My, Oh My, How Time Flies!!! Getting Off Antidepressants After Accidentally Taking Them For A Decade

Mike writes in with a frequently voiced concern:

I am a 48 year old male and I have been on Paxil for about 11 years now and have been wondering about getting off it. I am aware that there is “detox” time needed and I’ll feel like shit (among other things), . . my question is: should I get of the meds or is this something that I’m going to need for life? Or any other options?

Realize, of course, that I know nothing about your past history or why, at some point, some doctor (shrink or family doc) decided that you needed something to make life better.  And you were feeling lousy enough that you went along with the idea AND it MUST have done SOMETHING.  Cause here you are 11 years later still on it.  The missing component here, of course, is follow up.  Somewhere along the line this question should have been answered for you . . . like nine or ten years ago.  But here you are now, on the med for a decade and not sure.

As I see it, the worst case scenario for you is for you to go off, and have a return of the symptoms that caused you to go on it in the first place.  Since Paxil is most often used for Major Depression, anxiety or that difficult mixture of both . . . that is what could come back.  There is no way to know for sure if it will.  Statistically speaking, people who have had multiple episodes of depression/anxiety are more likely to benefit from long term use of antidepressants.  If, for example, you have had three episodes of depression since high school . . . go off the meds and you are likely to have another one.  Not 100% likely . . . but a high probability.  For some, going off the meds is worth the risk.  For others it is not.  If you had a single bout of depression/anxiety eleven years ago and you accidentally stayed on Paxil ever since, you absolutely deserve a try off the meds.  You still have a higher chance of getting depressed/anxious than the average population (cause you had it once), but I typically encourage a try off at some point if there has been only one episode.

The process of getting off is the sticky detail here.  It sounds like you have heard some of the horror stories of Paxil withdrawal.  We don’t actually call it “withdrawal” . . . we call it “discontinuation syndrome” . . . because it sound soooooo much better than withdrawal.  Discontinuation syndrome can happen with almost any antidepressant.  It is a very uncomfortable mixture of physical symptoms such as brain zaps (if you have ever had them you know what they are), light-headedness, and weird visual-perceptual issues.  None of them are life-threatening.  It just feels bad.  And it can last for weeks.  There are two solutions to this problem.  First, go down very, very slowly.  The initial decreases are usually tolerated well.  It that last 5 or 10 mg that can be difficult.  In the past, I have had patients quarter their 10 mg tablets and take 2.5 mg four times daily for a month or two . . . then three times daily for a month or two . . . then twice daily . . . get the picture?  The other way to get around discontinuation syndrome is to do a rapid substitution of Prozac for the Paxil.  Once you are sure things are stable with your mood/anxiety, taper off the Prozac.  They hit the same receptors and the risk of discontinuation syndrome with Prozac is zero.

Bottom line is that that fear of withdrawal should not be the deciding factor in getting off Paxil.  It should be a clinical decision based on your risk of having a relapse in the symptoms the medicine treated.  Of course, that decision should be made with a treating physician.  A psychiatrist is better than a family doc because of the experience factor, but it can be hard to find a good shrink.  Hope this helps!

–Dan Hartman, MD

2 comments to My, Oh My, How Time Flies!!! Getting Off Antidepressants After Accidentally Taking Them For A Decade

  • Wendy

    I have finally reached a situationally stable period of time in my life, and asked my Dr about reducing my meds. I was taking so many – 300 mg Buproprion, 1500 mg Valproic Acid, 600 mg Carbamazepine, 1 mg Clonazepam, 600 mg Seroquel, and 200 mg Lamotrigine. Ee gad! I have been diagnosed Schizoaffective,or Bipolar with occasional psychotic episodes.
    I have learned how to handle slips into psychoses, but when we tried to lower the Seroquel, got shaky.
    Now weaning off Lamotrigine 50 mg down for a month, then 50 mg every 2 weeks.
    My Psychaitrist is confused because I am both depressed (in the morning) and hypomanic starting in the afternoon.
    I am willing to use whatever natural means I can to reduce so many meds. I get how to learn better mental hygiene and all those methods of balancing one’s life that we all know (but I’m not 100%). Will that approach work on hypomania, too? Some in my support circle are worried about it, but I think it’s ok to ride it out?? Is this dangerous? Will I adjust to the weaning off?

  • doctordan

    Wendy–Your situation is not unique. Lots of folks on too much medicine and hoping to be on less. Take a look at the November 6, 2011 blog posting for a more detailed answer to your question. Hope all is well.

    –DH MD