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!
Rapid Response:
Paroxetine Withdrawal The Neverending Nightmare
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
Competing interests: No competing interests