Should I go off Paxil?
May 27, 2021 7:01 PM   Subscribe

I am a 72 year old male and have been on Paxil 40 mg for well over 20 years, the last 10 or so years without psychiatric follow-up - my personal physician has been subscribing the medication. I need help deciding whether I should try to go off Paxil. More following...

I originally started Paxil for symptoms of anxiety, depression and OCD. It helped immensely and I have had no further bouts of my initial symptoms! Plus, except for some minor sexual dysfunction, I have never really had any side effects. As I get older, I hear warnings about a connection between Paxil and dementia. This makes me think I should try it. I mean, if I develop psychiatric symptoms again I can always go back on it, right?

I'd rather not start up a relationship with a psychiatrist again. It's been a long time and for years I've been doing great. And if I'm not feeling well mentally I have no problems with starting up again. I am also well read on the problems/complications with stopping Paxil. My personal physician can help with dosing.

Does anyone here have experience doing this? Was it hard? What was your decreasing dose schedule? What do you think of this idea?

Oh, and I acknowledge you are not my doctor.
posted by anonymous to Health & Fitness (11 answers total) 2 users marked this as a favorite
Honestly, if I was fortunate enough to land on a drug that helped with my anxiety and depression with minor side effects, I would stick with it.

No judgement, just my hot take. It's been too long since I went off Paxil for my anecdota to be useful, but I wish you luck in whatever path you choose.
posted by sm1tten at 7:13 PM on May 27, 2021 [8 favorites]

What sm1tten said. Times infinity.
posted by Thorzdad at 7:22 PM on May 27, 2021 [1 favorite]

I quit paxil after being on it for about 3 years. It helped my depression, but I gained a lot of weight and slept about 14 hours a day. This was in the early 2000s, so it's a bit hazy,
but I believe I tapered down over the course of a month or so.

Things I remember:

Everything seemed suddenly very alive. I was suffused with emotion at all times.

I was incredibly horny.

I lost weight and slept less.

I developed severe sleep paralysis. I didn't know what it was at the time and it was terrifying.

I had brain zaps.

I plunged into a severe depression that didn't lift till I started on zoloft about a year later.

Take all this with a grain of salt; I was isolated and in a bad place personally when I stopped. I also had just started dating a heavy pot smoker and drinker and I promptly started self medicating with those substances. If you're in a more stable place in your life then probably you won't have the nightmarish roller coaster that I did. And of course all of this stuff is incredibly variable due to genetics. Are there any other SSRIs you could try that aren't implicated in Alzheimer's, possibly that your regular doc could prescribe? I would recommend tapering as slowly as you can stand it. I don't think a month was long enough for me (I would have dragged it out longer but I was running out of meds and had no doctor. )
posted by cat friend at 7:50 PM on May 27, 2021

This is just one piece of anecdata, but I dated a woman years ago who told me she had been on an antidepressant that worked really well for her with a very small dose. She and her doctor thought that since it was such a small dose she should try going off it. That turned out to not be a good idea for her and then when she tried to go back on that antidepressant it no longer worked for her. She had to start taking a different drug that had more serious side effects including sexual dysfunction.

It’s just my $0.02, but if it’s not broke, don’t break it.
posted by cali59 at 8:05 PM on May 27, 2021 [7 favorites]

Don’t rely on anecdata about people who aren’t even on the same drugs you are - mine is that I’ve gone on and off bupropion a few times as needed and it’s continued working fine for me. A friend also on bupropion has had a similar experience. People don’t talk as much about experiences that went fine.

I’d look for a mental-health-specific forum in addition to answers here - I looked at CrazyMeds when I was first considering medication, but apparently it’s been taken down. Probably Reddit has a relevant community but I don’t have specific suggestions. You can also try PubMed, which allows you to search abstracts for published medical research - I’ve used it for other medical conditions and found it very useful. None of these will have 100% excellent advice (some research is surprisingly bad!), but using multiple sources will help you sift out the helpful/reliable stuff.
posted by momus_window at 9:22 PM on May 27, 2021 [1 favorite]

You should also know untreated depression may also increase the risk of dementia. And in older adults, depression often looks like dementia.

I would do a careful risk/benefit analysis before you make your choice. You don’t have to establish with a new psychiatrist, but you could do one consult and then have your PCP manage from there.

Finally, while I don’t take Paxil I do prescribe (rarely)—it can be a very difficult drug to stop (which is why I rarely prescribe it). A psychiatrist could also discuss with you a reasonable taper schedule, and other methods to help mitigate SSRI discontinuation syndrome.
posted by namemeansgazelle at 9:52 PM on May 27, 2021 [5 favorites]

No anecdata re: Paxil, but what is your reasons for not wanting to see a psychiatrist? Although your PCP could probably help you with reducing your dose, as seen above, these things affect everyone differently, and if you do experience negative side effects, it can take a long time to get in for an initial appointment with a psychiatrist. Whatever you decide to do, I would recommend at least getting that initial appointment in, and see them every 3-6 months to stay in the system for easy access if needed.
posted by sillysally at 11:34 PM on May 27, 2021 [4 favorites]

If it works for you, it works for you, and I'd agree with namemeansgazelle that something that makes you functional is going to be better for your brain than any alternative.

If you're uncomfortable re-establishing a clinical relationship with a psychiatrist per se, then there are often PAs or NPs with prescribing powers in mental health clinics who are much less psychiatrist than actual psychiatrists. Your PCP should have someone or somewhere to send a referral. In very broad terms, those practitioners tend to think that 90s-vintage SSRIs are blunter instruments than newer meds, especially in terms of side-effects and withdrawal, but any transition to different meds is guesswork that requires self-monitoring and checking in relatively frequently. You'd also have to gauge your PCP's comfort level in taking over long-term prescriptions.

(Personally, I hate Paxil because it gave me all of the worst mental side-effects that are associated with it, but brains differ.)
posted by holgate at 11:58 PM on May 27, 2021

I personally would go to a psychiatrist or psychiatric nurse at least once to discuss this, but if you really don't want to go to a psychiatrist, you should still talk to your GP about it, because your doctor can discuss your specific risks for dementia with Paxil, in combination with your specific other medical risks, in a way that no one on the internet can assess for you.

Anecdata: Given my friend's experience with Paxil and mine with another similar drug, meds (esp. those with short half-lives) can be harder to taper off for some people than others. Some people really do have to go much more slowly than the pharmaceutical company's instructions. Sometimes people are prescribed another short-term (overlapping) antidepressant to help wean off the initial drug. It's another reason to work with your doctor on going off a medicine you've taken for so many years, if you decide you want to.
posted by nantucket at 4:11 AM on May 28, 2021

Addition to momus-window's post. Bupropion works in a very different way than Paxil. To put initials on it, bupropion is a norepinephrine/dopamine-reuptake inhibitor (NDRI) and Paxil is a selective serotonin reuptake inhibitor (SSRI), as are many other anti-depressants including Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva),
Sertraline (Zoloft). I think it's worth paying for a psychiatrist consult. I wouldn't think my GP would be a good source of knowledge.
posted by tmdonahue at 6:48 AM on May 28, 2021

Adding to the chorus to suggest consulting a psychiatrist.

A consult with a psychiatrist can get you two benefits-- an expert opinion on what exactly your risk for dementia is if you continue to take Paxil; and, if you decide to go off it, you'll get expertise for the best schedule to do that.
posted by tuesdayschild at 1:50 PM on May 28, 2021 [2 favorites]

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