Up and Down...why?

[panic_down_under]

I never got higher than the 50mgs on the trial as even the lose doses were sending my anxiety through the roof, got up to 10 MGs on Kexapro.

How long were you on the 50mg Zoloft, and 10mg Lexapro?

[Utah49er]

I did 6 weeks on Zoloft, but maybe didn't give it a great chance. I went 3 weeks at 50mgs, then I went down to 25mgs for a week cause I was struggling with increased anxiety. After the week at 25 went back to 50 for a week then back to 25 after that week, probably not the best way to give it a try. With Lexapro I was at 5MGs for a week, the 10mgs for 6 weeks.

[panic_down_under]

I did 6 weeks on Zoloft, but maybe didn't give it a great chance. I went 3 weeks at 50mgs, then I went down to 25mgs for a week cause I was struggling with increased anxiety. After the week at 25 went back to 50 for a week then back to 25 after that week, probably not the best way to give it a try. With Lexapro I was at 5MGs for a week, the 10mgs for 6 weeks.

The Zoloft never really had a chance. Did you switch straight from Zoloft to Lexapro, or was there a med free gap between them?

[Utah49er]

Straight from 25mgs of Zoloft to 5mgs of Lexapro. Stopped Lexapro on May 3rd or 4th, didn't start Paxil until June 1st.

[panic_down_under]

Straight from 25mgs of Zoloft to 5mgs of Lexapro.

Switching in those circumstances often has the new med kicking-in earlier, but the multiple Zoloft dose changes might have negated any carry over effect.

Stopped Lexapro on May 3rd or 4th, didn't start Paxil until June 1st.

Then you're effectively starting Paxil from a clean slate with kick-in likely to be in the normal 3-12 week window.

[Utah49er]

Ok, when I up my dose, does that timeframe essentially start over? Or is it just time on the med? Given my previous trials, do you think Paxil is a poor choice?

[panic_down_under]

Ok, when I up my dose, does that timeframe essentially start over? Or is it just time on the med?

The clock starts running from when you begin taking a therapeutic dose which for paroxetine is usually 20mg.

Given my previous trials, do you think Paxil is a poor choice?

It is the best SSRI choice. Whether it is the right one is another matter. When there is no response to two SSRIs usually the best option is to try either a SNRI, or TCA. However, given the circumstances, I don't think we can really say whether Zoloft, or Lexapro failed. It may have been mostly 'operator' error.

[Utah49er]

I like that, "operator error." I would for sure agree that was the case on Zoloft, but isn't 7 week trial (6 on 10mgs) of Lexapro a pretty good go? Would you have increased the dose instead of discontinuing? If I don't even start counting until 20mgs of Paxil, should I suggest to the doc just going up to get on with it?

---------- Post added at 17:55 ---------- Previous post was at 17:05 ----------

One more question haha. I take a pretty high dose fish oil supplement (I have for years) it was a big reason why I was able to decrease my Zoloft dose from the 100-150 range to 50mgs for the last 4-5 years. Not only did it "help" me lower it, it almost made me as my anxiety would be greater on the higher doses, then would decrease and level out to normal when I would drop the dose. Is it possible this supplement is making it harder for me to get on an SSRI? Or to be honest, the fish oil could have just been placebo the whole time, but it seemed like it made a big difference.

Also, I want to thank both "Panic Down Under" and "Handshan" for your advice and support. There is no reason for two people from Australia to care whether a formally care-free, happy 34YO Father of 3 (10-boy,7-boy,3-girl), and husband of one amazing wife, from the States gets his life back after 4 months of anxiety hell that happened simply because he quit taking a little tablet. You guys have been awesome and I want you to know I am grateful!

[panic_down_under]

but isn't 7 week trial (6 on 10mgs) of Lexapro a pretty good go?

As with all antidepressants it can take 12 weeks for Lexapro to kick-in.

Would you have increased the dose instead of discontinuing?

Yes. You can't say a med isn't effective unless you've maxed out the dose. Some need even a little more.

Is it possible this supplement is making it harder for me to get on an SSRI?

I don't think so. Omega-3 fatty acids, especially eicosapentaenoic acid (EPA), stimulate hippocampal neurogenesis just as antidepressants do, but it isn't as potent. A couple of studies have shown taking fish oil capsules can speed up antidepressant kick-in a little, but others found no such benefit.

Imho, fish oil is worth taking, however, be careful while on SSRIs as both are anticoagulants and there is an increased bleeding risk at high fish oil doses. I wouldn't take more than 4,000mg day while on any SSRI (or some SNRIs and TCAs), and dial even that back if you begin bruising more easily, or have nose, or gum bleeding, etc. Also, avoid aspirin and other NSAID painkillers, such as ibuprofen and naproxen, etc, while taking both (taking NSAIDs for more than a few days while on an SSRI is probably not a good idea anyway). There are no bleeding issues with acetaminophen, aka paracetamol.

[Utah49er]

As with all antidepressants it can take 12 weeks for Lexapro to kick-in. Yes. You can't say a med isn't effective unless you've maxed out the dose. Some need even a little more.

If that is true, I wish my psych doc would have recommended it. Good chance I would be nearly recovered right now instead of literally back to square one. Thanks for helping ease my mind about the fish oil, I take about 2Gs of it (approx 1500EPA and 500DHA). Well I guess nothing left to do now but get on with life the best I can during yet ANOTHER excruciating SSRI startup. 4 months has been a long time and has taken its toll on me, my wife and family, and my work (I own 3 car dealerships). I can recover from this right? I mean I haven't been somehow permanently damaged by all the medication during the last 4 months, and even over the last 8 years? I just know it is a long road ahead, and I wish I could see a light at the end of the tunnel, 4 dark months wanderng in the tunnel, really suck. Maybe I am starting to see a light, just hope it isn't a train coming at me!