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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Jackster on May 3, 2001, at 2:55:40
Just want to hear about other's experiences with switching ADs. When Paxil pooped out on me (due to stopping and starting again) I went onto Celexa (? another SSRI) without any transient effects. After a couple of months it was obvious that the Celexa wasn't stopping my Panic attacks, so my PDoc put me on Imipramine. This is when I spun out and got severely depressed. It also raised my heart beat which increased my anxiety. I then tried Prozac which gave me the worse panic attacks of my life. (anxiety being a common side effect). My theory is that switching from one SSRI to another caused no problems, it was when I went onto a tricyclic that I had terrible withdrawal symptoms. I would now like to try Zoloft, but am scared I will go through what I went through before. I'm back on Paxil (the only way to stabilise me, but it's not working on my panic attacks). Do I taper off first, or just go straight onto the Zoloft? Can anyone give advice?
Posted by JohnX on May 5, 2001, at 1:41:36
In reply to Switching from SSRIs to other AD types, posted by Jackster on May 3, 2001, at 2:55:40
> Just want to hear about other's experiences with switching ADs. When Paxil pooped out on me (due to stopping and starting again) I went onto Celexa (? another SSRI) without any transient effects. After a couple of months it was obvious that the Celexa wasn't stopping my Panic attacks, so my PDoc put me on Imipramine. This is when I spun out and got severely depressed. It also raised my heart beat which increased my anxiety. I then tried Prozac which gave me the worse panic attacks of my life. (anxiety being a common side effect). My theory is that switching from one SSRI to another caused no problems, it was when I went onto a tricyclic that I had terrible withdrawal symptoms. I would now like to try Zoloft, but am scared I will go through what I went through before. I'm back on Paxil (the only way to stabilise me, but it's not working on my panic attacks). Do I taper off first, or just go straight onto the Zoloft? Can anyone give advice?
Not sure about the Zoloft given your response to the other meds. Some people claim that MAOI inhibitors like Nardil are more effective at curing panic attacks (but they have crummy food restrictions). A different root would be to experiment with a beta-blocker (blocks sensitivity to adrenaline release) like Inderal.Also you could try taking a low dose of Klonopin while weaning onto the Zoloft. Zoloft can initially be activating like Prozac. The Klonopin is an anti-anxiety med. It can be addictive, but if you take it for only a few weeks while you wait for the Zoloft to take effect you should be able to taper it off.
my 2 cents.
Regards,
John
Posted by SalArmy4me on May 6, 2001, at 0:35:16
In reply to Re: Switching from SSRIs to other AD types » Jackster, posted by JohnX on May 5, 2001, at 1:41:36
I don't see any reason to believe that another SSRI will work well for you, considering that 3 of them have been largely ineffective. The Harvard Depression Algorithym suggests a trial of venlafaxine in these circumstances, and I agree: http://www.mhc.com/Algorithms/Depression/index.htm
Posted by Jackster on May 6, 2001, at 4:30:51
In reply to Re: Switching from SSRIs to other AD types » JohnX, posted by SalArmy4me on May 6, 2001, at 0:35:16
> I don't see any reason to believe that another SSRI will work well for you, considering that 3 of them have been largely ineffective. The Harvard Depression Algorithym suggests a trial of venlafaxine in these circumstances, and I agree: http://www.mhc.com/Algorithms/Depression/index.htm
I'm a little concerned about taking Effexor after all the bad postings on this board. I'm trialling Zoloft first, I guess I could try Effexor if it doesn't work. Also, the algorithm is for depression, not panic disorders.
Posted by Jackster on May 6, 2001, at 4:34:54
In reply to Re: Switching from SSRIs to other AD types » Jackster, posted by JohnX on May 5, 2001, at 1:41:36
> > Just want to hear about other's experiences with switching ADs. When Paxil pooped out on me (due to stopping and starting again) I went onto Celexa (? another SSRI) without any transient effects. After a couple of months it was obvious that the Celexa wasn't stopping my Panic attacks, so my PDoc put me on Imipramine. This is when I spun out and got severely depressed. It also raised my heart beat which increased my anxiety. I then tried Prozac which gave me the worse panic attacks of my life. (anxiety being a common side effect). My theory is that switching from one SSRI to another caused no problems, it was when I went onto a tricyclic that I had terrible withdrawal symptoms. I would now like to try Zoloft, but am scared I will go through what I went through before. I'm back on Paxil (the only way to stabilise me, but it's not working on my panic attacks). Do I taper off first, or just go straight onto the Zoloft? Can anyone give advice?
>
>
> Not sure about the Zoloft given your response to the other meds. Some people claim that MAOI inhibitors like Nardil are more effective at curing panic attacks (but they have crummy food restrictions). A different root would be to experiment with a beta-blocker (blocks sensitivity to adrenaline release) like Inderal.
>
> Also you could try taking a low dose of Klonopin while weaning onto the Zoloft. Zoloft can initially be activating like Prozac. The Klonopin is an anti-anxiety med. It can be addictive, but if you take it for only a few weeks while you wait for the Zoloft to take effect you should be able to taper it off.
>
> my 2 cents.
>
> Regards,
> John
Thanks for your 2 cents (which would have to 5 in NZ since we did away with 1s and 2s). I forgot to add that I was on Xanax since I trialled the Prozac (1mg twice a day) so that should help the changeover period. Do you have any advice on whether it is better to take Zoloft in the am or pm?
Posted by SLS on May 6, 2001, at 8:19:16
In reply to Re: Switching from SSRIs to other AD types » JohnX, posted by Jackster on May 6, 2001, at 4:34:54
> > > Just want to hear about other's experiences with switching ADs.
Here is a pretty good review of treatment-resistant depression (TRD) that includes treatment strategies. Dr. Thase expresses his perspectives regarding the issue of when to switch to drugs from different classes.
http://www.acnp.org/G4/GN401000105/CH103.html
- Scott
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