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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.  
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Avatar universal
I am currently on 15mg of Paxil and I am thinking of switching over to Prozac. Has anyone done this switch before? I don't like the weight gain from Paxil. I am still at a healthy weight, but with an eating disorder past it's beginning to cause more anxiety.
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Avatar universal
I start taking Effexor on Monday. I've just been weaning myself off cylexa.  Really hoping that the Effexor works for me. I didn't read much up on it yet, I would like to get some input if anybody has any! Thanks
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Avatar universal
I took Lexapro 10mg for 5 years it was great for my aneixty and I didnt expeirence depression either but I lost my job and insurance and needs a generic so I was prescribed celexa wow I gaing 60 lbs and was depressed the whold time but I attributed that to my lay off and other problems at home .  I am now trying prozac and have only been taking it for 2 weeks but I have been experienceing a lot of stomach problems, depression and anexity breakthrough. I have read good things about prozac and weight loss, do you think I should just give it more time or do you think I should get my doctor to up my dose which is 20mg now. please help.
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Avatar universal
Does anyone have issues with restless legs since starting your med? Seems like mine got worse when i upped my paxil from 10 to 20 mg
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Avatar universal
I have been on paxil...20 mg. My anxiety is still there although not too bad. My phsychiatrist recommends i switch to lexpro. I have anatomical narrow angle with out glaucoma, so i think thats part of my anxiety as any of the anti depressents can cause narrow angles. Been to countless eye Drs. One saud I should gooff meds to see if the angle issue improves, but i also have tinnitus and the anxiety med seems to help. Dr says I can just switch form one to the other med...What are your thoughts?
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Avatar universal
yes colleen I take collazope it helps but its addictived I guess like all the rest of these pills what I di is cut it in halph and take a quarter of a halph it seems to work only I hate to take any of these pills I wish u luck noodles1224
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Avatar universal
also must add....I had quite the alcohol problem while on Paxil.  After getting out of REHAB I googled Paxil, when I decided to stop taking it, and, lo and behold...Paxil has been associated with increased drinking....especially in females!!  If you don't believe me, google "alcohol and Paxil".  You will be amazed.  Still drink responsibly...but NO MORE PAXIL!!
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Avatar universal
I was on Paxil for a long time....10 years or so.  Dr. kept upping the dose until I was on a pretty high dosage.  It never seemed to help as much as I thought it should.  I suffered insomnia, weight gain, sexual disinterest, and again, no real results.  I decide to go off it cold turkey.  BAD CHOICE!   I went through serious withdrawals for about a month.....nausea, brain zaps, etc. But dammit!   I survived, and will never take it again.  Change in my living situation seemed to do more for me than Paxil ever did.  I would suggest Wellbutrin or Prozac if you really need something.  (I had tried Wellbutrin...helped me stop smoking, but made me combative...or maybe that was just deciding not to let people walk on me anymore!!)  Good luck!
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Avatar universal
My mother has Alzheimer's and is in a skilled facility.  Recently she is experiencing a bout of insomnia and is pacing the halls.  She has taking therapeutic dose of Prozac for 20 years, and Restoril at night.  She suffers mood disorder with depression.  She also takes .25 Xanax PRN for anxiety. Her mood is generally good.  Now it seems the doctors are wanting to switch up her meds, talking about Lexapro, Cymbalta,doubling her Restoril at night.  I would like some information as it is clear she won't get better with her Alzheimer's, but don't want to make her nuts with all the change ups.  She also is on Aricept and Namenda.  Help.
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1474625 tn?1371097079
I just want to let you know that I wasn't recommending to REPLACE Prozac with Effexor as you seemed to have gathered from Paxiled's post.  If anything it should go the other way around as one should always start with the known least side effect producing antidepressant.  I was only pointing out that when someone has been taking an antidepressant with a short half-life (using Effexor as an example due to its extremely short half-life) then Prozac with its long half-life taken at the end of a taper is great for Serotonin Discontinuation Syndrome.

And like I said in my last post, switching antidepressants when done correctly should not cause more harm than good.  I agree that most primary care physicians don't really know how most antidepressants work and what side effects they can produce, but instead rely on what drug reps say about their "amazing new product that will change the face of mental health for good".  

I believe many antidepressants are over-prescribed for very mild cases of this or that and may cause more harm than good in the sense of the long-term.  Although I'm not discounting those whose lives are disrupted on a daily basis due to depression or anxiety, and these cases are certainly warranted for antidepressant use. It's the cases where a patient expresses occasional mild anxiety to their doctor in passing, and he's grabbing the script pad before anything else can be said that worries me.
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1474625 tn?1371097079
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.
Helpful - 0
4981427 tn?1371670469
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.
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480448 tn?1426948538
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!!
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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!
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480448 tn?1426948538
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.
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4981427 tn?1371670469
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.
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480448 tn?1426948538
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!
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480448 tn?1426948538
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.
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4981427 tn?1371670469
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.
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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.
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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.
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1474625 tn?1371097079
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.
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Avatar universal
Oh, I wanted to add, stopping imipramine was very easy.  Stopping Paxil is, well, something else again!
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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.
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