Administrator rev ronin Posted December 20, 2018 Administrator Share Posted December 20, 2018 How many of you actually start patients on Paxil? I've never done it, due to other SSRIs being available and easier to stop, but one of the new NPs I work with started someone on Paxil the other day. Is my view of the drug just too summarily negative? What do other FP or Psych PAs think of it? Quote Link to comment Share on other sites More sharing options...
thinkertdm Posted December 20, 2018 Share Posted December 20, 2018 Worst ssri ever. Side effects, including weight gain, terrible. Much better alternatives. 2 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 20, 2018 Share Posted December 20, 2018 I have had more bad outcomes and side effects with Paxil than any other SSRI - followed by Zoloft. Weight gain, flat affect, withdrawal symptoms from one missed dose, akathisia - just not worth it. For anxiety with depression I prefer Lexapro - more subtle, weight neutral, no withdrawals that I have seen. I think Paxil had an OCD preference but I haven't used it for such. Paxil is also category D for pregnancy so I don't want patients getting pregnant on it. Lexapro still carries a C rating. Also more sexual dysfunction with Zoloft over Paxil and both over all others. 2 Quote Link to comment Share on other sites More sharing options...
LKPAC Posted December 20, 2018 Share Posted December 20, 2018 I've had good luck with Wellbutrin. generic is cheap. Works well, few s/e. helps anxiety and depression both. flexible dosing. easy to come off of it. 1 2 Quote Link to comment Share on other sites More sharing options...
thinkertdm Posted December 20, 2018 Share Posted December 20, 2018 Up-to-date has a nice chart of the various side effects of ssris, snris, etc. 1 Quote Link to comment Share on other sites More sharing options...
Joelseff Posted December 20, 2018 Share Posted December 20, 2018 I tend to not use Paxil as first line actually usually start with Zoloft. Most of my pts are on Medi-Cal (Medicaid) and Zoloft is covered as first line. I have had great experience with managing it and though it has more AEs than say Lexapro or Celexa most of my pts have done pretty well with it. Maybe I'm just lucky? Lol Sent from my SAMSUNG-SM-G891A using Tapatalk 1 Quote Link to comment Share on other sites More sharing options...
LKPAC Posted December 20, 2018 Share Posted December 20, 2018 I love it when we talk medicine here! 3 1 Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 20, 2018 Moderator Share Posted December 20, 2018 I use it sometimes (IM and Psych) all males - would not tend to use in females mostly have gone to Lexapro for SSRI (and even some elavil/remeron if sleep is a major issue) Wellbutrin for depression and ADHD sometimes zoloft but titration is a pain 50, 100, 150, 200 blah... prozac still use for people that are not consistent with takeing - LLLOOOONNNNNGGGGGG half life makes inconsistent dosing nicee 1 Quote Link to comment Share on other sites More sharing options...
Joelseff Posted December 20, 2018 Share Posted December 20, 2018 I use it sometimes (IM and Psych) all males - would not tend to use in females mostly have gone to Lexapro for SSRI (and even some elavil/remeron if sleep is a major issue) Wellbutrin for depression and ADHD sometimes zoloft but titration is a pain 50, 100, 150, 200 blah... prozac still use for people that are not consistent with takeing - LLLOOOONNNNNGGGGGG half life makes inconsistent dosing niceeGreat recs... Kids tend to do well on Prozac... Sent from my SAMSUNG-SM-G891A using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted December 20, 2018 Moderator Share Posted December 20, 2018 wow, kids on any SSRI - surprised of that with the increase of suicidal thoughts and attempts.... I pretty much avoid SSRI under 23 - wellbutrin instead Quote Link to comment Share on other sites More sharing options...
Joelseff Posted December 20, 2018 Share Posted December 20, 2018 wow, kids on any SSRI - surprised of that with the increase of suicidal thoughts and attempts.... I pretty much avoid SSRI under 23 - wellbutrin instead Do you see a lot of kids with MH issues? Prozac is the usual first line ssri for childhood depression and anxiety or an adjunct tx with stimulants for ADHD and has shown to be the most tolerated and efficacious for children. In fact Prozac is recommended before any other SSRI and wellbutrin. But you're right ssri's increase risk of SI And wellbutrin carries the increased risk for sz. Sent from my SAMSUNG-SM-G891A using Tapatalk 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 21, 2018 Share Posted December 21, 2018 Many of my patients are older and polypharmacy as well. Prozac and Paxil are NOT recommended in elderly. Long half life and nasty side effects. Lexapro does a better job but can lower sodium. Can be a tricky balance. I am grateful for the Pharm Ds at work who can do the interaction profiles on those when the Med list hits 13+ trying to balance Parkinson’s, CHF, DM and the whole fruit basket of stuff. My biggest challenge some days is med box bingo during bridge games when Thelma samples Louises RLS meds to see if they help........ 1 Quote Link to comment Share on other sites More sharing options...
MedicinePower Posted December 21, 2018 Share Posted December 21, 2018 Escitalopram for depression. Mirtazapine for depression with difficulty sleeping. The latter works just as well for Escitalopram but may be effective in ~4 week vs ~6 weeks. Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted December 22, 2018 Author Administrator Share Posted December 22, 2018 So, to summarize so far, no one except Ventana would start with Paxil as first line SSRI in any patient population, and him only in certain populations? Anyone else like Paxil? Anyone else avoid Paxil entirely? Quote Link to comment Share on other sites More sharing options...
Joelseff Posted December 22, 2018 Share Posted December 22, 2018 So, to summarize so far, no one except Ventana would start with Paxil as first line SSRI in any patient population, and him only in certain populations? Anyone else like Paxil? Anyone else avoid Paxil entirely?I have used it for pts with more activation/anxiety sxs and (anecdotally) have found it to help with depression/GAD pts who are predominantly insomniacs. Treating MDD and starting meds is really a symptom based approach. There is no one size fits all as you know. So while I usually don't start with Paxil I will not rule it out like I wouldn't completely rule out other meds if appropriate. Sent from my SAMSUNG-SM-G891A using Tapatalk Quote Link to comment Share on other sites More sharing options...
Joelseff Posted December 22, 2018 Share Posted December 22, 2018 (edited) On 12/20/2018 at 10:04 PM, Reality Check 2 said: Many of my patients are older and polypharmacy as well. Prozac and Paxil are NOT recommended in elderly. Long half life and nasty side effects. Lexapro does a better job but can lower sodium. Can be a tricky balance. I am grateful for the Pharm Ds at work who can do the interaction profiles on those when the Med list hits 13+ trying to balance Parkinson’s, CHF, DM and the whole fruit basket of stuff. My biggest challenge some days is med box bingo during bridge games when Thelma samples Louises RLS meds to see if they help........ All SSRI's by the way can alter sodium levels so use with caution with thiazides and I usually avoid in the setting of SIADH. I usually check BMP q3-6 mos on my MDD pts on SSRI esp elderly Sent from my SAMSUNG-SM-G891A using Tapatalk Edited December 22, 2018 by Joelseff Quote Link to comment Share on other sites More sharing options...
Lexapro Posted December 24, 2018 Share Posted December 24, 2018 (edited) I avoid starting Paxil in basically anyone. Lots of drug interactions, nasty "discontinuation" (aka withdrawal) syndrome, and many adverse effects. I have had luck getting several elderly patients off of it as well. I have seen a few psychiatrists/psych NPs swear by it for very severe anxiety disorders who have failed other options, though I think it's probably just the sedating effect of the med that the patient is perceiving as reducing their anxiety. Edited December 24, 2018 by Lexapro Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted December 24, 2018 Share Posted December 24, 2018 Have any of you folks dealt with patients who are taking St. John's Wort for their depression/anxiety? It seems to be the preferred herbal supplement. It also seems to have many drug interactions. Quote Link to comment Share on other sites More sharing options...
mmiller3 Posted December 24, 2018 Share Posted December 24, 2018 On 12/20/2018 at 9:49 AM, LKPAC said: I've had good luck with Wellbutrin. generic is cheap. Works well, few s/e. helps anxiety and depression both. flexible dosing. easy to come off of it. I love it for depression. I have not had good success with Wellbutrin alone for anxiety. Typically have to add in Buspar or another medication for anxiety. Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted December 24, 2018 Share Posted December 24, 2018 My seriously anxious patients tend to get just WHACKED on wellbutrin - it makes them meaner and edgier and generally intolerable. I prefer Lexapro for GAD with the rare zoloft patient. Lots of buspar in my world and then a boatload of atypicals. I don't ever start Paxil but have inherited patients on it. Our BHS dept handles it mostly. I don't like it but some patients are ok on it - for now. Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted May 18, 2021 Moderator Share Posted May 18, 2021 Wellbutrin is not really any good on anxiety (no indication either) Paxil great for weight gain in females, not much lese Buspar - placebo effect is 30% - not much beyond that honestly the antipsych meds are most helpful for the severe cases, but everyone shys away from even low dose, which is unfortunate Quote Link to comment Share on other sites More sharing options...
Cideous Posted May 18, 2021 Share Posted May 18, 2021 Never had any luck with Wellbutrin with anything but anti-smoking. Quote Link to comment Share on other sites More sharing options...
Komorebi Posted May 19, 2021 Share Posted May 19, 2021 (edited) I try to tailor antidepressants to presentation and best guess of which neurotransmitter would be most helpful to supplement. Monotherapy with Wellbutrin XL I usually use only for people presenting with low energy, poor concentration and poor motivation but an absence of traditional depression symptoms such as guilt and low self esteem, etc. I also use it pretty heavily as a first line for adult ADHD symptoms. My preferred SSRI is escitalopram and I find that because it is the most selective for serotonin and doesn't really affect dopamine or norepi much that it combos very well with Wellbutrin which affects dopamine and norepi without touching serotonin. Seizure risks with Wellbutrin are somewhat overstated per research. I am always cautious and never use it in someone with current seizures but it really doesn't lower seizure threshold as much as people proclaim. I rarely use paxil. Most FDA indications are just based on what the manufacturer went after, and most of the SSRIs are equivalent other than A. Side effects and B. Slight interaction with other neurotransmitters (ex: prozac tends to affect all 3 and thus can be more activating) Add on medications for resistant depression that I've find work very well are lamictal and abilify. Seroquel also helps especially with anxiety but it has to be higher than 200mg otherwise it's just expensive benadryl. Edited May 19, 2021 by Komorebi 2 Quote Link to comment Share on other sites More sharing options...
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