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Should I take Paxil or Lexapro?
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Should I take Paxil or Lexapro?

My therapist diagnosed me with coping disorder with acute anxiety and a touch of depression. She recommended Ativan for me, though she's not an MD, she wanted me to talk to my doctor. I talked to my doctor and she disagreed with putting me on Ativan. She recommended Lexapro. I went to the pharmacy and my insurance wound up not covering it (it was a hundred and something dollars!). They contacted my doctor and she faxed over an authorization for a generic prescription for Paxil. Well I got it filled and later that day I made the mistake of taking the Paxil a couple of hour before bed (I slept for 4 hrs). I suddenly remembered I was on Paxil 8 years ago and it made me hyper and I hardly got any sleep. I called my doctor's PA this morn and she told me that those are the only 2 recommendations that they have for me with respect to my diagnosis & that I'm on birthcontrol (Estrostep FE) and that they really didn't have any other options for me.  They also said I was too young (I'm 26) to go on other things (that didn't sound right to me). So with all that being said which one should I take? The Paxil is cheaper and I dunno if I'll react to it the way I did almost a decade ago and the Lexapro I've never taken but it's more expensive. I've heard the Paxil side effects are horrible.
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Ask for Generic Celexa....it is almost the same as Lexapro (it pretty much is the same) except it has one extra isomer.  My psychiatrist said it is more calming than Lexapro, but almost identical.  Ativan is fine for short term and it is definitely calming and it kicks in the same day usually within an hour.  But you can become dependent on it.  Same with Klonopin (same drug class), but I safely came of of Klonopin after 8 weeks with no side effects ( I just tappered off).

Paxil has a major weight gaining effect on some people.  My friend has been on it for 15 years and she is about 250 lbs.  She actually lost 30 lbs while pregant because she had to quit taking it.  Crazy!
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I think if you read the pi on paxil it has equal weight gain to weight loss making it weight neutral.  My friend takes it and it never effected her weight at all.  So I wouldn't let that scare you as that is patient dependent.  However, you tried it in the past and had agitation/ hyperactivity from it.  (you'd probably lose weight over the longhaul with that . . .)  So you may want to consider lexapro or celexa. However, paxil is generally considered to be extremely effective and more so than lexapro/celexa in terms of clinical data.  Another possiblity for the paxil is that this side effect you speak of generally is what they call a transient side effect in that it is in the begining of therapy and will go away after a short period.  Doctors get away from those start up side effects by starting with a low dose (say 5 mg and  take that for a week then go to 10 and then finally go to 20 mg----  the usual dose.).  That whole class of drugs is excellent and both drugs offered to you would be good choices to help with your anxiety and depression.  Good luck!!
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one last comment on ativan and that is that I'd agree with your doctor.  It is a controlled substance and if taken for a long term anxiety problem, it can lead to problems all its own.  Not worth it.  Your condition can be controlled in a safer way.  Good luck.
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Okay, folks, all these drugs are problematic if taken for a long time, the label "controlled substance" means very little.  Paxil is a lot harder to quit than many illegal controlled substances.  My advice is to make Paxil a last resort drug.  It can be very hard to quit and has a lot of side effects.  Lexapro by reputation has fewer side effects than the other two.  Ativan will have the fewest side effects, but it only works short term.  And nobody can tell you which will work for you, you only find that out when you take one.  As far as your decision goes, it's very rare for a therapist to recommend meds.  They usually don't like them much, as meds don't cure and it's the therapists who hear about all the side effects and med switching and difficulty with quitting them.  Psychiatrists only see us for a few minutes every few months and generally disregard whatever we say while they read us their script.  But I would still recommend talking to a psychiatrist before doing anything -- never do this through a general practice physician, they know even less about these meds.  Inform yourself of the options and the downsides before you choose, then once you choose, give it time to work and don't worry about it anymore.  As for weight gain, any antidepressant can cause weight gain, but Paxil is more known for it than other ssris.  Doesn't mean it'll happen to you.  I gained 50 pounds on it.  It's common.  But others have reported on here gaining a lot on Lexapro; I'm on it now, but haven't gained more than 15 pounds.  So you never know.  Good luck whatever you choose.
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I don't know you but I guess from your name and comments that you are the anti-paxil person.  I'm sure you have your reasons but it must be one big vendetta to tie yourself to it with your name here.  Interesting.  But as I said, you are informed on the subject and must have good reason.  

Anyway, I am a fan of paxil currently because a loved one of mine that I adore has had such wonderful success with it.  She has anxiety with panic attacks.  It has helped her beyond any other med.  Paroxetine has been around for awhile so her doc didn't prescribe it right away and used some newer meds.  Paxil was the charm that changed her life.  She had some side effects in the begining but they went away.  She did not gain a pound on it.  She's been on it for quite a while now.  She is much happier now (and so are we, those who love her.)  

I have seen such great results with all ssri's though.  It is an AWESOME class of meds.  The way anxiety and depression were treated before they were discovered and approved would make many people choose to suffer their illness vs. taking those meds.  That's why in the US, one out of every 4 adults takes or has taken an ssri.  

ALL ssri's need to be titrated down when a patient goes off of them and I couldn't imagine a doctor not recommending that these days.  With careful titration, I think I'd rather come off an ssri than a benzo . . . most people don't get addicted to ssri's . . .

to the person asking the question, the drugs all work pretty well.  It's just a matter of finding the one that fits your system and symptom profile the best.  Good luck.
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Suggest you read on the internet the horror stories of people on ssris and trying to go off them.  One should never generalize from the particular, so no, I'm not anti-Paxil, I'm anti-uninformed physicians, psychiatrists and patients, and lying pharmaceutical companies.  GlaxoSmithKline, the manufacturer of Paxil, had to be sued to admit it knew before ever selling the drug that it caused severe withdrawal in healthy volunteers.  It also has a high side effect profile, and is in fact notorious for weight gain.  And yet, because it's often the only medication that helps people, I'm not against it, I'm just against it as a first resort.  Same reason I oppose the snris, such as Effexor, as a first resort.  Too many people have terrible times on them and trying to get off them, so one should try gentler remedies first.  The problem is, psychiatrists don't tell you these things, and it was only these lawsuits that forced the FDA to require a warning on all ssris and snris that withdrawal is a serious problem and how to handle it.  Yet you still read on here about all these people being put on meds as a first resort, before trying therapy, before trying natural remedies.  Medication should be a last resort, but it should available.  The reason Paxil wasn't prescribed right away is because most psychiatrists now know how difficult a drug it is and usually start with ones that have a reputation for being easier.  But Paxil did help me more than anything else I've tried, it was the withdrawal that killed me, but it wouldn't have if I hadn't had a quack psychiatrist.  Unfortunately, there are an awful lot of those, especially the ones who work for insurance companies, and when a drug does go horribly wrong, whether it be an ssri or Vioxx, doctors don't know how to fix it.  So we do have to be careful.  You're also wrong about ssris being a big change.  In fact, tricyclics, which were around long before ssris, still work well and are being used more and more again because of the problems that have been discovered with ssris but were hidden by the manufacturers when they sold them to everyone.  Did you ever wonder why so many Americans are on these drugs?  Do you really think that many actually are so disturbed they need them?  Hardly.  They were sold as magic pills without consequence, and when the consequences were discovered, well, money and the lust for it will out.  Now, it's important to recognize, everyone will experience these meds individually, and hopefully your friend will never have to go off it because the longer you're on an ssri and the older you are, the harder it is to quit.  Just pray her psychiatrist actually knows how to do it, and your friend ensures beforehand that's true.  I didn't, many didn't, and paid for it.  But many also didn't pay for it, probably most, and had a relatively easy time of it.  Which is great.  I needed the medication, since therapy hadn't worked for me.  Many do, so I'm glad they're around.  But when you're one of the ones who gets creamed by a med, any med, it's not so reassuring that somebody else didn't.  Care much be taken with all prescription drugs, and the patient has to take that care, because physicians make all their money by doling out pills and learn all they know from pharmaceutical companies. The exceptions have long lines of patients, don't work with insurance, and are hard to locate.
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You have your opinion based on your experience and I have my opinion based on mine.  Yours isn't necessarily right nor is mine, just sharing our experiences.  I hope that the person asking the question considers all of the information given and makes the best choice for them.  You've been 'creamed' to use your word and I understand your bitterness and contempt.  You are a large beacon ready to WARN everyone and more power to you.  Maybe it will save someone from the experience you've had.  

One note, I wouldn't consider being on a tricyclic agent a picnic, however.  You can quote me all the studies in the world (and I hate to tell you this but I've probably read them) but they wouldn't convince me that they are preferable to newer classes.

I doubt either of us at this point have helped the poster.  Sorry about that passionsunkiss.  Good luck
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