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Adding Paxil to cocktail


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Okay, to sum up my past:  Effexor 150mg since 8/2002, when it lost its effectiveness in early 2004, my moron of a pdoc added Lexapro instead of trying an increased dosage of Effexor.  So I continued on both of those for a while, till I turned into whale shit again in early 2005.  So I have a new pdoc who seems to actually want to help me (what a concept).  I'm off the Effexor and Lexapro, and on Cymbalta.  Which brings me to the present.

The past couple weeks I've had major focusing issues, and an inability to concentrate at work.  Then a week ago I had my first full-blown panic attack.  I called my pdoc and went in to see him today.  I wasn't sure if the Cymbalta just wasn't working or what.  He told me that Cymbalta boosts the neuroepinephrine, which could be causing the panic.  So he has now put me on Paxil for the anxiety, focusing problems, and panic attacks.

For those of you in the know, does this make sense?  Does it make sense for me to be on an SSRI as well as a multiple reuptake inhibitor?  I'm trying to be proactive about my nutjobness and understand why I'm on what I'm on.  So I just wondered if what my pdoc did sounds right to y'all...

ETA:  Duh.  Didn't realize Lexapro was an SSRI also.  Oy.  In any case, I'm still wondering if the combo is a good one...

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Its an option but an unusual one. Normally if you want to play with the separate mood receptors in more detail, you use separate drugs, eg you would take an SSRI like paxil or lexapro and a NARI like strattera or reboexetine, and then look at wellbutrin or an ap for dopamine.

Cymbalta and effexor, in higher doses reuptake all three mood receptors (serotonin, noradrenaline and dopamine), so Im not sure the thoery behind this tactic.

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Um, Wellbutrin also acts on norepinephrine.

And the tactic is probably the same as taking an antidepressant and an AP separately instead of just putting everyone on Symbyax.

Hope that second part makes sense.

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Its an option but an unusual one. Normally if you want to play with the separate mood receptors in more detail, you use separate drugs, eg you would take an SSRI like paxil or lexapro and a NARI like strattera or reboexetine, and then look at wellbutrin or an ap for dopamine.

Cymbalta and effexor, in higher doses reuptake all three mood receptors (serotonin, noradrenaline and dopamine), so Im not sure the thoery behind this tactic.

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From what I've read, I'm not on a particularly high dosage of Cymbalta, but it was definitely enough to affect the norepinephrine levels, and he described adding the Paxil as like a "blanket" over that effect.  And that I probably didn't feel the panic attacks, etc. when I first started on the Cymbalta because I was still on the Lexapro.  He would have probably put me back on the Lexapro, but I asked for a different med since both Lexapro and Cymbalta cost $50 a month on my insurance plan.

Whatever the reasoning, so far it seems to be doing the trick.  I swear that I've felt a greater sense of calm since I started taking the Paxil, and I haven't burst into tears like I am wont to do.  Is it possible for it to work this quickly, or is it a psychological response?

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