![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Markwell on May 9, 2008, at 16:59:16
Here's my dilema, Paxil is the only AD that helps my depression but beyond 10 mgs I get terrible racing thoughts and 10 mg's doesn't provide enough depression relief. Is there anything I can
augment paxil with that will help w/racing thoughts that won't interrupt sleep? I tried welbutrin it helped but I couldn't sleep a wink.
Would depakote be helpful? My doctor wants me to try seroquel but I'm already a zombie with paxil. I don't want to gain 100lbs. Help
Posted by undopaminergic on May 9, 2008, at 20:17:53
In reply to Paxil dilema, posted by Markwell on May 9, 2008, at 16:59:16
Maybe some lithium or benzodiazepine.
Posted by Phillipa on May 9, 2008, at 20:52:32
In reply to Re: Paxil dilema, posted by undopaminergic on May 9, 2008, at 20:17:53
Yup just added the low dose l0 right now 5mg of paxil to my 50mg of luvox with valium. And I sleep. Love Phillipa
Posted by Quintal on May 9, 2008, at 21:18:05
In reply to Paxil dilema, posted by Markwell on May 9, 2008, at 16:59:16
Lamictal can augment antidepressants pretty well, and has antidepressant properties in itself. No weight gain either, though insomnia is common a few days after each dose increase during the titration period (tends to settle down after a few days/weeks).
Q
Posted by SLS on May 10, 2008, at 6:58:41
In reply to Paxil dilema, posted by Markwell on May 9, 2008, at 16:59:16
Wellbutrin actually quieted your racing thoughts?
> Would depakote be helpful?
Yes. However, some people experience a mild depressive reaction with continued use. If Depakote is going to work, it should work fast. I would expect to see improvements once you get up to 1000mg and occur within a week. You can use loading doses of Depakote and start right at 1000mg.
Abilify should help, but you will likely have an increase in anxiety and/or disturbed sleep. These startup side effects usually disappear within a week or two. You could take Klonopin during this period.
- Scott
Posted by Markwell on May 10, 2008, at 16:28:32
In reply to Re: Paxil dilema » Markwell, posted by SLS on May 10, 2008, at 6:58:41
Is there anything like depokote that might help. With Paxil I am right on the edge of being depressed so anything that may cause depression would not be good for me. My doctor is not much help in this area.
Posted by John Doughboy on May 14, 2008, at 17:22:54
In reply to Paxil dilema, posted by Markwell on May 9, 2008, at 16:59:16
When you say that raising your dose of Paxil gives you racing thoughts, is this a short term side effect or something that lasts after you've been on it for several weeks? How long did you take the higher dose?
Whenever I've started SSRI's in the past, they made me really anxious and agitated for like a week, then it went away. I had to use Xanax or Ativan to get on effective doses to tolerate the early side effects.
Posted by Markwell on May 15, 2008, at 14:45:31
In reply to Re: Paxil dilema, posted by John Doughboy on May 14, 2008, at 17:22:54
The racing thoughts seem to last at least long enough where I have to go back down to 10mgs. Also, noise (loud tv or radio) seem to get on my nerves. My concentration will be off also, trouble finishing a newspaper article. I don't know if I should up my dose of paxil and stay with it longer or look for a good augmentation, which has so far been elusive. Welbutrin was helpful but I couldn't sleep a wink on it. I just don't get much relief from 10mg of paxil. Any sugggestions as I see my doctor on Monday.
Posted by blueboy on May 21, 2008, at 7:19:11
In reply to Re: Paxil dilema, posted by Markwell on May 15, 2008, at 14:45:31
I have a suggestion. Assuming you are being treated under a diagnosis of depression, ask him to consider whether you are bipolar.
Posted by Markwell on May 21, 2008, at 7:31:37
In reply to Re: Paxil dilema, posted by blueboy on May 21, 2008, at 7:19:11
I asked and he said, no. How would that change my treatment?
Posted by Markwell on May 21, 2008, at 7:55:16
In reply to Re: Paxil dilema, posted by Markwell on May 21, 2008, at 7:31:37
I am currently taking 150mgs of lithium but it doesn't seem to be helping much (3 days). I don't have any mania only racing thoughts. Certain AD's make it worse, lexepro for one.
Posted by ace on May 23, 2008, at 0:05:18
In reply to Paxil dilema, posted by Markwell on May 9, 2008, at 16:59:16
> Here's my dilema, Paxil is the only AD that helps my depression but beyond 10 mgs I get terrible racing thoughts and 10 mg's doesn't provide enough depression relief. Is there anything I can
> augment paxil with that will help w/racing thoughts that won't interrupt sleep? I tried welbutrin it helped but I couldn't sleep a wink.
> Would depakote be helpful? My doctor wants me to try seroquel but I'm already a zombie with paxil. I don't want to gain 100lbs. HelpPolypharmacy is so cool these days amoung biopsychiatrists who have been ill-educated.
Has he stated anything about a TCA drug, or (shock! horror!) an MAOI....
Are you psychotic or have anxiety/depression that is intractable to all other treatments? If not, I wouldn't Seroquel.
I don't like any SSRI's but I would suggest alprozolam for the racing thoughts.....(if they have anxiety component to them)
Posted by Markwell on May 23, 2008, at 7:47:48
In reply to Re: Paxil dilema » Markwell, posted by ace on May 23, 2008, at 0:05:18
I'm just in a funk with a little anxiety. Which TCA would you recommend? I take ativan but I'm so afraid of becoming addicted. Maybe I should try 20 mg of paxil (10mg currently) with the ativan. At 20mg I found noise and common annoyances more intense.
Posted by william puga on May 24, 2008, at 23:51:02
In reply to Re: Paxil dilema, posted by Markwell on May 23, 2008, at 7:47:48
Lithium augmentation is one of the best ways to get an antidepressant to work. Typically, one needs about 10x one's weight in milligrams for bipolar (eg, if you weigh 150#, you need 1500mg per day), but usually 300mg twice a day can be very helpful. If low doses are helpful you reduce concerns regarding side effeects including tremors, diarhea and thyroid suppression.
Lithium is also helpful for racing thoughts.
Good luck!
Posted by william puga on May 24, 2008, at 23:57:03
In reply to Re: Paxil dilema, posted by william puga on May 24, 2008, at 23:51:02
By the way, you have to be very careful combining an SSRI with a TCA. There is an interaction that increases the TCA in the body and for some, that increase can be toxic/lethal.
Also, Paxil pharamacokinetics are funny in that increases in dose are not linearally related to blood levels, in other words, if you increase the dose from 10 to 20 mg, it does more than increase your blood levels twice as much. ?maybe 3 or 4x as much? Consider a smaller increase, eg to 15mg or less. It comes in liquid so even smaller increments can be used.
Good luck!
Posted by ace on May 25, 2008, at 23:36:20
In reply to Re: Paxil dilema, posted by Markwell on May 23, 2008, at 7:47:48
> I'm just in a funk with a little anxiety. Which TCA would you recommend?
When you say a 'little anxiety', what do you exactly mean? Does it significantly impede your level of functioning? How long have you had it? Is it in response to certain life events, or is it a long-standing problem? Gosh, I hope I don't sound to nosey here!
With regards to the TCA, I would say Clomipramine would be a good first choice....A lot of people just 'throw' this drug in the corner as stricly an anti-OCD agent, but it can also have wonderful anti-anxiety and AD effects.
I take ativan but I'm so afraid of becoming addicted.I wouldn't worry too much about this! If your anxiety is at a level where you need it, take it.
Benzo's are great drugs which have been misused by people who did not need them! A person can become medically dependent on them, this is true. But with a very very slow taper off, (not 1mg per week!) they DO NOT have a horrendous withdrawal.
There is no evidence to suggest over time people need to administer a higher dose to retain efficacy. This phenomenon only happens in the FIRTS FEW WEEKS of therapy. Actually- evidence mostly shows people slowly need less and less of the benzo as time goes on!
Maybe I should try 20 mg of paxil (10mg currently) with the ativan. At 20mg I found noise and common annoyances more intense.Seems like the Paxil, at 20mg, creates this syndrome- I have heard of agitation caused frequently by all SSRI's. This could wear off, or maybe it won't....hard to say. I am not a big fan of any SSRI, but obviously, you must do what you feel best for you.
It is so hard to predict certain things with these drugs.....I would try the 20mg, but i would not suffer with any s/effect too long...
I hope this helped a bit!
Cheers mate,
Ace:)
Posted by ace on May 25, 2008, at 23:44:21
In reply to Re: Paxil dilema, posted by william puga on May 24, 2008, at 23:57:03
> By the way, you have to be very careful combining an SSRI with a TCA. There is an interaction that increases the TCA in the body and for some, that increase can be toxic/lethal.
True here. I would only add a modicum of the TCA if you stayed on the SSRI. I was actually suggesting TCA monotherapy.I agree with your sentiments on Lithium too.
> Also, Paxil pharamacokinetics are funny in that increases in dose are not linearally related to blood levels, in other words, if you increase the dose from 10 to 20 mg, it does more than increase your blood levels twice as much. ?maybe 3 or 4x as much?I read about this along time ago with regards to Zoloft....Actually, this reminds on some articles I read which alluded to the fact that SSRI's produce more therpeutic effects at lower doses in a great portion of people....you heard of this before.....??
Consider a smaller increase, eg to 15mg or less. It comes in liquid so even smaller increments can be used.
>
> Good luck!
Posted by william puga on May 26, 2008, at 12:50:24
In reply to Re: Paxil dilema » william puga, posted by ace on May 25, 2008, at 23:44:21
Some meds have what is considered a "therapeutic window", which means if the level is too low or to high they don't work too well. Wellbutrin is one that is supposed to be like that. The ssri's aren't notorious for this but it can happen in some.
Posted by william puga on May 26, 2008, at 12:50:51
In reply to Re: Paxil dilema » william puga, posted by ace on May 25, 2008, at 23:44:21
Some meds have what is considered a "therapeutic window", which means if the level is too low or to high they don't work too well. Wellbutrin is one that is supposed to be like that. The ssri's aren't notorious for this but it can happen in some.
Posted by Markwell on May 26, 2008, at 14:28:12
In reply to Re: Paxil dilema, posted by william puga on May 26, 2008, at 12:50:51
I am currently taking 20 mgs of paxil (since Saturday) and maybe if I start getting racing thoughts I will have to increase lithium which I am currently taking 150mgs.
Posted by Markwell on May 26, 2008, at 14:34:02
In reply to Re: Paxil dilema, posted by Markwell on May 26, 2008, at 14:28:12
What would you recommend as a TCA? I'll try the paxil for a while but I'd like to have a backup plan. Does lithium cause weight gain? I thought it was some kind of salt configuration?
Posted by william puga on May 26, 2008, at 18:38:49
In reply to Re: Paxil dilema, posted by Markwell on May 26, 2008, at 14:34:02
Make sure you are making changes with ur doc's blessing...s/he knows your situation the best.
Lthium can cause weight gain but not in everyone. More than likely it won't but it can.
The tca with the least side effects is pamelor. Maybe a good alternative if ur doc thinks a tca is appropriate.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.