Help For My Son - Medication Question

[Diana55]

Hello all,

I've never posted before, but I'm looking for help for my son.  He suffers from panic disorder, GAD and some depression.  He is 27 years old, and has trouble posting, so I'm doing it for him.

He's been on 40 mg. of Paxil for 8 years, then up to 60 for 1 year.  The Paxil stopped working and his Pdoc suggested he withdraw from the paxil and go to Effexor.  He took him down quite fast, and my son suffered horribly.
It raised his blood pressure dangerously, so he had to go back on the Paxil.  

His Pdoc then tried taking him off the Paxil with Prozac, but coming off the Paxil completely, and off the Prozac was horrible for him ... so he's now back on the Paxil at 40 mg.  He's very depressed and sick of all this, and wanted me to ask:

Have any of you gotten of Paxil and if so, what did you use/do, to make it easier?  Did any of you go onto Prozac, from Paxil and remain on the Prozac?  If so, did it work well for you?

Are there ANY suggestions you can give him, to help him get off the Paxil with less effects?  Is there a med that you would suggest he try, other than the ones he's all ready tried (Effexor & Prozac)?  He did try  a few other meds, I've forgotten now, and none of them worked for  his panic attacks.

His panic is much worse than his depression.  He tells me he can live with the small amount of depression, but it's the panic disorder that messes up his life.

My son and I would greatly appreciate any help you can provide.  I hate seeing him suffer SO much for SO long, he's young and I would love for him to be  happy .... and he wants that too.

Thanks a bunch!
Diana

[dadinTN]

I haven't taken Paxil or Prozac but will try to offer some general advice based on my brief experience with Celexa....

A simple increase or decrease in the same medication can throw you off for a couple of weeks.  I know when I went from 10 mg to 20 mg, the side effects increased dramatically for at least a week.  

with that said, I think it should it is quite probable that your son would experience a change when going from one medication to another.  The length of 'down time' will vary from person to person but I think that given a little time, the new medication will result in improvement.

Everyone kept telling me that the celexa would work in 2 or 3 weeks.....well, it took about 6 to 8 weeks before it really worked.

[Paxiled]

Paxil can be a very tough medication to come off of.  You're son has also been on a very high dosage.  So it should be done very slowly, as slowly as necessary.  There is a protocol in the book The AntiDepressant Solution by Joseph Glanville; you can also find some on line if you google Paxil withdrawal.  Basically, they recommend a slow taper, and going back on the last dosage at which there were no symptoms of withdrawal if it gets too bad and tapering slowly.  Although some use liquid Prozac to help the taper of Paxil, you can also use liquid Paxil.  It allows a very slow taper.  It still might be hard, but knowledge is power.  If the psychiatrist isn't versed in this problem, find another one.  Most toe the pharmaceutical company line; you need one who sees everyone as an individual.

[Paulla]

I suffer from anxiety and panic disorder for 10 years!
I did not even see any kind of help from anti-depressants  other than making me so energized at all. Plus I developed heart palpitations from SSRI's. My doctor does not want me to take SSRI's anymore.
If your son does not have any addiction problems the only solution is benzodiazepines such as Xanax, ativan, Valium or Klonopin. but he can not take those everyday. he needs to take them during a paic attack or if he feels like he will have one Those would stop him from getting an attack with in minutes.
No caffeine at all. and drin a lot of water

[Ryan7591]

Hello Diana,

Paxil is the most potent SSRI type antidepressant on the market. Rarely is it effective at treating pure panic disorder, which suggests that you son has a strong component of coexisting depression. Depression can induce panic and vice-versa. The two almost always coexist. One usually dominates. The depression likely dominates. The key is to treat the dominating disorder.

The main issue with Paxil is it's short half-life. Paxil does not remain in the plasma for long, and after an "X" amount of time (typically ten years), Paxil tends to lose its efficacy. When it does, finding a replacement can be exceptionally difficult. The doctor was correct in using Prozac in an attempt to taper him off of Paxil, as Prozac carries a very long half-life. However, Prozac is only a fraction of the potency of Paxil, and it is generally ineffective for that reason.

Since the Paxil has lost it's efficacy at this point, it would be best to switch to an entirely new class of drugs. Since Paxil is the most potent SSRI, it is unlikely that any of the other SSRI's (Celexa, Lexapro, Luvox, Prozac, Zoloft) would be of benefit.

The SNRI's Cymbalta, Effexor and Pristiq are also unlikely to be of benefit. They are also highly stimulating, which may amplify panic. I would not recommend any of these, due to their stimulating quality.

The drug class that I would recommend are the Tricyclic Antidepressants, and in particular, Anafranil and Tofranil. Anafranil is the 1960's version of Paxil. The effect is very similar, however, Anafranil is far more potent than Paxil. The typical dosage ranges from 75-150 milligrams daily. Anafranil is very effective for obsessions/compulsions, and panic with concomitant depression. Tofranil is very effective for panic disorder with concomitant depression, but is initially more stimulating. This passes within a few weeks. Both drugs require four-to-six weeks for optimal efficacy.

In addition to the Anafranil or Tofranil, I would recommend Klonopin, which is a Benzodiazepine. A small standing daily dosage of 0.5 mg, b.i.d. (twice daily) in conjunction with a Tricyclic is perhaps the most effective treatment option for depression/panic from a pharmacological standpoint.

If he has not employed cognitive behavoral therapy, I would recommend that as well. There is no cure in the form of a tablet for panic disorder. With the aide of CBT, he can learn new skills to help him manage the overwhelming feelings.

Ryan

[Paxiled]

Paxil is very effective for panic disorder, and is no stronger than any other medication, it's a question of which one works and which doesn't.  Often this is a case of liver metabolites.  It worked much better for me than tricyclics.  Tricyclics stopped working after a few years, while Paxil worked better the longer I was on it, and I wasn't put on either for depression.  

That being said, Paxil for whatever reason is very difficult for many to come off of, and all these drugs have annoying side effects.  With Paxil, the side effects got worse as time went on.

The point being, all these drugs are very different depending on the individual.  You'll notice if you read this site people switching drugs all the time because of all kinds of reasons.  It's just very difficult to apply one person's reactions to what another will feel.

[Diana55]

Thank you all SO much!!!  Such great information here!

I want to reply to each of you individually, but have only a minute right now.  So I'd like to ask another quick IMPORTANT question, then I'll come back later and respond to each person.

My son's doctor just prescribed a Thyroid Booster to him, said it would work to calm him, as a relaxant, instead of a stimulant, as it's meant for.

I didn't mention that I don't live near my son.  He's in Seattle, and I'm in N.Y. state, so I feel so helpless.  He's very worried about trying this Thyroid Booster, and it worries me too, so I told him I'd ask here.

Have any of you taken one?  Have you ever heard of it being used for panic or anxiety?  I'd surely appreciate any info you might have.

To top it all off, Joe (my son) tole me tonight, that his girlfriend of 8 years, is moving away ... so he's heartbroken on top of all this.  As a mom, my heart breaks for him.  I think this is almost as hard on me, as it is on him.

Thank you guys, SO much!