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Chronic Anxiety Disorder.

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I have treated from chronic anxiety buy both CBT and medication and everything is very ok now, getting better well, my plan currently is (50 mg Paxil daily from 4 months until now), (Buspar 15 mg twice daily from 4 months until now) and (Wellbutrin 150 mg from 3 months until now). Not that (I have used Paxil for 6 years before by high dose in the intial then to constant does 10 mg daily and I did not get any problems within the 6 years.... but before 8 months I have withdrew Paxil so that I got relapse and come back to treatment again by these 3 medication plan as I mention firstly). The doctor recommend me to not cut the medication especially Paxil or use it for long time since the results are very positive .
My doctor now would like to reduce the plan since my responce for treatment is very strong, he would like to cancel either (Buspar or Wellbutrin) and fix one of them along with Paxil to encounter the side effects of Paxil (sexual side effects for example), he suggest to cancel the Buspar and keep Wellbutrin 150 mg along with Paxil (the Paxil will reduce gradually within plan until arrive to constant does 20 mg daily), in his opinion Buspar is false medication, our objection now which one to cancel and much more better along with Paxil in effect and encounter side effects, I do not know which one much more work along with Paxil and support Paxil well and what the role of both with Paxil (since I use both now along with Paxil) ? Please could you direct me correctly about that ? I hope get determined answer about that, thanks a lot.

Category: Psychiatrist

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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

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

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.

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

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.

Dr. Srikanth Reddy MD

Patient replied :


Thank you very much indeed .

Best Wishes

Your welcome, wishing you good health!!
Take care

Dr. Srikanth Reddy
Category: Sexologist
Doctor of Medicine (MD), Psychiatry Residency Program,2001 – 2012
M.B.B.S,Mahatma Gandhi Institute Of Medical Sciences, Sevagram

Certificate Course in sex Therapy and Counselling, Sexology and Counselling, A
Sexology,Medikon Sexual Sciences, Mumbai

Training in Advanced Neurology at a leading corporate hospital (CARE hospital) in Hyderabad

Child Psychiatry Training in National Institute of Mental Health and Neuro-Sciences, Bangalore

Sex Therapy and Counsellingat MEDIKON Sexual Sciences, Mumbai.
Dr. Srikanth Reddy and 4 other Medical Specialists are ready to help you

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