This year, I celebrated my 2nd anniversary of being Paxil-free. (The “hurray!” I feel compelled to type here is a complete understatement of my joy.) Back in 2004, I started taking the drug under the advice of my primary care physician for panic attacks and anxiety. After growing (very) disenchanted with its frustrating side effects, I decided to quit.
A row of split and shaved Paxil fragments, lined up in descending size, that I took near the end of my taper.
Here’s the CliffsNotes version of my withdrawal attempts. First attempt: Cold turkey. (Bad idea.) Second attempt: Wean by 50% each week by splitting pills into halves and quarters until I’m down to zero within a month or two. (Also a bad idea.) Third attempt: Wean at 10%-25% dosage by splitting/shaving pills for 7 months. Success!
It sounds so simple and sanitized when reduced to a mere sentence in the paragraph above! Truth is, withdrawal from Paxil (or any SSRI or SNRI antidepressant) can be challenging. Sure, it affects everyone differently: a close friend of mine only experienced tension headaches throughout the process, but I had the pleasure of dealing with headaches, lethargy, depression, dizziness, the “zaps”, nausea, and more. No matter which way it ends up affecting you, the following tips can help you prepare for the process of withdrawing from an antidepressant:
1. Get a social support network (both online and off).
This is essential. Sure, there are some people who can withdraw from an SSRI/SNRI with great ease, but if you take the public pulse with Google or even Twitter, you’ll see a ton of folks reporting difficult-to-handle withdrawal symptoms. So, find a trusted friend that you feel comfortable confiding in. It might seem awkward at first to even admit that you’re on an antidepressant (let alone attempting to withdraw from one), but you’ll find that having some real-life support is a lifesaver later on down the road when you’re dealing with bouts of crying between the brain zaps.
Also, consider joining an online support community like Paxil Progress. It’s a great place to ask for advice from others who are joining you on your journey to zero milligrams. You can find support there from people both nearby & around the globe nearly 24 hours per day.
2. Read about what to expect.
The number of studies and articles in peer-reviewed journals on SSRI withdrawal are few and far between, but plenty of anecdotal information is out there on the Internet and at the bookstore. I personally recommend Dr. Joseph Glenmullen’s The Antidepressant Solution, although his recommendations for dosage cuts are a little steep to me. (He had his patients withdraw from 20mg to 10mg — a 50% cut in dosage. Everyone’s different, of course, but when I tried to cut my dosage by 50% from 10mg to 5mg, I went back up to 10mg within a matter of a few weeks due to the harsh withdrawal effects.)
If you know the effects antidepressant withdrawal can have on your body and mind, you’ll feel more prepared. Like I mentioned above, I started taking Paxil for panic and anxiety. So, when I began having panic attacks after dropping directly from 10 mg to 5 mg, I fell into the trap of believing that my “original condition” had come back with a vengeance and that I needed to be on Paxil for life. After doing some research, however, I found out that other patients who had not taken Paxil for anxiety and panic but for other indications instead (like depression or extreme PMS) experienced panic and anxiety while withdrawing. With this in mind, I was ultimately able to work my way through the predictable, withdrawal-induced panic that was not a part of my original condition.
If you want a more thorough list of potential withdrawal effects and how to handle them, do a few Google searches for “antidepressant withdrawal” and “SSRI discontinuation syndrome.” (The latter term is the more sanitized name for withdrawal that you’ll see being promoted by drug companies.)
3. Write a list of reasons why you’re motivated to withdraw.
SSRI withdrawal might be a trying process for you; then again, it might not. You can’t be sure until you start the process. Just to be on the safe side, make a list of the reasons why you want to withdraw from your antidepressant. That way, if you find yourself wrestling with a particularly troublesome withdrawal effect and you’re thinking about giving up, you’ll have an archived reminder of why you should stay on course.
My own motivation for withdrawal was to regain my lost emotions. Paxil had slowly thrown me into a state of emotional flat-lining — I couldn’t feel joy, anger, sorrow, or excitement while on the drug — and I craved having it all back. This craving helped me to resist the common urge to return to my original Paxil dosage in order to quiet the withdrawal symptoms.
4. Pick a starting date (and stick with it).
In The Antidepressant Solution, Dr. Glenmullen does remind you to “work [your] tapering programs around the rest of [your] lives” (p. 164) and I couldn’t agree more - but at the same time, don’t use that as an excuse to continue putting the (sometimes unpleasant) process off into the distant future.
I decided to begin my third & final taper from 10 mg of Paxil right before I went to graduate school. I figured that now was as good a time as any, even though my course load was heavy and my part-time job responsibilities were demanding. I figured that there’s always going to be a perceived roadblock in the way, and if I were to wait until I was working full-time, I might not have a schedule flexible enough to accommodate the ups and downs of withdrawal. Besides, I didn’t want to be studying complex theoretical models and trying to absorb information about statistical research methods in graduate school through a foggy, Paxil-coated lens.
So, I began my taper about two months before my first semester began. I made sure to avoid making a dosage cut during the first week of classes, during midterms, and during finals. If I had a dosage cut scheduled during a week that I had a big paper due, I pushed back the dosage cut (and not the paper.) It’s completely possible to work the withdrawal process around your school or work schedule, but it’s extraordinarily exhausting and frustrating if you try and do it the other way around.
5. Keep a journal (and consider making it public).
A journal is a great way to not only keep track of your progress, but it’s also a great way to keep track of any patterns that might crop up in the withdrawal process. When I successfully withdrew from Paxil on the third attempt, I dropped my dosage in small increments and stayed on those dosages for several weeks until I “evened out” again. Thanks to the journal, I was able to predict when many of my withdrawal effects would kick in: headache at the 3-day mark, zaps at 4 days, an emotional wreck at 5. (Happily, I was also able to predict the upswing that followed the negative effects.)
A video journal is also a good way to both keep track of your progress and share your experience with others. If recording video isn’t your thing, do a little poking around on Youtube and you’ll be able to check out other people’s withdrawal-related video journals. Check out Amber’s series of “The Paxil Diaries” on Youtube.
6. Find another way to treat the original problem.
Let’s face it: it’s not difficult to visit a general practitioner, ask for a prescription drug by name, and have a script in your hand about five minutes later. (We have direct-to-consumer television campaigns, amongst other factors, to thank for this McDonald’s-esque service.) There are obviously many problems with this model of treatment, especially when dealing with mental health concerns. But one particularly glaring problem sticks out the most here: a quick visit to the doctor usually overlooks non-medical treatment options.
This is exactly how I found myself on Paxil after having some panic attacks in college, and I was never fully aware of the full gamut of treatment options that didn’t involve expensive daily pharmaceuticals. There are plenty of alternative treatments from which to choose — talk therapy for depression, cognitive behavioral therapy for anxiety, and biofeedback for panic attacks (to name just a few)! Take some time to research other types of therapies that you might be interested in, and — I can’t emphasize this enough — get started on one before you make your first dosage cut.
There are thousands of ex-antidepressant users out there. Are you one of them? What would you recommend to someone who is about to begin withdrawing?
Source:
Glenmullen, J. (2005). The antidepressant solution: A Step-by-step guide to safely overcoming antidepressant withdrawal, dependence, and “addiction”. New York: Free Press.
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Withdrawal Syndrome » 6 Ways to Prepare for Withdrawal from an Antidepressant | World of … (8/4/2009)
30 Comments to
“6 Ways to Prepare for Withdrawal from an Antidepressant”
Great article, Summer. One of the big problems is that no one is informed that they ~should~ prepare themselves for withdrawal from an antidepressant. When I came abruptly off Effexor a decade ago, I was not at all ready for the meltdown that followed. I reinstated, then tapered slowly off of it. An even bigger shock was what happened when I tried to get off the Xanax my doctor had prescribed to deal with some of the side effects of the Effexor he gave me. I went into full Benzodiazepine Withdrawal Syndrome. It took me literally years to get off benzodiazepine, years during which I was disabled in many ways. Now four years off, I’m still not free of the after effects.
What bothers me most about your story and my own is that when being offered these psychiatric medicines by our doctors, the potential risks of developing a chemical dependency is hardly ever mentioned. Doctors are even reluctant to hear that there ~is~ a problem getting off of them later. It took years before the medical community would admit that there is an SSRI Discontinuation Syndrome. They have one model of “addiction”, wherein the addict craves the substance in question and tends to abuse it, and won’t accept the very rational idea that if a patient is unable to discontinue a medication without severely disruptive consequences, that patient is an ~addict~ even though they don’t fit the psychological/behavioral stereotypes. Sadly, it is most often a result of patients sharing information with other patients, such as you have done here with this blog, or I did by writing a book about getting safely off benzos, that people can minimize the damage psychiatric drugs do.
To all those contemplating discontinuing SSRI’s/SNRI’s or benzodiazepines (Xanax, Ativan, Klonopin, Dalmane, etc.) please follow the advice in this article and gather as much information and support as you can, to prepare yourself for what may follow.
–Jack
Jack, thanks for the comment. I agree with you completely about doctors rarely mentioning the possibility of addiction and/or severe side effects. But it’s not necessarily the doctors who are at fault — many of them probably rely on the information provided directly from the pharmaceutical sales reps. And the information coming from the drug companies is bound to be spun into a shiny top hat & bow tie. Truthfully, all doctors who visit with any type of sales representative ought to go through a full course of training on identifying techniques of persuasion.
That being said, it’s not just the drug companies, either. I saved a Patient Prescription Information pamphlet that I received with my Paxil script back in 2006 from CVS. The black box warning isn’t yet on it, and I noticed this blatantly opinion-based comment in the “Side Effects” section:
“Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects.”
Seriously!? How can they say something like that? To anyone with a current Paxil script from CVS: can you check to see if this line is still printed on there?
It’s too bad that you had not heard of The Road Back, a very workable program that has been used by thousands of people and endorsed by many in the medical field, that helps get people off these types of drugs without side-effects. For others interested, just Google “The Road Back.”
Another reason why people need to start realizing why there is a problem with the statistic that about 70% of antidepressant prescriptions are written by NON psychiatrists. If you go to your PCP/OB/nurse practitioner/internist for psychiatric care, you will get the care that a non specialist can offer. This is not a slight or insult to the above providers, it is just they underestimate the expertise in writing for these meds IF the meds are indicated. And, if you want to help demystify and destigmatize mental illness, you as a patient or invested person to someone with mental health problems should be advocating for psychiatric/mental health services.
If I had a nickel for every person who came to me after seeing a non-psychiatrist for meds first, I would have one helluva dinner in front of me from a first class restaurant!
Road to hell, folks, it is not what any doc should realistically be thinking if the patient in front of them is asking for psychiatric meds.
just my opinion.
therapyfirst, board cert psych MD
Peter, the Road Back doesn’t guarantee no side effects while withdrawing. It just keeps you healthy. It could possibly make things easier, but it’s very expensive in this economy and when it comes to withdrawal from prescription drugs, there are no guarantees. If you could solve brain imbalances so easily, no one would be complaining about withdrawal.
It works for some, but for others it does nothing more than take a bit of the edge off. I would personally neither speak for or against it.
Thanks for this useful post. Were you aware that 1 ml and 0.5 ml graduated oral syringes are available from your pharmacist? Having one of these little puppies to control dosage would have made some of my daughter’s attempts to taper off sertraline, starting at 50 mg/day, a lot easier. Note that at the wikipedia sertraline site I am trying to add information about oral syringes and alternate ways to taper off (”Gradual discontinuation, or tapering, can be accomplished by breaking pills into parts or using a graduated oral syringe with the liquid form. However, in some cases sertraline users develop SSRI discontinuation syndrome even on gradual discontinuation. Transfer to another SSRI, with less SSRI discontinuation syndrome, has sometimes been effective at discontinuation.”), but the site guardians don’t like the information because it is uncited. If you know any relevant citations in the medical or psychiatric literature I would appreciate knowing them. In any event, I think you should feel free to “gently” modify that site.
Hi, A Dad. Yes, I am aware of (and have used) the syringes to take liquid Paxil near the very end of my taper. It took me awhile to get my hands on a bottle of liquid Paxil — it hadn’t yet gone generic yet when I was tapering, so a bottle cost $199 at CVS. (I didn’t have Rx coverage at the time, either. Lucky me.)
Anyway, I checked in the aisles at CVS and the smallest medicine droppers for infants didn’t have small enough measurements for my final few milliliters. So I asked the pharmacist if they had any diabetic syringes, and he happily gave me one (sans needle, of course).
I recommended this method to other people across the US who were also trying to taper down their dosage. Several of them said that their pharmacists would not give them a dropper, so they had to resort to guesstimation with teaspoons and other completely inaccurate measuring devices. It’s a shame that the logistics of withdrawal are nearly as frustrating as the mental and physical effects as well.
Regarding sources for that information, I can’t think of anything off the top of my head. Page through The Antidepressant Solution, though — much of it is available to view on Google Books — and hopefully it will lead you to some useful references!
thanks for the useful info 
Great article summer!
To Jack sorry to hear of your struggles.
Do you mind if i ask what your symptoms are at 4 years off? and do they come in waves?
my blog is about my journey of withdrawing from 6 meds including an antidepressant…
the about page offers tons of resources…both on and off my blog…
http://bipolarblast.wordpress.com/about
The Road Back is over priced…you can do all it says for a fraction of the price and pay attention to you individual needs as well…
for dietary guidelines to support yourself I recommend
Joan Larson’s
Depression Free Naturally
Thanks to each of you for your postings. I thought that I was the only one feeling dizzy when I skip a dosage or try to cut down. My Dr’s who prescribed the Paxil, specialty is internal medicine and I have seen a psychologist who agrees that I needed to be on the medicine. I AM NO SURE IF I WILL EVER GET OFF. But after reading these postings, maybe there is hope.
Dee
I am currently weaning off 225 mg of Effexor - I am down to 75 mg per day (I already weaned off 300 mg of Seroquel with no problems). I was advised to do the 50% reduction every 2 weeks by my psychiatrist and have pretty much stuck to that. The first reduction to 150 was killer - nausea, dizzy, night sweats - for about 2 or 3 days before I started to stabilize. The next reduction I did 75 + 37.5 for 2 days and now I’ve been at 75 for about 5 days. After my first reduction I did a lot of reading on the internet and found great information about the benefits of vitamins and supplements to help not only manage the withdrawl symptoms but also as a replacement for antidepressents. I started taking B Complex and Vitamin C, in addition to the multivitamin I was already taken, plus Ginger Root capsules twice a day for the nausea. Last week I did acupuncture for the first time and I have to say it was the best thing ever! I felt so good and the effects lasted a good 2-3 days.
The thing that frustrates me so much about all of this is the lack of information from the physicians and psychiatrists and drug companies. That and the way “they” hand over pills without fully explaining the long-term risks and side effects. I was put on Effexor 5 years ago after suffering from severe postpartum depression and attempting suicide. Granted, at the time I was in a crisis situation, but my psychiatrists never explained the side effects or even offered weaning as an option later in life. I was led to believe I would need to be on meds for life. But I had good therapy and made positive changes in my life, and am confident that I can live a full and healthy life without the aid of drugs.
Summer, yes, that statement is still printed on the drug inserts.
VERY IMPORTANT:
ALWAYS see your Psychiatrist so he can wean you off the drug.
DON’T attempt to do this yourself!!
Isn’t this website s’pose to condone people from ending their medications without a psychiatrist’s approval?
It’s very easy to end up in the hospital again after trying to wean yourself off anxiety medication or any psychiatric medication for that matter!
My 2 cents: Seek psychiatric help before you let go of a medication. He may just save your life.
Regards, Sara
Karen and Dee, I have slowly tapered from 4 meds down to 1. I expect to be completely off either this year or sometime next year depending on how things go.
And I was essentially told I would need to be on meds for life. Don’t believe that type of lie.
Sara, normally, your advice would be on target but not with psychiatric meds and most psychiatrists. No offense TF but you’re the exception to the the rule regarding psychiatrists who know how to taper people off of these meds.
If I had listened to my psychiatrist’s advice about tapering, it would have been too fast and there is no doubt in my mind that I wouldn’t have succeeded in tapering the way I have. Most people report similar experiences.
Many people come to the Paxil Progress Boards essentially reporting that their psychiatrists tapered them real quickly causing horrific side effects. When they complained, they were falsely told it was a return of their illness.
Anyway, I feel I saved my life by taking the bull horns and telling my psychiatrist I was going to taper and the slow plan (10% of current dose every 3 to 6 weeks) I was going to use to do it.
AA
Hi Sara.
Yes, there is a disclaimer on the website that suggests you review information with a doctor before making any decisions regarding medication, treatment, etc.
That being said, I believe that if someone truly wants to stop taking an antidepressant (particularly in cases like mine where it should have been a last resort & not a front-line treatment), they should certainly bring some research with them to the doctor’s office. SSRI withdrawal isn’t an exact science, unfortunately. So, some doctors will tell you to reduce your dosage in half for a week & then quit. Others might suggest an every-other-day dosing schedule (which worked out horribly for me, BTW, and I would never ever recommend it). Still others will attempt a cross-taper with Prozac. It’s easy to automatically trust a doctor that you’ve built a relationship with, but doing your own research in tandem & becoming a more competent consumer of prescription medication is a wiser choice for both doctor and patient.
On my primary care physician’s advice, I attempted to reduce my Paxil intake. My M.D. recommended tapering from 20 mg. to 10. That was a disaster, emotionally and physically. I had greater success, and dramatically reduced withdrawal symptoms, when tapering by 5 mg. at a time. I’ve let my M.D. know this. While she is a highly-regarded cardio-pulmonary critical care internist and med school teacher, she is NOT a psychiatrist, and her initial recommendation must have been what she herself had been taught — in a book, not by real patients.
I wa on fluoxetine, switched to amyltripaline, which I decided to take myself off of, because the side-effects were horrible. i felt a bit horrible for a few weeks, but it was alright. I am not starting to relapse (2 years on) and I can pretty much guarantee i will be medicated again. at least my new dr is against meds if they are avoidable. My old doc used them as a solution t everything, but my new doc sees them as a way to help you stand on your own two feet. cant wait to see what they put me on this time.
sorry *not = now. typos
Comment to ‘therapist’ - it is thanks to a variety of PSYCHIATRISTS who have had me on mega doses of a variety of psychiatric medication for years, sometimes a ridiculously high polypharmacy mess, that I have now ended up with a heart condition! I’m not sure where you are from, but I am in Australia and after 27 years of experience with a wide variety of psychiatrists NONE of them paid heed to or were cautious about prescribing taking into account negative side-effects, so don’t tell me it is ONLY people who go to insufficiently qualified professionals that end up in this kind of a mess. PSYCHIATRISTS have a lot to answer for in regard to the physical health and subsequent additional disabilities brought on by injudicious presciption of these drugs.
Summer - I thank you for your wise advice re coming off medication. It is the most balanced view I have come across so far. I have made note of your ideas and am preparing myself for coming off mertazapine which has seen me put on massive amounts of excess weight in just 7 months.
Hi permssion! I’m glad you found it useful. Certainly the weight gain sounds awful, and I just pulled up the Wikipedia article for mertazapine — perhaps you’re also experiencing a great deal of drowsiness too. Both weight gain and excessive sleepiness look common for that drug. Best of luck with the withdrawal & remember to treat your body & mind well!
all this is making me depressed. i was on zoloft for a few years and found myself flat lined so then my psychiatrist wanted me to try cymbalta. that sucked. after working hard over the last few years on my negative thoughts and anxiety i decided to stop all antidepressants. im on day 5 and the withdrawls are drving me crazy. dizziness, cold sweats, light headed, light sensative and nausea have been happening every afternoon at about the same time. i feel crappy and i just want it to stop. readin here that it will take longer than i thought is scary.
Hi Quinbee. I know withdrawal sounds like a lot of work, but the ultimate result is a much smoother transition. I’ve personally attempted to withdraw from Paxil cold turkey and it was an awful decision (and it wasn’t long before I was back on my full dose again). I know you might want to get out of this mess as soon as possible — I’ve been there — but a slower taper seems to lessen those awful symptoms for a lot of people. Paxilprogress.org got me through the worst of my withdrawal — the folks there are very helpful & genuinely concerned about your progress — so if you haven’t been there already, I highly recommend it. You’ll find others who are going through the same thing at this very moment.
Can anybody help me ! I stopped taking celexa cold turkey about 2 weeks ago and started having hot flashes & night sweats. Today I feel weak and foggy. Did anybody elsew have this ? What should I dostart back on and then try to taper off. I wanted to go off because of side effects. I broke three teeth grinding. I think that that was a side effect of the Celexa. I’ve been on this drug for about 4 years.
Anyone in my shoes ????
Hi lw,
The reason you are going through this is because you stopped Celexa on your own!! Typically an individual taking antidepressants or any medication is suppose to tell their doctor and their doctor will slowly lower the dosage of the medication and then completely take you off. The effects encountered after stopping a medication on your own can be so extreme that you can have flu like symptoms.
I can guess some of the reasons why you stopped your medication, but I would strongly encourage you to speak with your doctor before you feel worse.
Best of luck
Yes, I agree. Most doctors want to taper you way too fast - or not at all. When I first started taking Paxil nobody knew about the withdrawal and I was certainly never warned. A doctor I saw recommended Effexor but I really hesitate because it seems to be the worst to withdraw from. Also, my daughter took it and on the third night, she was hearing voices in her head that kept her awake. They say people in the same family can have similar reactions, so I don’t know why anyone would suggest that drug for me.
So, Dr. T , with all due respect, the doctor can be part of the problem.
I will look into Glenmullen’s book. Thanks for the info.
Up until mid-January 2009 I was taking 100mg of Sertraline (Zoloft). I weaned off by by reducing 25mg each week. Even till this day, I still experience flashbacks / ptsd and some depression. I take B-12 16000 mg / day and L-Tryptophan 200mg/day. They work on some days, and on others they seem to have little benefit.
I’m thinking of going back on Sertraline but on the lowest dosage and see of I can slowly wean off slowly this time.
Do you know of anyone who has tried doing this? Was it successful?
Thanks for the insight, I’m relieved to know others are dealing with the same issues.
I am currently taking 50mg of Seratraline and I am very sensitive to the side effects as it is. If I am just one hour late in taking the pill I have nausea, headaches and hot flashes and tremors, and at times I get agitated. I have been wanting to get off the medication for quite some time but the side effects are too much.
I can cut the pill in half, but I can’t really go any smaller than that, seeing that the pill is very small to begin with.
And, even after I lower the dose and I am off the medication, how long will the symptoms last?
Is there anything I can take to rid the nausea and fatigue?
Please help.
Good article, and I especially like the part where you end with: This is not professional advice. Only your doctor knows best how to treat you best!! (yes, that’s the very best part!)
When my son’s psychiatrist told me exactly to stop his Luvox after taking it for five years, I said “NO”, I would not. She told me to give him 50% for three days and then zero.
Not to mention that the Luvox caused my son to become ‘bipolar’, and my whole family lived in fear and agony for years. So then we spent one year trying to find the right medicine…on top of the Luvox…to treat his manic depression, and if it were not for me, and only me, he would long be dead. There were no warnings, nothing, and a year of agony. Then , when there was no mood stabilizer that did not kill him, the psychiatrist wanted him on risperdal.
Anyway, the best thing that ever happened was when my son got into trouble and someone called DHS and sent out a caseworker to my house. The guy was great, (except that he was paranoid and distracted that someone was watching him all the time) but he listened very carefully, then asked for permission to talk to my son’s psychiatrist and the next day I got the order to take my son of the Luvox. That was the very end of bi-polar, and he has not had even one second of a symptom of such in n ow about three years.
(the whole issue was never discussed or mentioned again after that, as if five years of hell never happened.)
Thanks again for writing this,
KATRIN
correction: where you NOT end with!!!
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Last reviewed: By John M. Grohol, Psy.D. on 6 May 2009
