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.
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.
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?
Glenmullen, J. (2005). The antidepressant solution: A Step-by-step guide to safely overcoming antidepressant withdrawal, dependence, and “addiction”. New York: Free Press.