Q. Will my anxiety relapse if I stop SSRI?
Hello doctor,
I am a male who was diagnosed with generalized anxiety disorder (GAD) and social anxiety, eight years back. Initially, I was prescribed Paxil 20 mg, which helped treat my anxiety and depression but I started having side effects of weight gain, fatigue, and sexual dysfunction. When I stopped taking medicine, I started having anxiety and depression again. So my doctor prescribed Zoloft 50 mg and Wellbutrin XL 150 mg. After taking these pills, I started having side effects like extreme weight gain, fatigue, decrease libido, erectile dysfunction and slight hand tremors. I am worried to take a combination of two tablets for my illness because I read that taking one medicine is better than taking two. Is it true that Wellbutrin XL, when combined with SSRI, causes weight loss? And if I stop taking SSRI completely, will my anxiety relapse? I am looking for a medicine which helps my illness without causing any side effects as mentioned above. Please note that the following medications are not available in my country Valdoxan, Edronax, Desyrel, Pristiq and Viibryd.
Hi,
Welcome to icliniq.com.
Paroxetine acts on multiple receptors, and it is known for its withdrawal effects of weight gain due to its antihistaminic and anticholinergic action. SSRI (selective serotonin reuptake inhibitors) can cause significant sexual dysfunction. Usually, Bupropion along with SSRI is prescribed to reduce its sexual side effect. In your case, you are using Sertraline with Bupropion, and you are reporting no improvement in weight gain or sexual function, it is not that common to gain weight with Sertraline, but it can happen. Buproprion traditionally is an activating drug, and it is useful for reducing weight and improving sexual functions. I suggest you try taking Escitalopram 10 mg and Buspirone 15 mg (7.5 mg twice daily). Escitalopram is a classic SSRI, which has a minimal side effect of weight gain and sexual dysfunction. I know you do not want to take multiple medicines, but it is a much better approach to handling your illness. I would suggest you start this combination of drugs immediately after consulting your specialist, as some people are more sensitive to the adverse effects of the drug, so we may have to explore multiple options before we find the right combination for you. Continue doing daily exercises, meditation and relaxation exercises. Thank you.
Hello doctor,
Thank you for the answer. But I wanted to ask if BuSpar and Lexapro are better than Zoloft and BuSpar to manage weight gain. What about the combination of BuSpar 60 mg and Wellbutrin XL 300 mg instead of a SSRI?
Hi,
Welcome back to icliniq.com.
The chances of weight gain with Escitalopram and Buspirone is much less and theoretically more effective, but it varies depending on the individuals. The combination of Bupropion with Buspirone does not make sense, in fact, Bupropion is not an ideal anti-anxiety drug. It was probably added by your doctor to counter sexual side effects of SSRI. If you want to avoid SSRI entirely, then I suggest you try Buspirone alone starting at 15 mg gradually and increase to 30 to 60 mg depending on the effects. Consult your specialist doctor, discuss with him or her and take medicine with their consent. But, Buspirone acts better in combination with Escitalopram and needs only lower dose of both when together. Thank you.
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