Paroxetine -- only slightly worse for withdrawal? Write a letter!

[altostrata]

Send e-mail to the authors of this article.

Dr. C.U. Pae, Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 2218 Elder Street, Durham, NC 27705, USA; and Department of Psychiatry, The Catholic University of Korea, College of Medicine, 505 Banpo-Dong, Seocho-Gu, Seoul 137701, South Korea. pae@catholic.ac.kr; chiun.pae@duke.edu

Dr. A.A. Patkar, Associate Professor of Psychiatry, Duke University Medical Center, 2218 Elder Street, Durham, NC 27705, USA. ashwin.patkar@duke.edu


Expert Rev Neurother. 2007 Feb;7(2):107-20.

Paroxetine: current status in psychiatry.

* Pae CU,
* Patkar AA.

Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA. pae@catholic.ac.kr

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with antidepressant and anxiolytic properties. It is commercially available in both an immediate-release (paroxetine) and a controlled-release formulation (paroxetine CR). The latter product was developed to improve gastrointestinal tolerability. Paroxetine is the most potent inhibitor of the reuptake of serotonin among the available SSRIs. It has approved indications for the treatment of major depression, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder and social phobia in adults. Paroxetine CR is approved for the treatment of major depression, social anxiety disorder, panic disorder and premenstrual dysphoric disorder in adults. While the overall efficacy of paroxetine appears to be comparable with other SSRIs in the treatment of major depression, it is approved for use in a wider variety of anxiety disorders than any other antidepressant. Long-term data suggest that paroxetine is effective in preventing relapse or recurrence of depression for up to 1 year. Limited data show that paroxetine maintains a therapeutic response over 1 year in obsessive-compulsive disorder and up to 6 months in panic disorder. The side-effect profile of paroxetine is largely similar to that of the other SSRIs, although paroxetine tends to be more sedating and constipating in some patients, perhaps due to its anticholinergic activity. The potential for discontinuation syndrome and weight gain appears to be slightly higher with paroxetine than with other SSRIs. This review focuses on the immediate release and controlled-release formulations of paroxetine. It summarizes the efficacy and tolerability data for both formulations, with a particular emphasis on paroxetine CR which was introduced in 2002. It also discusses emerging evidence in other clinical areas and recent data that have led to modifications in the safety profile of paroxetine.

PMID: 17286545 [PubMed - in process]

[altostrata]

From: [altostrata]
Subject: Paroxetine discontinuation syndrome
Date: February 10, 2007 8:53:13 PM PST
To: chiun.pae@duke.edu, ashwin.patkar@duke.edu
Cc: k.mccauley@future-drugs.com, m.robertson@future-drugs.com

Drs. Pae and Patkar:

I read with interest the abstract announcing publication of Paroxetine: current status in psychiatry. Expert Rev Neurother. 2007 Feb;7(2):107-20.

In this paper, you have found that paroxetine has potential for discontinuation syndrome only "slightly higher" than other SSRIs. You may be interested in finding out exactly what, in patient experience, this "slightly higher" potential means.

On paxilprogress.org, an online support group for those suffering from Paxil discontinuation syndrome, I have asked those suffering from discontinuation syndrome for more than six months to post their case profiles. The topic is titled "RESEARCHERS Look here for case histories of prolonged discontinuation syndrome" at the top of the General Discussion sub-forum. The link to this topic is http://www.paxilprogress.org/forums/...ad.php?t=20079.

The more than 50 case reports posted in this topic are only a fraction of the cases reported on the site, which is a compendium not only of the suffering caused by withdrawal syndrome itself but from the frequent medical malfeasance in treating it.

Speaking for myself, after more than two years of nearly disabling discontinuation syndrome, I am still recovering after tapering from 10mg paroxetine over 10 weeks. I have many symptoms indicative of dysautonomia, noradrenergic hypersensitivity, and dopaminergic downregulation, including lack of joint and muscle flexibility and emotional blunting. Because misdiagnosis of discontinuation syndrome is almost universal -- which, by the way, makes your findings suspect -- I have been unable to find appropriate medical treatment. My only assistance has paxilprogress.org.

I urge you to review these cases on paxilprogress.org and consider their medical implications.

Sincerely,

[altostrata]

cc Kelly McCauley, Morag Robertson, Senior Editors, Expert Review of Neurotherapeutics

[altostrata]

From: k.mccauley@futuremedicine.com
Subject: RE: Paroxetine discontinuation syndrome
Date: February 12, 2007 6:03:01 AM PST
To: [altostrata]

Dear [altostrata],

Many thanks for your mail and for contacting me regarding your
experiences. There appears to be a problem with the Paxil Progress
website at the moment but I will try to connect again later today.

I am delighted that you have decided to contact the authors of the paper
with your view on the article from the point of view of a patient. The
article that was prepared was based on a combination of professional
experience and reviews of the already existing literature. The article
was then peer reviewed by 3 independent researchers in the same field
and the paper amended to their specifications.

It is to this end that the scientific review process was carried out to
publication standards; however, it is imperative that patient concerns
are also considered and communicated correctly to the scientific
community, and I hope that by initiating this dialogue with the authors,
you will enable this to happen. I have attached a complimentary copy of
the full article should you wish to read further and should you have any
further queries, please do not hesitate to contact me.

I wish you the very best in your endeavors and for the future.

Regards,

Kelly

[altostrata]

From: [altostrata]
Subject: Re: Paroxetine discontinuation syndrome
Date: February 12, 2007 9:32:09 PM PST
To: k.mccauley@futuremedicine.com

Thank you, Kelly. Please do attempt to look at paxilprogress.org again.

I realize patient reports are only anecdotal; however, very few studies are being done in this area. The assumption is that the incidence of severe discontinuation syndrome is negligible. It is an assumption for which there is no statistical evidence. It is more likely severe discontinuation syndrome is rarely recognized and therefore underreported, as Dr. Peter Haddad has pointed out on several occasions.

You will find paxilprogress.org to be extremely interesting.

[scotty]

Figures...the one day that we are down she came here!!! Alto, this dialogue you have going is great!!

[rdjanis]

My thoughts exactly... we hardly ever go down!!

Amazing Alto!!

[altostrata]

From: [altostrata]
Subject: Re: Paroxetine discontinuation syndrome
Date: February 12, 2007 10:11:44 PM PST
To: k.mccauley@futuremedicine.com

Kelly ---

Thanks very much for sending me the paper. It reads as though the authors were promoting paroxetine CR even in the section on neonatal risk -- an issue I find especially appalling. I noticed there is no indication of who funded their study. Was it perhaps GlaxoSmithKline?

This information should always be included in the publication of a medical study.

Thanks again,

[altostrata]

[altostrata]

From: k.mccauley@futuremedicine.com
Subject: RE: Paroxetine discontinuation syndrome
Date: February 13, 2007 1:34:08 AM PST
To: [altostrata]

Dear [altostrata],

Many thanks for your correspondence. The authors were not funded by
GlaxoSmithKline and they signed an Author Disclosure Form to verify that
this was the case, however, I do understand your frustration given your
personal experience and I will certainly put aside some time today to
look at the website and read through the patient messages.

I do hope the authors of the paper contact you regarding your work and
that they take this into consideration when next preparing a paper on a
similar topic.

I wish you the very best in your treatment and if I can ever be of any
assistance in the future, please do not hesitate to contact me.

Kindest regards,

Kelly

[altostrata]

Thanks, scotty, for moving the posts about my correpondence with Kelly McCauley, senior editor of the medical journal in which this article was published.

Folks, please write to the authors of the study, Drs. Pae and Patkar: e-mail chiun.pae@duke.edu and ashwin.patkar@duke.edu

[summer bee]

Originally Posted by altostrata

"The latter product was developed to improve gastrointestinal tolerability."

oh, eat me; the latter product was developed to keep the big bucks rolling in as the regular formation went generic!

but: great dialogue, alto! if i find any spare time this week i'll see if i can type something up.

[Kitsyl]

Good for you, Alostrata! I hope they come here and read what's really going on with this crap.

[altostrata]

Write them with an invitation! The more patients that speak up, the better.

Otherwise, researchers will just keep on spinning in their ivory towers and never realize what "slightly worse for withdrawal" means.