J.B. is someone who went through Paroxetine withdrawal at about the same time I did and had a very similar experience. She’s also an excellent researcher.  Her extensive research eventually came together in the following document. With J.B.’s permission, I swiped this document from another site and reproduced it here in a slightly different form (I added a table of contents, corrected some grammatical errors; stuff like that, nothing big). NOTE: Some of the information on this page may be out of date, and I haven't checked to see if any of the links work. Got to paxilprogress.org to confirm the accuracy of this information.

J.B.'s Almost-Complete Guide
to Withdrawing From Paxil

The only (almost) complete information about withdrawing from Paxil, from beginning to end, has come from piecing together message board postings of those folks who have actually done it. There has been a big need for this information in one sourcenot just bits and pieces. I've tried to gather as much as I could from former Paxil users' experiences (including my own) and to share it with those attempting to get off Paxil. Feel free to distribute this document in any way.

When withdrawing from Paxil, you have to decide which method is right for you. Everyone is different, so experiment. Tapering the dosage down over a period of time seems to be the preferred way to stopversus quitting Paxil "cold turkey." The withdrawal symptoms during tapering are generally much less intense than going cold turkey.

Although some people can quit Paxil and suffer no withdrawal repercussions, countless numbers of folks have quit or tapered and have suffered nausea, dizziness, electric shock sensations sometimes known as "the zaps," headache, flu-like symptoms, balance problems, anxiety, sleep problems, gastro-intestinal problems, sweats, vivid dreaming, sensitivity to light and/or sound, etc. The list goes on and on...

Withdrawal from Paxil is happening in much greater numbers than the manufacturer, Glaxo SmithKline, has reported to the FDA.


- Table of Conents -

The Ignorance of Doctors
The Vicious Circle of Paxil
Before You Begin...
Tapering Down Method
Cutting Pills
Paxil Liquid (suspension)
Your Paxil Reduction Schedule
Cold Turkey Quitting—Zero
What are "The Zaps"?

The Switching Method
Some Suggestions During Withdrawal
Natural Remedies
Dangerous Combinations
Serotonin Syndrome
Post Paxil
Vitamins and Herbals
Withdrawal Syndrome
Documented in Medical Journals


Withdrawal can be miserable, so it's important to figure out what works best for you and puts you in the least, if any, discomfort. Plus, it really helps to plan out your withdrawal carefully.

Sadly, a lot of doctors/psychiatrists don't know about the withdrawal effects of Paxil. Some even will deny that they happen. In a perfect world, you should have been told about the potential for withdrawals from Paxil at the time it was prescribed for you. Most folks aren't. Withdrawal from Paxil and SSRI drugs is a documented fact and I will provide a list of medical journal articles later on that you can copy and take to your doctor if he/she is an "unbeliever."

The most important thing is to make sure that your doctor is aware of the withdrawals from Paxil and understands the tapering method. How you decide to taper is up to you, because some doctors will taper a patient too quickly. Tapering has to be individualized. One size does not fit alland don't let any doctor tell you otherwise.

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The Vicious Circle of Paxil

Quite often, Paxil patients, who are unaware of withdrawal, go to doctorswho are also unaware of the withdrawaland the ignorant doctor diagnoses the withdrawal symptoms as depression or anxiety "relapse." The doctor will then try to actually INCREASE the patients Paxil dosage.

When you withdraw from Paxil, it's not always pleasantbut have some judgment here, especially if your doctor tries to increase your dosage and starts talking about 'relapse' returning. This mistake of doctors diagnosing 'withdrawal' as being 'relapse' has been noted and journaled in several medical publications. Make sure your doctor knows about and ACCEPTS the fact of withdrawals from this drug. If not, find a new doctor that does.

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Okay, so you're ready to quit Paxil.
Before you begin...

Withdrawal effects usually start between 2 to 3 days after reducing or stopping the dosagebut they can start as soon as 1 day or take as long as 7 days. Generally, by day three you should start to know. If you taper too fast, believe me, you'll know.

When decreasing your dosage, be aware of how you act & react emotionally to situations with othersafter all, this is a psychological drug. Be prepared for mood swings.

It's also best to try this when you have days off from work. It's not fun to get nauseous, dizzy, anxious, etc., at workand then have to drive home? In other words, if you have Saturday and Sunday off, try tapering your dose on Fridayyou should start to know something by Sunday in most cases. Be sure to keep that little 10mg piece on Paxil on hand (explained below). Don't leave home without it, and don't go away for the weekend without your normal dosage with you. I don't suggest experimenting with tapering on a "weekend getaway" trip either. Do it in your normal surroundings.

Plan a schedule for tapering in advance. By learning what to expect and informing yourself, you will save yourself a lot of unnecessary worrying.

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Tapering Down Method

If you are taking 30mg and above, you can start by dropping down 10 milligrams lower than your normal dose and see if you start to experience any withdrawal effects. Save the 10mg piece and take it with you.

If you are taking 20mg or lower, start with a 5mg decrease. The example below refers to the 10mg drop. Follow the directions with a 5mg drop instead of 10. Save the 5mg piece and take it with you.

If you DON'T have any noticeable withdrawal effects from this decreaseremember, give it 3 to 7 days for withdrawal effects to start. Stay at this minus 10mg dosage until you've determined you're out of the woods. Decide how long your body needs to adjust to this decrease before lowering the dose again. 1 week? 1 month? Longer? You have to decide this based on how you feel physically and psychologically.

Once you eventually taper down to taking only 10mg a day, then go to 5mg for a while, then 2.5mg, and then try zero. The last 10mg has been the most difficult drop for some. And some people don't develop withdrawals until the last 10mg.

If you DO HAVE noticeable, unbearable withdrawal effects from this decreaseSTOP. Take the 10mg piece to finish out your regular daily dosage. If you start to have unbearable withdrawal symptoms, a 10mg drop is too much for you. Start taking your regular full dose again tomorrow and wait a few days to start this process over with a 5mg decrease. Most withdrawal effects subside after taking the regular dose again. The next step now is to try decreasing Paxil by 5mg, and if the withdrawal effects start with this decrease, repeat the above steps with the 5mg piece that you saved and hopefully still have with you. You may have to decrease dosage in 2.5 mg increments if the withdrawal effects from a 5 mg drop become intolerable.

This is the point where you have to figure out if you are one of the lucky ones and can taper off Paxil with easeor if this is going to be a long and tedious processor if you're somewhere in the middle.

Some people can come off Paxil with no problems. Others, on the extreme, have found it necessary to drop in increments as low as 2.5 mgs for months and then taper the last few milligrams with the Paxil liquid (if you can get it). You have to find what works for you. And if you do develop some withdrawal symptoms, you must decide just how much withdrawal you can tolerate before having to return to your normal dose and start tapering in a smaller increment.

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Cutting Pills / Paxil Liquid (suspension)

Any pharmacy can sell you an inexpensive pill cutter. With a pill cutter, you can cut a pill in half (and a half pill in half). People have also used razors, Exacto knives, and nail clippers to make really small doses. Eventually, get your pharmacist to refill your prescription with the 10mg pillsit will be much easier to cut these into smaller doses once you've tapered below 10mg.

Another great alternative to cutting or shaving pills is to get the liquid form of Paxil (if it's available in your country). The orange flavored Paxil liquid is good for accurate, small tapering doses as small as 1mg. Most pharmacies have it or can get it for you. Some pharmacists have never even heard of the Paxil liquid form so don't let them tell you it doesn't exist. Here's the info in case they do:

Paxil Oral Suspension (liquid): Orange-colored, orange-flavored, 10mg/5 ml, in 250ml white bottles. NDC 0029-3215-48.  Take this NDC # with you to the pharmacy.

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Your Paxil Reduction Schedule

As stated, tapering down Paxil is an individualized process. By having patience and sticking to a reduction schedule, you might not develop withdrawals. Below is Jeff's example of a reduction schedule and his comments.

"Here's the approximate schedule that worked for me.

From 60mg to 40mg in 10mg steps.
From 40mg to 30mg in 5mg steps.
From 30mg to 20mg in 2.5mg steps.
From 20mg to 0mg in 1mg steps.

Down to 20mg, I was chopping up tablets to control the dosage. From 20mg down, I used the liquid Paxil.

Every change in step size indicates a point where the withdrawal symptoms hit. When this happened, I went
back to my previous dose for a few days, then started again with smaller steps.

I was decreasing my dose about every 4 days. This made sense to me because if the withdrawal symptoms were going to hit, it always seemed to happen in the 2nd or 3rd day after a dosage decrease.

I was stuck for a long time at 20mg. Fortunately I changed doctors and the new one told me about the liquid Paxil. From there on it was pretty smooth sailing in 1mg steps all the way to 0mg unless I missed a dose or got impatient and tried to go faster."

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Cold Turkey Quitting—Zero

I quit Paxil cold turkey. For me, it was Hell and completely incapacitating for more than a week. By Day 3 with no Paxil, I knew something was really wrongbut it took 3 days for the withdrawal to even begin. Having no prior knowledge of withdrawals, and not being told by my doctor or pharmacist that this may occurI was in for quite a ride. I now wish that I had known about the tapering method before I decided to cold turkey off Paxil.

Days 4 through 8 were the absolute worst. I had a low-grade fever, night sweats, headache, nausea, balance problems, sleep disturbances, upset stomach, and the zaps like you wouldn't believe. At one point, I was up to 14 zaps per minuteyes, I actually timed them. It took a total of 3 weeks for these symptoms to gradually subside.

For most, cold turkey is not the way to go.

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What are "The Zaps"?

The zaps are little shock-like sensations, which occur during Paxil withdrawal. More annoying than painful, the sensation would start in my mouth and head and 'shoot out' towards my extremities for a split second like a low voltage shock. If you were ever dared as a kid to touch a 9-volt battery to your tongue, then that's the best way I can describe a zap. They can happen with head and eye movement, or even while sitting perfectly still. After a while, you can begin to hear the zaps happening in your headlike a 'swoosh' sound.

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The Switching Method

Although I don't suggest switching drugsone SSRI drug for anothersome people have used this method to taper themselves off Paxil. Even if you decide to switch drugs, withdrawal from Paxil can still happen using this method. Prozac, Celexa, Zoloft, Luvox, and the other SSRIs also have their own very similar problems as well. If you switch drugs, in a lot of cases, you're right back having to taper yourself off the new SSRI drug too. Some people have switched SSRIs with easeothers haven't. This method can start a merry-go-round of SSRI related problems.

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Some Suggestions During Withdrawal

As far as alleviating the withdrawal symptoms, it seems folks have tried everything available, both over-the-counter and herbal remedies. You must make sure to read the product information for anything you try for potential interactionsespecially if you take some other drug in addition to Paxil.

Here are some suggestions to help ease withdrawal:

Drink large amounts of water. It really helps to keep your system flushed.

A multi-vitamin and B vitamin complex are good.

Try to keep something on your stomach. If you have to, eat several small meals a day, rather than large ones.

For nausea: crystallized ginger, ginger chews, ginger tabs, ginger ale (from a health food store).

For nausea/dizziness: Bonine, Dramamine, (also know as Antivert) in the US, Gravol, Meclizine in the UK
(from the drug store)
.

For headache: Whatever over-the-counter 'headache drug' that you can normally tolerate is okay. Some have suggested the drowsy "P.M. formulas" at bedtime of Tylenol, Excedrin, etc., to help with sleep disorders, but againread the label.

Some have tried cold formula remedies, but cold formulas sometimes have an ingredient which can 1) cause anxiety, and 2) interact with Paxilin a bad way. It would be best to stay away from cold medications.

For anxiety/nervousness:

Kava Kava capsules and tea (from a health food store).  Check out these links for more information:
http://www.kcweb.com/herb/kavakava.htm
http://www.tnp.com/propages.asp?ID=30
http://www.herba-medica.com/reports/kava.htm

Valerian (from a health food store).  Links:
http://www.theherbsplace.com/valerian.html
http://www.tnp.com/substance.asp?ID=94
http://www.nutramedix.com/text/Piu/thirdparty/valerian.htm

Inositol (from a health food store).  Links:
http://www.tnp.com/substance.asp?ID=141
http://www.healthhelper.com/vitamins/vitamins/inositol.htm

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Dangerous Combinations—Serotonin Syndrome

There are many herbal and natural remedies available as alternatives to taking prescription drugs. They should not be taken with Paxil (or any SSRI drug), or while tapering from Paxil. Serotonin syndrome can occurand it is potentially fatal. Serotonin syndrome is basically 'serotonin overload' to your system. Paxil affects serotonin and so do many herbal and natural remedies. Do not mix Paxil and any drug/herb that also affects serotonin. It can be a terrible experience, if not deadly.

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Post Paxil

If you are completely off Paxilfor no less than three weeks, you can think about taking an alternative herbal/natural. The side effects of herbals/naturals are usually much less harsh than taking a prescription SSRI drug. But not all people tolerate herbs/naturals. Side effects with these can occur in some cases, but they are generally tolerated much better than prescription drugs. Some of these herbal/natural products claim to be just as effective as the prescription drugs for the treatment of depression.  The suggestions below are not to be taken in conjunction with Paxil.

St. John's Wort

Warning. St. John's wort should not be combined with MAO inhibitors, SSRIs, other antidepressants, meperidine (Demerol), or dextromethorphan for fear of serotonin syndrome. When switching a patient from an SSRI to St. John's wort, a 3-week drug-free period should be observed, because some SSRI agents have a long half-life.

http://www.tnp.com/substance.asp?ID=89
http://www.hypericum.com/
http://www.kcweb.com/herb/stjohn.htm

SAMe

SAMe appears to raise levels of dopamine, an important neurotransmitter in mood regulation, and higher SAMe levels in the brain are associated with successful drug treatment of depression. SAMe possesses anti-inflammatory, pain-relieving, and tissue-healing properties that may help protect the health of joints.

http://www.smart-drugs.net/depression-SAMe.htm
http://www.healthyplace.com/Communities/Depression/ect/selfhelp/same.html
http://www.impakt.com/webArticles/same_shows_promise_for_depressio.htm
http://www.tnp.com/substance.asp?ID=212

5-HTP

5-HTP may increase serotonin synthesis, and thus researchers are studying the possibility that 5-HTP might help people with depression.

http://www.tnp.com/substance.asp?ID=127
http://www.mqrx.com/5-htp.asp
http://www.thehormoneshop.com/5-htplibrary.htm
http://www.raysahelian.com/5-htp.html

Good vitamin/herbal overview links regarding depression and anxiety:

http://www.vitaminshoppe.com/...etc. (Click on "Depression")
http://www.tnp.com/topic.asp?ID=110
http://www.naturalhealthconsult.com/depression.html
http://www.vitaminshoppe.com/learning/...etc. (Click on "Anxiety")

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Withdrawal Syndrome
Documented in Medical Journals

Evidence of Paxil (paroxetine) withdrawal syndrome has been documented since the time that Paxil was first prescribed to the general public in 1993. It is a wonder why more doctors don't know about it. With so many drugs on the market, most doctors rely on the information from the pharmaceutical representative about new drugs, instead of informing themselves with outside, unbiased sources.

Why would a pharmaceutical rep risk hurting sales by telling a doctor about nasty side effects & withdrawals?

How would a doctor know about a drug's side effects & withdrawals if his/her only information source was from the drug company representative?

Some doctors will not believe a patient's claims of withdrawal. They don't see message board postings and support sites as having credibility. The only valid sources that these doctors will believe are from well-known published medical journals.

The list below is a collection of published medical journal articles and studies on SSRI withdrawal syndrome from 1993 to present. It's a shame that so many doctors have never seen any of these articles. If your physician is one who needs highly credible medical journal sources, print out the list below and take it to them.

Independent Reports


1993

Is there a serotonergic withdrawal syndrome?
Biol Psychiatry 1993;33:851-2. Mallya, White, Gunderson.

Paroxetine (Paxil) "We have received 78 reports of symptoms occurring on withdrawal of paroxetine, including dizziness, sweating, nausea, insomnia, tremor and confusion. Such reactions have been reported more often with paroxetine than with other SSRIs. Reactions tended to start 1-4 days after stopping paroxetine and in several patients resolved on re-instating treatment. Paroxetine should not normally be discontinued abruptly."

1993 Committee on Safety of Medicines & Medicines Control Agency (Great Britain)

1995

Withdrawal syndromes after paroxetine and seatrain discontinuation.
J Clin Psychopharmacol. 1995 Oct;15(5):374-5
Fava GA, Grandi S.

A possible paroxetine withdrawal syndrome.
Am J Psychiatry. 1995 Apr;152(4):645-6.
Phillips.

Paroxetine withdrawal syndrome.
Am J Psychiatry. 1995 Jan;152(1):149-50
Pyke.

Potential withdrawal syndrome associated with SSRI discontinuation.
Ann Pharmacother. 1995;29:1284-1285. Lazowick, Levin.

1996

More cases of paroxetine withdrawal syndrome.
Br J Psychiatry. 1996 Sep;169(3):384.
Pacheco, Malo, Aragues, Etxebeste.

Antidepressant withdrawal syndrome.
CNS Drugs. 1996;5:278-292.
Lejoyeux, Adès, Mourad, Solomon, Dilsaver.

1997

Paroxetine withdrawal syndrome in a neonate.
Br J Psychiatry. 1997 Oct;171:391-2
Dahl, Olhager, Ahlner.

Paroxetine discontinuation syndrome in association with sertindole therapy.
Br J Psychiatry. 1997 Apr;170:389
Walker-Kinnear, McNaughton.

Antidepressant withdrawal syndrome.
Br J Psychiatry. 1997 Mar;170:288
Young, Currie, Ashton.

Newer antidepressants and the discontinuation syndrome.
J Clin Psychiatry. 1997;58(suppl 7):17-22. Haddad

Possible biological mechanisms of the serotonin reuptake inhibitor discontinuation syndrome.
J Clin Psychiatry. 1997;58(suppl 7):23-27. Schatzberg, Haddad, Kaplan, Lejoyeux, Rosenbaum, Young, et al.

SSRI Withdrawal Syndrome
1997, American Society of Consultant Pharmacists, Inc. Skaehill, Welch

1998

Treatment of disequilibrium and nausea in the SRI discontinuation syndrome.
J Clin Psychiatry. 1998 Aug;59(8):431-2
Schechter.

Withdrawal syndrome associated with abrupt discontinuation of SSRIs.
J Am Pharm Assoc (Wash). 1998 Jul-Aug;38(4):500-1
Wincor.

Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial.
Biol Psychiatry. 1998 Jul 15;44(2):77-87
Rosenbaum, Fava, Hoog, Ascroft, Krebs.

Withdrawal syndrome caused by selective serotonin reuptake inhibitors.
Schweiz Rundsch Med Prax. 1998;87:345-348
Bryois, Rubin, Zbinden, Baumann.

Selective serotonin reuptake inhibitor discontinuation syndrome: putative mechanisms and prevention strategies.
Can J Psychiatry. 1998 Jun;43(5):523-4.
Rojas-Fernandez, Gordon.

1999

Selective serotonin reuptake inhibitor discontinuation syndrome: putative mechanisms and prevention strategies.
Can J Psychiatry. 1999 Feb;44(1):95-6.
Benazzi.

2000

Withdrawal syndrome after the use of serotonin reuptake inhibitors.
Tidsskr Nor Laegeforen. 2000 Mar 20;120(8):913-4.
Fagan.

Serotonin discontinuation syndrome: does it really exist?
W V Med J. 2000 Mar-Apr;96(2):405-7.
Nuss, Kincaid.

Paroxetine withdrawal syndrome.
Ann Med Interne (Paris). 2000 Apr;151 Suppl A:A52-3.
Belloeuf, Le Jeunne, Hugues.

Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria.
J Psychiatry Neurosci. 2000 May;25(3):255-61.
Black, Shea, Dursun, Kutcher.

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The information provided here is not intended to replace that of your doctor. Having a doctor that knows and understands the withdrawals that occur from SSRI drugs like Paxil is of utmost importance.

Good luck!

J.B. (03/05/01)