November 30, 2004

8:02 PM

Psychotropicdrugfilter:
I'm probably getting off Paxil after seven (!) years and I wonder:
(1) Anyone gone through the withdrawal syndromes and have any advice or heads up on what to expect? I'm terrified.
(2) I have had no "sexual" problems on Paxil. What anti-depressants should I stay away from if I really really want my libido intact?
I'm male and 29.
posted by anonymous to (13 comments total)

Withdrawal on Paxil varies a lot from person to person. You definitely want to step down -- if your doctor hasn't provided you with small-dosage tablets (IIRC 10mg is the smallest, but they're scored and can be easily be broken so you can reduce your dose in 5mg increments) you should be sure to ask. I was taking 20mg and reduced my dose by 5mg each week. When I got down to 5mg per day, I started getting the withdrawal symptoms in the evening (I took the pill in the morning) so I decided to just stop at that point and get it over with.

My symptoms were mild. You know the startle reaction you sometimes get when you see something out of the corner of your eye that you weren't expecting to be there? That's what it was like, except it happened pretty much continuously the first day, anytime my eye moved, and there was never anything actually there. Stronger cases of the "zaps" (as they are called) can feel like actual electric shocks. I've also read reports of people feeling nausea and having other symptoms. The worst of the symptoms are apparently pretty rare. However, you've been on the drug for quite a long time, and I wouldn't be surprised if yours are worse than mine. Sorry.

If you haven't had any sexual side-effects on Paxil that's pretty good news, as it might mean you won't have any such side effects on other SSRIs either. Of course, every drug is different in every body, and there's really no way to predict your response to any given one without taking it.
posted by kindall at 8:20 PM on November 30, 2004

This may sound ridiculous, but I have, occassionally been separated from the Celexa I continue to take and gone through a mild withdrawal with a mild version of the "zaps" referenced. I've also experienced something similar to "zaps" without and SSRI while sick (flu, if I recall), and in both cases, ordinary aspirin seemed to help.
posted by ParisParamus at 8:33 PM on November 30, 2004

anon - why are you stopping it and what dose are you currently using?

On preview, kindall's comments seem very representative of what I have seen in patients. Although the longevity of use probably becomes irrelevant after a point, i.e. 6-12 months. Absolutely get smaller doses. 5 mg per week decline is a good titration in general. Klonopin can be helpful to tone down the side effects as well. Don't listen to overly dramatized accounts of withdrawl. FWIW, I am no longer prescribing Effexor because of similar difficulties with discontinuation, despite what an effective SSRI it can be.

On second preview, PP, most newer SSRI's have a fairly short half-life, so missing even one dose can bring on mild w/d, esp. at lower doses.
posted by docpops at 8:37 PM on November 30, 2004

I agree with docpops -- I'm on Paxil CR 37.5mg, and if I miss it for a day, I get very dizzy and nauseated. If I miss it for two days, watch out! I vomit and get migraines; essentially if I miss for two days I have to stay in bed the third.

But if you get weaned off, like recommended above, I doubt that you'll have the kinds of problems I have. I was going from a high dose to none, which of course is a bad idea. (Not that I was trying to wean -- just simple forgetfulness. I put my husband in charge of doling out any and all pills in the evening and now I don't miss anymore. Is much better.)
posted by sugarfish at 8:44 PM on November 30, 2004

The "zaps" suck. But don't be terrified, they are not life-threatening. Knowing that they exist puts you way ahead of where I was. For me, it felt like the room would shift down about a foot, but I was still in the same place. The effect lasted about a week, then it never happened again. One cautionary note: I do remember walking my dog one night and falling over onto my neighbor's lawn. While it wasn't dangerous, it was pretty embarrassing. But it went away, as will the other side effects. I second kindall's recommendation to reduce dosage. I didn't do that very well, and it may help you avoid the problems that I experienced.
posted by kamikazegopher at 8:46 PM on November 30, 2004

I've been on Paxil for years without much in the way of side effects. On the whole, I've been very happy with my experience. I just feel normal.

But if I forget to take it for a day or two, as just happened recently due to an insurance change, I experience a number of unpleasant side effects. These include the zaps, which I documented in detail on my personal site, and unusually vivid dreams (which is both good and bad, really).

The general course of action for getting off Paxil is to have the pharmacy give it to you in liquid form. Then, with the help of your doctor, taper yourself off a milligram at a time. Use a syringe to measure the dosage.

I've not gone this route yet, but it's what I plan to do eventually. While I'm not uncomfortable right now, I don't like the idea of taking a pill every day for the rest of my life. I imagine you feel much the same way.

What's troubling is that GlaxoSmithKline never publicized the addictive (in the sense that one can't simply quit cold turkey without discomfort) nature of the drug and my doctor never mentioned that it might take some time to get off it. Knowing what I know now, I'd still have chosen to go ahead with it, but all of us should have been made aware of these issues from the outset.

In any case, best of luck! I'm hoping that after you wean yourself from the Paxil, you'll find that you don't need to substitute it with another medication.

On preview: I am not a doctor, obviously. Docpops, on the other hand, probably is. He's quite right in pointing out that you shouldn't put too much stock in reports of horrible withdrawal symptoms. In my case, they have been uncomfortable but not at all debilitating.

I've spoken and written about it not because I've felt particularly ill, but because I (along with many others) was never informed about the possibility of withdrawal. The zaps are terrifying if you don't know what they are. It feels as though you're about to have a seizure or a stroke of some kind. But if you're prepared for them, it's not a big deal.
posted by aladfar at 8:49 PM on November 30, 2004

Aladfar makes a good point. I used to have this elderly, frail, extraordinarily depressed female patient who would swoon, nay, nearly implode if she took even homeopathic doses of the most benign meds, and we used liquid zoloft in small aliquots, which she was able to take. So you could even take that route if you wanted to be particularly careful. And your doctor should treat the request with gravitas if he/she knows what they're doing.
posted by docpops at 8:55 PM on November 30, 2004

As someone who just started out on 20 mg/day of fluoxetine (generic Prozac) last Thursday this thread makes me very nervous. I know Prozac and Paxil are both SSRIs -- does anyone know if Prozac has similarly daunting withdrawl symptoms? I wish someone had told me about these before I started... :/
posted by puffin at 4:01 AM on December 1, 2004

puffin: Prozac's withdrawal symptoms tend to be a lot less severe because its half-life is a lot longer: ~6 days vs Paxil's ~20 hours, if I remember correctly. Prozac is even sometimes used to help people withdraw from other SSRIs.

anonymous: I've never been on Paxil, but I did withdraw from Zoloft, whose half-life is only slightly longer, by halving my 50mg dose for a week and then stopping. In hindsight, I should've tapered my dose more gradually. It gave me the zaps (which aren't that bad from an experiential standpoint, but really make you wonder what the hell has been done to your brain) and messed with my emotions for a week or so, but it wasn't too terrible and I made it through okay. Easing off milligram by milligram with the liquid is a good idea - you could even drag it out over a period of months if you wanted to be really cautious.

good luck!
posted by introcosm at 5:43 AM on December 1, 2004

hi anon - i started weaning myself off paxil this week. i've tried before but i think that i went too quickly on my earlier attempts, cutting my dose in half (as my doctor suggested) instead of going gradually. i do suffer from many of the classic withdrawal symptoms -- nausea, headaches, zaps and hyper-emotions (a cooking show made me tear up yesterday!). anyway, i am cutting back by 5 grams this week and feel the effects with much less severity than i did the last time i tried. so go slowly, and you'll have nothing to be terrified about.

aladfar, i know exactly what you mean. if anyone had told me about the addictive qualities before i started, i might have requested a different treatment. at any rate, it would have been nice to be informed.

anon, my email is in my profile if you care to write. i'd be happy to let you know how my weaning process progresses. otherwise, good luck to you.
posted by katie at 6:15 AM on December 1, 2004

I do hope everyone who is weaning themselves off remains highly aware of their emotional and behaviourial states. The times I've tried to go off meds have ultimately resulted in relapse, and it took me a few falls before I learned to recognize the symptoms really early instead of waiting to hit bottom.
posted by five fresh fish at 9:26 AM on December 1, 2004

Friend of mine recently got off paxil due to a loss of health insurance coverage. Withdrawal symptoms were mostly headaches and some nausea... also, as fff hints at, a great deal of the anxiety the medication was meant to treat, since you've gotten used to treating the disease with the drug rather than by any other means. And vivid dreams, but this wasn't a problem for him -- while on the drug he often felt insufficiently rested on account of a lack of dream activity.
posted by dagnyscott at 12:59 PM on December 1, 2004

I've seen the suggestion that a single dose of prozac can ease the withdrawal from paxil since its longer half life helps let you down more easily.

As has been mentioned, the key thing is to have some idea of the symptoms so nothing takes you by surprise. The wife of a friend was able to come off paroxetine without suffering any side effects at all; I wasn't so lucky.

When I went through the process some five years ago there were still plenty of doctors (including my own) who were unaware of the "discontinuation symptoms". Not exactly helpful when you've got an attack of the "zaps" and don't know what the heck is happening to you.

On the actual symptoms, I suffered mild nausea and stomach pains for a couple of days each time I reduced the dose. The "zaps" started a couple of days after I took the final dose and lasted for about a week. The actual sensation was a tingling that started in my fingers and toes and then seemed to rush through my body into my head making me feel almost like I was going to black out for a fraction of a second. The more active I was, the more frequent the "zaps". If that sounds rather frightening then I should say the actual experience was far more weird than painful.

I can't comment on the sexual problems since paroxetine, fluoxetine (Prozac) and venlafaxine (Effexor) have all effectively neutered me.

And what fff said. After a couple of minor relapses I became able to recognise the onset and manage it using cognitive behavioral therapy techniques. This worked well until I hit a major downer which needed the drugs to lift me enough for the CBT to become doable again.
posted by arc at 2:00 PM on December 1, 2004