Meds require long tapering period

Dear Dr. Roach: Would you please speak about the proper way to wean off of Paxil? I have been taking 20 mg daily. I took 10 mg alternating with 20 mg every other day for one week, then 10 mg daily for four days, then stopped. I developed dizziness, nausea, fatigue, tinnitus and intermittent “brain zaps.” I felt terrible. These symptoms did not resolve after six days, so I started back on Paxil, and symptoms were relieved. My primary care doctor just said to “wean off slowly.” Could you be more specific so that others don’t have to experience these symptoms? — C.T.

Paroxetine (Paxil) is one of the selective serotonin reuptake inhibitors, probably the most common class of antidepressants used. Paxil has prominent anti-anxiety properties as well. All of the SSRIs, but Paxil in particular, can cause withdrawal symptoms if weaned off too quickly. Some nonpsychiatrist prescribers, especially general doctors like me, sometimes are unaware of how slowly this drug should be tapered off. Although you did have a taper, it was too fast for you, and too fast in general.

You’ve identified some of the most common withdrawal symptoms already: dizziness, headache, fatigue and nausea. I have heard the very term “brain zaps” from others getting off Paxil as well.

Four weeks is a reasonable tapering period, but eight weeks or even longer is necessary in some people. A pill cutter, easily obtainable at any pharmacy, will be your friend. I’d recommend cutting the 10 mg pills in half, and take 15 mg alternating with 20 (alternatively, you could break the tabs into 1⁄4 if possible and take 17.5) for a week, then 15 for a week, then 15 alternating with 10 (or 12.5) for a week, and continue dropping the dose by 2.5 mg every week.

As the dose of Paxil is going down, so too might the dose of a replacement drug be increased, if appropriate, as prescribed.