QUESTION:
Dear Doctor,
I have almost all the symptoms of GAD (especially my mind never shutting off) along with depression and irritable bowel syndrome. I have read over all of your FAQs and looked at any that talked about GAD, Paxil, or Celexa. In many you seem to say that Paxil is not good for GAD; but in one of your most recent, you recommend Paxil for it.
Is Paxil good or bad for GAD if I also start on BuSpar? Would Celexa be a better option (along with BuSpar)?
Prozac and Effexor make me too nervous. I just got off of Effexor. I am just now realizing that my problems could be more from GAD than depression. I am also seeing a counselor. I am going to my regular doctor in a week and I need to know what you suggest. She hasn’t done a very good job in diagnosing me, but I can’t afford a Psychiatrist. I have a few of the symptoms of OCPD, but I don’t think I have it. If I did, would your treatment for me be any different?
Thank you in advance for your reply.
ANSWER:
I do not recommend Paxil for the generalized anxiety disorder, particularly the cognitive component. This is especially true if it runs in your family, making it the genetic type of GAD.
Paxil helps some patients with the somatic generalized anxiety disorder, but I suspect it’s “subclinical” panic disorder, or relief of anxiety symptoms, by relieving depression and/or social anxiety disorder.
If Prozac made you nervous, all SSRI’s will make you nervous including Paxil and Celexa. Once you’re on the full dose of BuSpar (usually 15mg twice daily) for a week, you will likely be able to take Prozac or another SSRI without it making you too nervous. Sometimes starting with a low dose first can make that process easier.
OCPD responds beautifully to 60-80mg of Prozac, usually 80mg daily. Things stop feeling like they’re a “big deal.” I go into this at length in “Biological Unhappiness.”