Paxil side effects--alternative

[kcwdad]

I'm a 37 yr. male on 20mg Paxil to treat anxiety.  Former symptoms included short temper, over-analysis, and an inability to see a half-full glass.

Paxil has worked quite well at resolving these issues, but side effects of lethargy/fatigue and loss of sexual function are unsustainable.  Urinary hesitation is a bother, but no big deal.  I've also gained weight, but from what I've read, Paxil is supposed to decrease appetite for carbs--maybe unrelated (who doesn't love a good carb?)

Questions:

1) Is Zoloft or Wellbutrin a better answer, or something else or another combination, based on my former symptoms?  My PCP thought Wellbutrin might have fewer side effects.  

2) Is Wellbutrin associated with fatigue or sexual dysfunction?

3) A friend on Zoloft said it did not reduce her energy, but actually increased it.  But might it increase nervous energy?

4) If I do switch off Paxil to another SSRI, how do I wean from Paxil, and can I wean concurrent with starting a new med?  Would Wellbutrin or Zoloft negate the typical Paxil withdrawl symptoms?

5)What I am likely to give up in switching off Paxil, i.e. is there a particular aspect of anxiety relief it's best at that Wellbutrin or Zoloft are less effective?

Thanks!

[Roger Gould, M.D.]

These are all good legitimate and clear questions.
1. Wellbutrin is commonly used as an adjunct or substitute when sexual function and weight is an issue.
2. No fatigue or sexual dysfunction.
3. Zoloft can increase both energy and nervous energy. It can be overstimulating and counteract the anti-anxiety effect you are  looking for.
4.You would use Wellbutrin and Paxil concurrently at adjusted doses for about 3 weeks, then gradually wean from Paxil.
5. I think I answered this in other answers.

[kcwdad]

Thanks for the clear answers.  Two quick related follow-ups, if I may.

- When is Wellbutrin a better supplement to Paxil vs. replacement for it (esp. in light of my goals of reducing sexual and energy side effects).

- To restate my former Question #5 in the context above, if I switched to Wellbutrin (and weaned off Paxil), 1) what might Wellbutrin not do as well as Paxil, and 2) What different side effects is it known for?

In other words, why would anyone choose Paxil over Wellbutrin?  Is it less aggressive in treating anxiety? Or is it primarily a matter of trial and error with different drugs against people's inherently different brain/body chemistries?

[Try_to_be_social]

It seems theoretically Wellbutrin is superior in that it does not cause fatigue, anxiety, or sexual dysfunction, while Paxil may cause all the 3 side effects above. But practically, which is superior all depends on your good self. Try Wellbutrin is the only way to see which is better.

One’s meat is another’s poison,

From Try_to_be_social

[piglette]

I'd disagree with the comment that wellbutrin doesn't cause anxiety. I used to take paxil for several years but after a 1-year break the psychiatrist I am seeing persuaded me to try wellbutrin. Although I enjoyed the very first dose and it worked as it supposed to, i.e. I had more energy, not-diminished libido, now that I am in the 3rd week of the medication I find that its effect weans by the evening (although I am taking the CR or whatever, long lasting version) and I feel anxiety. I am baffled because I didn't have this before I started to take wellbutrin. I had only general malaise and shyness but not this kind of unpleasant feeling. I feel like screaming and I am outright depressed in the last few days. And, yes, I am short-tempered, like the woman who took wellbutrin to quit smoking. It is a roller-coaster, with most of the time riding low. If anybody has similar experience, please post it. I'd like to see if this reaction is a general side-effect of Wellbutrin or something only I experience.

[Paximus]

I am 18 years old and began using Paxil three weeks ago. I noticed within the first week fatigue and sexual dysfunction.   I have a few questions...

1) Do these symptoms go away after a certain period of use?  And if so, how long does it take to go away?

2) If these symptoms are begining to have negative effects on my daily life, can I just stop using Paxil imediately, or do I have to gradual stop?

3) Can these side effects result in any permanant effects?

Thanks for listening,

-Paximus

[gysgtgarciausmc]

Hi i was on paxil 20mg and xanax 2mg , I was on and off for periods of time , now after reading a lot on paxil and xanax , well i decided to quit cold turkey the paxil cause there was no more prescription and i kept the xanax ,im trying to coupe with the withdrawal symptons of paxil , using xanax to at least aviate them im using only 1mg or  less a day of xanax or when i need to slow the withdrawal process , i have been of paxil like for 2 weeks now , and some symptons are gone others are WORSE , i mean i dont know why is that if its been 2 weeks of it

[tonechild]

Hello, I have been taking paxil for 6 years and have suffered fatigue for all 6 years.  I thought the fatigue was normal but came to find out that it is indeed a problem that I need 15 hours of sleep to feel "normal" I also always look tired to people.  Paxil also does not cure "nervous energy" as I feel nervous just the same.  The only difference is that Paxil has removed my overanalyzing and paranoia as a result.  Paxil caused me to work a stable job, and be fine with not having any friends.. It destroyed my social life because I need to sleep all the @#$R%#$ time.  I hate Paxil. I cant wait until I try something else.