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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Ami on January 22, 2000, at 13:42:56
Hi,
I've been taking 20 mg of Paxil for approximately 6 years to treat dysthmia. I've changed doctors over the years due to moves and insurance changes. My meds are currently prescribed by a primary care physician who is essentially clueless in regard to these things. I'm a mental health professional myself and basically manage my own mental health care with therapy and adjusting my dosages. Here's the problem- I want to try life without Paxil but am frightened of becoming emotionally unstable again (as I was 6 years ago). I cut my dose to 10 mg approximately one month ago and have noticed that I've been extremely moody, sensitive, and tearful over the past week. Is this common? A short-term effect of my body adjusting to lower doses? Or is it a sign that I need 20 mg and my always? Any advice on how to titrate off the medication at least for a short experimental period would be greatly appreciated.
Thanks,
Ami
Posted by cg on January 22, 2000, at 21:09:13
In reply to advice on titrating off Paxil, posted by Ami on January 22, 2000, at 13:42:56
Maybe you cannot see that you NEED that Paxil. If you completely stop, it may not work again. Don't mess with a good thing. In my experience, you may be very sorry. Controlling dysthymia is much more valuable that testing to see if you can do without medication. Do without the dysthymia instead, it will be much more acceptable.
Posted by Cam W. on January 23, 2000, at 10:42:29
In reply to advice on titrating off Paxil, posted by Ami on January 22, 2000, at 13:42:56
> Hi,
>
> I've been taking 20 mg of Paxil for approximately 6 years to treat dysthmia. I've changed doctors over the years due to moves and insurance changes. My meds are currently prescribed by a primary care physician who is essentially clueless in regard to these things. I'm a mental health professional myself and basically manage my own mental health care with therapy and adjusting my dosages. Here's the problem- I want to try life without Paxil but am frightened of becoming emotionally unstable again (as I was 6 years ago). I cut my dose to 10 mg approximately one month ago and have noticed that I've been extremely moody, sensitive, and tearful over the past week. Is this common? A short-term effect of my body adjusting to lower doses? Or is it a sign that I need 20 mg and my always? Any advice on how to titrate off the medication at least for a short experimental period would be greatly appreciated.
>
> Thanks,
> Ami> Ami, dysthymia is a bugger to treat. After a six year trial you should withdraw slowly from Paxil.
With regards to dosage, 20mg qd is a moderate dose. Have you tried higher doses to battle dysthymia? A trial of 30mg to 40mg might be in order to see if that works.> If you truly want to try a drug holiday from Paxil, it may be time to try. If your dysthymic symptoms return, you can always reinstate the Paxil
and it should be as effective as it is now. I really have seen any tolerance upon discontinuation and then reinstatement. Although I have heard of one or two case reports of it, many other factors were probably involved in these cases (eg polypharmacy with other meds, non-compliance, etc).
Give it a shot.> Being on Paxil for six years, here is how I would approach withdrawl. For about two weeks, I would take 20mg one day and 10mg the next. For the next two weeks take 10mg qd (daily). Then take 10mg one day and 5mg the next for two weeks. (That is if 10mg Paxil is available where you live and your insurance pays for it - if not eliminate the 5mg qd dose). At this point you could probably quit taking Paxil altogether, but to be on the safe side, I would take 5mg daily for a week or two & then drop it to 5 mg every 2 days for a week or two.
> This method of withdrawl is ultra-conservative and you probably would be able to stop with little or no problems if you cut the intervals to weekly instead of evey two weeks. Paxil has a short half-life and does not build up in the body like Prozac, so a quicker withdrawl could be done. Ask your doc, your pharmacist or one of the docs at the clinic about this. All will probably my method is too slow, but I say "go slow & low" to avoid even one sleepless night. Good luck. - Cam pharmacy consultant, mental health services.
Posted by Scott L. Schofield on January 27, 2000, at 23:48:35
In reply to Re: advice on titrating off Paxil, posted by cg on January 22, 2000, at 21:09:13
> > Hi,
> > I've been taking 20 mg of Paxil for approximately 6 years to treat dysthmia. I've changed doctors over the years due to moves and insurance changes. My meds are currently prescribed by a primary care physician who is essentially clueless in regard to these things. I'm a mental health professional myself and basically manage my own mental health care with therapy and adjusting my dosages. Here's the problem- I want to try life without Paxil but am frightened of becoming emotionally unstable again (as I was 6 years ago). I cut my dose to 10 mg approximately one month ago and have noticed that I've been extremely moody, sensitive, and tearful over the past week. Is this common? A short-term effect of my body adjusting to lower doses? Or is it a sign that I need 20 mg and my always? Any advice on how to titrate off the medication at least for a short experimental period would be greatly appreciated.
> Maybe you cannot see that you NEED that Paxil. If you completely stop, it may not work again. Don't mess with a good thing. In my experience, you may be very sorry. Controlling dysthymia is much more valuable that testing to see if you can do without medication. Do without the dysthymia instead, it will be much more acceptable.
I would not want to speak as to the wisdom of discontinuing treatment with Paxil. I know dysthymia is difficult to treat and that the SSRIs are a good place to start. Certainly, if one particular SSRI does not yield a substantial improvement, one of the others may. One trick to help prevent or mitigate withdrawal effects is to use Prozac as a sort of descending bridge to the bottom. Of course, this is only feasible if you suffer no ill effects from the Prozac itself.
This works because the Prozac is being used as a substitute for Paxil. Whereas the body eliminates about half of the Paxil every day, it takes a week or more for Prozac. I don't know how often it is done now, but when I last read anything about it, doctors were giving their patients one 10 or 20 mg dose, and allowing it to clear without further dosing. Sometimes this would have to be repeated i.e. 20 mg for week 1 and 10 mg for week two. I believe this method was also used for Effexor, another pain-in-the-ass drug to get off of.
Good luck.
- Scott
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