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Paxil and/or cigarettes for stress?
May 6, 2011

Hello,

I am a person who has always been prone to depression. I have taken Paxil for ten years now. It has helped me through some very difficult times.

In October of last year I was told that I was HIV+. At that time, I started a course of antiretrovirals, which have caused by CD4 counts to increase. Because of the stress and panic I feel over my condition, I have been advised to change antidepressant medication. When I was diagnosed, I stopped smoking cigarettes. Lately the cravings I have felt for tobacco have greatly increased my stress level.

Given all of the medications I am currently taking, I really do not want to experiment with new psychotropic drugs. I am also wondering if it is okay to have one or two cigarettes a day if it will decrease my stress level.

Please advise.

Response from Dr. Fawcett

Paxil is a good choice in terms of few interactions with HIV medications, as well as its effectiveness for symptoms of depression and panic. It sounds like it has worked for you for a long period of time, although it is not unusual for such a medication to lose its effectiveness quite suddenly. You don't say who suggested changing medications, but I would speak with your physician about your concerns. Since stopping smoking is so difficult, and you have been without cigarettes for such a significant period of time, I would really suggest finding other, healthier ways to deal with your stress. There are nicotine support groups that address dealing effectively with cravings. For the overall stress you are going through, remember that a combination of medication and talk therapy has proven to be the most effective intervention, and support groups or other forums where you can get support (and give it to others) could be very beneficial. Good luck.

-David



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