at 16:36:22

In reply to Do I need to go on PAXIL again ??, posted by Janelle on October 6, 2001, at 12:58:20

Lamotrigine DOES work on serotonin, alleviating anxiety and depression (unipolar or bipolar), according to these and other studies:

Southam E, Kirkby D, Higgins GA, Hagan RM. Lamotrigine inhibits monoamine uptake in vitro and modulates 5-hydroxytryptamine uptake in rats.
Eur J Pharmacol. 1998 Sep 25;358(1):19-24:

"The inhibition of the p-chloroamphetamine-induced 5-HT syndrome in rats suggests that lamotrigine also inhibits 5-HT uptake in vivo. These effects probably reflect an affinity for biogenic amine transporters..."

Erfurth A, Amann B, Grunze H. Female genital disorder as adverse symptom of lamotrigine treatment. A serotoninergic effect?

Neuropsychobiology. 1998 Oct;38(3):200-1:
"The new anticonvulsant, lamotrigine, is becoming an important tool in the treatment of bipolar disorder, including bipolar depression. Its efficacy in bipolar depression might be linked to its inhibition of serotonin uptake..."

Kumar TC, Khanna S.
Lamotrigine augmentation of serotonin re-uptake inhibitors in obsessive-compulsive disorder.
Aust N Z J Psychiatry. 2000 Jun;34(3):527-8.

Shiah IS, Yatham LN, Lam RW, Zis AP. Effects of lamotrigine on the 5-HT1A receptor function in healthy human males.
J Affect Disord. 1998 May;49(2):157-62.


 

Re: Do I need to go on PAXIL again ?? Janelle

Posted by jay on October 6, 2001, at 20:23:30

In reply to Do I need to go on PAXIL again ??, posted by Janelle on October 6, 2001, at 12:58:20

Hi Janelle:

I am honestly in a similar boat. I am trying to find a balance between and a.d. and a mood stabalizer/antipsychotic, balancing out the depression, anxiety, and agitation.

Damn, it is scarry. I would think it is possible the other two meds may be tipping your scale "down", but I also understand the fear of going on an a.d. and getting manic.

Maybe it could be something you tried at low doses, going slow. Could you say use a pill cutter and break the half (10mg) into a five mg dose of Paxil, try that for a few nights just to see how you feel? Make an appointment with your doc for a few days down the road, if you feel ok,(if not make it asap!), then go from there.

I have heard some amazing stories of combos of Zyprexa and an SRI/SNRI. All's you can do is try, and just judge how things go on a daily basis. Keep coming back for support, and let us know how it goes (is going).

Best...and take good care..

Jay

> Hi -- I urgently need feedback and opinions here -- my situation is: I was on Paxil for about 7 years with GREAT SUCCESS - it kicked in very soon, no noticeable side effects, took me out of depression, eased anxiety, got rid of repeated racing thoughts, and now that I am in a position to look back on things and compare how I felt while on it to how I feel now, I also see that it helped me become more outgoing, assertive and comfortable in social situations. However, it was mostly life circumstances (a bad relationship) which caused my obsessive nature to barrel out of control and I became hypomanic, which my pdoc thinks the Paxil may also have contributed to.
>
> So, after getting off it too rapidly (horrible withdrawaly symptoms), I tried a couple of other SRI's (Celexa, Effexor) neither of which worked for me. My current cocktail is 100 mg of Lamictal (50 mg twice a day) plus Zyprexa & Klonopin at night for sleeping. My pdoc firmly believes that I'll be okay WITHOUT any SSRI, because she thinks the primary problem is the hypomania stuff.
>
> I have been leery from the start about this idea, and now I'm starting to think I may be right, and I may indeed need to be on an SRI a-d. I say this because it has been about 3 weeks since I've been completely off any SSRI for years, and the first couple of weeks I was feeling just fine BUT now this past week (#3 without any SSRI a-d), I've been feeling increasingly *cruddy* - more anxious, more social phobic, nervous, jittery, cannot concentrate, plus very lightheaded, rubbery legged, more tired than usual ...
>
> In fact, I'm starting to feel so *desparate* for some relief from these disturbing symptoms (I'm anxious about feeling anxious!) that next week when I have my next pdoc appointment, I'm going to not only tell her about all of this, but ask if I should try the Paxil again, perhaps at a slightly lower dose than in the past. I'm not worried about the hypomania anymore because the Lamictal is definitely controlling that and I figure it would balance out any hypomania tendencies that Paxil might cause.
>
> HELP! What do people out there think? What should I do? Does it sound like I'm depleted of serotonin or something and I need to get back on Paxil, or perhaps some other SSRI? Thanks for any input here.
> -worried Janelle

 

JAY: Thanks, please read: jay

Posted by Janelle on October 6, 2001, at 23:28:09

In reply to Re: Do I need to go on PAXIL again ?? Janelle, posted by jay on October 6, 2001, at 20:23:30

I'm *sorry* to hear you're in a similar boat, but it does help to know that I'm not alone in this!

Yes, I could use a pill cutter and break the half (10mg) of Paxil into a five mg dose of Paxil, although having been successful on Paxil before, I think I'd start with 10, see how that felt and go up to 20 if need be (I had been on 30 all those years and don't want to go that *high* if Lamictal can balance out the Paxil).

Interesting you mentioned amazing stories about combos of Zyprexa and an SRI/SNRI. I'm currently ON Zyprexa, so it would be even more interesting to see if adding Paxil worked well with that as well as the Lamictal!

Thanks for your info and support, and I sure will post on here how it goes if the pdoc decides to put me back on Paxil. I have a feeling she will simply have me up the Lamictal because she wants to see if I can remain off any SSRI a-d and only need Lamictal.

 

SAL: thanks for info re Lamic. works on Serotonin! (nm) SalArmy4me

Posted by Janelle on October 7, 2001, at 0:33:57

In reply to Re: Do I need to go on PAXIL again ?? Janelle, posted by SalArmy4me on October 6, 2001, at 16:36:22

 

Re: Do I need to go on PAXIL again ?? Janelle

Posted by Chloe on October 8, 2001, at 8:48:00

In reply to Do I need to go on PAXIL again ??, posted by Janelle on October 6, 2001, at 12:58:20

From my own personal experience, where the BP2 diagnosis is fuzzy, I think a small amount of an effective AD can be prudent. In your case Paxil.

I take 1 mg of Celexa (the usual starting dose of Celexa is 20 mgs!) to augment my Lithium and Neurontin. It's amazing that such a small dose of an SSRI can put the spark back into me. Without it I drag, and just have no "verve" for life.

I too was on Lamictal, it clearly has nice AD effect. But not like an SSRI. Some how the SSRI's are unique and work very well for some people. You might be one of those that just needs a splash of Paxil to feel "right". And by taking a subtherapeurtic dose there is the lower side effect profile ie, less weight gain or sexual dysfunction, etc.

I hope your pdoc will be open minded to your adding back a smidge of a med that really seemed to work for you.
Take care,
Chloe

 

CHLOE: pls read my topic way below! (nm) Chloe

Posted by Janelle on October 8, 2001, at 23:12:37

In reply to Re: Do I need to go on PAXIL again ?? Janelle, posted by Chloe on October 8, 2001, at 8:48:00


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