Nervous about starting Paxil

[acfierros]

I have been struggling with insomnia/anxiety for several months.  My doctor gave me a bottle of 30 pills 1 mg klonopin and wanted to start me on celexa.  He said once the celexa kicks in I wont need the klonopin anymore.  I never did do the celexa just the klonopin for a little while only at night to help sleep.  Sometimes I would cut the pill in half.  I found other meds I tried for awhile like trazadone and melatonin, none of them help me because it is more an anxiety issue.  My body is tired but my mind wont rest.  Now my doctor wants me to take Paxil.  He says do the 1mg klonopin every night at bedtime for 2 weeks until the Paxil kicks in.  I have read Paxil is for anxiety.  What I don't understand is why would you still need to take klonopin if the paxil should work.

[Paxiled]

I tend to side with Anxiousnomore here.  First, it doesn't sound like anyone with the expertise to do so has diagnosed you with the kind of chronic anxiety or depression that would call for medication at this point.  If how you stated it is true, you had no problem with either of those things until you underwent a series of very stressful events that have left you in a bad mental state.  You tried therapy, which is the place to start, but you weren't able to follow through.  If it were me, I'd try to find another therapist and work through this -- it seems you need some recuperation, not medication.  Now, know that this forum has people with astoundingly opposing views of the use of medication -- I believe, because medication always has side effects and makes the body work in an unnatural way that it's always best if you can to fix what's wrong without using it -- and I speak as someone who wasn't able to do that  and someone only medication helped, but I still feel that way.  Others on here believe everyone suffering like you are needs to be on medication.  So you're getting different pieces of advice because we differ on here and experts in the field differ as well.  My own test is, if your life is so disrupted you can't function very well and you have no idea why this is happening then you're probably going to need something relatively quickly before things spiral out of control.  If you're functioning but just not doing well, then I think therapy is the place to start because of the medical maxim that doctors swear to as part of their training, First Do No Harm.  Again, all medications ever invented are attempts by humans to improve on evolution, and how much you believe in the ability of humans to do this will have an influence on where you come out on this.  If you have decided medication is the place to go, I highly recommend doing it with the most highly recommended psychiatrist you can find, not a general doc.  General docs don't really know that there are differences between these meds -- some are more problematic than others for more people.  Paxil and Effexor are the most difficult of all antidepressants to stop taking, and your experienced and good psychiatrists virtually never start with these meds if you've never taken one before.  As for your contention that Paxil is for anxiety and Celexa isn't, that's false -- all antidepressants are used for both.  Some are better for it than others because of the level of stimulation they cause, but Paxil and Celexa are in the same class of drug so you don't have that problem.  Most psychiatrists will start with either a tricyclic antidepressant such as imipramine or if it's an ssri, and most will start with ssris these days, with Prozac or Lexapro.  Prozac isn't the best for the most people for anxiety because it's a bit more stimulating than other ssris, but because it has a longer stay in the body it appears to be the easiest to stop taking.  Lexapro appears to be the drug with the least awful side effects for the most people, though that might be hype, it's hard to say.  Celexa is very similar to Lexapro, it's the older version of it.  All ssris are used for both depression and anxiety, and it's trial and error as to which one works best.  A good psychiatrist will taper you onto it slowly so you get used to the side effects, and will taper you off of it when you decide to stop taking it as slowly as you need to so you avoid withdrawal problems.  As for the klonopin, I agree, you don't need both, but Anxiousnomore is right that benzos such as klonopin start to work more quickly than antidepressants -- the latter take 4-6 weeks for most people to notice if they're going to work or not, but know that side effects start right away.  For some, they work much more quickly than that.  For others, they take more time.  Dosages should be upped slowly until the recommended dosage is reached.  If you do take the klonopin, don't take it daily -- take it only as needed.  This benzo lasts longer in the body but takes longer to start working than shorter-acting benzos, and again, it's trial and error whether they work or not.  Your insomnia seems to have arisen with your stress, so one assumes that some lifestyle changes such as exercise, meditation, and therapy will help.  As for melatonin, this is not a drug like the others -- it's a hormone your body uses to set your body clock.  Dosage is important, as most people take too much -- with this one trials showed it works better with less.  A good starting dose is 1mg, and the most anyone should probably ever need would be 5mg.  There are also a host of other sleep aids out there in the world of things that are natural, such as valerian, chamomile, homeopathy, passionflower, hops, and many more relaxing herbs, but once you start taking the benzo if you do so don't take these -- they act on the same neurotransmitter, GABA.  There are a lot of ways to skin a cat, and to me it just makes sense to move from least invasive to most invasive as the need goes.  Whatever you choose to do, and I know this is hard, I've been there and am still there, best of luck to you.  Finally, even if you do go on meds, please do still try therapy if you ever want to stop taking them.  Again, best of luck to you.  

[Paxiled]

Sorry, there's a hole in this -- I meant to say that when you know what caused your problem in the first place, and you seem to know the things that triggered it, therapy is more likely to succeed.  For those of us who have no clue as to why we go this way, therapy is a harder road but not an impossible one for some.  

[specialmom]

So, that's what I don't understand.  You aren't nervous to take a benzo which as a class has a long record of issues with (as much or more than today's antidepressants).  You already sound a bit dependent on the konopin, unfortunately.  You may want to consider this.  Regardless of what antidepressant you take, it will be best to follow you doctors advice and start slow, increasing dose with that and wean off the benzo.  Benzo addiction is real.  good luck

[specialmom]

Actually, insomnia and sleep issues are often associated with anxiety and depression and when you treat those conditions, the sleep issue resolves.  I'm not a fan of adding sleep aids myself other than melatonin.  I absolutely agree with your doctor that you take the short acting benzo as you get your other long term anti depressant on board.   Why would you not start the Celexa?  Paxil is a drug that does help may people.  LIke every medication out there, it's not for everyone and it can be trial and error to find the right med.  Titrate up slowly if you begin taking it.  If you do that, start up side effects are minimized as the medication gets into your system and starts working.  Paxil (and most ssri's) take 6 to 8 weeks to 'kick in' and be at therapeutic levels.  If you are fearing not being able to continue on Klonapin, understand that dependence can develop to that medication.  You will want to be very aware of that.  Follow your doctor's suggestions and communicate with them.  This should help your sleep issue tremendously.  good luck

[specialmom]

I do agree also with lifestyle choices that aid in helping with anxiety and sleep issues.  Obviously, alcohol is a no no, good bedtime routines, eating well, exercise, meditation, deep breathing etc. and that psychotherapy should be utilized for the best result in feeling better.  good luck

[acfierros]

Thank you I left a comment on the first person who commented. I have been nervous about taking antidepressant I wish I didn't have to go this route because prior to being in the hospital I never had this issue but then I think all the stress has built up.  I just want to be able to sleep like I used to I love sleep they going a day or two without sleep has hurt me and now going to bed at night scares me because I'm always worrying if I'm going to fall asleep so that is when I'll do 1 mg or maybe a .5 Klonopin. Now I realize I can't keep doing this or else I will come dependent so I have no choice but to get on the Paxil

[AnxiousNoMore]

You have 2 problems, anxiety which needs one med and sleeping issue which requires a different med. You don't want to take klonopin, celexa or paxil for sleeping issues. You have been prescribed these meds for anxiety, but you are self medicating and not taking the celexa so your doctor can't help you much if you continue with that practice.
You need to level with your doctor so he knows what is going on - no idea why you kept that a secret?

Reading about sleep disorders might help you find ways to relax so you can get a good sleep, or else go to a sleep clinic for help. Seeing a therapist may help with the anxiety - have you tried that?
You are right that if the Paxil starts to work you don't need clonopin, however it takes weeks for the Paxil to have any effect on you, unlike the clonopin which can give very fast relief.
It appears you have a few things to discuss with your doc.

[acfierros]

Thank you for your comment. I have seeked a therapist but then she got a medical issue and had to quit.  I need to find a new one. I was hospitalized in April with gastritis.  When I came home my sleep schedule went totally out of whack. That's when insomnia began the insomnia turn into anxiety. I know all this has been caused by stress because I have been under tremendous stress for over 6 months we went through hurricane Harvey our house flooded I lost my job 2 months prior. My mom and I don't get along and many other issues. The reason I didn't start the Celexa I read more for depression. But then also I've been scared of the side effects of all antidepressants I read too much into it. I've tried too many medicines and I'm going to quit taking melatonin trazodone all this other job that I have probably poisoned my mind. I want to eventually get off the Klonopin and do just paxil and hopes that I will have good results to get better. I don't know how the Paxil affect my sleep if it's going to cause insomnia or drowsiness.