Hi Mr XXXXXXX

Thanks for posting your query in detail.

Important points of your case:

1. Duration of anxiety disorder 5 year.

2. Good response to treatment: effexor and paxil

3. Best response on effexor

4. Recurrence of anxiety or withdrawal symptom on treatment discontinuation

5. Confusion related to treatment duration


As you have described your treatment history well, I will try to give specific answers.
1. From your description it is not clear if your symptoms are due to recurrence of anxiety or withdrawal symptoms on treatment discontinuation. Among the drug you described, Paxil has some withdrawal effect on discontinuation, even on slow tapering. Other drugs are less likely to cause withdrawal symptoms. Panic attacks as mentioned are less likely withdrawl symptoms but recurrence or worsening of anxiety.

2. I would prefer to use 'Effexor' in the case of recurrence of anxiety due to treatment discontinuation. The reasons being - you had noted best response with effexor and you were shifted to effexor from Prozac in the past probably because of poor response to Prozac. Alternatively there is no harm in starting Paxil too. Discuss with your treating physician to decide the best line of treatment.

3. 'Laxotanil' and 'Xanax' use is justified for short term treatment, but under guidance of your physician, so that he can taper it as soon as possible.

Last but not the least, I think you will need long term treatment may be for years or lifelong as symptoms are recurring after tapering of medication.
Learn to work closely with your Psychiatrist. The treatment failures happen because you take decision about medicines without consulting doctor.

Hope this will help you.

Wish you Good Health

Regards

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Hello,

Thanks for your query.

First of all, you might want to discuss the issue of this transition from Paxil to Prozac with your prescribing psychiatrist. Both these drugs are Selective Serotonin Re-uptake Inhibitors (SSRIs). It is not advisable to take two SSRIs at the same time, as you run the risk of Serotonin Syndrome (due to increased serotonin levels).

Additionally, Paxil is known for discontinuation symptoms. It needs to be tapered off gradually. There should be a week's time interval between stopping Paxil and starting Prozac. But since you are already in the process of the transition now, you may have to consider a gradual taper off of Paxil. Stopping Paxil abruptly, even if Prozac is being taken might bring on discontinuation symptoms. And in such a situation, you will probably need the help of other medicines such as benzodiazepines (Clonazepam, Xanax, etc.)

The discontinuation symptoms are expected to last another week or two. And you can expect the symptoms to be less severe with the help of the other medicines such as Xanax. The use of Xanax should be supervised by your doctor. The symptoms are also expected to be less in severity as Prozac will start working on the serotonin system. However, mere addition of Prozac does not mean Paxil withdrawal symptoms will be taken care of completely.

Please make sure you do not stop Paxil abruptly. You can extend the transition period by a week while you reduce Paxil dose gradually. Your doctor can help you with a feasible plan for this.

I hope this helps you regarding the transition problems and the withdrawal symptoms. Please let us know if you wish to discuss more.

Take care.

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