First time Paxil user experiencing nausea

October 19, 2005 6:48 AM

Hello all, My doctor prescribed Paxil for me last night due to my heavy case of anxiety and seasonal depression. I took it about 2 hours ago (one pill, 20mg) after my breakfast and I am experiencing some nausea and shakiness in my hands. From what I understand, Paxil can take up to two weeks to 'kick in' but considering my past with other chemicals, things always affected me differently than most people. For example, whenever I took any cough syrup that had Dextromethorphan chemical inside of it (cough supressant), it would make me feel like I was completely out of it for at least a week, even if I only took two recommended doses per day. I suppose it's just my body and the way it reacts to certain things. I am just wondering if there are any Paxil users on this site who could tell me a thing or two about what it was like for them the first time they took it, or maybe anything else that I need to know. Thank you kindly.
posted by smoothie to Health & Fitness (24 answers total)

Response by poster: I apologize for having the whole question show up rather than just the summary! Is there way to edit this?
posted by smoothie at 6:50 AM on October 19, 2005

Heya.

I was on Paxil for a while, and experienced almost exactly the same symptoms. Tweaking when I took it compared to when I had to eat (and sleep) helped ameliorate those effects somewhat, but bear in mind that your body is adjusting to a new chemical being put into it. While it does take time for the drug to have any effect on your mental state, it will have much simpler biological reactions from the moment you start taking it and absorbing it into your bloodstream. Give it a week or two, and your body will begin to adjust.

As well, I would like to ask: do you have a psychiatrist overseeing your medication? Paxil isn't right for all people for all situations, and most general practitioners aren't versed enough in its (or indeed any antidepressant medication) intricacies to really be sure they're prescribing the best fit for your situation. Talk to your doctor; I'm sure s/he knows a psychiatrist who'd be happy to consult on the case and keep an eye on things.
posted by dirtynumbangelboy at 7:03 AM on October 19, 2005

I had a horrible time getting used to the same dose of Paxil, with nausea and shakiness being the main symptoms. Also a loss of balance and tendency to fall over if I stood up too quickly. I found that taking my dose in the morning with breakfast rather than in the evening made things much, much better. (Presumably the side-effects were time-shifted to when I was asleep and didn't notice). For the first two weeks I found that I still felt slightly nauseous at all times when I wasn't actually eating, but this went away.

A close friend of mine had the exact same experience; she too switched to taking her dose in the morning and immediately felt much better. We never understood why our doctors had suggested taking it in the evening and never asked.

You are probably quite forgetful at the moment; keep a few pills at work or in your bag or something so that if you forget to take your pill in the morning you can still have one when you remember. Skipping a day sucks.

I remember that when coming off the drug I had a lot of problems with shaking hands and loss of balance; I reduced the dose to 10 mg and then zero over a period of two weeks and had fewer problems than people I know who came straight off. (Might seem a long way off to you now but it will happen!)
posted by nowonmai at 7:21 AM on October 19, 2005

As DNBB says, all antidepressants may take some time to work on your anxiety and/or depression. Unfortunately, the side effects begin right away and (usually) lessen with time. I'm also extremely sensitive to med switches and experience the same things that you do.

Also know that these meds don't work in the same way for all people. The practice of psychiatric medicine is very nuanced. So I would second getting a specialist to oversee your treatment. They are MUCH more aware of the slight differences in med treatments, etc. They can also advise you ahead of time on the different withdrawal effects should you have to switch, the different side effects, which meds might be more effective on SAD versus general depression, etc. They should also check for other causes of your symptoms...sleep disorders, hormonal imbalances, thyroid, etc.

Take what you read on the Internet with a grain of salt. There is a load of information out there and it is very easy to become overwhelmed by conflicting information or accounts. Educate yourself while choosing your information sources carefully. But don't be afraid to challenge your providers or to ask them detailed questions.
posted by jeanmari at 7:22 AM on October 19, 2005

The Wikipedia entry on Paxil (paroxetine) indicates how very negatively this drug is regarded by many, myself included. Read it to get a good overview of just how controversial the medication is, however as with all meds, your mileage will vary. From personal experience it's a superb antidepressant with unacceptable side effects (specifically sexual).

Note also that the technical definition of 'addictive' and the lay understanding of the term differ, such that Paroxetine is not, technically addictive in that you don't require ever larger doses to get the same effect. If you try and come off the stuff however you'll get a nasty surprise, bizzare 'electrical shocks' and other withdrawl symptoms. Most people would consider this an addictive drug in the normal sense of the word.

Again reading Wikipedia I note there is a group who consider the sexual downside of Paroxetine possibly permanent. To my distress, I suspect there may be some truth in this. Oh dear.

This is not a well understood drug, for all its mass prescription and despite the fact that it certainly does work. You might be better with something else, for example Remeron. Good luck.
posted by grahamwell at 7:49 AM on October 19, 2005

Response by poster: Thanks for the replies everyone. The sexual side affect got me thrown off a little and I really do hope it doesn't affect my sex life.

Does anyone have any experience with using Paxil and having no sexual side affects?
posted by smoothie at 8:14 AM on October 19, 2005

This is helpful, as is most of about.com on this subject. I didn't wish to scare you - you'll either experience the sexual side effects or you won't. If you do, tell your doctor and she'll help you switch to something else. Wellbutrin or Remeron are much better from this point of view.
posted by grahamwell at 8:31 AM on October 19, 2005

nausea and shakiness are common side effects. I also could not stop yawning. It was weird, but mostly paxil had a very positive effect on my. Many people have bad experiences with it, but it can affect people very differently. Give it a few weeks.
posted by corpse at 8:37 AM on October 19, 2005

The only sexual side effect I had was lasting longer, which depending on how you look at it is good or bad. I have since went off, and had no side effects while decreasing my dose. I went down 5 mg every 5 weeks. The sexual side effects disappeared as my dosage decreased.
posted by corpse at 8:42 AM on October 19, 2005

I experienced mild nausea for about 10-14 days, lessening in effect each day, when I began taking Paxil (brand name is Seroxat in the UK). It's perfectly normal, as far as I am aware.

I have had two periods of taking the drug - each time for about a year, but the last three months of both periods was a very, very slow reduction in the dose. It's not advised to just stop taking it - that will screw up your brain chemicals.

I didn't experience any sexual side effects from taking it. I've not taken any medication for about three years, but if I ever became ill with depression again, I would not hesitate to take Seroxat. It was a life-saver for me during two very, very difficult periods of my life and gave me the equilibrium to look at things with some clarity and make some much-needed changes.

Good luck.
posted by essexjan at 9:01 AM on October 19, 2005

This isn't strictly related to your question but it is relevant - Paxil has a number of nasty side effects not only when starting the drug but most importantly when coming off it. Dropping Paxil is a hellish experience for most, and for some people the side effects they experience while coming off it can last for six months or longer. The horror stories are legion, and the Wikipedia article only scratches the surface. Please ask your doctor to try a different SSRI. The only other one I'd make a point to avoid is Wellbutrin, but nothing compares to what you hear about Paxil in large support groups.
posted by Ryvar at 9:02 AM on October 19, 2005

A great site with lots of real world anecdotes about Paxil and other antidepressants is CrazyMeds. The author sorts through the drug company spin and tells you what's real and what's BS.
posted by Serena at 9:06 AM on October 19, 2005

I took Paxil for a very short period. After taking the first pill I lost control of the muscles in my hands-the fingers would either bend backwards, splayed, unnaturally, or would curl into fists so tight that my fingernails dug into my palms. I went to the ER(I was TERRIFIED), they gave me benadryl, and I never took it again.
posted by Juliet Banana at 9:22 AM on October 19, 2005

I've written about my experiences with Paxil fairly extensively, and have linked to them here more than once. Still, I think it's good to discuss these things openly and frequently. So, with the obligatory request for pardoning the self links:

Paxil Zaps
No More Pinkos
More on Paxil

You'll note that all of those entries are written in the first person plural - an obnoxious habit that I've since abandoned. Apologies for the snobbery of it.

To answer some of your questions directly:
Shakiness and other reactions to antidepressants are entirely normal. If it starts to bother you, talk to your doctor and try something else. I was on Zoloft for a time, and it simply didn't work out. Paxil was much better for me.

Sexual side effects are common, but I've not experienced them at all. Except, like corpse mentioned above, I seem to last significantly longer. This might bother your partner, but if you explain it openly, it's not something that anyone really minds. What really worries people is that it will reduce your desire for sex. Thankfully, this has not been the case for me; I'm just as horny as ever.

Also, as mentioned above, quitting Paxil is difficult. You'll find out lots more about that should you read about my experience with the "zaps". So if you miss a dose or two, don't freak out when you start feeling strange - it's also completely normal. Unfortunately, I found this out the hard way and thought I was having a stroke or a seizure of some kind. So when you're ready to wean yourself off the drug, make sure you do it gradually. You can get it in liquid form and go down milligram by milligram if you need to.

Lastly: Paxil changed my life for the better. It took a long time for me to accept that I had a problem and to seek out medical help (to quote GI Joe, that's half the battle). When I finally got to Paxil I found that I finally felt normal. Not high, not happy, not drugged, just normal. If your depression and anxiety is at all like mine, this is what you're praying for. Paxil (I should say paroxetine as I only take the generic) worked for me. It might work for you. If it doesn't, you can try something else. The point is that there are solutions and you can feel better. Good luck!
posted by aladfar at 9:34 AM on October 19, 2005

I would again like to say that it has different effects for different people. You just here about the horror stories more. IT could be the drug for you, give it a chance to settle in your system.
posted by corpse at 9:37 AM on October 19, 2005

We never understood why our doctors had suggested taking it in the evening and never asked.

Because drowsiness is a common side effect.
posted by kindall at 9:37 AM on October 19, 2005

Another option, rather than switching meds, is to talk to your doctor about going down to 10 mg to start. Sometimes 20 mg is too much for people just starting out. I think it's only offered as 20 mg size and up, so you may need to split pills.

I had to do this with Prozac in the late 80s. Back then it only came in capsules so I would literally have to open them up, break up the powder in halves, restuff one half of the gel capsule, and swallow. Pain in the ass. But probably saved my life.

I'm on Paxil now, have been on several types of SSRIs over the years. Email in profile if you want to chat.
posted by Sorcia at 10:15 AM on October 19, 2005

I quit taking Paxil because I became a complete sloth; I had no motivation to do anything whatsoever.
posted by mischief at 12:14 PM on October 19, 2005

Paxil made me want to kill myself. No other anti-depressant made me feel this way (and I was in NO WAY suicidal to begin with).
posted by necessitas at 12:18 PM on October 19, 2005

I think it's only offered as 20 mg size and up, so you may need to split pills.

Paxil is available in 10 mg pills.
posted by kindall at 12:52 PM on October 19, 2005

I've prescribed Paxil and other SSRIs hundreds of times. The first thing I'd recommend is halving your dose to 10mg daily; tablets can be split by pressing them with thumb and finger on a tabletop. When the time comes to stop (you've been stable for 6-12 months), taper off slowly; 5 mg/week sounds about right. This need to taper off slowly is more true for Paxil than for other SSRIs (Prozac, Zoloft, Celexa/Lexapro).

Loss of libido is a common side effect with SSRIs, although it affects a minority (1/3?). Loose stools is probably the second most common, affecting <10%. These effects resolve when the drug is stopped. If you're ill enough to warrant treatment with Paxil, don't be afraid to try it. And BTW, generic paroxetine is -much- cheaper than Paxil.
posted by neuron at 3:04 PM on October 19, 2005

I began taking paroxetine (generic Paxil) about a week ago, and it's given me mild nausea, too. It has also made me feel pretty tired/fatigued. From my experience with other SSRIs (and from what my physician says), these things lessen over time. My nausea's already almost disappeared.

I recently read on crazymeds.org that discontinuation syndrome can be particularly nasty with paroxetine, so it's important to make sure not to skip a dose. Silly as it may seem, I've found that using a pill container (the sort that has a compartment for each day of the week) really helps me remember to take my meds.

Also, to add to what neuron said, not only is generic paroxetine cheaper than Paxil, it's a lot cheaper at Costco or Costco.com, and you *don't* have to be a Costco member to use their pharmacy.
posted by needs more cowbell at 4:30 PM on October 19, 2005

I had some symptoms starting it, they lasted only a few days. When they say "2 weeks to kick in" I think they mean for the antidepressive/antianxiety characterstics. It will make an impact on your brain chemistry from day one.

I took 20 mg daily for about five years and had no significant problems or side effects from it. There's no question in my mind it helped me, made me more productive, and allowed me to get more out of therapy (which I started well before I started taking it).

I would experience physiological manifestations if I missed even a single pill and it would take 1-2 full days for those to resolve completely after resuming medication - so I second the advice to get a one-a-day pill case to help keep you on a regular schedule - and take it at the same time as consistently as possible. Before bed works best.

There were definite phsyiological manifestations following withdrawal of the medication. They were unpleasant and irritating though not impairing and took about two weeks to resolve completely. I didn't taper down or do anything special about it, I just stopped taking it. I figured it had to clear up eventually and gritted through it. Perhaps my experience is atypical but it did not remotely live up to the "horror stories" some have referred to, it was just annoying little sensations, diminishing in frequency and instensity over time.
posted by nanojath at 8:43 PM on October 19, 2005

When I first started Paxil I had headaches, a constant feeling that I was about to yawn, but then I couldn't yawn, and a gagging feeling.

Now I have only one side effect, which is that it takes me longer to acheive orgasm. I have heard from friends on Paxil that this is common, both amongst men and women.

The "zaps" are unpleasant.

Overall I am doing great on Paxil, but wish there was some way I could be free of it and feel right. (I am taking it for social anxiety and depression).
posted by Jesse H Christ at 9:05 PM on November 6, 2005