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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by ZeeZee on March 1, 2003, at 20:56:32
Hi Jackie
Hope you are doing well and by now benefiting from your change of med's.
I'm currently on 15mgs of Paxil and it's been a rough ride. With each increase of dose I go through the same s/e's and as soon as I begin to feel well, it gets upped again.I know you addressed this already, but I need to ask again. I believe that at only 15 mgs. the panic is in fact being muted. It seems much further from the surface and much more difficult to trigger. However, my "old" thinking about doing things and my agoraphobia is just as strong.
When I took MAOI's they truly gave me a sense of a "new brain" and all the anticipatory anxiety and what if thinking was erased. In it's place was a sense of confidence and courage.I'm not experiencing any of that on the Paxil. Although it may be the dose, my friend who also took it told me he never did get the feelings described above. Instead, he explained that because the panic had abated, that over time, and slowly, the old avoidance behavior and thinking extinguished itself.
Did you find this to be true for you. I'm very disappointed if in fact this is the case. It's the agoraphobia and my resistance to even "try it out" that is my greatest problem. I feel I very much have the same old brain, just minus the panic - (I think). I was hoping the Paxil would be a boost in the arm and help me get out there to push my boundaries.
Hope to hear from you soon.
Regards,
ZZ
Posted by male34 on March 1, 2003, at 23:10:59
In reply to Jackster, One more time please! re: Paxil, posted by ZeeZee on March 1, 2003, at 20:56:32
iwas on paxil it worked for my agoraphobia ive had since 4th grade now 34 ,so hows that for help, butm it was work on my part also i had to inch my way further ,agoraphobia i believe no meds will fix 100%,its us that must work on it.as for paxil im off it now weight gain! i went off paxil SLOWLY!!!! now on lexapro less side effects to early to judge it for me ,but paxil was alwyas tough for me upping it and coming off was tough at first then I learned paxil is slow gradual on and off and youll be OK
Posted by Jackster on March 2, 2003, at 1:13:35
In reply to Jackster, One more time please! re: Paxil, posted by ZeeZee on March 1, 2003, at 20:56:32
Hi Zee Zee
I'm always happy to answer any of your questions!
This one's a bit of a 'chicken and egg' (i.e. which came first) situation. I remember very clearly the first time I realised the meds were actually working. It was about a month after I'd started taking them (and really wasn't sure if they would work or not). My partner and I were on holiday (always a difficult time for an agoraphobic!)and we'd stopped on the way somewhere for a toilet break. Normally I'd feel v anxious because it would mean us having to go our separate ways for a few minutes. So I was all amped up - but the weirdest thing was - once I was in the situation I felt this strange sense of calm. So the anticpatory anxiety was still there - but no panic actually happened. After that I started trying things all the time and would feel a little apprenhension - but once I was actually doing my exposure therapy - I wasn't panicking at all. From what I remember - at the beginning - I would still have the negative 'what if' thoughts - but was actually able to think - don't be ridiculous - that's completely irrational and the thoughts would go away. I think what they usually say about SSRI's is that it won't stop the anticipatory anxiety - but it will stop the panicking. So is your 'what if' thinking happening before you try something - or while you try something? If it is while you are trying something - it sounds like you need a higher dose. If it is before you try something - that is anticapatory anxiety. That will go away eventually after you get out and successfully do things a few times - you just need to 'retrain' your brain to realise that it's not a scarey situation anymore. (I hope this is making sense!)
Is there something you can try - which is just a tiny little step? I have things I can do to test out my reaction - like driving on the motorway for one exit.
When I first started Paxil I went up to 20mg. This worked great for a couple of months, and then I needed to go up to 40mg - which then worked for me for about 3 years. 40mg is the dose they recommend for panic disorder. I'm not saying you should be on this - but you may need to be on at least 20mg to get the best benefit. you've done so well to get this far - it's just a tiny little step! Well done for hanging in there! Going from 15mg to 20mg should be a lot less harder on you than previous dose increases. It's only a 33% increase compared to 5-10mg (a 100% increase) and 10-15mg (a 50% increase).Your body should adjust much quicker.
MOAI's are considered the 'gold standard' for anxiety problems - so maybe the Paxil won't be quite 'up there' with them - but it was enough for me to completely change my life.
I'm now on 40mg Paxil and 20mg of Nortiptyline. I think it might be 'muting' the panic a bit now - but it's hard to tell since I don't even know if I'm on the effective dose and won't know until I've had a blood test. I had a surprise test of it this week - I work on the 22nd floor of a building and they sent an email out advising us that the lifts weren't working properly and that we should use the stairs. This is not the sort of thing an agoraphobic on the 22nd floor likes to hear! I was feeling really anxious - but to my surprise it didn't actually tip into a panic attack - which may be a sign that the nortrip is starting to work. Keep your fingers crossed for me!
Unfortunately I can't see my PDoc until 19 March - so I won't know until then if I'm at the right dosage. So much waiting!
Anyway - hope this helps - and you should be really proud for getting as far as you have - I know how hard it's been.
take care
Jackie
Posted by ZeeZee on March 2, 2003, at 9:38:54
In reply to Re: Jackster, One more time please! re: Paxil, posted by male34 on March 1, 2003, at 23:10:59
Please let me know how you do on the Lexapro, I've heard mixed reviews for those with panic disorder/agoraphobia.
As always, thanks and good luck to you.
Posted by ZeeZee on March 2, 2003, at 9:53:46
In reply to Re: Jackster, One more time please! re: Paxil » ZeeZee, posted by Jackster on March 2, 2003, at 1:13:35
Jackie,
As always, thanks so much for your detailed response. It does sound like you are doing well, although like me, may not totally realize it yet.
You're right, it is getting easier to make it through the s/e's with each dose increase. It took me 3 weeks to adjust to the 10 mgs. but I've gone through the same s/e's upping it to 15 mgs. in less than one week. That does make me feel more hopeful.
I think it's my anticipatory anxiety that is the greatest right now. My husband and I went to the shopping mall yesterday (normally this wouldn't be a problem for me but has been as of late - being too far from home) and I felt some anxiety about going. I was determined to "just see" how'd I do, so I didn't take anything and I did fine. I was a little uncomfortable but the panic just wasn't there. It's kind of weird because it's like a struggle within my brain to stop something that is no longer happening. My husband definitely felt that I had made progress.
I hope I will find the courage to get out there and try more things, that's the hardest part for me, but then again, it might take a while in baby steps.
You're right, I should be proud of hanging in there considering my fear of taking even the first tablet of Paxil (no longer an issue). As is typical I'm way too hard on myself.
You also have much to be proud of. I've heard nothing but horror stories about coming off of Paxil and you sound to be handling this quite sensibly and well.It's funny when you mentioned the elevator not working - right now I'd rather walk than take an elevator 22 flights!
Good luck to you and please keep me posted on how you're doing and your wedding plans!
Regards,
ZZ
Posted by ZeeZee on March 2, 2003, at 16:39:23
In reply to Re: Jackster, One more time please! re: Paxil » ZeeZee, posted by Jackster on March 2, 2003, at 1:13:35
Hi Jackie
I know we just spoke but I had such a positive experience today and wanted to share it! I hope I don't jinx myself.
I live in the suburbs in one of the largest cities in the US. We moved here about a year and a half ago with no friends or family. When our daughter entered graduate school downtown of our city we were ecstatic. However, my disorder made it impossible for me to enjoy her relatively close proximity and for the first time as her mother was not able to be there for her. I either avoided going to see her with my husband or had to drug myself to make the 45 minute interstate drive in some of the worst traffic in the nation.
She's in the midst of studying for midterms and in need of some TLC. I made her a bunch of her favorite dinners and we drove down there today to bring it to her. I was mildly apprehensive but decided I'd just have to deal with it. Not only did the trip prove to be painless it was down right pleasant and enjoyable, I didn't want to come home.
There were no thoughts about "the distance from home" or "how long it would take us to get back home if I needed to flee". I felt totally comfortable. I kept thinking of my good experience yesterday and your words of advice.
I think it is truly working!I hope this will continue and I now look forward to trying out some more journeys.
Thanks again!
ZZ
Posted by Jackster on March 3, 2003, at 3:02:09
In reply to Re: Jackster, Good News!, posted by ZeeZee on March 2, 2003, at 16:39:23
That is such good news!! I know exactly how you feel - I bet you're on an all time high! It definitely sounds like you're past the worst (the yukky start up side effects) and now you're finally getting the benefit of the Paxil. It will just get easier and easier as you try out things and realise that you don't panic in the hard situations any more.
Well done - I know how hard this has been for you - make sure your husband treats you for your fantastic bravery!
Keep your fingers crossed for me - in the next couple of weeks I should either be getting the benefits of the nortrityline or finding out that I need to up the dose. Either way I guess it's progress to the final goal.
Keep me posted!
Jackie :)
This is the end of the thread.
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