On trying to get off Paxil, did anyone’s doctor switch them over to Prozac? I’ve been reading a pile of medical journals and articles today that recommend that doctors do this for patients having difficulty getting off Paxil. I’m just curious if anyone has done this and if it worked…

Response:

Yes! I have just begun this process this week. I am on my 4th day of taking 10mg Prozac as I slowly taper off Paxil. I have been on Paxil 20mg/day for more than 4 years and have tried to get off it about 5-6 times over the past 2 years, only to experience the severe withdrawal effects that were intolerable for me when I got down to 5 mg.

About 3 weeks ago I found several message boards that let me know that I am not alone in this struggle to get off Paxil. Because I could not get any medical support about this, no one knew what I was talking about. And by the way, I only recently started going to a new doctor, who has been very agreeable to help me with this. I have talked to several doctors, pharmacists, psychiatrists, and a physician’s assistant who works in a drug rehab clinic, and have some references that recommend this method. Titrate each medication: one up (Prozac), one down (Paxil).

The best reference I have found about this is the Journal of Clinical Psychiatry, 1997;58 pages 37-40. The article is “Clinical Management of Antidepressant Discontinuation.”

I understand why this method would work, that is, it makes sense, as long as it is combining very low doses. I am down to 5mg Paxil for the past 3 days, with only 4 days of Prozac 10mg/day so far in my system, after doing 10/5/5/10, Paxil only.

Someone said:

“Do you think how one gets off Paxil depends on why one went on it in the first place? Like if someone went on it for bad depression as opposed to someone (like me) who went on it for other reasons than depression? Maybe that is why it was easier for me to get off it?”

You’re probably right. The longer you were taking it probably makes it harder to get off it too.

Also, I’m not sure about this one, but anyone who manages to wean themselves off the Paxil slowly is, perhaps, less likely to have a rough ride — as opposed to someone who found out the hard way by trying to get off Paxil cold turkey and ended up having go back on it and start all over again.

I followed my doctor’s orders and stopped taking the Paxil cold turkey and went through a week of pure hell. I think that experience was such a shock to my brain and my neurochemistry that my nervous system has never fully recovered and, subsequently, the weaning process has been more harsh for me than it would have otherwise been.

I was given Paxil because of post-traumatic stress that I experienced last year after, well, a traumatic event. But even before that, although I’d never taken an antidepressant until Paxil, I used to have periods of mild depression, and I’ve had them all my life. Perhaps that indicates some slight chemical imbalance, or maybe it’s just a part of the personality I have, which is that I have a tendency to think about things way too deeply.

I may not have the most normal or average personality profile, so maybe there is something a little bit out of whack, neurochemically speaking. But I think this slight out-of-whackness may account for my having the personality that I have (and I wouldn’t want to be anyone else). And it’s these little details, these quirks of personality, which I think may influence how someone reacts to getting off Paxil — and which are completely overlooked in the generalizations that are proliferated in the current medical literature.

Some people may be slightly predisposed to having a rough ride getting off Paxil.

And then there are people who have had chronic depression or severe depression (the two are not necessarily the same), an obsessive-compulsive disorder, or some other psychological or social disorder their whole lives, and who have probably taken other antidepressants before Paxil came along and will probably continue to take antidepressants their whole life. If anyone is going to have a hard time getting off Paxil, I would think this group must be at the top of the list. But I don’t know.

I think what a person was prescribed the Paxil for probably does plays a part in how well they’re able to get off it. And a lot can be explained by that. But there are other factors.

Personally, I have always had a low tolerance to any kind of drug. For instance, although I don’t drink caffeine or alcohol anymore, I can get pretty close to drunk off two beers. Whenever I found myself in a situation where someone passed me a joint, one drag and I’d be complete toast. Half a cup of coffee and I am zooming. I have always been like this.

So when someone with this kind of metabolism throws Paxil into their system — it’s no wonder it’s ruined my life. It’s no wonder that stopping Paxil cold turkey (imagine that, going cold turkey!) nearly killed me. The post-traumatic stress I was experiencing just before I started taking the Paxil was dealt with very effectively through communicative therapy, and nothing of that experience is an issue for me anymore. The continuing trauma of the Paxil withdrawal — now that’s another story altogether. I think I could have had a relatively smooth ride, but my doctor’s advice to stop taking the Paxil cold turkey was the wrong advice, and I wish to hell I hadn’t listened to him.

That’s my rambling take on why I have had a rough ride. I think it could have been avoided. But like you said, some people will inevitably have a rougher go at it. It is so important for people to be as well informed as they can be about this junk. When I initially took Paxil, and when I followed my doctor’s advice to go off it cold turkey, the principle of informed consent was completely ignored.

Hence, I have this overwhelming desire to sue GlaxoSmithKline for deliberately misinforming and not informing doctors and their patients of the withdrawal effects of Paxil. What can I tell you? I’m human.

From Jane:

For the last 10 days I have been alternating between 20mg and 15mg. Wednesday night I came home from work and after dinner got very dizzy. I absolutely panicked and took 20mg instead of the 15mg I should have taken. Felt better shortly thereafter. Now, I am really worried about being able to get off this damn drug. I went on it due to anxiety and dizziness. How will I ever get off it if this is a withdrawal symptom? I took 15mg last night and feel fine now.

My response:

I don’t mean to belittle what you’re going through, because I think I know what you’re going through, but so what? So you took 20mg instead of 15mg. Big whoop. When I began weaning by alternating, the same thing happened to me a few times — I had to take the higher dose instead of the lower one. Then I felt better and was ready to move on.

The best way to get through this crap is to play it by ear. Don’t lower the dosage until you’re ready to lower it — and you’re not going to feel ready precisely every 7 days. None of this crap runs on clockwork. I don’t think you should feel discouraged because you had to take a 20 instead of a 15. It’s not a setback. You may have to take the lower dose every 3rd day — who knows? You work it out as you go a long. I was winging it the whole time I was weaning, and now I’m off it completely and I’m never going back. It can be done.

As far as I can tell, there is nothing consistent about this process. Throughout my weaning, I had days where I felt great. They were rare, but they were there. Most of the time I felt like crap. Then I had my window of heightened vitality about a month ago where, at least sexually, I felt like I was a teenager again. That lasted for about 10 days or so. Then I was completely impotent. Oh joy oh bliss. About four days ago, I didn’t have a single brain zap; my eyes weren’t heavy, nothing — and my spirits immediately got better, despite still being impotent. Then two days ago I got hit with the brain zaps like I’d never had them before. It was as if my body was letting it all go with one final surge. (Just a theory.) But at the same time, the impotence disappeared. I don’t feel like a teenager again, but I’m back to normal, or at least getting there.

There’s no predicting how things are going to progress. It’s a roller coaster to say the least — and that’s one of the hardest things about it, that it’s such an up and down experience. But it does get better. Sometimes it’s such a slow process that it’s hard to tell if anything is happening. But in the long run at least, there’s progress. You might not notice it yet, but as you continue with the alternating, you’ll eventually see that you’re getting somewhere. Don’t let the inconsistencies and the slowness of the process discourage you.

I was in complete control of my weaning off Paxil. My doctor was only there to supervise the process and to give me a prescription of Xanax when I needed it. He suggested I go down by 10mg, but I said no way. I had tried it cold turkey and it nearly killed me, and I knew whatever I did, I wasn’t going to rush it. So I went down by 5mg every two weeks or so, and it was a relatively smooth ride.

If your doctor had you go down by 10mg at a time, it’s probably because the “current medical literature” suggests that he do so. In other words, he’s just reading out of book. The book says do this and he does what the book tells him to do. But, unfortunately, those books don’t take into account individual variations — the fact that everyone is different.

Personally, I think a 10mg drop is always too much. It’s a guaranteed rough ride if you ask me.

If you just got down to zero after being at 10mg and you’re feeling dizzy, etc., I’d take 5mg for awhile, until you feel ready to go down to zero.

When I got down to zero, which was a few weeks ago now, many of the symptoms lingered, especially the dizziness and the electrical sensations. On the two or three days in which I couldn’t hack it, despite the Xanax, I took a tiny little piece of Paxil, and it helped. I’m sure I could have roughed it out, but allowing myself to take just a little bit made the journey a little more bearable. At no time did I go back to taking the Paxil every day, or become dependent on it again, and now that I’m completely off it, the road is still a bit rough, but I’m a thousand times better off now than when I was withdrawing from the Paxil.

Your doctor didn’t lower your dosage to 5mg probably, first of all, because GlaxoSmithKline doesn’t officially make a 5mg pill, which, in your doctor’s mind (and the minds of many other doctors) means that 5mg isn’t a therapeutic dose. So it probably doesn’t even enter his mind to prescribe 5mg daily. Secondly, your doctor most likely just doesn’t know any better.

If you think you should be on 5mg before going down to zero, do it.