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Avatar universal

medication change from Lexapro. Prozac vs Paxil

I have been on Lexapro for a while, but due to some side effects I am switching.  I am exhausted on Lexapro.  I cannot get through the day without needing a nap.  I can barley keep my eyes open through the day.  This is unlike me.  I also am having slight nausea.  It's also not helping me as much as I'd like for anxiety, although it has been great for my depression.  My doc wanted to switch me to Prozac.  I was told I wouldn't be as tired on Prozac and that it might help me better with anxiety.  I chose against it.  I asked for Paxil.  I have read that Paxil is good for anxiety.  My doc was willing to let me try Paxil so I left with a script for Paxil.  I wonder if I should've tried the Prozac.  I had a doc tell me once that Paxil causes significant weight gain.  Should I have tried Prozac?  I don't want to gain a bunch of weight or stay tired all day long.  However, I can't take anything that is too stimulating, because it'll make me too jittery.  
34 Responses
4981427 tn?1371674069
I think it's best to listen to your doctor if he's basing his choice off of your symptoms.  I know people with anxiety are classic for trying to figure out the problem and classic for "what ifs".  My old psysician did tell me about the weight gain with paxil so I could not do it, I tried but my anxiety was so high about the weight gain.. Its your choice and you really don't know which was is going to be the best for you but my advice would be to listen to your doctor.  If that doesn't work then you can always try something else.  

I am in the process to switching to Lexapro and I am discouraged because i'm also very tired, your body doesn't get used to it?

Good luck with whatever you chose!  Let us know how you are doing.
1474625 tn?1371100679
All antidepressants work differently in different people.  Paxil may not cause you to gain weight, and if it helps with your anxiety then I would suggest you stay on it and monitor your weight.  If you start gaining weight you can always switch to Prozac.  

Another antidepressant good for anxiety is Effexor.  This is an SNRI which is slightly different from Paxil, Lexapro, Prozac, etc.  It is both a serotonin and norepinephrine reuptake inhibitor which acts as a dual combatant for anxiety.
480448 tn?1426952138
Hello, welcome!

Actually, Paxil, while it may work for some people (everyone is different of course), it's one of the more difficult ADs to tolerate and is notoriously difficult to come off for many people.  Prozac is much more "user friendly" in that respect.  All ADs in the same class work quite a bit differently in their mechanism of action.  Effexor (an SNRI as mentioned above) is also a tough one to get off, compared to other ADs.  Lexapro, Zoloft, Celexa and Prozac are typically the easier tolerated ADs (again, everyone is different).

I personally would recommend sticking with the SSRIs vs the SNRIs for anxiety, because due to the fact that their primary mechanism of action affects norepinephrine (aka adrenaline), they are quite activating, and can cause more anxiety.  SNRIs are much better suited in the treatment of depression as the primary diagnosis (versus anxiety), whereas SSRIs are more appropriate for the treatment of anxiety as a primary diagnosis.  Of course, there are people who have been successful with an SNRI for anxiety.

How long were you on the Lexapro?  I'm wondering if you gave it enough time, as typically any start-up side effects usually resolve around the 2nd week, and what you describe sounds pretty common, side effect wise.  What dose were you on, and for how long?  You may have started on a dose that was a bit too high.  Did you already start taking the Paxil?  If so, what dose are you on?

Just remember, however you decide to proceed, ALL of these ADs can take up to 6 weeks to make a noticeable difference in the symptoms.  It's tough, but it's imperative to give these meds time.  Sometimes, dosage increases are needed as well, so you may be looking at an adjustment period of a couple months or more, to be fair.  

Also, therapy is essential in treating anxiety.  While meds can help to control the symptoms, the REAL work happens in therapy, where you learn coping mechanisms, and learn how to change your thinking.  It's usually the thought process behind anxiety that keeps people stuck in the cycle.

Best of luck...please let us know how you're doing!
Avatar universal
Sart with the paxil and if you gain to much weight simply ask to be switched to the prozac.  Don't start wonder what if what if what if....it will drive ya crazy.

Give the med a try.
Avatar universal
Look, folks, you can't just switch from Paxil to Prozac.  That's what Nursegirl was trying to say.  Paxil is one of the most difficult meds to stop taking, and yes, it does come with significant weight gain for many people.  It can also make one very tired, just as it can make one very stimulated -- there's no way to tell beforehand how one will react.  Personally, I'd stay away from Paxil and Effexor just as Nursegirl said unless they were the last thing left to try.  And I also agree, how long were you on the Lexapro?  I've been on Paxil and Lexapro, and Paxil was much more sedating and made me gain a lot of weight, and I'm very active.  Or was.  Prozac can be stimulating, and its effectiveness with anxiety by reputation isn't as good as other ssris, but it is the most benign to stop taking.  So my opinion is to listen to Nursegirl here, and be careful about people saying these drugs are easy to switch from one to another -- they often aren't.  As for the best for anxiety, by reputation, Zoloft is the best for anxiety, but again, I'd give the Lexapro a good shot before just switching -- often the tiredness goes away with time, but Paxil is much stronger than other ssris and so its less likely to have side effects go away.  You can research all this as well.  Good luck whatever you decide.
4981427 tn?1371674069
I saw your post back to anxiety advice, I was wondering if you thoughtt that the tiredness goes away in time along with the other side effects?
480448 tn?1426952138
It should if it's a side effect.  Sometimes it takes your body longer to adjust.  2 weeks is typical, but some people report that it takes them longer to acclimate to the med.

Anxiety itself can cause a lot of fatigue, so if a person is still experiencing significant levels of anxiety, that would definitely attribute to the feeling of being tired.
Avatar universal
Thank you for the responses!  I would like to start off by saying that I have dealt with anxiety my entire life.  I successfully took Zoloft for many years & went off of it for a while.  I tried to go back on but could not tolerate it a second time around, which can happen.  I did not experience the fatigue on Zoloft that I am experiencing with Lexapro.  I felt more relief from anxiety & fatigue on Zoloft, but some say otherwise while they took Zoloft.  It goes to show that we all are different.  I would not let MY experience discourage anyone from trying Lexapro.  I started Lexapro last year.  I went off of it for like 6 weeks several months back so I am far from the 2 week start up side effects.  When I stopped for 6 weeks the fatigue let up so I now it is a lasting side effect (for me).  I am now wondering if I should stick with Lexapro, deal with the fatigue (which is hard to deal with) & see about adding in a benzo to offset break through anxiety.  I was hoping to avoid benzos.  I must add, Lexapro has done wonders for my depression!  The main start up side effect for me was migraines but they got better.  The only side effect that has not went away has been the ridiculous fatigue.  I am torn on if I should try out the Paxil or what I should do.  
480448 tn?1426952138
What about Celexa?  Lexapro was created as basically a drug similar to Celexa that is supposed to be easier to tolerate, but some find they tolerate Celexa better.  If you saw results with the Lexapro, but the fatigue was bad, perhaps Celexa may be a good alternative.  Just a suggestion.

I would try that or the Prozac before the Paxil, just my opinion.
875426 tn?1325532016
I took Celexa and gained I believe it was 35 pounds amongst other negative side effects.  I don't recall tiredeness being one of them for me though.

Prozac has been around for a long time and if I were to try a prescription SSRi again (which I hope not to), that would be it, as I don't think it's supposed to cause weight gain.  It did cause constipation for me, but that was the main side effect I can remember I had.  But, unfortunately, I was taking it as a migraine preventative and it wasn't working for that and they said I had to be off of it two weeks before I could try another preventative.  I wound up with a miserable migraine the whole time while I was waiting.  I do have a relative who got the hand shaking problem from using it long term.

I didn't have a good experience with Paxil and my time taking it was short-lived.
Avatar universal
And don't ignore the tricyclics.  They can have some irritating side effects, but also work well, and the side effects as usual are different for the individual.  Imipramine is one that can be useful, but avoid clomipramine, that one has a reputation for really bad side effects.  For me, imipramine worked about as well as Paxil, but it did cause dry mouth and headaches, but the sedation wore off, which never happened with Paxil.  Oddly, Paxil eventually gave me insomnia as well as being sedating.  Problem with imiparmaine was, it stopped working, and I will say the Paxil never stopped working, it worked better over time actually, but the side effects got worse over time as well.  By the way, you say there's still breakthrough anxiety with the Lexapro, but few people find complete relief in medication, they just tamp down the symptoms.  If there is complete relief it's in therapy or some other way to change the way we think, not in medication, but that is, of course, very hard to accomplish.
Avatar universal
Oh, I wanted to add, stopping imipramine was very easy.  Stopping Paxil is, well, something else again!
1474625 tn?1371100679
I would just like to make a few comments on your post from June 12th.  Like you said everyone is different, and there's no way of knowing how each different SSRI or SNRI will effect someone, and you can switch from Paxil to Prozac, and actually to stop taking antidepressants (especially those with shorter half-lives such as Paxil or Effexor with a half-life of 24hrs) it is recommended to switch to one with a longer half life such as Prozac with a half-life of 4-6 days.

Also, if you read about the different SSRIs and SNRIs Effexor and Paxil both are actually recommended for multiple anxiety disorders such as Generalized Anxiety Disorder, Social Anxiety, and Panic Disorder.

The problem with switching between antidepressants is the difference in their half-lives and the risk of Serotonin Discontinuation Syndrome if switching from a long half-life antidepressant to a short half-life antidepressant, but symptoms of which can be lessened by taking Fish Oil capsules with DHA and EPA.
Avatar universal
Have no idea if you ever tried to quit Effexor or Paxil, or where you're getting your info from.  The only time you switch from one antidepressant to another is after tapering down pretty much to nothing from the drug you're on.  While some do use Prozac to help those trying to stop taking an ssri, it's only used at the tail end of the taper for those having a difficult time.  The idea is to get hooked on the Prozac instead of the other ssris.  Effexor is completely different, in that Prozac will have no substitute whatsoever for that drug's impact on norepinephrine, not targeted by Prozac at all.  Now, for those who have an easy time of quitting, it doesn't really matter what you do, but the cautions are for those who have a difficult time.  With Paxil and Effexor, this is most people.  Paxil also has a very strong effect on choline receptors, which no other drug probably approaches in this category.  But again, first you taper almost completely off the first drug, then if the person is having a difficult time you can try Prozac to see if it will help.  Even then, it is often used in very small doses in the liquid form just to get people past it.  I've been through this, and I've researched it because I had to -- these protocols can be found in books adn on the internet, but will not be known or used by most doctors and psychiatrists, which is a problem.  Peace.
Avatar universal
And I should have added, part of the problem people have switching drugs is that when you're having a hard time with withdrawal and you're put on another drug, you're essentially dealing with two drugs at the same time -- the withdrawal effects from the first drug and the side effects of the new drug.  It's impossible for the patient to tell which is which, and it's impossible for the doctor to tell, either.  I'm not sure if I've got the name right, but there's a good book by I think Joseph Glenmullen on this.  Also, an English psychiatrist named Healy or Healey has good protocols for doing this safely so as to prevent the messier problems people often get doing this too quickly.  Peace again.
4981427 tn?1371674069
Thanks Nursegirl, I'm exhausted with this lexapro but i'm hoping to adjust to it, you know how great I am with med changes haha.
480448 tn?1426952138
Great info, Paxiled.

There is just so much info out there about meds that is either wrong or confusing.  I agree with your post, especially the part about trying to replace something like Effexor with Prozac.  Also, it's SO true that when a person is trying to go from one to another, often insult is added to injury, and like you said, it's impossible to determine what symptom is from what med.
480448 tn?1426952138
I hear ya sweetie.  Hang in there!  I know the waiting is SO hard.  We want to feel better right NOW!  :0)  The trial and error process that comes along with meds is rough.

You're doing great, truly.  You're perservering!
4981427 tn?1371674069
First my pysician told me to stop zoloft cold turkey (after i've been on it for 15 years ) and switch over to paxil.  I bugged out and didnt' last very long, the fact about paxil being so hard to get off of made me very sscared, and the weight gain.  I switched to a psychiatrist that has me on a taper/increase schedule with zoloft and lexapro.  I had to be 100mg of zoloft before starting the lexapro, then she introduced the 5mg of lexapro, then the next week she dropped the zoloft down 25mg.  then the next week dropped it down another 25mg and increase the lexapro to 10mg... etc.  i'm doing much much better than the first doctors ridiculous practice but is what you are saying is it shouldn't even be done that way?    And if I continur it this way how long do you think I should give it before I assume its not working?  Because although i'm better, i'm still way too anxious.  I think the xanax is what is giving me the help really.
480448 tn?1426952138
Usually, the new med isn't introduced until the person reaches a much smaller dose, due to concerns of serotonin syndrome.  Even is SS isn't an issue, there is definitely more anxiety doing it that way, and like Pax said, it muddies the waters when you're trying to figure out what's what.  But, no sense in dwelling on that now...what's done is done.

You have to keep sight of the fact that you ARE seeing improvements.  It very well may be the Lexapro...you won't know yet IMO.  You have to give this time.  I always tell people to exhaust ALL possibilities with one med before trying another.  

I know it's so hard to wait it out.  I think with your history of being on a higher dose of the Zoloft, it's very likely you will need a higher dose of the Lexapro before you find a therapeutic level.

I really hope you start feeling better soon.  I know it stinks hon.
Avatar universal
Hello. I was also on lexapro for a while. I had to switch because it gave me sexual dysfunction. I had the exhaustion problem while on Zoloft. Currently I'm on pristiq and it works much better. But everyone is different. Mental health is such a mystery, they never know why medications work for some people and not for others. You just have to try them until you find what works for you. I always thought getting on medication would be the easy answer. But I learned the hard way I'm always going to have to work at this. Good luck in your medication search. Post an update so I know how you're doing!
480448 tn?1426952138
Excellent post meg!  All very true.  And while it's certainly true that everyone reacts differently to meds, it IS helpful for us to share what we DO know about these meds, the trends, the commonly reported things, as it helps people better make an informed decision on what med to talk to their doctor about.

For example, while I don't discount for a second that Paxil and Effexor have helped countless people, they are not the first meds I would recommend a person trying, and I think it's important for people to understand that there are meds that are more logical to try first, and that certain meds carry greater risks than others as far as side effects, ease of tolerating the med and the discontinuation syndrome associated with those meds.

For example, if someone newly diagnosed with panic disorder stated that their doc recommended Effexor out of the gate, I would caution them to research the med, and ask the doc why that was being recommended over something like Zoloft.  Sadly, not all docs have a good understanding of the different meds, not to mention a lot of people are having their PCP handle their meds, which can mean the doc may not be aware of the meds that are more reasonable to start with.  That person may go on to have an awesome experience with Effexor, but they need to be able to make an informed decision.  

"You just have to try them until you find what works for you. I always thought getting on medication would be the easy answer. But I learned the hard way I'm always going to have to work at this"

Beautifully said!!
4981427 tn?1371674069
I was concerned with the SS too!  But my psychiatrist said its very rare and its also is usually seen with massive amounts of medications.  She just explained that it would lessen the withdrawl from using the lexapro while i'm coming down off of the zoloft.  But like you said whats done is done.  It was a heck of a lot better than stopping cold turkey lol....

But I get what you are saying.  I just hope i get there soon because i'm sick of taking this damn xanax! haha.
1474625 tn?1371100679
I have gotten my information from college courses and personal experience, and yes, I have had to stop taking Effexor in the past because it wasn't helping my anxiety issues.  I've also tried almost every type of antidepressant out there recommended for anxiety: tricyclics, SSRI's, and Effexor (the only SNRI I've tried).  Effexor was most definitely the hardest one to get off of due to serotonin discontinuation syndrome.  I stopped taking it without the help of my doctor because I started getting discontinuation symptoms if I had just missed my dose by only a few hours.  The only way I got through the withdrawal is by downing up to 8 fish oil caps/day which helped tremendously.  

I also didn't say that the antidepressant with the longer half-life should be administered at the beginning of the taper, and actually I was implying the contrary as like you said administering it at the beginning of a taper just mixes discontinuation symptoms and new side effects, so I figured I didn't have to go into detail, but here is the detail I left out:  administering one low-dose long half-life antidepressant such as Prozac at the end of a taper should reduce most symptoms of serotonin discontinuation syndrome, and if it doesn't fish oil should.

But my point is this, if someone is having a difficult time on one antidepressant and hasn't seen the results they should within the specified time frame it is perfectly fine to switch to a different antidepressant after tapering to the lowest dose possible of the first one.  Yes, at first there may be some discomfort with discontinuation syndrome from one antidepressant to the next depending on how much and what neurotransmitters are affected and how closely related the two antidepressants are, but it takes up to 3-4 weeks from some antidepressants to work in some cases so by that time one should have normalized to the new one and stopped feeling discontinuation symptoms from the first one.

I personally never did well with any of the antidepressants I was prescribed.  Zoloft and other SSRIs gave me a flat affect, nortriptyline did nothing, amitriptyline gave me odd sensations that it was summer in the winter when I had no view to the outdoors, and Effexor continually gave me "brain zaps", so I ended up switching to clonazepam, and that was the end of it.
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