Stopping Paxil.

This can be terribly difficult. But it can be done. (Note updates!)

I note Dr. Stephen M. Stahl's "dosing tips":

"For patients with severe problems discontinuing paroxetine, dosing may need to be tapered over many months (i.e., reduce dose by 1% every 3 days by crushing tablet and suspending or dissolving in 100 ml of fruit juice and then disposing of 1 ml while drinking the rest; 3-7 days later, dispose of 2 ml, and so on.) This is both a form of very slow biological tapering and a form of behavioral desensitization."

So if a dose was lowered from 20 mg to 19 mg, that would be a 5% reduction. But he's describing a 1% reduction. (As the dose gets lower, the proportion changes, of course.) He adds:

"For some patients with severe problems discontinuing paroxetine, it may be useful to add an SSRI with a long half-life...prior to taper of paroxetine."

He also notes that paroxetine inhibits its own metabolism, making tapering even more problematic for some (i.e., the effect of a dose reduction can be magnified. The patient is not only taking less, he's also eliminating it faster). -Essential Psychopharmacology: the Prescriber's Guide by Stephen M. Stahl, Meghan M. Grady (Editor), Nancy Muntner (Illustrator)

Note! Dr. Stahl and I can't tell you what to do. We aren't your doctors! (See disclaimer in sidebar.)

Why I'm posting this: I notice that I'm getting lots of hits from this site today. (5/20 update: the link has been changed, and now there's no access to this forum. There was much outrage about some psych-blogging, including mine.) There's horrific pain and anger in this thread. Obviously, for many, there's been a complete breakdown in the relationship between psychiatrist and patient. I hope that no one has to go through the pain that they're describing.

Update: related post here. And note, please: no medical advice is given on this blog! (I've come perilously close to breaking my ironclad rule, here.) Eat a healthy diet, look both ways when you cross the street, and talk to your doctor about any and all med changes! Patients should have a doc in their corner, looking out for them!

Yet another update (6/13): Baldrick has an important comment.

"one of the problems with the internet is that large numbers of people with rare conditions/reactions/discontinuation reactions congregate in one place. They may or may not have atypical ideas, metabolisms or disease presentations."

However, I'm afraid that I'm going to have to delete any comment that gives, or appears to give, medical advice. That includes posts that say, "Do this" (whatever "this" is). The issue of whether, and how, and when to stop meds is controversial. Each patient is different. Please speak to your doctor! No medical advice is given on this blog.