Drug info - paroxetine (paxil) for post-bone marrow transplant anxiety

[Benga]

hello all
a friend's relative has been prescribed 20mg paroxetine (paxil) for a few weeks, to deal with her (AML leukemia related, post marrow transplant) anxiety.
it's a tense situation, a few months after the transplant, where her condition is stationary but could easily degenerate, which would in the case imply death in less than 6 month.
coping with such tension is not easy, and her GP, not the hospital crew in charge has prescribed 20mg paroxetine.

well apparently she's not reacting to it well at all, physically (vertigo, fatigue, nausea and others) and especially mentally. Sudden bursts of fear, insomnia, and general feeling of having strange thoughts.

she's of course wondering if she should keep on with this.
it was prescribed by a GP (not by the hospital team following her, she has not informed them), with no actual psychological supervision.

and since i remembered the bit about the potential SSRI / suicidal tendency increase, i looked into it and it seems like this one's a heavy controversial one, with side-effects rebound / withdrawals issues etc...

since there's no planned medical supervision, and it's apparently becoming problematic, i find this pretty worrying, especially regarding mood issues.
she's also combining this with zolpidem to get some sleep every night.

I advised her to inform the prescriber of her desire to stop using this, so that they can plan a way to come off it smoothly, and to try gradually diminishing doses.
it's been around a month, so tolerance might be build and apparently this can be quite problematic, as many posts here point out

would love some input on the subject.

the possible severe anxiety rebound effects are worrying, with little medical supervision, coming from someone who describes recent sudden bursts of general fear, insomnia, and starting to wonder if she should have had this marrow transplant (which boosts her survival chances to 40% if successful), since life meant worrying about possibile complications all the time.
i'm not sure if this was before or after the paxil perscription (which was for general anxiety). not trying to play doctor here, but i have this feeling that this particular anxiolitic was not the ideal choice in her situation, and that the lack of supervision is slightly worrying, especially in her particular case (post acute myelogenous leukemia related marrow transplant ), where one would probably need something to cope with stress and anxiety, but not something with possible adverse effects on the symptoms.

thanks

b

[dcrn]

Benga, I will try to help as much as I can. Before I do anything here, xxxxxxx a wonderful website with so much information about Paxil shared throughout the entire world. They have a huge forum with the nicest people who can give her the best advice possible.

First of all, let me say this. Paxil is probably one of the worst anti-depressants. Doctors have no clue how to have their patients stop this strong anti-depressant. Paxil treats anxiety and depression. I was put on Paxil (also 20mg) because of anxiety that was because of Swims previous cocaine use. After swim stopped using cocaine all the anxiety came up on me. Swim used cocaine heavily for about a year..and he's been clean for more than a year aswell..quit cold turkey

Anyways, Paxil does work but it has one of the worst withdrawal symptops from any SSRI's. You say she's been on it for a month, while this is not such a long time, her brain has been already accumulated and used to get the extra chemicals that Paxil gives you. I don't know if you know anything about SSRI's Benga but what Paxil does it helps improve unbalanced chemicals (seratonin) ...uneven chemicals in the brain are the ones giving us anxiety, fear, depression - ssri's help your chemicals get even. It's a simple as that. So when you take away Paxil from someone, their chemicals go up and down, and this is when the nasty withdrawals come from. Paxil SHOULD NEVER be stopped cold turkey...it can have serious even lethal withdrawal symptoms. PAXIL-PROGRESS has some excellent ideas on how to successfully stop Paxil...little by little...until you completely go off and your brains starts using its natural chemicals that have been now improved.

I started with 20mg...tablets,...then went to 15mg...then 12...then 10mg...and started to taper of with Liquid. Paxil. SOMETHING THAT I STRONGLY RECOMMEND TO ANYONE THATS WANTS TO WEAN OFF. It usually comes in a bottle 250ml or 300mg. PAROXETINE SUSPENSION that's what's its called. This is used by oral syringe as you draw certain ML's needed. Right now I'm taking 8mg which is 4ml on the syringe. You'll find the chart on paxilprogress.org

So my best advice for your friend is to have someone highly trained/qualified slowly wean her off from Paxil and prescribe something else.

Goodluck

[Benga]

thanks for your answer. yes i'm familiar with how SSRI's work, but i must say i'm a little upset that someone dealing with such an anxiogenic situation ( possibly dying in the next 6 months) be put so lightly on such a problematic one, which is known to have heavy side-effects.
we'll see how it goes, what withdrawal management plan, if any, is offered by the GP (not sure the prescriber's actually aware of such issues), and take it from there.

[Rainbowzz]

Heres what my friend SWIM said:

I really do not think that putting someone on an SSRI for anxiety over possibly dying is the right option. Rather, I think she would be better off with a mild dose of a benzo.. has this been tried? I mean she shouldnt have any problems getting it, considering shes in just about the most stressful situation any human ever has to go through.

The other thing is most SSRI meds dont become completely effective for 6+weeks.. so by the time she just started to adjust to it, they would be taking her off it. Thats basically giving her enough time to work up a dependance on it and have to go through the hell of withdrawls along with surgery.. no, it just doesn't make any good sense to me at all.

I would HIGHLY suggest she ask to get OFF this drug now.. as she sounds like its doing more bad than it is good and honestly as I said before, doesn't make any rational sense, especially if she is not being followed.

Also. I was put on paxil when I was only 13.. it ended up hospitalizing me, causing me to almost jump off a roof, and a whole host of other issues. My aunt is a nurse with the VON in canada, she teaches doctors, and she told me she fully beleives that paxil is THE single most toxic SSRI and the worst for withdrawl that there is. She said its the one thats the hardest on the body as well.

HTH!