Comment by 69mlgsniperdad | Hacker News Reader

Comment by 69mlgsniperdad | Hacker News Reader

I have been on paxil(paroxetine) three separate times. Each was between six months and one year in duration. The first time, I was on a 10mg daily dose. I had quite a few issues when starting the medication the first time; however after a few weeks, I felt great. When I initially discontinued, I had the worst side effects I have ever experienced. Electric shocks in my neck and back of head, depression, mood swings, and terrible panic attacks lasting almost two weeks. The doctor told me it wasn't 'addictive' and there is no issue stopping the medication, afterwards I changed my physician. The new doctor also insisted there were no known withdrawal symptoms. If you google the issue there are thousands of reports and dozens of websites about this exactly. I have no idea why doctors tell people there is nothing to worry about but there are certainly many negative side effects experienced while starting and discontinuing SSRI's. For subsequent treatments of paxil and other SSRI's, I have made sure to slowly titrate my dose when starting and discontinuing treatment. 1/4 doses for a week, half for a week, 3/4 for a week, and then full dosage. I have done the same for discontinuing, sometimes even more gradual then that, and have avoided the terrible experience since.

Doctors can be notoriously ignorant and contradictory when it comes to mental illness-treating drugs. There's a lot of literature out there and a lot of them don't keep up. I don't know why it is.

Not that you shouldn't trust doctors, but I always do some Googling to get a second opinion about all psychoactive drugs I'm prescribed.

It's very very uneasy when doctors are too handwavey on your issues. You don't know if they're skipping beats because they don't want to explain 10 years of med school so you obey, or if they just don't want to investigate more than what the usual answer is.

I tried to nitpick on things that mattered for me, but you cannot easily claim "I'm more up to date than you on <xyz> illness" to a legal doctor without feeling a little ridiculous.

That's why I root for more non invasive monitoring and intervention. Many doctors told me the "based on these tests, you have nothing", bailing out when I asked for more because deeper tests would require potential ICU. So you end up floating in the unknown hoping for the best.

You may or may not be more up to date on a particular illness, but you are the best authority on your specific case.

But you have your own bias. The amount of fuzz from your personal data can be huge. That's why I wish I could have objective monitors and not rely on sparse visits to the doctor when symptoms aren't here.

One dared me to reproduce heart failure on the spot because there was some tension between me and him.

It odd.

Objective measures are always nice, but when there are none it all comes down to self report. Your own bias will still be present in that, and then you get to add on the doctors own bias. We hope that their experience can cut through both sources of distortion, but the less common the problem the harder that is.

For GP's, it's because there's an increasing amount of information in every single field, so it stands to reason they'll be more on top of some than others. Where it gets bad is when they choose not to keep at least slightly up to date (well, literally UpToDate) on things like basic mental health that make up a huge portion of most GP practices.

You should always seek a second opinion from different specialists. If all of them tell you the very same thing it is probably safe to assume what they recommended is well established. But its far from being always the case. Doctors are not machines and influenced by a number of factors so none of them should be considered infaillible.

My girlfriend has this with Zoloft. The doctors are telling her how to withdraw and if it doesn't work they just don't believe it. It seems they are trained to believe their textbooks to the point of ignoring things right in front of them.

I have some horror stories on this sort of drug and attitude which I don't wish to detail here with an identifiable account, but you are spot on. Many people have suffered in the hands of doctors with that attitude, some irreversibly harmed in the process.

Arrogance, showboating, non-science and anti-pragmatism are the biggest killers.

Agreed. Doctors would never get away with the level of shoddy care or outright patient abuse they often do in any other field except psychiatry. There are some fantastic psychiatrists and GP's who do a fantastic job with psychiatry, but just as many if not more crappy ones. Very frustrating, and a disaster for patients.

I had this too with Zoloft and the doctors didn't believe I was on a high enough dose to experience the side effect. It was bad for a week and was sporadic for another week or two. I was surprised that the doctor was so skeptical about a known side effect. It's not like I was trying to get more of that sweet sweet Zoloft. Medical devices have an incident reporting database that are required to be updated by companies and health professionals. Every pharma product should be subject to the same reporting -- whether the practitioner believes it or not.

Reporting for drugs is a standard for a long time now. You should report any adverse event to your physiciand and they are under obligation to report it to the pharma company who in turn sends annual reports of adverse events to the authorities. Serious side effects get reported to authorities within 24 hours and can lead to further investigations.

A bunch of drugs were stopped in the past because of post marketing reports.

Very good. I work preclinical and am familiar with the devices version. Glad the same is in place in general pharma too. Although it does seem the results are not well communicated. Do you know the rules in place for a recall vs update to recommended protocols?

I had a similar experience. I've only ever taken Paxil once, for maybe a month or so. Going into it, the only side-effect I experienced was an inability to climax during sex—-yeah, I know, too much information, but people need to know what they're getting into. When I stopped taking it, I experienced the same electric shock sensations you're talking about. My eyes twitched terribly, and I bounced back and forth between wanting to kill myself and wanting to kill everyone else. That lasted for around two weeks.

After that experience, I decided it was better to just feel depressed.

No. It's not too much information. People should know about this. You are by far not the only one.

Ironically, sexual issues can cause depression, and sexual issues are a side effect of a lot of medications used to treat depressions.

Improperly managing side effects (i.e. letting people know ahead of time about possibilities, using compensatory medications or switching altogether) is a big problem with many people who prescribe psychotropics. In competent hands, most people can generally find a medication or combination that works for them with tolerable side effects.

Not too much information at all. I think it's a known side effect, too.

That's very weird. I am on zoloft, and I got a entire lecture from my psychiatrist when starting about how important it was to not miss doses, and the consequences of suddenly stopping taking the medication.

I suspect this is probably highly regional, and highly doctor-specific. Was this doctor a General Physician, or a psychiatrist?

Yea my psychiatrist did not prep me at all for sexual side effects upon taking them nor for the withdrawal symptoms after getting off of them. I'm still on a small zoloft dose but so much of what i understood about what was going on was gathered from what people say in forums online...that's basically the worst possible route for getting information on medicine but it worked for me? And I'm on some big public tech company health insurance.

I think it's very much a doctor issue. It's probably worth looking for a better psychiatrist.

Sorry you had such experience. I had discontinued paroxetine immediately, because me and my doctor didn't think it was working. It wasn't. After taking 3x20mg daily, for a year, I just stopped, and had no side effects. Neither did I have any effects while taking it. It was useless for me. Zoloft was the same, I just gained a lot of weight, and had some side effects. Currently on fluoxetine, which seems to be working, but it might be placebo because the clinical significance of it in moderate to severe depression was disproved in a study. I officially have bipolar with moderate depression, and take aripiprazole and fluoxetine. I also once was taking haloperidol which was like torture (haloperidol 10mg 1+0+1). I was 14 at the time. What the hell.

Good to know, I had to take paroxetine for cripping anxiety, and will probably attempt end of treatment in a month.

I remember being off one day (10mg per day) and having the same sensation you get when an elevator stops after going up. A chill in your spine, except it was very intense, and located in my brain only. Lasted a day, only thing that would relieve it is swallowing something..

I really hope I don't have to enjoy this kind of black magic again next month. I'll be sure to go off very smoothly.

I recognize the irony in giving dire warnings to someone about to discontinue anxiety medication but:

* Research the potential withdrawal effects. They're much more upsetting and disruptive when you don't know what to expect or how to attribute the effects. But don't panic preemptively and expect all of them, just commit them to memory so that you don't panic if and when they occur.

* As others have suggested - taper off as gradually as you can.

* Do not schedule the discontinuation around any deadlines or professional engagements. Use a bad case of the flu as an excuse - assuming you're in the northern hemisphere it's flu season, and conveniently enough SSRI withdrawal symptoms can resemble those of the flu (http://www.aafp.org/afp/2006/0801/p449.html).

Having been prescribed paroxetene for crippling anxiety and having suffered through severe withdrawal effects myself, hopefully this will help.

Thanks, I think I can handle it now, I came back from the dead, any temporary shit that still allow for eating and walking will be water under the bridge quick.

Your experience is remarkably similar to mine. They are more and more rare, but after nearly 6 years off the medication, I still experience the occasional brain shock. Compared to the early withdrawl period, it's more of an annoyance than anything - but when the shocks were coming constantly, it was an incredibly unsettling experience.

I hope you're well now.

In Sweden it is clearly stated on the package that you are not to abruptly stop the medication. The suggested discontinuation method is half doseage for a minimum of two weeks, anecdotally I would double that period.

Do they have a reliable process that if followed to the letter would bypass the side effect?

These drugs affect different people so differently that it is likely that there is also no single process that works reliably.

I watched a loved one suffer the very same withdrawal. It's no joke.

Reply on news.ycombinator.com