What is the correct way to wean off a pt. on Paxil? - page 3

by Jo Anne -OLD

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I have read many ways to wean off the drug. What is the common way?. A pt. told me that her doc is starting her on Zoloft at the same time he is weaning off the Paxil. What is the correct way?.... Read More


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    [QUOTE=Psychaprn]
    Quote from winterblue
    "Even with Effexor, which is probably the worst (withdrawal) of the bunch."

    ITA with you on this. Speaking of this sort of withdrawal, are there many RNs/Docs who are now aware of it? (officially known as Discontinuation Syndrome). I find that too many HPs have no idea it exists, and its becoming more common. Any thoughts? (Or should I start a new thread for this topic ?

    I'm a Psych. APRN and have seen pt.'s have no effect from sudden cessation of an SSRI BUT MORE commonly have flu like sxs., rebound anxiety or depresion, insomnia etc. I think all SSRI's should be tapered down slowly. One exception is Prozac as it has a long half life. I am very frustrated as a Cardiologist just told one of my pts. to stop all her EFFEXOR XR., can't wait to talk to him.
    Perhaps he's concerned about Effexor's effects on cholesterol and BP. It's not very significant, but in a patient with cardiovascular disease, it may be something to avoid.

    As far as SSRI DS, I think it's made it's way into the psych arena, but not so much the GP field. It all depends on how active the physician is with CMEs and conventions, journals, ect..

    I think it helps to switch someone to an AD with a longer half-life while attempting to stop an offending AD like Paxil or Effexor. I took Effexor XR for a number of years and had to stop once because of insurance costs. I had some Celexa on hand and took them to counter the withdrawal. It worked.
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    First I would like to say that IMO Paxil is evil!!!

    I had to switch to Paxil for insurance reasons. It did nothing for my depression/anxiety but I like to refer to it as "pack on Paxil". I gained 25 pounds.
    I was weaned off by the cutting the dose in half bit, but we only did it over a month.
    I am now back on my drug of choice Welbutrin XL.
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    Quote from austin heart
    First I would like to say that IMO Paxil is evil!!!

    I had to switch to Paxil for insurance reasons. It did nothing for my depression/anxiety but I like to refer to it as "pack on Paxil". I gained 25 pounds.
    I was weaned off by the cutting the dose in half bit, but we only did it over a month.
    I am now back on my drug of choice Welbutrin XL.

    Well, I'm just the opposite. I took Paxil 20 mg when it was fairly new, before they even had 10 mg. It was a Godsend for my problems, which include classic migraine, dysthymia, and GAD. For a year I was happy, normal, and migraine-free. Unfortunately, due to the potency of the drug, tachyphylaxis kicked in after about 12 months and I was forced to start looking for alternatives. No other drug, except Effexor, came close to the efficacy I had with Paxil. I didn't have any withdrawal (SDS), I just went to something else. I've even tried to take it again in recent years to no avail. I'm now on Cymbalta for 5 days, and had been on Effexor for 5+ years until now. As they always say, everyone is different, thus their response to individual medications is different as well.
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    [QUOTE=TCASII]
    Quote from Psychaprn

    Perhaps he's concerned about Effexor's effects on cholesterol and BP. It's not very significant, but in a patient with cardiovascular disease, it may be something to avoid.

    As far as SSRI DS, I think it's made it's way into the psych arena, but not so much the GP field. It all depends on how active the physician is with CMEs and conventions, journals, ect..

    I think it helps to switch someone to an AD with a longer half-life while attempting to stop an offending AD like Paxil or Effexor. I took Effexor XR for a number of years and had to stop once because of insurance costs. I had some Celexa on hand and took them to counter the withdrawal. It worked.
    THE CARDIOLOGIST RETESTED HER OFF EFFEXOR XR-TRIGLYCERIDES STILL HIGH. HOWEVER, THE PATIENT FORGOT TO TELL US SHE HAD RE-STARTED ESTROGEN RECENTLY SO THE CARDIOLOGIST SAYS EFFEXOR XR IS OKAY. ALSO, SEROTONIN SYNDROME IS AN IMMEDIATE CONCERN AND CAN BE ACUTELY DANGEROUS VS. CHOLESTEROL OR BP EFFECTS. SOME PTS. CHOSE BP MEDS OVER STOPPING AS EFFEXOR WAS SO EFFECTIVE FOR THEM. OH WELL-EVERYONE'S DIFFERENT. AND THIS IS AN INTERESTING DISCUSSION.
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    I regards to cholesterol and triglycerides the ssri's do have an effect on both. The weight gain is a significant adverse reaction that is caused by elevated cortisol levels. If someone decides to wean off these drugs the cortisol stays VERY high for a significant period of time. In my son it has taken a year since his last dose of paxil to see any weight loss. He has now lost 43 pounds in 3 months(he had a gain of 60 pounds on paxil for one year). His cholesterol was 240 on paxil and is now down to 170 off paxil. No change in diet or exercise. So if people are looking at an immediate change in cholesterol/triglycerides it can take at least a year off the drug to see a difference.
  6. 0
    Quote from lsyorke
    I regards to cholesterol and triglycerides the ssri's do have an effect on both. The weight gain is a significant adverse reaction that is caused by elevated cortisol levels. If someone decides to wean off these drugs the cortisol stays VERY high for a significant period of time. In my son it has taken a year since his last dose of paxil to see any weight loss. He has now lost 43 pounds in 3 months(he had a gain of 60 pounds on paxil for one year). His cholesterol was 240 on paxil and is now down to 170 off paxil. No change in diet or exercise. So if people are looking at an immediate change in cholesterol/triglycerides it can take at least a year off the drug to see a difference.
    Are you stating that cortisol levels are increased by SSRIs, thus weight gain and other metabolic issues are a problem associated with these medications?

    While it's true that about 50% of depressed individuals have increased cortisol levels, and perhaps discontinuation of an SSRI might lead to a rebound of cortisol production, most reports I've seen indicate endocrine response to various ADs are anything but predictable.
  7. 0
    Quote from lsyorke
    Winter, as you can tell I've gotten very involved in getting this information out. Withdrawal(Discontinuation syndrome) can be very dangerous if not done slowly. I'm involved with another website that is totally about paxil withdrawal. The owner of this website has published a "withdrawal guide" and it's available online for free at www.paxilprogress.org. Getting off paxil is no simple process of just weaning the drug. It involves giving the neurotransmitters time to re-adjust to the "new" environment, during this time the symptoms can be VERY bizzare and scary if you don't know what they are.The background for this withdrawal guide is from first hand experience and the experiences of thousands of paxil users.
    Amen!!!!!!! I have learned this first hand. I care for my Mom, who has numerous medical issues. She had been on Paxil for depression (chronic) for several years. She was in rehab after a total knee replacement and the brilliant house rehab MD eliminated her Paxil with no weaning and no warning. We wondered what was going on when she had nightmares, and all these other symptoms. The withdrawals lasted weeks ans weeks and slowed her rehab by about a week. My question is: why arent MDs aware of the dangers? Paaxil is a common drug!!!!!
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    Most doctors don't know about it since the "initial" prescribing information didn't include the fact that withdrawal(especially cold turkey) is as bad as we now know. The drug insert says that discontinuation syndrome is mild, self limiting and last about 2 weeks, and is exhibited by flu like symptoms. We,who have watched family members go through it, know that this isn't always the case.
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    I have been on Paxil 20mg for about six months, but about a month into taking it I quit cold turkey, and was fine for about a week (symptom free,) and then I started to feel extremely anxious all of the time. In fact, this nearly caused me to fail a couple of classes (I had to leave class many times because I could not sit in class for more than five to fifteen minutes at a time without feeling like I was going to have a panic attack,) I even went to the ER two times because my pulse, BP, and feeling of constant anxiety (thought I was dying a few times,) got sent to a cardiologist because they couldn't find anything wrong with me (and btw my heart is very healthy according to my Cardiologist,) and then after two weeks of feeling like this my regular care doctor ask me if I had stopped taking any medication, and I told him I had stopped taking Paxil because I didn't like the way it made me feel (turns out something else was causing that,) anyway, now I have gained about 30 pounds on these **** pills, and I have decided to wean myself off by cutting the dosage in half for the first month and then cutting the dosage in half again the second month, and quitting by the third month. This is the best way to do it according to all the research I have read, and I consider myself lucky to be on such a low dosage (will be easier and faster to wean myself off.) On the contrary though, Paxil DID WORK AS INTENDED, in fact, it was a miracle drug for me, but I am at a place in my life where I don't need medication like Paxil to help me function!

    And kudos to me for resurrecting this seven year old post! Google is amazing, in its own way.
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    Holy thread resurrection Batman! My god, I've lived a whole lifetime since this topic ended!!!! :-O Whatever works for you. Some people can D/C a short-acting drug without any withdrawal, whereas others have major symptoms even with a taper schedule. I stopped Effexor XR back about 4 years ago and haven't been on ADs since. I used Prozac to do it though. ;-)


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