paroxetine and clomipramene

I have an anxiety disorder. I'm not sure of the diagnosis. A psychologist said it was GAD with pronounced obsessional tendencies. Following a nervous breakdown 7 years ago I was prescribed paroxetine (paxil). Paroxetine dramatically removed my symptoms and for a year or two I felt amazing and I managed to get through my phd. Gradually though bit by bit my symptoms returned. Things reached a head 7 months ago when I suddenly snapped. I found that my anxiety suddenly attached itself to flying. I never had a problem with flying before. I can get on an unimportant flight without any hassle. But if the flight is expensive, important and booked more than a week in advance, I'm filled with overwhelming anxiety. I have been switched from paroxetine (50 mg/day) to clomipramine (target dose 75 mg/day)

questions
(a) Can Paroxetine lose its effect over time? (i.e a period of several years)
(b) I'm worried that the target dose of clomipramine will be too low to treat my condition. I've read that typical doses are 200 mg/day. If I was close to the max dose of paroxetine, won't I need a high dose of clomipramine?

[Roger Gould, M.D.]

Yes, Paxil can lose effect, but not sure it is biological, it can also be that the underlying anxiety is reactivated for new stage of life reasons, and that is what needs to be addressed, so counseling is definetly in order.

Also, the specificity of your anxiety makes it even more important that you try to understand the why's and don't overly rely on medication.

The maximum dose issue is not a real issue. These are different drugs,and people respond differently to different doses, so try the lower dose, it will probably be enough, especially if you have counseling as well.

[hey3]

Hi Nic4. I understand exactly. I also have or have had GAD and I have the same problem with flying. If it is booked for months, I have a terrible time boarding a plane. The last time I flew, nearly a year ago, I was on Paxil. I didn't break a sweat. It was the first time since about the age of 19.(32) I had too many side effects with the Paxil and quit taking it. I have the same problem with crowds. I hope you find something that works. Hydroxine might help. It is an antihistamine but also is given to help with anxiety. Congrats on you Phd.

hey3

[desteny]

I was on Paxil cr 25 mg "which is the same as regular Paxil just it is time released" for almost 2 yrs... It worked great for me. I was put on it because I have social anxiety and use to have really bad panic attacks everytime I would leave my house. Paxil cr Worked great... never once did I have a panic attack while on Paxil.... then the FDA took it off the market recently.. which really upset me!. But my Doctor started me on regular Paxil 20 mg now thats what I'm taking along with klonopin 2 mg day.. I recommend this medication for anyone suffering from social anxiety, panic attack disorders, general anxiety disorder, any kind of anxiety... I have tried other medications such as zoloft, effexor xr, prozac which didn't help at all for my anxiety.. Also Klonopin it too helps with my anxiety. Paxil gave me my life back.. I would recommend it to anyone.