I had started with treatment for GAD. I cannot do anything without medication after I have withdrawn it. Help me tune the medications for extended usage

Hi,

Welcome to icliniq.com.

At first I would like to tell you briefly about Generalized Anxiety Disorder or GAD that you are already well aware of.

This is a chronic, relapsing and debilitating common psychiatric disorder characterized by anxiety and worry about several events and activities for a majority of the day over a 6 months time period.

The anxiety and worry associated with GAD can be distinguished from normal anxiety by their excessive nature, the difficulty involved in controlling them, and their interference in everyday life.

Having said this I like to emphasize again that it is chronic and relapsing disorder. So if any one needs to discontinue medication it should be done in graded manner. Abrupt discontinuation should be avoided at any cost.

• In your case I feel that medications are over prescribed as I do not find any literature supporting use of wellbutrin in anxiety disorder. If you were had secondory depressive symptoms due to GAD in that case it can be rationalised partially only as the Paxil takes care of both depression and anxiety (This is evident with your history of good response with paxil 10 mg for last 4 years).

• In regard to your question, I reserve my opinion at this stage as the history of your problem presented at this portal is just tip of the iceberg.

• I like to request you to book online consultation with me so that I can assess your problem in detail for further management and rational medication prescription.

You might be aware that every medication has its own side effect and risk benefit, analysis need to be done before every single prescription.

In response to your question "Is it true that the effect of these medications become weak or insignificant with time?" I assure you that with prescribed medication like paxil, the answer is NO.

There is no evidence of tolerance with SSRI (Paxil) and wellbutrin. Although such reports you can find in many websites managed by quacks and non medical personnel. I would say it is a MYTH and not a true phenomenon.

I hope I have answered your query to a good extent. Consult a psychiatrist online for further help --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

First I would like to inform you that the information provided below is applicable for GAD only. If you had other symptoms of any psychiatric disorder than GAD, there will be a different answer.

Yes. You can continue with Paxil 60 mg and Buspar 30 mg. You need not to take wellbutrin in GAD as it does not have anti-anxiety effect. The reason for prescription of wellbutrin might be due to one or two reasons.

1. Associated depressive symptoms along with GAD symptoms. In this indication it can be rationalised to a partial extent only as paxil takes care of secondary depression due to GAD. Other than this if wellbutrin is used with paxil it should be used after due conclusion than paxil is partially effective in depressive symptoms. I mean to say not to start wellbutrin and paxil from starting of treatment.
2. If you had sexual dysfunction due to paxil then wellbutrin may be used to reverse this side effect. It is off-label use in most of the european countries.

So my conclusion is that if you do not have any sexual side effect due to paxil than it is better to discontinue it. Althogh withdrawal symptoms are not that much troublesome with wellbutrin.

• My advice is to reduce the dose 25 to 50 mg per week. For the next week you can reduce to 100 mg once a day for one to two weeks according to your body's response. Then after one to two weeks you can go down to only 50 mg per day for another one to two weeks. After this you can discontinue it all together. This means you need to take three to five weeks to discontinue 150 mg of wellbutrin.

• I undertand that you want to add remeron 15 mg but as you said in your first query to me that anxiety and depression went away. I am not convinced with both the things at same time. If you are responding to paxil and buspar then why to add remeron. It will cause you weight gain and some excessive sleep . And if this happens then probably you will try to discontinue remeron.

I think you continue with buspar and paxil only. Your current sleep problem may be due to wellbutrin and hope with discontinuation of wellbutrin it will be over. What I think is you can use 7.5 mg of remeron at sleep time on s-o-s basis during wellbutrin discontinuation phase.

Once your wellbutrin is over you can reassess your need with the help of treating psychiatrst or with me. I emphasize again that the information provided in this answer is my personel opinion and has the huge judgemental component.

During real conversation or consultation every thing is discussed in detail and suggestion is based on the mutual agreement of the patient and doctor. I would suggest you to consult a psychiatrist online for futher discussion --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist

Hi,

Welcome back to icliniq.com.

I am really happy to see that something is working albeit not to the expectations.

Considering all pros and cons of current treatment I will consider increasing Wellbutrin (Bupropion) first to 300 mg and after a fair trial of two to four weeks, an increase in Prozac (Fluoxetine) can be considered, if absolutely necessary. The reason for such decision is largely based on side effects. The current side effect profile is largely attributed to Prozac, except theheadache. So, if we increase the dose of Prozac at this level it is possible that there will be more side effects.

Regarding your question about weight gain both medicine help in weight gain and they do it independently. Generally, Wellbutrin has a better effect on weight control thanProzac. Loss of one to two kg is not remarkable but it is significant as you started on positive side after a long time.

As I said earlier there is no significant interaction between these two medications and it is common practice to use both molecules in the same patient across the world. I hope this answers your question.

For further doubts consult a psychiatrist online --> https://www.icliniq.com/ask-a-doctor-online/psychiatrist