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

Specialties Psychiatric

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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?.

Specializes in Med-Surg, Wound Care.

The fact that your psychiatrist put you on two medications that essentially act with the same result put you a serious risk for serotonin syndrome!

Specializes in OB, M/S, HH, Medical Imaging RN.

I don't agree but everyone is entitled to his/her own opinion. I'll trust the one with MD behind his name.

I have seen patients get an unbelievable amount of SSRI's and other antidepressants and never come close to serotonin syndrome. I'm not saying it can't or doesn't happen.

It's common practice to taper down SSRi's and at the same time start a new med.The change from one to the other happens quickly (within days) and I have never seen any problems. Even with Effexor, which is probably the worst (withdrawal) of the bunch.

Specializes in Med-Surg, Wound Care.

Good Luck to you Dutchgirl. I trusted my sons "top in the country" psychiatrist also. It almost cost him his life.

Specializes in OB, M/S, HH, Medical Imaging RN.

Warning received and heard. I'm sorry your outcome was bad and hope your son is doing ok now. I've been with my psychiatrist for over 7 years and trust him but as a nurse never blind to things that can go wrong. I'm always careful.

Specializes in Labor and delivery, NICU, PP.

"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?)

Specializes in Med-Surg, Wound Care.

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 http://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.

"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.

"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.

Specializes in ICU.

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.

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.

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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