These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.
Anxiety Attack
Question: I’ve been taking 20 mg of Paxil per day (irregularly) for about a year. I recently stopped taking it altogether, and
I have just experienced a brief, but excruciating anxiety
attack. My doctor tells me the my options are to resume taking
Paxil or try a regular dosage of Klonopin (and Melloril if
necessary). Could my anxiety attack be
a reaction to stopping the Paxil or is it more likely to be a
recurrence of the problems for which I was prescribed Paxil in
the first place? If the former, I would have serious reservations
about resuming a course of Paxil. If the latter, it would be
worth putting up with the side effects to prevent another
recurrence.
Answer: Paxil is an excellent treatment for anxiety and panic disorders. I suspect that it is not due
to stopping the drug , but to lack of treatment of an underlying problem. Anxiety attacks
tend to occur in clusters and then be absent for long periods of time. I usually tell my
patients to occasionally taper and stop the medicine to see if they are experiencing a hiatus of
the anxiety. Some will need it daily for the rest of their life. Others less so. Long term
side effects so far appear to be minimal.
Paxil/Prozac
Question: I have been on Paxil (20 mg) for a year now and seems like it has not been doing much good lately. I mentioned this to my doctor and he switched me to Prozac (20 mg). He said I could just stop the Paxil immediately and take the Prozac. He also said the Prozac would not start working well until about 4 weeks into my system. Whenever I have run out of Paxil or forgotten to take one, I seemed to become very unpleasant (mean and angry). This gets even worse in the period of getting the Prozac into my system. Does this sound right? Could I take a Paxil and a Prozac during this time to help my mood change for the better?
Answer: Both of these drugs are similar and I doubt that one would be markedly superior.
However, you are really taking very small doses. Most patients need to be on 40 to 60 mg and even
doses of 80 or 100 are not uncommon. Sometimes small doses of amphetamines will
markedly improve the performance of this class of drugs.
Alternative to Paxil
Question:My son has taken Paxil, but can not really afford it, and neither can we. It is derived from Tryptophan, is it not? Can he take Tryptophan instead? The doctor who gave him Paxil just tried it to see if it would help his depression. It did, but as I said, he can’t really afford it. Tryptophan is available through a German connection, and he did take it years ago when it was still available in the US. It also helped. What concerns me is that a pharmacist in Nebraska told my husband that taking Tryptophan instead of Paxil could be very detrimental to our son. [His age is 24.] Any suggestions? Are there social agencies that help with the purchase of necessary drugs?
Answer:Taking tryptophan will do no good at all with your son’s depression. This drug is a serotonin reuptake inhibitor(SRI), which tryptophan is clearly not. There are several drugs in this class and usually using zoloft, prozac, etc will have similar results. Many drug companies will treat patients with free medicines if the patients physician will certify that the physician is not being paid-hence, a true charity case. I would discuss billing etc. with your physician, I have several patients who are on these programs.
