Hello
Thanks for using doctor spring for posting your query.
I have gone through your question in detail and I can understand what you are going through.
Paxil is an excellent drug for anxiety, but you have been using it in very high doses. IT should be reduced to either 37.5mg or 25 mg over next 6 months if the symptoms are well controlled.
Regarding the twoother medications, of them bupropion acts on the nor adrenaline and dopamine transmitters where as paxil works on serotonine. As a result there will be a broader cover of anxiety and it would be wise to continue with paxil and welbutrin.
My experience with busporione has not been good. It acts through serotonin transmitters like paxil and the effect is good only for short term anxiety but not for long term anxiety.
I would suggest that you should go ahead with the combination of welbutrin and paxil and the paxil dose has to come down a bit. Do continue with the cbt.
Also plan to continue to take your treatments atleast for 1-2 years as the symptoms were very severe and it need lot of medications to control them.
I hope I am able to help you with your concerns.
If you need any further help do let me know so that I can help you.
Kind regards
wish you good health!
Dr. Srikanth Reddy MD
Psychiatry
Patient replied :
Dear Dr. Srikanth,
Thank you for the valuable answer,The final plan of my Doctor will be to arrive to constant does within gradually plan over 6-8 months from now (150mg or 300mg Wellbutrin daily morning and Paxil 20mg or 30mg daily evening) and I will stay on this plan at least 2 years or more but not less, Do you agree with that plan ? How can withdraw Buspar correctly without any problems ? (Note that I use Buspar as 15 mg twice daily from 4 months until now) . Thank you very much again .
Best Regards
Hello
Thanks for the follow-up.
Yes your current plan is appropriate and should not be a problem. The best part is you are planning to take treatment for a long period (2 years) which will minimize the chances of relapse.
Regarding withdrawing buspirone, i would suggest to reduce the dosage by half ever 5-5 days so that 30mg will become 15 mg in 5 days and then to 10mg in next 5 days and then finally to 5mg in next 5 days and then stop. The whole process may take 20 days or so. The treatment of anxiety has to be withdrawn gradually to prevent withdrawal relapse.
Regards
Patient replied :
Hello again,
I have asked my doctor a question that : Are these medications (i.e Paxil and Wellbutrin) have limited effect, in otherwords are the effect of these medications decrease by the time of using ? He said to me completely no.. the effect stay present and minimize the case as long as you adherent with doses, and this concept only concern to some kind of medications called Benzodiazipens, Could I take your opinion about that please ? Many thanks.
Best Regards
Hello
Your psychiatrist is right. There is no reduction in the efficacy of the drug with their use. Even after using for a long time, they will still be effective.
Its the benzodiazepines and carbamazepine that can have reduction in their effect with their use.
Regards
Dr. Srikanth Reddy MD
Patient replied :
Hello,
Thank you very much indeed .
Best Wishes
Your welcome, wishing you good health!!
Take care
Thankyou