Paxil can't be that bad, right?

April 27, 2011 7:25 PM

After a year in counseling to address anxiety, my therapist recommended pharmaceutical treatment. My doctor prescribed Paxil. I'm nervous as all get-out about taking it after reading horror stories on the internet. Am I overreacting?

So I have a bag full of 20mg Paxil sitting in my medicine cabinet. After searching for "Paxil experiences", I get the impression that this stuff is more or less the most horrifying stuff in the world. Taking everything I've read into account, upon taking a few doses my genitals will shrivel into uselessness, I will gain several hundred pounds, I will try to kill myself, and will spend most nights vomiting and sweating ceaselessly. Oh and if I want to quit I will spend the rest of my life in Requiem-style withdrawal.

I know, I know... I shouldn't take horror stories on the internet seriously. Only people who have had negative experiences will want to tell everyone about it, and problems have a way of growing in the telling when addressing a group.

But still, I'm nervous about this. What can I really expect? Anyone out there start the SSRI voyage and had really good results?

posted by anonymous to Health & Fitness (17 answers total)

Any SSRI can have bad side effects. I know someone who had to try several before she found one that didn't cause bad side effects. But it was better than the anxiety.

Personally, I found that St. John's Wort (which is an herbal SSRI) did the job for me, and I needed really very little to relieve the depressive issues I had. (Divorce turned out to be even more effective, but that's another story.)

Any reason you're starting with Paxil and not a different SSRI?

Have you asked your doctor about these side effects, and why he chose Paxil over the many other available anti-depressants on the market?
posted by musofire at 7:39 PM on April 27, 2011

There is no way to know which SSRI will be for you until you try it.

I had a mixed experiences myself, Paxil made me feel great. Unfortunately, it also caused a great deal of muscle soreness in the mornings which led me to discontinue the drug.

St. John's Wort works for me as well, but it increased my sensitivity to the sun significantly.
posted by Harpocrates at 7:43 PM on April 27, 2011

I think I was responsible for at least 90% of the Internet Horror Stories about Paxil the first few years of its existence. I had lots of side effects, and bad withdrawal since doctors at the time had no idea that it could cause those withdrawal symptoms. But a lot of how I felt about the side effects--rather than how the effects themselves felt--was driven by (a) not realizing the effects were out there, were possible, were in some cases common but not really dangerous, and (b) feeding myself on too much negative information about them. Scaring yourself, it's hard to gauge whether the things are even working.

SSRIs are really individual, with different levels of side effects for everyone. Paxil seems to me to be on the stronger end of the continuum, but a friend swears that her Zoloft experience was far worse, and Zoloft was like taking chewable vitamins for me--no side effects but no visible good effects either.

So rule one of trying SSRIs is, don't freak out about side effects or withdrawal symptoms. If the side effects are unpleasant, you can switch meds. If you need to go off them entirely, your doc can work with you on a gradually tapering dose that doesn't give you weird Zombie Lightning Flash symptoms. All of that is covered. You don't have to constantly monitor yourself for side effects. You'll know if you're getting them, and you'll have a plan in the back of your head.

And, you know, the pills are not necessarily forever. I haven't been on psych meds in almost a decade, but I really don't see how I would've made it through my 20s without them, side effects and all.
posted by mittens at 8:03 PM on April 27, 2011

(I've been on five SSRI's) My shrink calls Paxil-"Packs the pounds". It's a mystery as to why your doc thought this was a first front line SSRI, but I'd question it. Zoloft is pretty weight neutral and the half life is less so you can withdraw easier. That drug was the single source in completely curing the agoraphobia I suffered for thirty years! Cymbalta, on the other hand is a horror story, best working drug I've been on but there is no exit door for this, withdrawal is a bear. Many docs prescribe Wellbutrin which also helps with smoking and other habitual crutches, and is actually aids in weight loss.

Not to be too crass but most anti-depressants have the unfortunate side effect of making orgasms less intense or not actually achieving them at all, so as a seasoned taker, I'd advise the best line of defense is to use whatever mechanical means necessary to keep the action going, aim for once a day or more, sort of like training your body to sustain the desire.

Start on the smallest dose possible (if you are not suicidal) and build up to see how you react. Anti-depressants are the best thing since shredded wheat when you get the dosage and formulation right.

Good luck, you sound like you haven't lost your sense of humor, that's a great sign things will go your way.
posted by ~Sushma~ at 8:04 PM on April 27, 2011

I like this site for non-hysterical info on SSRIs and other medications.

As far as any SSRI goes, "YMMV" is the word. You may have to try more than one to find the one that's right for you, although they ostensibly all work the same.

You don't say whether your doctor is a GP or a psychiatrist. I find the latter are generally better at prescribing SSRIs with particular people in mind. You might get a referral to a psychiatrist for your meds if that would reassure you.

I too was really scared to take SSRIs in the beginning. I had some side effects during the first few weeks, but I tolerate them very well now, and they really help me.

Good luck!
posted by sister nunchaku of love and mercy at 8:04 PM on April 27, 2011 [2 favorites]

Would your insurance mind paying for a trip to a psychiatrist for a prescription? A lot of people find Paxil hard to quit.
posted by Adventurer at 8:08 PM on April 27, 2011

I'm on zoloft, which has quite a few internet horror stories as well, though I think less so than Paxil. And, well, the horror stories were all true for me when I first started it. Nights spent vomiting and shaking uncontrollably, hot flashes, panic attacks, nearly constant thirst and dry mouth, etc. etc. etc.

And I will still tell you that the Zoloft is one of the best things that ever happened to me, once I got through the initial adjustment period. I'd second the psychiatrist recommendation, rather than starting with the GP.
posted by kittenmarlowe at 8:41 PM on April 27, 2011

All anti-depressants have side effects. And because everyone's brain chemistry is different in really subtle and minute ways, a drug that's a nightmare for some will be just fine for others. You just have to try it. I recommend seeing a psychiatrist or psycho-pharmacologist rather than a GP, and keeping in regular contact with them (monthly appointments) about how the drug is working for you. Whatever you do, if you do experience unwanted side effects, do not stop taking the meds without speaking to your doctor. I'd also recommend starting a medication diary of sorts, noting any side effects, mood, sleep, etc. It can really help when trying to find which medication is right for you.

If you want an anecdote, I took Paxil. It made me feel less depressed and helped me sleep. The only side effect I experienced was what I call "the jitters". I couldn't sit still. If I was sitting, I had to be tapping my foot or shaking my leg or whatever. For that reason my doctor switched me to something else, but really it was quite a mild side effect. Nothing that I would classify as "nightmarish", to be sure.
posted by katyggls at 2:11 AM on April 28, 2011 [2 favorites]

Currently tapering down from Effexor here, after trying Lexapro and Wellbutrin and getting variously unsatisfactory results with them as well. You really should see a psychiatrist if you can. Psych meds are... complicated, and even psychiatrists can't really predict how any given individual will react to a particular medication, but since keeping up with these particular drugs is their full-time job, they should be expected to have a deeper knowledge of them than a GP. I think you'd probably be better off trying Wellbutrin before Paxil for anxiety, largely because of the side effect profile. I unfortunately got hives from it, but I hear good things about it from those who can tolerate it.

Effexor also has some pretty nasty withdrawal, but there are ways to make it easier (thank heavens). I don't know whether the situation is exactly the same with Paxil, but part of the reason Effexor withdrawal is so unpleasant is the short half-life of the drug. So when coming off it, it's not uncommon to be prescribed a low dose of Prozac to help with those symptoms, because Prozac has a longer half-life and is easier to come off. I just started the Prozac today, and I do hope it helps. But I was having a negative reaction to the Effexor before I started trying to come off it.

If you're able, a psychiatrist will be invaluable for information and support if it's time to go on meds. The internet will be a little less helpful if you let it scare you. But it is really good for information if you can force a little balance on the hysteria.

Mostly unrelated, but potentially helpful: I've discovered that my anxiety seems to respond very well to kava, or in more serious instances valerian. You might consider trying those as well.
posted by Because at 2:12 AM on April 28, 2011

2 weeks and you may notice a slight change. Tell someone you trust you are going to take it. If they notice some bad changes that you don't recognize, they need to tell you so you can tell your doctor. It will.take roughly 6 weeks to have your system really fully SSRI-ized, but the two week mark should be a good indicator for how things should go. Not every med works for every person. You may find that it takes two or three different ones to find the right one. Each one may be a titrate up and a titrate down process. This means it could take twelve weks to find the right med for you. Don't get discouraged if it does - you want to be on the right one and it sometimes just takes time to find it.

Expect to need more sleep, to find yourself yawning when you wouldn't normally, and to possibly feel a little thick headed. But, you should also notice your ability to deal with things without your brain getting in the way. Mess don't fix you, they buy you the time and mental ability to do so, so most importantly, be working on the underlying issues or else no med you are offered will fix things in the long run
posted by Nanukthedog at 3:36 AM on April 28, 2011 [3 favorites]

Everyone experiences medications differently, and it seems that SSRI's are among the most dramatic in manifesting those differences. My suggestion (read: what I wish someone had told me) is to not only see a qualified doctor, but have at least one person who knows you well monitor your emotional state while you take these medications. I know it would have helped me.

I had very little reaction (positive or negative) the two times I've taken Zoloft for depression. Initial upswing (which may have come from the feeling of doing SOMETHING at last), followed by increased paranoia. On the other hand, I have a friend who has taken a very low dose for agoraphobia for years now and had fantastic results. He was unable to leave the house before, was miserable, with lots of OCD manifesting. Now he's got a life he enjoys. He'll never be outgoing, but he has friends and can talk to strangers, goes hiking and travels. He has a great outcome, and no plan to go off the meds.

Paxil, on the other hand ... Here's my story, which you didn't ask for (as it's negative), but may serve as a cautionary tale. My fatigue and body aches were misdiagnosed as depression, and a neurologist put me on Paxil and sent me to a psychiatrist. The psychiatrist did not have a working relationship with pre-medication me, and so wasn't able to see the changes in my behavior and life outlooks. He dismissed my husband's concerns about my attitude shifts rather off-handedly. While it is true that people coming out of depression often experience behavioral shifts, mine weren't in keeping with my philosophical or spiritual beliefs. The scary thing is that my husband didn't know the half of it ... I was daily suicidal. The problem is that the medication shifted my thinking so I felt that I deserved these negative thoughts. In this morass of self-castigation, I didn't share my thoughts with anyone. I remember sitting in a dark room in my house, crying, just wanting to die, and truly believing the world would be better off without me.

The weight gain was almost incidental to this. I had always been a naturally thin person. I hate the taste of chemical additives and like fresh vegetables; I'd never even wanted to add dressing to a salad. Just wasn't it my makeup. Within a few weeks of starting Paxil, my hunger was incredible... the takeout dinner that would have lasted three meals previously now barely satiated me. My stomach felt physically full, but my urge to just EAT was overpowering. It was a compulsion. For example, I ate an entire box of Twinkies (and I HATE Twinkies!) in one sitting, but couldn't realize that this was not normal. When I finally, 50 pounds later, hesitantly mentioned this to the doctor, he laughed and said, "Well, Paxil packs it on..." and switched me to Zoloft.

I don't know if my reactions were so negative because I didn't actually NEED an SSRI at the time, or if my individual body chemistry just couldn't deal with the Paxil, but having an close, non-over-reactive friend (NOT a spouse or partner), with whom you're really comfortable, doing a check-in with you a couple of times a week to see how you're REALLY doing may be a literal life-saver. I'm actually very thankful for the weight gain, despite my inability to drop these extra 50 pounds, because without that visual signal that something was wrong I might have stayed on the Paxil until I ended my life, or became so erratic that someone checked me for weapons. The key point here is that normally-outspoken me didn't tell ANYONE what was going on in my head. That was the Paxil's hidden side effect. I really wish someone I trusted had asked me the kind of questions that might have made me go "Ohhhhhhhhhhhh.... maybe it's the MEDS!"

To reiterate: get the care you need, but make sure you have backup.
posted by theplotchickens at 3:51 AM on April 28, 2011

I had zero side effects with Paxil. No weight gain, no pain, no anxiety, no sexual side effects, nothing. When I decided to switch drugs, I had zero withdrawal symptoms.
posted by decathecting at 5:10 AM on April 28, 2011 [1 favorite]

I think that it will be strickly YMMV on it. I've personally taken it and it was horrible (however, I was also 14 at the time). But I have known quite a few people who have had good experiences with it. On the other hand, I take Effexor and while I would never switch unless absolutely necessary, you should read the horror stories on that.

It really just depends on the person. I have tried Paxil, Lexapro, Zoloft, Luvox, Effexor... uh... I think that is it. There are lots of people who can take any number of those drugs, they just didn't work for me (except Effexor). If you are seriously concerned about the side effects then talk to your doctor again about it. Most doctors will not put you on a medicine unless they believe that the benefits will outweigh the risks. Good luck!
posted by ForeverDcember at 6:13 AM on April 28, 2011

This means it could take twelve weeks to find the right med for you. ~ Nanukthedog

No, it means it could take a lot longer than that. I don't want to worry the OP, but my fairly complicated case of depression took four years to find the right combination of meds. (Caveat: I was on two decent but not very helpful meds for a year at a stretch each. If I'd done all the med changes one after the other as soon as I realized stuff wasn't really working, it probably would've only taken 2 years total.)

IF and only if an SSRI is the ONLY answer for you (i.e. you don't need other meds in combination with the SSRI), you should still be taking 12 weeks to taper up and wait for the med to work, as recommended by STAR*D (the largest patient-based study). Multiply that by the number of drugs you could possibly take (6 different SSRIs are on the market, according to Wikipedia) and you're looking at, worst case scenario, 18 months to give them all an adequate trial.

The same study says that 1/3rd of patients respond to the first antidepressant, of those left, 1/3rd respond to the next, etc, etc.
posted by saveyoursanity at 6:21 AM on April 28, 2011 [1 favorite]

That's not even touching the ideas of meds in combination, by the way, and this is why you need a psychiatrist, NOT a GP.
posted by saveyoursanity at 6:22 AM on April 28, 2011

I was successful with my anxiety/depression treatment with my GP, but maybe she was more knowledgeable than the average GP. It did take more than one try of med, and ultimately Zoloft was the best for me. All had some level of side effects, it depends on what you can live with. Zoloft started out at a low dose and gradually increased it. Some weight gain 8-10 lbs then stopped gaining. Very, very jittery for 2-3 weeks in the beginning as well as very tired but both eventually stopped. It was worth fighting through the first month though.

I have gone off of it once and again the key is going very gradually. It was hard, but not as bad as a lot of stories online.

I think the key is to be patient, and keep trying because something will work but it may take some time.
posted by maxg94 at 6:36 AM on April 28, 2011

One thing to keep in mind is that people seem to be much more willing to share negative stories/complaints than positive information. While your search may yield mostly nightmares, it could just be that the people with positive experiences are out there living their lives and not posting.

Advice others have given is pretty much spot on. I'd also like to add that if you decide you want to add supplements or herbal meds to your current regimen, you need to let your doctor know. Even though those meds are non-prescription, they can still have interactions with your prescribed medications.

I will say that I did not have a bad experience on Paxil, but it only provided temporary relief for me and I ended up having to switch. I did not have bad withdrawal, either.
posted by catwoman429 at 7:37 AM on April 28, 2011 [1 favorite]