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    How is anxiety disorder treated ?

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Posted on Sun, 22 Apr 2012 in Anxiety and Stress
Question: hi, im a 36 year old male , i have anxioty disorder and have been on different medication over th past 5 years, strated with prozac , then effexor then finally for hte last year i have been taking Paxil (seroxate) . the resons why i switched from effexor to paxil is that effexor was so good that i decided it was time for me to quite, I quit in 2 weeks and then hell broke lose with side effects etc so my doctor put me on paxil. i was taking 1*25mg +1*12.5 mg so total 37.5 a day. things got better for a year, then i decided i want to get of it again so i started tapering down by -10% everymonth, i went ver well till i reached only 12.5 mg a day. now comes the problem. after a cuple of month i strated getting light anxioty again. so my doctor suggested i go up in my dose again which i refused causei hated this dug and what it does to me (sleeplesness, lack of consuntration etc) so he told me i can switch to prozac if i want, the method was to take one 20mg of prozac every day allong side paxil for a week then stop paxil and continue with prozac alone. I did that , the forst week was fine , but now things re very bad, im gettign contiues panic attacks, as sson as i wake up in the modning, numness in my head and no ability to concerntrate or work. the only way i ontrol it is by taking laxotanil 3mg and that doesn;t work also so i started taking xanax .5mg twice a day , hoping that these are just wothdrawal dimptoms and wll go away in a wek or so once prozac kicks in.
my question is :
1- should i hold on and wait , will proza ake the withdrawal symptoms of paxil go a away, and how long will this take I'm having serious panic attacks that I didn't get in years.
2- sould i just go back to paxil (seroxate) and double the dose.
3- an mean while if yo tell me to wait ill prozac kicks in , is it ok to use xanax and laxotanile like im doing now.
please help me im very desprate and i dought my doctors advise and now i can't get in touch with him.
doctor
Answered by Dr. Ashish Mittal 16 hours later
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
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashish Mittal 6 hours later
thanks doctor, but now that i have already started the switch from paxil to prozac and 2 weeks in to prozac, should i wait, will the withdrawal symptoms lessen. and how long should they last.
i don't want to go back to either effexor or paxil, becaouse of there side effects, sexualy and weight gain, i put on 25 kilos with effexor and paxil i dont want that again,
so should i just wait till the symtoms disapear. or willit take months
doctor
Answered by Dr. Ashish Mittal 27 hours later
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.


Above answer was peer-reviewed by : Dr. Raju A.T
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Answered by
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Dr. Ashish Mittal

Psychiatrist

Practicing since :2004

Answered : 1858 Questions

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