Alternatives to Paxil

[peterch]

My wife of 22 years is seriously ill and I'm having lots of problems with depression plus anxiety. I feel depressed all day and I lay awake feeling scared at night. In the clinical literature depression combined with anxiety is what Paxil is recommended for. So today I was given a prescription for Paxil.

I've reviewed the peer-reviewed literature (my undergraduate degree is in neurophysiology and I work for a medical products company) and the data seems to suggest that at least 10% of paroxetine patients have serious, intractable withdrawal problems , which is way higher than other antidepressants! This is not news to anyone here.

Still, in reviewing the literature I have not been able to find any other antidepressant with strong anxiolytic (anti-anxiety) properties that is as well tolerated as paroxetine. Among the SSNRI's 25% of venlaxafine (e.g., Effexor) patients suffer severe nausea. 54% of mirtazapine (e.g. Remeron) patients suffer from somnolence (sleepiness). And most of the other SSRI's (e.g., fluoxetine/Prozac) increase rather than decrease anxiety!

So my question is, given the dangers of paroxetine WRT withdrawal, what's a good, effective well-tolerated alternative when depression is comorbid with anxiety?

Thanks in advance for comments, especially if they are based on study/research data, not just anecdotes.

[Katesmom]

The basis of this website is 'freedom is in you,' so if you are looking for another medication-based route, you are not likely to get it. In fact, you will hear from a lot of people who would argue that that 10% number is hugely deflated from reality. I have read more reliable (read that as not researched by someone associated with big pharma) that count the number of withdrawal victims (of any kind of withdrawal, not just severe and protracted) as closer to 66%.

As for the atypicals, like effexor and cymbalta, their half-lives make w/d so untenable that some people can never get off of them.

First of all, if you are looking for things based on research only and not anecdotes, you have to know that we are not research scientists. We are just people who have lived through SSRI use. I think that is pretty significant. These drugs are studied before approval for 12 weeks max, so the users who populate this site ARE the long-term study. We have a sticky in the general discussion forum where members post their symptoms in a simplistic way regarding w/d issues that last for more than six months aimed at researchers.

As for what works, we have studies on the site (check out the Research forum) that show that exercise and therapy are both more effective than any kind of medication. Additionally, the Methods of Wellbeing forum is chock-full of people's suggestions of all kinds of ways to improve their mental health. There are stickies about both fish oil/omegas and magnesium. Those supplements are miracle workers for some people. Magnesium particularly seems to do an amazing job on anxiety.

The bottom line is this--you have an identifiable cause for your anxiety and depression. There is a root to it that is emotional. Why try to treat these normal human emotions with medication? Brain-altering, life-altering medication. This is not a brain problem. This is something that should be addressed in talk therapy and through support groups with other family members going through something similar. Most hospitals or hospices have some kind of counseling for just this type of situation.

[Dawn B.]

I agree with Katesmom. You have a real reason for the depression and axiety you are feeling. I would not recommend trying to deaden those emotions with a drug such as Paxil. Yes, it might very well work, but eventually you would have to either deal with getting off of it, or poop out, which would lead to getting off it or another drug.
If I was you, I would seek help by talking to someone such as a pastor, trusted friend, etc. and pray. Those are the things that help me.
There are natural supplement type things you can get at health food/vitamin type stores to help you relax, that will not cause you harm or addiction.
God bless you and your wife.

[peterch]

Originally Posted by Dawn B.

If I was you, I would seek help by talking to someone such as a pastor, trusted friend, etc. and pray. Those are the things that help me.

I'm not religious and my wife is my closest friend. WRT to exercise - I already regularly run 10K's so I think I'm getting plenty of exercise.

There are natural supplement type things you can get at health food/vitamin type stores to help you relax, that will not cause you harm or addiction.

I tried valerian and St John's Wort but they had no effect whatsoever. Also, it's big mistake to think that just because something is "natural" it's any safer than a synthetic. St John's Wort affects most of the same reuptake enzymes as the commercial A/D's and has been demonstrated to have plenty of side-effects and drug interactions. Kava kava, which used to be a popular natural anxiolytic has largely been taken off the market because of all the hepatic toxicity, including several deaths.

Originally Posted by peterch

I'm not religious and my wife is my closest friend. WRT to exercise - I already regularly run 10K's so I think I'm getting plenty of exercise.


I tried valerian and St John's Wort but they had no effect whatsoever. Also, it's big mistake to think that just because something is "natural" it's any safer than a synthetic. St John's Wort affects most of the same reuptake enzymes as the commercial A/D's and has been demonstrated to have plenty of side-effects and drug interactions. Kava kava, which used to be a popular natural anxiolytic has largely been taken off the market because of all the hepatic toxicity, including several deaths.

I believe Kava Kava is now considered safe. There was a period a few years ago when there were problems, but it was found to be due to where the extract came from if my memory is correct. Kava Kava is marketed by several vitamin companies, including NOW Foods, an award winning producer.

Since you have the exercise down (for me, the absolute best method in controlling depression and anxiety), you may want to go the supplement route. GABA, 5-HTP, SAM-E and Magnesium are all noted to have a positive effect on anxiety.

After a year off of Paxil, I ended up in Stanford Hospital with severe depression and anxiety. While there I was put on Celexa and when I asked my doctors about whether it works on anxiety, I was told that all SSRIs can work on anxiety due to the similar nature of their effects. The reason some are not FDA approved for anxiety is that the drug company did not want to spend the money for the tests needed to gain this classification. I was also told that it takes 4 weeks for SSRIs to begin working on depression but up to 6 months to work on anxiety. My own experience with Celexa bears this out. If you still want an SSRI approved for anxiety, I believe Zoloft is so classified.

I agree with the others who advised staying away from these drugs. There long term effects are not truly known and your rolling the dice as to whether you will be one who is dramatically affected by side effects and protracted withdrawal symptoms.

[Johnnny off Paxil]

I am sorry for your misfortunes..your anxiety and depression are a normal response to this huge stress.. I would be too.

Now as for Paxil.... if you think you've got problems now...hahahahah
Paxil will bring you quickly to the Gates of Hell..to the Plains of Despair, the Valley of Sorrows and you will KNOW SUFFERING as you've never known it.
Best to stay away from Paxil or any SSRI or Benzo( Ativan, Xanax, Klonopin)


No amount of exercise or "self help " jump start you out of this, and neither will a cute lethal pink pill....... you are going through some very tough times...your response is perfectly normal...... I would try to find a councilor, or psychologist or therapist.. someone to talk to, to share your grief and sorrow... the healing your looking for is not found in a pill..that would be a horrendous mistake.


Oh and I should state that I used alcohol to cope with my Fathers death and my families lack of spirituality, the experience was devastating, but all the alcohol did is make me ill..it did not stop the pain and grief.

Lastly, hardships and misfortunes happen to us all, in older societies we had our extended family and society to help us share the burden, the unfortunate circumstance of this modern society is that we are so fractured and our sense of community almost non-existent..so we suffer..we suffer alone.
So you will need to seek out that help, seek out that support group or community...and sometimes the families we come from are so dysfunctional, they cannot be a source of support or strength..unfortunately.
Lastly, as an antidote to this, knowing your condition, its a good idea to keep up healthy habits and to weigh in on the side of being pro-active...just coming here and asking questions is a big step.

Regards, Johnny

[acornicus]

Peterch I would first like to say that I am so sorry to hear that
your wife is in such poor health. I lost my Mom when I was 27 and
I am now 42. The emotions that you are experiencing seem to be
quite normal under the circumstances. My feeling on AD's is that they
are an "acceptable" form of coping. You could just as well use any
number of illicit drugs to numb the pain and cope. During my Mom's
passing I found more comfort in Faith, Family, Friends, and counseling
than any drug wether legal or not. I hope you are able to find your way
through this tough time..

God Bless,

Aaron

[Songbird]

Originally Posted by peterch

Also, it's big mistake to think that just because something is "natural" it's any safer than a synthetic.

This is true, however pharmaceutical drugs kill many more people each year than any natural remedies. Natural remedies seem to be pulled off the market as soon as there is any problem, this rarely happens with pharmaceuticals (Vioxx is the only one I can think of).

I don't think there is an answer to your question, as all the SSRIs work in much the same way, the SNRIs are probably worse and the anti-psychotics pretty heavy duty stuff, all of them have side effects and withdrawal syndromes. To be honest, it's like choosing between the frying pan and the fire.

Another issue to consider is people's individual reactions to the various drugs. I have used both Paxil and Celexa for anxiety and it worked okay, but for some people they would not work well or even cause severe adverse reactions, there is no way of knowing how you will respond to the drug as an individual.

[westeewoman]

[quote=Katesmom;425872]
As for the atypicals, like effexor and cymbalta, their half-lives make w/d so untenable that some people can never get off of them.

cymbalta and effexor are not atypicals they are SSNRIs.

[safarigal]

From my personal experience the only way to overcome anxiety and depression is through lots of therapy. The pills helped me very little, they didn't teach me coping skills or new behavior, they only deadened my emotions.

[Ezin]

These antidepressants are often described as 'stimulant-like' because their adverse effect profile reflects that of a stimulant.

If you have a 'good' reaction to these antidepressants, then you should feel the effects typically generated by stimulants. It has been described as "These drugs are stimulants for people who would otherwise be fatigued, distracted by negative thoughts, or have difficulty concentrating. With their energising, attention-focusing, mood elevating, and calming effects, serotonin boosters would make almost anyone feel better, so long as they did not experience distressing side-effects" (Glenmullen)

Which is also why you discovered the 'increase in anxiety' phenomenon. Standard stimulation effects.

The paroxetine withdrawal figures you quote are most likely underestimated, since "In one study on Paxil, after only a few weeks on the drug, a significant dependence syndrome was visible in up to 85% of healthy volunteers upon withdrawal "(Healy, trial testimony in Tobin vs SKB. Correspondence between Dr Healy & UK regulators available either at socialaudit.org.uk, or healyprozac.com).

Similarly (and anecdotally, yup, I know, but there is a statistical point coming ), another friend of mine has come down with a mystery illness, this time, 6ish weeks after having a low dose of Lexapro (SSRI, escitalopram) stopped dead - sensory abnormalities (sore eyes, hyperacusis), acute fatique, sleep disruption, lethargy, joint pain, depression, increased anxiety, flu, agorophobic indications, gut problems (full colonoscopy), heart oddities - with all blood & investigative tests coming back negative. The doctor states it is not related to the antidepressant use, which was prescribed for grief. The friend is currently housebound, has already cancelled her usual busy Xmas social calendar, wishes to see no-one, and is so lethargic/apathetic that her hobbies are beyond her capability. This is an anecdotal story that will never make it to any statistics, because the doctor discounts delayed withdrawal, and considers the antidepressant connection null-and-void. And, a few days ago, another friend, on escitalopram, is now reported by a relative to be suffering from tiredness. If these type of anecdotal reports were statistically rare/infrequent, then I should not be hearing them from within my very limited social circle, they join: 1 x mystery vomiting, ear infection, & flu (accidental venlafaxine cold turkey); 1 x eye photosensitivity (fluoxetine); 1 x relationship problems (venlafaxine-induced lethargy, multiple dose shifting); 1 x police called (violent alcohol + venlafaxine reaction); 1 x withdrawal reaction (fluoxetine).

If you are weighing up the SSRIs/SNRIs/NaSSa options then do consider investigating the emotional blunting aspect, to see whether this falls within your acceptable benefit/risk parameters.

The trial studies/summaries/references to unpublished data that I've read don't indicate that any of these antidepressant drugs falls into the 'good, effective well-tolerated alternative' category - since the results were commonly enhanced through use of the following methodology: placebo responders were pre-removed; as were those displaying severe adverse effects; and secondary medication (benzos, I believe, but I don't have the refs in front of me) was allowed and administered to those exhibited the typical forms of agitation. They struggle to prove any efficacy over placebo.

On an individual basis, you could have a 'good' or 'bad' reaction to any one of them - the odds being roughly 50:50.

The mirtazapine (Zispin/Remeron) should only be prescribed to those in deepest darkest depression, after other options have failed, and where sedation is the primary requirement - it may leave one on the sofa, unwilling to move, except to eat another piece of cake.

The UK MIND site has a number of booklets available (online) which go through the relevant options for anxiety/depression. They may be of some assistance in sorting through the general options, and they sort through the respective categories of drugs, as well as the individual drugs themselves:

http://www.mind.org.uk/Information/Factsheets/

I suspect you already know the pros/cons of those benzos which are viewed as having the most anxiolytic properties? As with all benzos, short-term use, 2-4 weeks maximum, possible withdrawal & rebound post-drug. 'The Ashton Manual' available online, http://www.benzo.org.uk/manual/index.htm, will provide equivalencies & information (Chapter I).

The situational nature of your anxiety/depression runs counter to the prescription validity of many of the options... so although I wish there were an answer to your question, my own personal research conclusions (at present) would indicate not.

If you feel that the insomnia (in itself directly linked to the exhibition of depressive-like symptoms) is a major factor in the current situation, then you may find some alleviation if this can be directly addressed to even a minor degree, since the knock-on effects of sleep deprivation/REM deprivation can be debilitating in themselves. If all standard methods of getting some sleep fail, then the very occasional (and low) dose of a benzo may be therapeutic in the short-term, beyond that, they will mess with sleep architecture - plus more - & leave one in a worse position.

I regret that I cannot be more positive about the medication options. I do not envy you your balancing up of the various benefit/risk equations.

My very best wishes.

[Songbird]

If you are willing to consider alternative options to medication, I would recommend the book "Healing without Freud or Prozac" by David Servan-Schreiber. This book presents a number of options, all of which are supported by scientific research. These options include EMDR, heart coherence, fish oil and exercise, among others.

I would also personally recommend the books "You Can Heal Your Life" by Louise Hay, "Feel the Fear and Do It Anyway" by Susan Jeffers, and especially "End the Struggle and Dance with Life" by Susan Jeffers. These books have helped me immensely.

Another book I found very helpful for anxiety is "Breathe to Succeed" by Tania Clifton-Smith, which teaches good breathing techniques, which can help to alleviate anxiety if there is a tendency to hyperventilate.

There are also other books recommended by PPers to help with anxiety and depression, maybe others will chime in. Also some PPers have mentioned that "Holosync" has been helpful for them.

[mapleleafgirl25]

I love louise hay and her book you can heal your life is AWESOME..i have it here at home!!

[Songbird]

Originally Posted by Ezin

If all standard methods of getting some sleep fail, then the very occasional (and low) dose of a benzo may be therapeutic in the short-term, beyond that, they will mess with sleep architecture - plus more - & leave one in a worse position.

For short term sleep issues, I found zopiclone good, it preserves the natural sleep architecture, gives much better quality sleep than a benzo.

[moedaddy]

Hello,
I'm sorry that your best friend is suffering. I am currently involved in graduate neuroscience research...but I've learned more about paxil and a/d's through experience than any research I have done. And because you seem very aware of the evidence-based options, I'll make other points instead:
I may be wrong, but since you are not religious...do you look to science for all the answers? Again, I may be wrong about this assumption. But if this is the case, please understand that it doesn't have all the answers when it comes to the human mind...far from it. I'm sure you know that neuroscience is just in its baby stages right now.
I have great respect for science, and I'm one of those people that needs to know the 'why' to everything. But I had to work in my spirituality too... and paxil brought me closer to God (through w/d). Why not open the spiritual part of you. I believe life's circumstances are paving the way for you to grow in other ways.
Also, if you are not meditating I would start doing so now. It will help you put things in perspective as you deal with your challenges. In addition, exercise is not all that you need. 10k's were a piece of cake for me - I did longer distances and marathons. But still, science and exercise were not everything and so I took paxil.
Another thing I've been working on during w/d is patience. This is one of the hardest things...I still have problems with it, but I am becoming a patient person. Why not use your current challenges to become a well-rounded person?
Again, maybe you are doing those things already...but if not, you will have to do them someday. And why not start now?
The body always tries to heal itself, I hope that your wife gets better.
Take care.

[csnyder002]

I agree with so many of the posts here........and just to put my two cents in- here's my advice: Use your head...not mind altering drugs to cope. You are a smart guy, use your head!!! Get support from friends, family, couselors, and other resources...not from a pill.

[blankets]

peterch, there is nothing wrong with you that requires medication. You are feeling exactly how you are supposed to feel in that situation, and it isn't a bad thing. It shows how much you care. You'll go through the natural steps until you don't need to anymore. Everyone has to cope with losing someone else or watching someone they love suffer. It's not like you are sitting there feeling horrible for no reason at all. You have reasons! The drugs won't fix it, the pain will come back as soon as you stop taking them. This is actually very true, I found that when I came off the pills seven years after my parents split up I started to go through the natural pains of dealing with that. Not only did I have that to deal with, but the horrible protracted withdrawals as well as other emotional issues I had "accumulated" in drawers that Paxil had thrown my understanding of into. You can't even say 'that won't happen to me' roll your eyes and pop the things, there are so many people taking them that the chances of it happening are increasingly high!

My suggestion is to try to indulge in things that have given you pleasure. Arts? Music? Dance? Go see a play, writewritewrite, go for a walk somewhere you've always loved, paint a picture, sit with friends and watch.. hockey, football, basketball - whatever you like. Then for an hour or two a day, let yourself feel how you are feeling. Stop fighting it and just let it come. Cry if you need to, throw a pillow, yell, run. You will get through this, but you have to remember what it's coming from. Don't let it go astray - blame yourself, blame anyone else, or feel horrible about who you are. You can control it not going there if you remember it has nothing to do with that. If you want, add supplements to your diet and try to get more sunlight, but I have no doubt your neurotransmitters are working just fine. I wish you the best...