New Nurse on Paxil

Farawyn · Jul 19, 2015

And my question is, how is the fact that you can't just quit an SSRI/SNRI cold turkey not a dependency???? You become dependent on the ADs too. Why is one worse than the other?? I tried to find out why some people are so much more sensitive to the SSRI/SNRI and there is some interesting theories out there (not going into it here).

Benzos can be addictive. You need more to get the same reaction and they are easily abused. Not so with SSRI. No one craves Paxil.

You can't quit prednisone "cold turkey" either. Some meds just need to be tapered.

Marshall1 · Jul 19, 2015

This is my personal, non-medical opinion - try the medication - give it a few weeks - you can look up side effects online - you may or may not have them - there is only so far positive thinking, praying, meditation, dietary changes etc can go when it's a biological/chemical issues...everyone is wired differently...some diabetics are able to control their illness with diet, some take pills, some take insulin - does this mean those that need insulin are somehow failures because they couldn't just control it by diet? NO. And it's NO different with people who struggle with depression/anxiety or other mental health issues. Obviously situations can cause or contribute to depression, anxiety and certain its prudent to cut down or out caffeine or similar if someone has anxiety - etc. but sometimes medication is necessary. I currently take an SNRI - for me, it works - I am not "numb", have not gained weight, I am just..calmer, more able to manage anxiety and depression - I tried MANY other options before going on medication - was resistant to it - my only regret is I didn't go on something sooner - good luck

Farawyn · Jul 19, 2015

Marshall, I agree, except for a few weeks timeline for the SSRI. I feel the minimum time should be 3 months, unless you are having crazy ass side effects that cannot be tolerated.

I didn't look up any articles on this, either, but a few weeks doesn't seem like it is enough time.

I'm not against benzos either, btw. Just be careful with those.

Dogen · Jul 19, 2015

Three to six weeks is the average for the antianxiety effects of most SSRIs. If a person is experiencing comorbid anxiety and depression a trial is typically 6-10weeks. So... it depends. We tell people 2-3 months as a conservative estimate.

Benzos are great if you're the patient who uses them as a rescue drug, when anxiety is starting to take over. The problem is a lot of people have a hard time doing that because benzos feel good. There's a reason you can score Ativan on the street but not Paxil. But, that's not to say I never use them. I'm just cautious. :)

RenaBoz · Jul 20, 2015

I'm on Paxil for anxiety/stress, 37.5 mg QOD. The only side effect I've noticed was inability to orgasm/ deceased desire. At 37.5 QD, it stomped a mudhole in my sex life. I cut it back to QOD and I'm fine. Saved my sanity and probably my spouse's life. Lol

elomi18 · Jul 20, 2015

I'm only on Paxil 12.5 mg... how is 37.5 mg on Paxil affecting your anxiety/stress?

Curious1alwys, BSN, RN · Jul 20, 2015

Benzos are great if you're the patient who uses them as a rescue drug, when anxiety is starting to take over. The problem is a lot of people have a hard time doing that because benzos feel good. There's a reason you can score Ativan on the street but not Paxil. But, that's not to say I never use them. I'm just cautious. :)

I must be the only person in the world that benzos don't do anything for. I just don't get it. I've taken Ativan and Klonopin and I mean....nothing! If they make me calmer I sure as heck don't notice! Yikes. You must have to take a high dose to feel anything...

Curious1alwys, BSN, RN · Jul 20, 2015

I am struggling with anxiety right now. It's gotten to the point that keeping jobs has become difficult. I have been in and out of therapy and on and off of various AD's for decades (SSRI's sedate me severely so deemed intolerable). It is such a complicated thing. One thing I never get though....how do you use cognitive behavioral therapy for anxiety in bedside nursing? I mean, if I am anxious because I think I forgot to to turn the coffee pot off or my kids might get sick that is one thing. But in bedside nursing you CAN kill someone, you CAN know too little and be dangerous, there really may be no one else to "have your back" if the you know what hits the fan. THIS is what brings on my anxiety. But these thoughts are NOT irrational: they could really happen!!!. They are real in bedside nursing, especially in part time or POOL type jobs. How to get around this?

The biggest mistake I made in bedside nursing was starting out as a new grad in a role that moved me around from unit to unit and facility to facility on a near daily basis. It was like suicide. If you are anxiety prone, best to have ONE job, full time, and work there for years not months. Make friends. Get to know the routine and the protocols. That is your best chance. If I only had one job that is def how I would do it now. How can other nurses "have your back" if they are never given an opportunity to get to know you? I think Ruby Vee comments in another thread about staying put as a new grad and I really think truer words have never been spoken if you are prone to work related/performance anxieties. Good luck finding something that works!

Farawyn · Jul 21, 2015

I must be the only person in the world that benzos don't do anything for. I just don't get it. I've taken Ativan and Klonopin and I mean....nothing! If they make me calmer I sure as heck don't notice! Yikes. You must have to take a high dose to feel anything...

Rhetorical "you"?

Dogen · Jul 21, 2015

Most people don't need high doses of benzos for effect. Most of my patients (if they're on benzos) are on 1-2mg of Ativan PRN, and my inpatients get 1-2 q2-4hrs.

I'm not sure what I can tell you re:SSRIs, given the TOS. What have you tried? Generally speaking, for most people some are more activating (Prozac, Zoloft) and others more sedating (Paxil, Lexapro). There's less evidence that SNRIs like Effexor work for anxiety, but it tends to be more activating, if one were to try it.

CBT is the standard treatment for anxiety, not because people see dangers that aren't there, but that they catastrophize present dangers and overestimate the likelihood of danger. They tend to need more evidence to make a decision but are also bothered by being uncertain. All of which are things CBT can help with.

Been there,done that, ASN, RN · Jul 21, 2015

And sometimes those other ways aren't enough. I'm currently taking both an antidepressant daily and anti anxiety melds prn. I don't intend to need either long term (plan with PCP is anti anxiety med for current crisis period and 9-12 months for the antidepressants). Statements like this only contribute to the stigmatization of mental health issues and people's unwillingness to seek help when it's needed.

I am not against " seeking help" I am against throwing a pill at a psychological problem.

I was experiencing severe depression from a series of exogenous events, and prescribed the wonder drugs. They led to suicidal ideation. Stopped THAT junk cold turkey and live to tell the tale.

Do your research on the efficacy and adverse effects of the antidepressants that make big Pharma even richer.

Then, we will talk again.

Been there,done that, ASN, RN · Jul 21, 2015

I'm on Paxil for anxiety/stress, 37.5 mg QOD. The only side effect I've noticed was inability to orgasm/ deceased desire. At 37.5 QD, it stomped a mudhole in my sex life. I cut it back to QOD and I'm fine. Saved my sanity and probably my spouse's life. Lol

Yep.. causes inability to reach orgasm. How's that for promoting mental health?

Give me a good old fashioned orgasm.. over a pill, any day.