Fwd: [SSRI-Research] Paroxetine Withdrawal The Neverending Nightmare

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Thu, 04 Dec 2003 08:45:33 -0500

[sSRI-Research] Paroxetine Withdrawal The Neverending Nightmare

 

Paroxetine Withdrawal The Neverending Nightmare

13 November 2003

Deborah A Garrand,

Paroxetine Patient

LU4 0UH

http://bmj.bmjjournals.com/cgi/eletters/324/7332/260#19263

 

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Re: Paroxetine Withdrawal The Neverending Nightmare

 

Email Deborah A Garrand

 

I am one of the supposed 7% who experience severe withdrawal symptoms.

 

I was originally prescribed 20mg per day of Paroxetine by a trainee General

Practioner who worked one day a week at our doctor's surgery. This was a

result of an enquiry on my part at age 33 as to whether there was anything

new that could be done to help with the mostly mild panic attacks and

generalised anxiety I had suffered since age 14, and which no therapy

available to me at that time had been of help - including cognitive

behavioural therapy, counselling, hypnotherapy, and therapy on my own of,

over 8 years, forcing myself to face all the things which tended to induce

panic attacks, on a daily (where possible) or weekly basis - a tortuous

regime. I was never free from attacks for more than a day or two at a time,

although attacks were less frequent after a course of acupuncture, followed

by a course of St John's Wort.

 

I had been on 20mg of paroxetine for just over 1 year after being free of

panic attacks for a blissful 9 months, when first attempting withdrawal

under the guidance of my GP. She recommended taking 20mg one day, and none

the next. However, this produced the severe 'electric head shock' type

symptoms on the morning after the missed dose, plus severe nausea and

dizziness, panic attacks and blurred vision. The only relief came from

keeping my eyes still. She insisted I continue this, despite worsening

symptoms, and also insisted I must continue going to work through this even

though - to my boss' horror - I was too ill to do anything apart from just

sit still at my desk.

 

I was also in the final stages of organising my wedding at this time, and to

my enormous disappointment at the time, and regret forever afterwards, I had

to abandon some of the most important wedding shopping and decisions to

others thereby not having my own choices. I received no support at all from

my doctor, other than an insistence to persevere. Fortunately this attempt

at withdrawal was abandoned in time for recovery prior to the wedding,

thanks to the timely intervention of a hospital doctor.

 

The second attempt at withdrawal, under a new and very much more supportive

doctor, involved dropping the dose from 20mg to 15mg. I was able to do that

with only minor problems - slight dizziness and nausea, no other problems.

These cleared up within about a fortnight, returned a fortnight after that,

and then cleared up altogether. I remained on 15mg for several weeks.

 

However, dropping the dose from 15mg to 10mg was more difficult. The

electric shock sensations, dizziness, nausea, panic attacks, nervousness

started within 48 hours and worsened over the course of 7 days. I therefore

returned to the 15mg dose for a couple of weeks before trying to 'yo-yo' the

dose by taking 15mg one day, 10mg the next, 15mg the next and so on. The

symptoms were more distressing this way, with the nausea never going away.

After 2 weeks of feeling worse and worse I stopped this, and returned to the

15mg.

 

One major difficulty in withdrawal was the problem with dizziness - I

travelled by train to London each day to work, and the movement of the train

exacerbated the nauseousness as well as the dizziness. As my doctor insisted

that withdrawal was necessary, I quit the job I had done for 10 years, and

which I loved, to work locally. This entailed a salary drop of two thirds

making finances at home difficult. But there is absolutely no way I could

have coped with the withdrawal symptoms while commuting and working a

stressful job.

 

After a few months in the new job, stable on 15mg, I attempted to reduce the

dose again, this time by chipping off a tiny piece of the 5mg quarter of the

tablet. I experienced mild nausea and chills after about 48 hours each time,

but this disappeared within 14 days. By cutting slightly larger and larger

pieces off the quarter tablet, leaving 14 days between each change, I was

able to reach 10mg successfully without too much distress.

 

I have concluded that the 'yo-yo' dose idea where the dose is higher one day

and lower the next, then higher again, is far more likely to produce

withdrawal symptoms than just keeping a steady dose every day.

 

My doctor recommended staying on 10mg for two months before attempting

further reductions in dosage. Two weeks after achieving 10mg, severe flu

like symptoms appeared. I was unable to get warm even though it was full

summer with 90 degree temperatures. Panic attacks were terrifying enough

that my husband wanted to call an ambulance. My doctor said it was a delayed

result of the withdrawal which does sometimes occur. These flu- like

symptoms and severe panic attacks came and went with great unpredicatability

over a period of 3 weeks before disappearing altogether.

 

Having achieved a few symptom free weeks towards the end of the summer, I am

now attempting to reduce from 10mg to nothing, and have switched to the

liquid suspension to make accurate measuring easier than cutting tablets. I

began the reduction two months ago, by reducing the dose first from 10mg to

9.5mg. This brought back the inibility to keep warm, plus headaches, mild

panic attacks, muscle spasms, dizziness, blurred vision and inability to

concentrate. I therefore increased the dose to 9.75mg. The symptoms

disappeared within 24 hours.

 

By decreasing the dose by tiny fractions every 2-3 weeks I have now managed

to reduce to a fraction under 9.5mg, experiencing only very minor problems -

blurred vision and mild nausea being the worst. If I reduce the dose by too

much too soon, symptoms do become unbearable. At this rate it is going to

take at least 12 months to reach zero - which, at this point, seems like a

never-ending nightmare. The blurred vision and panic attacks in particular

are problems each time they occur, since they affect my ability to do my

job. The mild nausea is fairly easily controlled by taking Gaviscon after

each meal for a few days until the symptoms settle down.

 

My husband is keen for us to try for a baby and, as I am now almost 38, the

biological clock is ticking away fast. If it takes me another year or even

two to get off this drug, the chances of us having children will have

diminished considerably. So I am keen to stop it as soon as possible. I

realise I may have to go back to living with panic attacks in the end, but

so long as they are just mild and not what my experience has been from

paroxetine withdrawal style panic attacks, I shall cope.

 

If anyone knows of any way to control the withdrawal symptoms, or speed up

the withdrawal so it is finished sooner than 12 months but without me losing

my job or having to take lengthy sick leave, I would be very grateful to

hear from them!

 

Competing interests: None declared