Is it possible to reduce the side effects of my social phobia medications?

Q. Please suggest the best drug for GAD and social phobia. What are its side effects?

Answered by
Dr. Maneesh Gupta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Oct 14, 2017 and last reviewed on: Aug 25, 2023

Hi doctor,

I will first summarize my case, and then I will put my query. I had been diagnosed to have GAD and social phobia before 10 years, and I was taking Paxil 20 mg daily in the evening along with CBT. The result was excellent. The anxiety and depression went away, but with a very high level of weight gain, significant fatigue and some sexual dysfunction (low libido). Due to the side effects of the drug, I tried to withdraw it all together around two years back, and there was a relapse. Therefore, I have come back to the medication with some changes. Initially, my doctor replaced Paxil with Prozac and Wellbutrin XL, and then replaced Prozac with Zoloft. Wellbutrin had many side effects on me. Hence, I avoided it altogether. He also avoided Effexor. I am currently on Zoloft 50 mg in the evening along with Buspar 10 mg four times daily. The query now is, which of the following strategies will have few side effects like fatigue, weight gain, impotence, decreased libido, and to delay the ejaculation? A combination of 20 mg Prozac during the evening time along with Buspar 10 mg every six hours daily. A combination of 10 mg Lexapro in the evening along with Buspar 10 mg every six hours a day. A combination of 50 mg Zoloft every evening along with Buspar 10 mg every six hours daily. How would you arrange the side effects? I would like you to mention the side effects regarding impotence, libido, weight gain, fatigue, drowsiness, negative impact on the system and liver in long-term usage, control GAD, SAD and social shyness, delayed ejaculation as a positive side effect, interfere with food, other medicines and supplements etc., in a descending order. Please discuss every question in detail according to your practical experience. Best regards.



Welcome to

I read your query. Out of the three options, the third option would be the best possible concerning the balance between the effectiveness and side effects. Zoloft (Sertraline) and Lexapro (Escitalopram), both are almost equal regarding the side effects and efficacy. Based on my experience, Prozac (Fluoxetine) is a weaker drug regarding the effectiveness. With my practical experience, impotence and loss of libido are known side effects of all the three drugs. The probability may vary but, it is about 10 to 20 percent. Lexapro is the most drug to cause weight gain when compared to Zoloft and Prozac. Again, fatigue and drowsiness are known to occur with all the three medicines. But, it is more familiar with Lexapro. Delayed ejaculation is not a predictable side effect. Hence, cannot say among the three. Zoloft and Lexapro do not interfere with almost all the medicines, whereas, Prozac may do so. The long-term impact on the body and liver is almost negligible for all the three. They are all safe on a long run. The effectiveness of control on SAD (seasonal affective disorder), GAD (generalized anxiety disorder), and social shyness is better with Zoloft and Lexapro compared to Prozac. Between the two (Zoloft and Lexapro) it is hard to judge. Some patients benefit more on Lexapro and some on Zoloft. To conclude, I reiterate that, based on the information you have provided, the third option is the best among the three. (Zoloft 50 mg with Buspirone 10 mg, every six hours). Thank you.

Hello doctor,

Thank you for the response.

Yes, the doctors here also agree with the third option. However, I would like to take your advice to be sure. Is the combination dose low, high, or sufficient enough to control the case (Zoloft 50 mg with Buspirone 10 mg, every six hours)? Is it better to elevate the dose of Zoloft to 100 mg? Should I take Buspirone 10 mg every six hours or eight hours for a better result? Is Cialis 2.5 to 5 mg daily or Levitra 5 mg better for a weak erection?



Welcome back to

The dose of Zoloft at 50 mg is a moderate dose. It will depend more on individual tolerability and expectations of the treatment. If I treat 100 patients with GAD with Zoloft, then 50 mg would have been prescribed to about 50 patients. Weak erection in an individual who is receiving SSRI (selective serotonin reuptake inhibitor) would require an assessment of libido and how much that is contributing to a lack of proper erection. I have not used Levitra (Vardenafil) till now. Tadalafil - Cialis can be taken up to twice a week, in a sexually active person, but not daily. Thank you.

Hello doctor,

My psychiatrist has decided for years to use a combination (SSRIs) permanently along with CBT techniques to control and manage my chronic GAD, SAD, and performance anxiety. I cannot go without medication to manage my chronic anxiety. My life has changed dramatically and positively since I used SSRIs medication. Currently, I am using Wellbutrin XL 300 mg and Prozac 20 mg daily. However, I fall asleep very fast and wake up with a feeling of a very heavy head. Also, I experience jitters and tremors. The positive thing about this combination is weight decrease and improved erection. My doctor has given me new plans instead of the current ones, and I want your opinion about the best of these plans. Replace Prozac 20 mg with Lexapro /10 mg and continue Wellbutrin XL 300 mg, replace Prozac 20 mg with Zoloft 50 mg and continue Wellbutrin XL 300 mg, replace Prozac and Wellbutrin with Zoloft 100 mg and start Metformin to encounter weight gain due to Zoloft, replace Prozac and Wellbutrin with Lexapro 20 mg and start Metformin to encounter the weight gain due to Lexapro, replace Prozac and Wellbutrin with Lexapro 10 mg and Buspar 30 mg and Metformin to encounter the weight gain and replace Prozac and Wellbutrin with Zoloft 50 mg and 30 mg Buspar and Metformin to encounter weight gain. Kindly suggest the best option from among the above to help with my condition and reduce side effects like weight gain, sexual dysfunctions, fatigue, sedation, premature ejaculation, and anxiety. Thank you.



Welcome back to

I understand that you are looking for a change in medication. Two years back, when we had discussed your case, you were on tablet Zoloft (Sertraline). In terms of weight gain, tablet Lexapro (Escitalopram Oxalate) is more likely to cause weight gain than tablet Prozac (Fluoxetine Hydrochloride). I do not have experience in prescribing tablet Metformin off-label to manage weight. Regarding sexual dysfunction, tablet Prozac causes an improvement in premature ejaculation and has a lesser tendency to cause decreased libido when compared to tablet Lexapro. Tablet Prozac and tablet Zoloft are better at managing fatigue and sedation than Lexapro. All SSRIs (serotonin reuptake inhibitors) are safe in the long term. In my opinion, tablet Lexapro scores better in terms of managing anxiety when compared to tablet Prozac and tablet Zoloft. I hope this helps. Thank you.

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