Question about Paxil???

sharann, BSN, RN · Apr 10, 2002

(((((DUCKIE))))),

First I must say you are fortunate to realize that you have a supportive husband. This is a great help as you well know.

Next, I too have had bouts of Panic attacks which mix with depression. Was on antidepress meds for 4 years, stopped them for 3 years...was fine...then BAM!!!...out of nowhere depression hit like a bomb (so to speak). Grudgingly wnt back on Effexor 3 yrs ago and have been depression free since. I have had rare instances of panic attacks, but these are very rare and only I think during extreme stress. Now, that's my experience. I think you need to know if your symptoms arise from physical, emotional, or (more likely) a combination of factors. Many people have "imbalances". Thank goodness there are so many of these new meds to try now. Paxil made me insane (I got hyper as heck), but I know many who do great on it! Wspecially those with panic disorder primarily with depression as a sidekick.

My best advice from my own experiences: Start out with the lowest possible dosage you can. If the doc suggests 20 mg, ask if you might start with 10 mg, just to gague your response. If you react badly, then you have less drug to get out of your system. If you don't react, then maybe the dose can be upped. My main point is to do it GRADUALLY. This goes for stopping these meds as well, to avoid the above mentioned "withdrawl like syndrome".

Good luck and hang in there! :kiss

duckie · Apr 10, 2002

I have read and reread every word written here. Thank you so much for your posts. I thought about canceling my doctors appointment, didn't want to be veiwed as a nut, but then I decided, I'm not a nut, I just am not me and want help figuring out why. I have lost all interest in the things I used to live for. I have done every craft under the sun, have a craft room you could probably start a store from and I cannot even bring myself to get into anything. I'm getting to where I don't like me and I used to be so outgoing and loved to be with people. I'll see what the doc says and will try whatever he thinks is best. Thanks again for everything, you are all a great support system and I'm sending you all a big heart felt hug because it takes a lot to care about someone you don't even know.

sharann, BSN, RN · Apr 10, 2002

"it takes a lot to care about someone you don't even know."

We do it daily as nurses, don't we Duckie?

Please let us know how the appt goes etc..

prmenrs, RN · Apr 10, 2002

If you get put on an anti-depressant and it doesn't work, work w/a psychiatrist to find the right one for YOU. Psychiatrists know more than anyone about those meds, they spend all day doing medication adjustments, and can work around any other drugs you're on; if you want to talk, go to a psychologist or MSW or MFCC.

I'm on 3 psych drugs @ present, and 2 antihypertensives--makes life interesting!! I'm hoping when I retire, I can get off some of them. Hang in there, things will get better. I'm glad you're going to get some help. Living w/stuff like this is miserable!

fairyprincess2003 · Apr 10, 2002

Hi there

I am a student at The University at Buffalo School of Nursing. Your post about Paxil caught my eye. I will post some research and findings I have for you. I hope you will feel better in the future whichever treatment you find.

As we know depression in caused by a decrease or lack of serotonin. And although 60-80% of depressed people will respond to meds, the best outcomes come from the use of both meds and psychotherapy.

Delgan(et all) 2001. Paroxetine better known as Paxil is an antidepressant(a Selective Serotonin Reuptake Inhibitor). It's indicated in the treatment of depression, panic disorder, obsessive-compulsive disorder, and social anxiety disorder. It's action is that it inhibits neuronal reuptake of serotonin in the CNS, thus potentiating the activity of serotonin(therefore increasing serotonin).

The therapeutic effects are: antidepressant actions, decrease in frequency and severity of panic attacks, obsessive-compulsive disorders and social anxiety.

Its Pharmacokinetics include: It's well absorbed following oral administration and distributed throughout body fluids and tissues including the CNS. It enters breast milk. It is highly metabolized by the liver and has a halflife of 21 hours.

Paxil is containdicated in hypersensitivity or current MAOI therapy and should be used cautiously in renal or hepatic impairment, hx of mania or suicide attempt. Safety in pregnancy or lactation has not yet been established, therefore I would advise against it.

Note that serious drug-drug interaction and that MAOI's should be stopped at least 14 days prior to paroxetine therapy.

Route and dosage for depression for adults: PO 20mg as a single dose in the morning(may be increased as indicated).

Note to the pateint: You must take Paxil exactly as indicated, as with any meds, do not double dose, avoid alcohol, use good hygeine to improve dry mouth, wear sunscreen, and seek psychotherapy.

Please also note that cocurrent use of Paxil with Xanatx(an anti anxiety and sedative hypnotic agent) result in additive CNS depression.

Weitzel(et all) 2001. Notes frequent Paxil side effects(although severity varies) as: A vague feeling of body pain/discomfort;

hypertension, syncope, tachycardia;

Pruritis, sweating;

Nausea, vomiting, constipation, diarrhea;

Weight gain or loss;

Drowsiness, dizziness, concentration impaired, insomnia, headache, vertigo

Rhinitis, cough

It is also advised that while when used correctly most cases produce non threatening side effects, you should be aware of Serotonin Syndrome which is the result of too much serotonin, which usually occurs in conjunction with other serotonergic agents. You should speak with your provider before considering this or any treatment, concerning interactions with meds, you health hx, and finding the best treatment for you.

Do not let the side effects discourage you in your quest for the proper treatment. The serious side effects are not experienced by the majority, and the positives have had profound enlightening effects on many. Overall Paxil should have the positive effects of:

Increased sense of well being

Renewed interest in surroundings

Decreased frequency/severity of panic attacks and anxiety:)

note: May require 1-4 weeks of therapy to obtain antidepressant effects.

You may also want to keep in mind that other SSRI's may work for you. In a study by Davden(et all) 2002., he found using the lowest cost SSRI ia an ethical and reasonable approach. His study for the use of SSRI tx for clinical depression in primary care settings found that Paxil, Prozac, and Zoloft were all equally effective in the tx of depression. The rates of adherence played the most influential role in effectiveness.

In my conclusion although there are some precautions and care needed to be taken with Paxil, as with any med, most pt's experienced an improvement of their depression, physical symptoms, and quality of life. The benefits are evident for many. Paxil may be right for you, but only you and your healthcare provider can work together to find the most beneficial treatment.

I wish you good luck and hope you find the best thing for you, and getting your life back on track. As with any antidepressant, including therapy shouldbe implemented to receive the best possible outcomes:)

Davden,C.(2002). Are paroxetine, fluoxetine, and sertraline equally effective for depression. The Journal of Family Practice, 51(3), 285-288.

Delgin, Vallerand.(2001). Davis's Drug Guide for Nurses(7th ed). Philadelphia, PA: FA Davis: 753-754, 23.

Weitzel, C.(2001).SSRI's and Paroxetine Side Effects. RN Magazine, 64(8), 43-48.

RNforLongTime · Apr 10, 2002

{{{{{DUCKIE}}}}}}}} Sending hugs your way!

I also think that you should go see a psychiatrist as he/she would be the best doctor who would be able to adjust your medications appropriately. I realize that you are nervous as there is still such a stigma associated with "mental illness". There are alot of people who take antidepressants and it is nothing to be ashamed of. I am glad that you have support from your husband. I'll keep you in my prayers and please let us know hoe you are doing!

Kelly

P_RN, ADN, RN · Apr 10, 2002

Duckie. Me too. Zoloft from 50 mg up to 150 mg now and Wellbutrin 150SR added when I had all my disability problems.

Psych said that was the ticket and I seem to be responding. It does take a while to notice it.

I tried getting off Zoloft once a couple of years ago and had some bad trembling and emesis. Then the last time....no problem at all. Zoloft is an SSRI. Wellbutrin is dopaminergic.

And we DO know you and we DO care.

judy ann · Apr 10, 2002

(((((Duckie))))), I may have never met you, but I know you quite well. I was dx as severly depressed in '91, and have been on prozac since then. I now am on prozac 80 mg daily, wellbutrin 80mg bid and had been on buspar bid for a while. You see, I do understand that deep, black vortex that sucks you in. I also had always loved crafts, especially knitting. I have knitting projects that I hadn't touched for years. I also recommend seeing either a psychiatrist or psychologist for some talk therapy. It makes a world of difference, and I am able to pour out my guts to my psychologist when I would never think of telling this stuff to my closest friend. You are not alone. It is unfortunate that mental health problems are not visable, and leave no scars that any one can tell that you had them. It is also unfortunate that mental health problems have such a stigma. I had a friend who had a tumor about the time I was dx with depression. I told my psychologist that I was envious of my friend. She could have her tumor cut out. I was stuck with my depression. Just remember, according to statistics, three out of ten Americans are depressed at any given time, and it is estimated that more than 60 percent of the population will have had depression at some time during their lifetime. I often wonder how many weren't counted. Some folks, in their trying to help, say that we should just cheer up, get some exercise, change out diet, read uplifting books, etc,etc,etc. Bless them, they really don't understand. I hope they never have to understand by experience. Just remember, you have many friends, co-sufferers, and people who care. Many of us fit in all catagories:kiss Hope this helps.:kiss

Jacaut · Apr 10, 2002

Forgive me if I'm repeating something someone else has said- I haven't read beyond the initial posting.

Paxil is contraindicated for people with suicidal tendencies. Prozac is generally best for those with eating disorders (esp. bulemia). Read your drug cards and go to the Dr. prepared so that you can be the best patient- one who is interested in your own care and who is able to discuss treatments. I know it's VERY hard when you are depressed- but you never know- it could actually be a symptoms of another disorder. Or worse.

Get help, and get hugs.

We care- honestly!

Jackie

micro, RN · Apr 10, 2002

duckie..............

I say good for you for acknowledging that there is something that needs changed..........

I along with a lot here.....as we see can say been there and done that........

unfortunately, I heard what you were saying about a "stigma" being out there about us depressed people being nuts.........no, we are not........and even if we were.....

dang nab it folks.......it is part of the human condition.....

now micro steps out on limb.........

as a been there and done that person and may be doing that right now person(you know taking that antidepressant medication kinda stuff).......

will express a couple opinions here after readin your thread duckie and a couple others here also.....

first off duckie......only you know what is unacceptable for you...........and medication is not wrong......just make sure that you are knowledgeable and actively participating in your care.........

antidepressants come in many forms-----am going from memory.....

as when I get on the bb.....i relax....I don't get out any medical books to prove any points i just chill and share.........

so from my memory banks.........antidepressants from micro's brain on discussion=ssri's, tricyclic's, MAOI's, and miscellaneous.........and now a day's you also have St. John Wort's, etc.....and there are merit to those........also.....

personal favorite of mine is ..............as that is the only one that worked for me.........have been off of it in periods of my life.........and hope to be off of it again someday......but if not....that is okay also................

Mario, I believe made a good point.........there is a definite correlation between diet and exercise and depression.......and this can aid in your health and speed of feeling better...................

rather you continue to take an antidepressant or you are

able to discontinue it.........

Changes in your diet and exercise habits can help immensely and does.............take it from a been there done that'er

I am not dissuading you or anyone from seeing a psychiatrist..........as I know some good ones.........but it is not a necessity.........if you have a good,and I mean "good" dr.(gp/family practictioner) that you trust and can intelligently converse with.......they can handle putting you on an antidepressant.....and monitorring the effects of this.........and if they are "good", then they would be the first ones to say.....i think we need to bring in a psychiatrist.

and in closing......as you can all tell by now......Duckie hit upon another of micro's soapboxes.......and Duckie.....to you i apologize for being so windy and wordy.........and further maybe I will just PM you or you can PM me anytime.........

but to close in 25 words or less.......

how come as nurses.......we still feel a stigma about depression as well as so much other out there......

there has been proven physical reality of depression.....

there is actual clinical depression.....

there is actual clinical depression that is exacerbated by situational depression...........

depression is a fact........

and it is not just in our heads, folks.......

it is a reality.......

theories exist=heredity, environment, situational, biochemical, and all of the above........in my case.....maybe all of the above.........

know i have surpassed my ending in 25 words or less......but then again micro is never micro when on a soapbox.....

duckie, take care and care for yourself.........and I love you, micro

TO ALL that replied to this thread.........you are such great and caring people.......sharing and caring..........this new form of medium that we have to communicate is a great thing when used correctly.........keep on sharing and caring..........

micro says up too late again on this great bulletin board with her friends in cyberspace.........

Mary Dover · Apr 10, 2002

OH MICRO - I so totally agree with you!

"how come as nurses.......we still feel a stigma about depression as well as so much other out there......

there has been proven physical reality of depression.....

there is actual clinical depression.....

there is actual clinical depression that is exacerbated by situational depression"

I for one, as a psych nurse, vow to continue to work as hard as I can to dissuade that stigma.

There are so many points in this thread, from everyone, that have given me pause to think. As NURSES - we are all in one of the most stressful professions in the world. My own primary care physician has a theory - that people in high stress positions are perhaps more vulnerable to chemical imbalances > mood/anxiety disorders than maybe even the general population. Makes perfect sense to me. And I'm not talking about clinical depression alone. I refer to any mood disturbance that makes functioning at one's optimum level near impossible.

My own personal theory is that the whole world would be a much nicer place if Prozac was in the water supply.

Peace and love....

Mary

VickyRN, MSN, DNP, RN · Apr 10, 2002

DO NOT Paxil (or any other SSRI) if you are taking Ultram, it can cause a seritonin syndrome.

What exactly is seritonin syndrome????

I wonder if this is anything similar to the extreme, dangerous (and rare) transient side-effects which my husband experienced after taking Prozac??? About four years ago, my husband (who had always been moody), became increasingly withdrawn, anxious, with suicidal thoughts. Couldn't function at work (very stressful job) and eventually had to leave on disability. Went to a family practice doc and was seen by his PA--put on Prozac. After just a few days of Prozac, my husband's hands began to shake uncontrollably, he became EXTREMELY nervous, panicky, nearly out of control. Went to a real psychiatrist, who immediately took him off of Prozac (side-effect was life-threatening) and started (what was to become) a long trial of other medications. Paxil, as well as other SSRI's, all had the same debilitating side-effects on him. My husband was diagnosed with major depressive disorder and panic disorder and was nearly sick enough to be committed (the psychiatrist told him that he was the second worst case of depression she had ever witnessed in her career). After going through MANY medications (all samples, which the doctor provided free of charge), he was placed on an extremely high dose of Remuron, as well as benzodiazopines. He was on this regimen for quite a while, which made him functional, though zombie-like. The real breakthrough didn't occur until he received special ministry at church. Now he is doing 1000X's better, has been off of all medications since October, 2000 (slowly weaned off). He is now an ordained minister and is pursuing a degree in theology .

I'll be praying for you, Duckie. If anyone can relate to the ravages of depression, I can. You are blessed to have a very supportive husband. Just remember that human beings are tripartite entities--each possessing a spirit, soul, and body. Treating the body for neurochemical or hormonal imbalance is very, very important--the psychotropic medications can be real life-savers. I don't want, in any way, to downplay their importance. Oftentimes, the real problems are much deeper, in the realm of the soul and spirit. So, the "root" problems (whatever they may be) will also need to be eventually addressed.

Also, hormones can play a BIG role. Thyroid hormone, even a seemingly insignificant, subclinical hypothyroid condition, can have such a depressant effect. Are you premenopausal??? Estrogen, progesterone, LDH, FSH--if this hormonal "soup" is out of whack, it can MAJORLY make you feel out of whack. You may need a thorough workup by a reputable endocrinologist.

My thoughts and prayers are directed your way :kiss