Combination Therapy for Anxiety?

I'm 25 years old and have been suffering from a combination of depression and anxiety for years. I have tried numerous SSRI's, most did not work because of my habit of skipping doses. Only in the past few years have I been on Paxil and it's worked wonders. It did have a large, negative effect on my libido. After I graduated from college, thinking that a major outside stressor was gone, I weened myself off of Paxil to find that my depression was gone and I haven't been close to having a panic attack, but I still had symptoms of anxiety & (extreme) irritability. This has become more severe since I began a rigorous PhD program this year (I'm only taking preliminary summer courses now, the real stress is soon to come). In addition to my constant state of anxiety and irritability, when I feel overwhlemed or threatened, I tend to shut down.  I sleep A LOT, lose my concentration, and have zero energy. This symptoms are already beginning to act up. Not a good way to start grad school. I began therapy to help develop healthy stress/coping mechanisms and decided that I really need to be on medication. I am deeply concerned about the sexual side effects of paxil (I was only taking 20mg to get my previous results & still had sexual side effects).  I've been on Wellbutrin for about a month (150 mg bid), but it seems to have added to my physical anxiety, like a caffeine fit (no, I don't consume caffeine!).  On only 150 mg a day I didn't notice any differences in my state. It might also be worthwhile to mention that other than walking around my campus and taking stairs when I can, I get no exercise. I've been toying with the idea of starting yoga to relieve my extreme muscle tension and spasms.  Aside from this, I am very healthy (weight, etc.). Okay, now after all of this background, my question is: is there a combination of paxil and wellbutrin (or something else) that I can take to help relieve my anxiety and counteract the sexual side effects. Would 10 or 15 mg of Paxil (or Paxil CR) be enough to deal with my anxiety now that depression is no longer an issue? Does Wellbutrin really work to counteract the sexual side effects of Paxil without reducing its effectiveness?  I'm trying to get this sorted out asap since classes begin in 4 weeks and it takes that long to feel any effect from Paxil.  If some sort of combination therapy can be effective for anxiety, what are typical dosages? Times of Day? Thank you for taking the time to read through this insanely long e-mail. Also, thank you in advance for your advice.

[Roger Gould, M.D.]

Yes, the combinatin of paxil and wellbutrin has proven to be quite effective and safe and to greatly reduce or eliminate the sexual side effects. You might ask your doctor about the new version of paxil which is paxil cr 12.5mg.  It is slow release,once a day, and has less sexual or eating effect.

Stay with the therapy...that combination is even more important.

[robandfab]

i relate.  to all of it.  paxil seems to be the worst of the ssri's when it comes to sexual side-effects.  one thought i had in reading your posting was that you fit much of the criteria for bipolar 2 - the anxiety, sensitivity to threatening situations, lack of energy and irritability.  i have the same symptoms and have been tried on depakote and lamictal to treat the atypical bipolar disorder.  neither one did any good but they might work for you.  the lamictal is supposed to be very effective with symptoms like yours.  the other thought i had was adderal.  without a doubt, it has been the most helpful drug i've been given.  it's not a cure-all, but far more effective for me than the ssri's, mood stabalizers and any others (serzone, effexor, wellbutrin.)  the constant lack of energy will be instantly treated and, for me anyhow, without the jittery, too much coffee feeling.  don't listen to all the ******** about how it's going to turn you into a drug addict.  this can be an extremely effective medication.  good luck.