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Suggest Treatment For Depression And Anxiety While On Cymbalta And Wellbutrin

Posted on Fri, 17 Feb 2017

Question: I have a panic disorder associated with depression. I have been taking cymbalta 60 mg and Wellbutrin 300 mg for a few years. I have clonazepam .5 when needed but I rarely take it. My brother died two weeks ago and my anxiety has spiraled out of control. To the point where I had to leave work yesterday and take two days off, hoping this will calm down and I can work next week. I am a CMA and I work for a busy dermatologist office. I have been reading that cymbalta may not be the best for panic disorder. I used to take Paxil many years ago. I have been having to take the clonazepam to keep from losing my mind. I have an apt with my PCP today, should I ask to be put back on Paxil? Am I going to die? Am I going to survive this?

Answered by Dr. Seikhoo Bishnoi (22 minutes later)

Brief Answer:
Yes Paxil is better option for anxiety and panic.

Detailed Answer:
Hi, thanks for asking from HCM

I am sorry for your loss. Cymbalta is Duloxetine and is a SNRI drug. The drug is commonly used in depressive disorders and also has efficacy in anxiety disorders.

Paxil or Paroxetine is a SSRI drug and is used in anxiety and depressive disorders. Yes Paxil will be better option if your main distressing symptoms are anxiety and panic. Paxil will also help in sound sleep and will control the symptoms. If we consider depression with somatic symptoms or pain symptoms then Cymbalta is better option.

So you can talk with your doctor regarding Paxil. Avoid stopping the doses of Cymbalta suddenly. Tapering of doses will prevent any withdrawal symptoms.

Thanks. Take care

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Seikhoo Bishnoi (1 hour later)

Should I stop the Wellbutrin now or do I need to taper off? I have read that it is a "brain exciter" and maybe I don't need that? Can I just stop it?

Answered by Dr. Seikhoo Bishnoi (7 hours later)

Brief Answer:
Better to reduce the doses over 2-3 weeks.

Detailed Answer:
Hello again

Even Wellbutrin dose should be tapered. Though the drug doesn't cause much withdrawal symptoms but if doses reduced by tapering then the risk of withdrawal is minimised.

You are currently on 300 mg and you can reduce the dose to 225 mg per day (150 and 75) for one week and then 150 mg per day for next week followed by stopping the drug completely. This will reduce any chances of withdrawal.

Talk to your doctor for Paxil and other dose adjustments.

Thanks.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Seikhoo Bishnoi (3 hours later)

Just wanted you updat you on what my PCP did - she said that trying to introduce Paxil at this time during a severe anxiety situation would not be a good idea. Instead, she doubled my dose of cymbalta from 60 mg to 120 mg (yikes) and left everything thing else as is. I'm praying the cymbalta increase will address the anxiety. She says we can try changing to another SSRI in a few months but not to change too much right now.

Answered by Dr. Seikhoo Bishnoi (26 minutes later)

Brief Answer:
In that case continue with 120 mg Cymbalta.

Detailed Answer:
Hello again

Well if she wants to continue with Cymbalta then that is good. Increased dose of Cymbalta would help to control your persisting panic symptoms.

Once you become stable then trial of shift to Paxil can be taken.

Thanks.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Remy Koshy