Effexor vs. Paxil for GAD--side effect differences

[kcwdad]

I took Paxil 20mg for 1 yr from my PCP (not a psychiatrist)--great results in reducing what I believe is GAD (constant "nervous" feeling in stomach, hair twirling/nervous habits, social withdrawl, negative thought spirals and over-introspection, negative outlook on everything, etc.)  

I went off Paxil due to frustration over 1) somnolence (sleeping good part of weekend days away), 2) asthenia (the 5 mile run I'd done for years became a difficult chore), 3) lessened motivation (one of the good parts of anxiety, I guess), 4) sexual dysfunction and 5) weight gain (5 side-effects in one patient--not bad, eh?)  Withdrawl symptoms were unpleasant but not near as crippling as I've read about (mostly brain zaps).

Now I've been on Wellbutrin for about 4 months--not doing much for me.  Anxiety has crept back but all side effects gone--I feel like my old self again--good and the bad.  So do I strike a new Faustian bargain with Effexor?  I wouldn't hesitate to give up Wellbutrin, but I found SSRIs to be a "commitment": the odds of success need to be sufficiently high to outweigh the pain of withdrawl.

Specifically:

1) Given I experienced these 5 side effects above with SSRI, would that same SSRI action in Effexor be *likely* to cause same effects (i.e. how often does the norepinephrine action counteract each of these 5 side effects)?  Which of the 5 most/least likely not to recur with Effexor?

2) Am I better off with Paxil/Zoloft + Wellbutrin or Buspar, or is my non-reaction to Wellbutrin a sign that it wouldn't do much in combination w/ Paxil?

3) Any other drug/combo better for my condition and side effects experience?  

"Anxious" for your reply,

KCWDAD

[Roger Gould, M.D.]

This is an intelligent well formed question, I wish their was enough information to respond accordingly.  It turns out that the only way to answer the question is by trial and error.  "less likely" is a statistical answer but does mean much here because people respond in an idiosyncratic way to these medications, and to these combinations. Secondly, your life changes, and with that your anxiety level changes.  The one question you didn't asked is the most important..how about using your mind to control your symptoms...how about therapy, talking through your anxieties, increasing your wisdom in life.  That's the way to avoid all side effects.  That would be my advice, help yourself to some insight, minimize the medications, and grow out of your symptoms...

[Try_to_be_social]

There is no such thing as the best drug or drugs combination for GAD or other types of anxiety. It is by trial and error that one will find the best drug/s for oneself. The most important is the combination of the drug/s and the individual and psychotherapy. Have you had CBT? There are a lot of difference between difference SSRIs with respect to their effects and side effects. Lexapro is newer and claims to be an improved formula over Celexa. Since you have experienced side effects from and quitted an SSRI, Praxil, you are wise to think about attempting another class of antidepressant like SNRI. There are 2 SNRIs, namely Effexor XL and Remeron. Forget about Wellbutrin and its combination since it did not work on you at all. There is no harm trying Buspar. What about Benzo, like Konopin, which will neutralize some of the initial side effects of some antidepressants? Benzo is good if you use it carefully.

[3rdMajor]

Prozac should be a good choice SSRI.  Xanax or Klonopin in the benzo family.

[StupidMe]

It is self-healing to write diary of your anxiety everyday, e.g.
<table border="1" width="100%" bgcolor="white">
<tr><td>Date</td>
<td>Situation leading to unpleasant emotion/sensation.</td>
<td>emotion/s, sensation/s. Rate intensity 1-10</td>
<td>Automatic thought/s. Rate them 0-10.</td>
<td>Rational response to automatic thought/s. Rate them 0-10.</td>
<td>re-rate automatic thought/s 0-10. Rate emotions 0-10.</td>
<td>Further action</td></tr>

<tr>
<td>1/11</td>
<td>1 a.m., unable to sleep</td>
<td>Anxious. <br>4</td>
<td>I won't be able to do my work properly tomorrow because I need a full 8 hours sleep. 8</td>
<td>Looking back when I've had a sleepless night I can see that I still got things done & my work was about the same quality as usual. 7</td>
<td>2 <br><br>    1.5</td>
<td>Rather than just lie in bed thinking, drink a cup of warm water. Fall asleep in 15 min.</td>
</tr>

<tr><td>11/2</td>
<td>Join colleagues for lunch. They didn't acknowledge me & carried on talking.</td>
<td>Anxious. <br>5</td>
<td>They don't like me. They think I'm boring. 4</td>
<td>They are enjoying their conversation & aren't thinking about me. They certainly don't look hostile. 7.5</td>
<td>1  <br><br>   3</td>
<td>Listen to what they are saying & find an opening to join the conversation. Ask a question. Stop mind reading. </td>
</tr>

<tr><td>11/3</td>
<td>Asked to do some of my boss's work because he is going to the dentist this afternoon.</td>
<td>Angry. <br>4</td>
<td>It's not fair. I shouldn't have to do his job, I've got enough of my own work to do. He's just off-loading on me. He should have got organized to go outside of work hours. 7 </td>
<td>He'd been in pain. It's not a routine check up & there probably weren't any out of hours appointments available at short notice. 9</td>
<td>0  <BR><br>   0</td>
<td>Gather more information before anger.</td></tr>

<tr><td>11/3</td>
<td>Same as above</td>
<td>Anxious. <br>6</td>
<td>I'll make a mass of it. 6.5</td>
<td>He wouldn't have asked me if he didn't think I could do it. There are many others he could have chosen. 8.5</td>
<td>1.5 <br><br> 2</td>
<td>Ask him a bit more about the job so I know exactly what to do.</td></tr>

<tr><td>11/4</td>
<td>At home</td>
<td>Palpitations/<br>breathless/<br>chest tightness. <br>8</td>
<td>I'm having a heart attack. 8</td>
<td>It's just anxiety & overbreathing.I've had this feeling many times before & not died. Furthermore, it goes away when I distract myself & distraction would not stop a heart attack. Maybe I'd too much coffee. 2</td>
<td>6 <br><br> 6</td>
<td></td></tr>

<tr><td>11/5</td>
<td>Shopping</td>
<td>Faintness,<br>unreal, <br>breathless. <br>7</td>
<td>I'm going to collapse. 7</td>
<td>No I'm not going to collapse. My pulse is racing & my BP drop to faint. I feel faint because more blood is going to my muscles  which is a normal response when people feel they are in danger, even if as now the thought is wrong. 0.5</td>
<td>6 <br><br> 6</td>
<td></td></tr>
</table>

[emeraldeyes1646]

just be so careful of the effexor withdrawl.  i have been on prozac, wellbutrin, and zoloft before.  NONE had the dibilitating withdrawl effects like effexor.