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Dr. K
Dr. K, Psychiatrist
Category: Mental Health
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Experience:  15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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I have been taking Paxil, at varying doses, for almost 15 years.

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I have been taking Paxil, at varying doses, for almost 15 years. I am now in the process of weaning myself off of paxil because I have developed a problem of an almost complete lack of intenstinal motility. A The problem reached its worst point when my paxil dosage was at its highest point: 40 mg. A very recent colonoscopy revealed no cause for my extreme constipation problems other than a redundant colon, which isn't all that uncommon an isn't normally considered a problem.
I have gradually reduced the dosage of Paxil from 40 mg to 7.5 mg and plan on reducing it further, to 5 mg. starting next week. I have experienced some of the wierd dizziness, but not a lot of emotional symptoms. However, Past (unsuccessful) attempts at getting off this drug has taught me that 5 mg is the dosage at which I can expect to start experiencing such fun things as intense free-floating anxiety and deep depression, a combination that can leave me nonfunctional.
It is imperative that this time I succeed in becoming paxil-free. When, in the past, I saw a doctor for the withdrawal symptoms I was experiencing, the response was, "well, that's just how you are when you are not on the medication." NOT TRUE! What I experience when going through Paxil withdrawal is much more severe than what I experienced before going on Paxil. In fact, my initial reason for going on Paxil was to deal with performance anxiety so that I could meet the performance requirements for a degree in music. The drug was unsuccessful in that regard, but I continued taking it because I couldn't get off it.
Anyway, Sunday I will be reducing my dosage of paxil to 5mg. Past experience, on past unsuccessful attempts to get off of paxil, has taught me that 5mg is the threshold at which I start experiencing significant emotional withdrawal symptoms, such as free-floating anxiety, lethargy and significant depression. These are not symptoms that go away in a day or two; they hang around for weeks -- how many weeks I don't actually know because I always ended up going back on the drug to escape the hell of withdrawal.
So my question is this: do you know of a medication that can help me get through paxil withdrawal. I thought about imprimainine, which I took eons ago for a short while, but it has an even greater anticholinergic effect than paxil, so that would be kind of self defeating. Atavan is out because it doesn't help the anxiety, it just makes the depression worse.. Forget Buspar; it just makes me nervous and jittery. So does Welbutrin.
BTW, I focused on Paxil because your last answer to me indicated that you thought that, of all the medications I am taking, it is the most likely one to be causing my extreme constipation problems.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. K replied 5 years ago.

Here are some ideas: antidepressants that your body flushes out quick (like paxil) are the ones with the most withdrawals. Although it doesn't work 100% of the time, I had some success using prozac to help people get off other meds like paxil.


Prozac usually doesn't have withdrawals b/c it stays in your bloodstream a very long time; however, there are exceptions to this rule as well.


Here is another option: go even slower with the dose reduction. In other words, make sure you are taking the 7.5 dose for at least 2-4 weeks before lowering it further. Then, instead of going straight down 5mg...alternate 7.5mg with 5mg every other day. Also, splitting the dose may help. That is, take 5mg in the morning and 2.5mg later in the day...or when you're on a total of 5mg, take 2.5mg twice a day.


These are the best options now. Not everybody gets severe withdrawals, and some people like yourself can be more sensitive to these effects. We still don't have lots of treatment options to help reduce these effects.


If you don't want to try the prozac...and you do want to be on a different antidepressant, getting on that 1st before lowering the paxil may also help.


I hope this helps...let me know if you need clarification. Good luck.

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Customer: replied 5 years ago.
I took prozac for a few months shortly after it came out. It had absolutely no affect.
Taking 2.5mg doses of paxil twice a day sounds good, except that I can't get a 2.5mg crumb with my pill splitter. I have 30mg and 20mg pills to work with. I can get 5mg by splitting the 20mg into 4 pieces, but attempts at smaller splittings just leaves me with crumbs.
The physiological problems caused/exacerbated by the paxil adds urgency to the elimination of paxil from my system. I mean, how healthy can it be to have one, small bowel movent every two weeks?!
It appears that I must prepare myself for what I already know I will experience, and basically withdraw from society until I am through the process.
Expert:  Dr. K replied 5 years ago.

Even if prozac had no effect for depression, it still theoretically could help decrease paxil withdrawals. Can you secure a new prescription of paxil...and maybe check to see if any local pharmacies have the liquid version? With the liquid version it would be much easier to fine tune the dose. Otherwise, the lowest tablet available is 10mg (which is very should have it for a cash price of $4/month).


I'm no GI expert, but it doesn't take an expert to know one small BM every 2 weeks is not healthy.


I wish there were better options to help you through this. Knowing it's been rough before should at least help you be prepared...but I do honestly think trying the twice/day dosing and going slowly can help make this more manageable...


Anything else?

Customer: replied 5 years ago.
Prozac, like paxil, is an SSRI. I do not want to substitute one SSRI for another SSRI!
While I am, in principle, open to the idea of twice daily dosing a 2.5 mg paxil, I don't know of a way to achieve this, given the limitations on how many times I can split a pill. I was really hoping you knew of a medication that I didn't know about, something different, which would help me -- especially with the anxiety. The truth is, my personal psychiatrist is clueless (hence my resorting to this site). I was hoping you had more to offer than she does. (My insurance prevents me from being free to change psychiatrists).
Expert:  Dr. K replied 5 years ago.

There are several med options for treating anxiety. Even if ativan didn't work, a different med in the same family might (clonazepam or diazepam...i would avoid xanax which is the most addictive of the group).


I also prescribe vistaril (hydroxyzine) a lot. It can help sleep & anxiety; in general it's not as strong as the others I mentioned (it's an antihistamine...i nickname it "turbo benadryl").


Seroquel in low doses can help anxiety (12.5mg to 100mg); so can geodon. These meds need to be monitored carefully for possible long term side effects if you stay on indefinitely.


In general, I recommend patients dealing with anxiety consider psychotherapy & relaxation therapy. I can understand not wanting to do psychotherapy if the anxiety is mainly a withdrawal issue; but the relaxation therapy can still help. Formal relaxation therapy (yoga, tai chi, meditation,etc is proven by studies using sophisticated brain scans to calm down the brain. This book could help too: The Relaxation & Stress Reduction Workbook (New Harbinger Self-Help Workbook) by XXXXX XXXXX; here's an example of a simple exercise to start with:


What else?

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