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Re: advice on titrating off Paxil

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.


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poster:Cam W. thread:19412
URL: http://www.dr-bob.org/babble/20000112/msgs/19456.html