[NPInfo] Psych question

Sun Sep 9 08:26:14 PDT 2007

Hate, hate, hate Effexor!! I would suffer withdrawal symptoms if I was even
a couple of hours late with my dose. And the withdrawal symptoms when trying
to quit is horrendous. Needs several weeks of very slow tapering along with
Prozac or another long acting SSRI to help with the withdrawal. I've often
said I don't know how heroin withdrawal can be any worse than trying to kick
Effexor. I took the drug for about 3 courses throughout the years as it
worked great with food cravings, binge eating, and weight loss. 
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Louise Moon Rosales
Sent: Sunday, September 09, 2007 6:16 AM
To: NP Info
Subject: Re: [NPInfo] Psych question

I agree with Priscilla.  I will go to Effexor after 2 or 3 trials on 
different SSRI's.  I have had students experience symptoms of withdrawal 
after missing just one dose.  My favorite SSRI for GAD is Zoloft.  The 
biggest problem with that are the very common sexual side effects.

I also am hesitant to prescribe paxil in women of child bearing age because 
of the risk of congential heart defects should they become pregant.  It also

is hard to wean off of because of the discontinuation syndrome.

Here is a link to the FDA statement on Paxil:
http://www.fda.gov/bbs/topics/NEWS/2005/NEW01270.html

Louise Rosales (who takes the psych np certification exam 9/21!)

----- Original Message ----- 
From: "Priscilla Merrill" <prispunnyfnp at metrocast.net>
To: "'NP Info'" <npinfo at nurse.net>
Sent: Sunday, September 09, 2007 6:30 AM
Subject: RE: [NPInfo] Psych question

> Effexor not my first choice as it's VERY hard to get off of and much more
> seratonin withdrawal.  Many love it and it's one I'll switch to if the 
> SSRI
> not effective.  Another tip to work with the "poop out" of the ssri or
> weight gain/fatigue is to add on low dose buproprion at a later date.
> Everyone is unique in how they respond to these meds.
>
> Priscilla
>
> -----Original Message-----
> From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
> Of Lisa Meyer
> Sent: Sunday, September 09, 2007 12:33 AM
> To: NP Info
> Subject: Re: [NPInfo] Psych question
>
> I just took over another NP's position in a university counseling center.
> She apparently was quite fond of long-term benzo prescribing, as I have 
> had
> one sorority girl after another in for "refills".  Most of these girls, in
> my mind, don't even meet criteria for an anxiety disorder, just usual
> situational stressors of college life.   Anyway, I have disappointed 
> several
>
> young ladies, and have started a few on SSRI's.  How do you all think
> Effexor compares in your experiences to Lexapro and Paxil for GAD?
>
> Lisa
> ----- Original Message ----- 
> From: "Shelby Havens" <shelbyhavens at hotmail.com>
> To: <npinfo at nurse.net>
> Sent: Thursday, September 06, 2007 1:36 PM
> Subject: RE: [NPInfo] Psych question
>
>
>>I prefer Paxil for patients with panic attacks or severe anxiety. It is a
>>little more anticholinergic (sedating) and less activating than Prozac,
>>Zoloft, and other SSRIs.
>>
>> I am fine with long term benzo use in patients with anxiety disorders, as
>> long as they do not have a substance abuse history. Buspar can be 
>> helpful,
>
>> but it must be taken TID due to the short half-life, and it tends to be
>> effective only in patients who are benzo-virgins. If a patient has used
>> Ativan or Xanax for longer than a brief period, they generally won't like
>> Buspar.
>>
>> Best Regards,
>>
>> Shelby Havens, ARNP
>>
>>
>>
>>
>>>From: <mmarnp at ec.rr.com>
>>>Reply-To: NP Info <npinfo at nurse.net>
>>>To: NP Info <npinfo at nurse.net>
>>>Subject: RE: [NPInfo] Psych question
>>>Date: Thu, 6 Sep 2007 13:57:03 -0400
>>>
>>>I agree 100% with Priscilla, Benzo's for maintenence is bad medicine
>>>although episodic use until SSRI kicks in is appropriate.  I do like
>>>Zoloft a little better for several reasons: 1--Less weight gain,2-,  Less
>>>male sexual side effect, and 3--it is now generic.  (1 & 2 are reflect my
>>>clinical experiences and my not be supported in the literature but I 
>>>don't
>
>>>care)
>>>Michael
>>>---- Priscilla Merrill <prispunnyfnp at metrocast.net> wrote:
>>> > Nope, xanax is the Devil's cocktail.  Very habituating and SSRI's are
>>>DOC if
>>> > pt needing med.  I like Lexapro, "clean" and gentle. Otherwise,
>>> > behavior
>>> > mod, emotional freedom technique.
>>> > Most of us prefer clonazapam only for very rare occasions since less
>>>buzz
>>> > and longer action.  I explain that SSRI's take a week or 2 to kick in
>>>but
>>> > the klonopin gives more immediate relief but agoraphobia is a long 
>>> > term
>>> > progressive situation that a short acting anxiolytic is not indicated
>>>for.
>>> > Counseling to figure out what's behind the fear of exploration outside
>>>the
>>> > home.  I have had great success with getting to the root of it, not
>>> > that
>>>I'm
>>> > a professional counselor but often times, rape or abuse is part of the
>>>story
>>> > that is hidden and when safe territory is provided, out it comes.
>>> > Best wishes to this person.
>>> >
>>> > Priscilla Merrill FNP
>>> >
>>> > -----Original Message-----
>>> > From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
>>>Behalf
>>> > Of David Mittman
>>> > Sent: Wednesday, September 05, 2007 6:52 PM
>>> > To: NPinfo
>>> > Subject: [NPInfo] Psych question
>>> >
>>> > My Esteemed Colleagues:
>>> > I remember years ago Xanax being the drug of choice for
>>>agoraphobia/panic.
>>> > Is it still?
>>> > Someone I know asked if there was something else they could use and 
>>> > was
>>>not
>>> > sure if there were meds used that worked but may not have an 
>>> > indication
>>>for
>>> > it. She also was on Xanax for a long time (do not know the dose) and
>>> > was
>>>now
>>> > placed in Ativan.
>>> > I did not say anything except I am sure there are reasons. I SHOULD
>>> > have
>>> > asked if the agoraphobia returned when taken off the long standing
>>>Xanax,
>>> > but did not.
>>> > Dave
>>> >
>>> >
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