Doctors' Answers to "Frequently Asked Questions" - Paxil

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Paxil and Delusional thinking [posted 1/12/99]
Question: I have a friend who is taking paxil and was wondering if there has ever been a record of paranoia or delusional thinking while taking this. Her behavior is out the ordinary and I was wondering if it could be because of the Paxil. She believes someone is stalking her and I know that they are not. Any help would be appreciated.

Answer: Wouldn't be common, but you would need to check with the FDA or the company - Smith Klein: 800-366-8900.

Weight Gain and Paxil [posted 1/8/99]
Question: I am a 35 year old female and am currently being treated for situational depression with Paxil. I took Paxil about a year ago and noticed increased weight and up to 4" gained around my waist, abs, and hips within a month of taking the drug. At that time, I went off Paxil for 10 days and immediately lost 2-3". The depression returned a few months later and I resumed the Paxil. It has been about 6 months since then and I have gained another 4-5" around my waist, etc. I am very physically active. I walk or bike 45-60 minutes keeping my heart rate within 110-130. I lift weights and do spot exercises, i.e., crunches, leg lifts, etc., 5-6 times/week. I eat very healthy and have counted calories, fat grams, protein, etc., in my efforts to at least keep my weight and size stable. I just keep getting bigger. I have decided try another test and stop Paxil for 10 days to see what happens. Are there any side effects of this? Any withdrawals, besides the recurring depression? The situation, which has put me in this position is slowly being resolved, with me being an active participant to fix it. I have more confidence and I know that within 6 months, this particular situation will be completely gone. I have a history of depression in my immediate family, (Mother, 5 sisters) and I know it's hereditary. I have suffered depression in the past, but through counseling I have learned ways to combat it and to function normally for the most part without any drugs whatsoever. I think I will be okay without the Paxil, but I'm still nervous. The weight gain is impossible though. I'm ready to quit exercising. What's the point if I just continue to get bigger? Any ideas?

Answer: You'll be fine without the paxil. But, you might try other options Serzone, Celexa, or St. John's Wort. Most patients who experience depression once will need sporadic or continual treatment. This is especially true if other first degree relatives have similar problems.

Paxil vs. Zoloft [posted 1/7/99]
Question: I have been on Paxil for approximately 1 1/2 years. This time has been wonderful, absolutely free from depression and anxiety. However, I have gained 25-30 lbs. and have significantly decreased sex drive. My (wonderful) physician has decided to switch me from Paxil to Zoloft in the hope that this may decrease my appetite so that I can lose some of this weight. He says it's mainly trial and error. I have, over the past few days, been weaning myself off the Paxil, and am about to begin (gradually) taking the Zoloft. Is this a pretty normal procedure and is it indeed possible for the Zoloft to have the opposite effect as far as weight gain is concerned? I really hated to tinker with it at all since I feel so great otherwise, but my family and physician (and me) seemed pretty concerned about my weight.

Answer: I doubt that you will see much difference between these drugs, they belong to the same family and usually have the same side effects. Drugs which might help your sex drive would be Serzone and Celexa. Whether they help the weight is hard to know until you try them.

Paxil Side Effects [posted 1/6/99]
Question: What are the side affects the first week taking Paxil? I am taking 10 mg a day. I feel like I should be taking a stronger dose. I have had panic attacks for about six years now, and I feel very nervous taking this.

Answer: Dry mouth, constipation, decreased sexual drive, decreased orgasmic ability.

Paxil & Sleeplessness [posted 12/02/98]
Question:  I am currently taking 30 mg. of Paxil for 4 months so far. 20 mg previously for 6 months. I still need trazadone to fall asleep. I started with l00 mg and now I am weaned down to l/3 of a 50mg tablet. Why can't I sleep without traz? You say Paxil has a side effect of insomnia but is that a permanent side effect. Will I ever be able to sleep without Trazadone? I need an answer. Also I have normal blood pressure and at one time I wanted to decrease my dose to 20 mg. so I cut l/3 off a 30 mg. pill for 2 days. My blood pressure went up to l40/90 and stayed between l35/85 to l40/90 for that period of time. When I resumed to 30 mg everything was back to normal ll5/74. Is is possible that I experienced anxiety and my blood pressure rose as it use to when I got anxious. Maybe I should try to drop down more gradually like to 25 mg. My Dr. Will let me try going down but said to wait till after the Holidays because they can be stressful. I need an answer fast. Thank you

Answer: Generally, if one experiences sleep disorders on SRI antidepressants they will persist as long as the medication is taken and abate once stopped. As to the blood pressure, not sure about this. Your suggestion seems reasonable.

Could These Effects be Symptoms of Paxil Withdrawal [posted 11/3/98]
Question: I have been taking 10mg of Paxil since approx October 1997. My physician thought it might help alleviate some stress at work which seems to cause headaches occasionally. Recently (approx 1 week ago-about Sept 5) I stopped taking the Paxil because it seemed to cause me problems at work. I had the feeling of my mind not being sharp, kind of like being on timed release or slow motion. I didn't feel as alert at driving. I don't have any problems with depression. I was treated for breast cancer and am a 3 year survivor and plan to stay that way. In the last few days, I have had several things going on and I am not sure which is causing my symptoms, the PAXIL non usage or something else. It's allergy time in my state and they have been acting up really well this week. I have also been to a Physical Therapist occasionally to neck manipulation because I sit at a desk w/computer and at my age those activities don't seem to mix very well. Now for my symptoms this wee! k - - I have a very slight "tingling or numbness" - very slight like I have the very ending effects of novicaine (you know like when it is wearing off from dental work). It is in my face, arms and hands and slightly in my legs. This is not affecting my activities except that it makes be feel "not quite right". I just had my neck manipulated last Friday and then again this Monday (5 days ago and two days ago). Do you think this numb and tingling feeling is from the withdrawal of the PAXIL or could it be related to some nerve problem from my neck manipulation. I did not check with my Physician before quitting the PAXIL - you know how we are - no time to take care of ourselves. If you think it is the PAXIL withdrawal, how long might I expect it to last? I plan to see my Physician in about a week. Thanks so much for your attention to my questions.

Answer: Most patients don't have a major problem stopping the SRIs. Some will experience a wide range of symptoms which seem to coincide with stopping the medication. It is entirely possible that your headaches and these numbness are tied to the same problem since cervical headaches are very common. If you are having withdrawal symptoms, they usually subside in 2-3 weeks for most,occasional patients have 6-8 weeks of symptoms.

Paxil & Hair Loss [posted 10/21/98]
Question: My doctor just prescribed Paxil for my depression/anxiety symptoms but I read about hair loss as a possible side effect. I just got off of a 5 week trial of an estrogen (Estrace) that caused significant "male pattern baldness". Now that my hair is starting to come back in I am scared that 20mg Paxil will do the same.

Answer:Not usually a problem.

Paxil & Weight Gain [posted 10/19/98]
Question: I've been taking this drug, Paxil, for exactly 1 year. When I began taking this medication, I weighed 130 pounds. Since then I've put on an additional 40 pounds. I've tried twice to stop taking this drug, both times I had withdrawal and had to start over again at an increased but half dose. I don't have a mental problem and my doctor just told me that she's never had anyone on this particular drug for this amount of time. Imagine how I felt. Right now I'm on day 2 of my try to- get- off- the- med-project again. Now my doc also says that there is no scientific proof that this drug causes any weight gain, however, I've read a lot of info that has contradicted everything that she's said. I'm not saying that she's wrong, but does it or does it not cause weight gain and if so why? How do you stop it? Is there anything that you can take to counter act the weight gain? Also if this drug isn't addictive then why do so many people have this awful feeling of withdrawal with such severe symptoms? How long will it last and how long does it take to get this out of your system? Please help me with these questions as no one here seems to know the answers. Your response will be greatly appreciated.

Answer: About 40-50% of my patients gain weight on SRIs. About 10-25% lose weight and the rest seem to be in between. There are patients who seem to have severe problems decreasing the medication, for reasons that aren't exactly clear. I don't have any particular ideas about how to minimize this problem.

Paxil & FAA Requirements [posted 10/8/98]
Question: I have been taking 20mg of paxil per day for the past 8 months for panic disorder. until now, I have been a student pilot, but when I went to get my physical I was medically grounded. the doctor stated that paxil has been know to cause involuntary muscle spasms which could be dangerous to a pilot. he stated in his words that paxil was "bad news". paxil has been very effective in the treatment of my panic disorder, but if I can't fly then I no longer want to take it. are there any suitable alternatives to paxil that would allow me to continue flying?

Answer: Well, you need to check with the FAA. They have certain requirements about drugs which differ from what most physicians consider to be a problem. However, I think the FAA physician is full of it. Paxil is well tolerated and should not have any of the effects he/she is describing.

Paxil & Vaginal Bleeding [posted 10/6/98]
Question: I had been taking Paxil for 3 days, 5 mg. per day, and I started bleeding vaginally and having major discomfort, itching and burning, in this area. I have had a urine culture come back negative and have had no other tests showing any reason this should be happening. About two years ago, I took Zoloft for anxiety and also had bad reactions to this medicine. I asked my doctor if this could be related to the Paxil, and she said in very rare cases it could be. My doctor has since took me off the Paxil, and my bleeding is starting to slow down. She wanted to try Prozac on me, but now I am very afraid to try any other medicines in the SSRI family. Since I have had bad reactions to Paxil, and Zoloft, will I continue to have bad reactions to these types of medicines in the SSRI family, and if I would, what would you suggest. I suffer from panic disorder and anxiety disorder and I would really like some input. I currently take twenty mg of Xanax, and my doctor wanted me to taper off as this medicine is very addicting. The xanax doesn't control my panic or anxiety and I suffer from this on a daily basis. I currently go to therapy and am under a doctors care, but they do not seem to know the answer to this question. I appreciate your input.

Answer: Try different drugs like Wellbutrin, Effexor, etc. Not in the SRI class and usually help.

Paxil & Alcohol [posted 10/2/98]
Question: I have been taking 20ml Paxil for almost a year and I've had great results with the drug for my anxiety attacks. I am noticing when I go out with my buddies and really tie one on, I tend to be very aggressive in my pursuit of having a good time (not sexually.)I also find myself extremely confident around women even though I have a steady girlfriend. I love my girlfriend to death and would never cheat on her but when I drink excessively and while on Paxil, I find myself being very touchy, feely with the woman and even wanting to ham it up with the guys excessively. Please note I do not have sexual desires for the women while all of this is happening. I'm never like this when I don't drink. Quite the opposite. When I wasn't taking Paxil and I'd drink excessively I never acted this way. Is there a drug interaction going on here when I drink excessively?

Answer: Certainly sounds like it. Ethanol is clearly a drug that alters behavior. Different people have quite different reactions to its ingestion from somnulence to aggression. I'd either decrease the Paxil the day before and the day of your outings or decrease the etoh, preferably the latter.

Paxil [posted 7/30/98]
Question: I would like to have details as to what this drug is used for.

Answer: Paxil is an antidepressant of the serotonin reuptake inhibitor class. It is used to treat depression and anxiety disorders. Side effects are dry mouth, constipation, decreased sexual libido, occasional sleep disorder, occasional nausea.

Common Cold Medication with Paxil [posted 7/23/98]
Question: My wife is sick with a fever and cold symptoms. What medicines (over the counter) can she take while taking Paxil?

Answer: Paxil is remarkably symptom free, including interactions with other medications. There are no over the counter medications that would be dangerous.

Question: I have taken antidepressants on and off for about 12 years. I respond best to SSRIs, and have been taking Paxil for 2-3 years now. Lately, it seems like it isn't working as well. I read that after about a year, the effectiveness of the drug diminishes. I have also heard that some people switch to effexor because it is different enough to continue working. I take Paxil not only for depression, but also to help control an eating disorder, so I don't know if Effexor would help where that is concerned. I have tried going off antidepressants, but each time eventually results in a downward spiral, so that is not an option. Also, if I forget to take my medications for even a day, I feel physically ill. Could this be withdrawal? Is that normal?

Answer: I have seen these reports, but clinically I haven't seen this tolerance effect. I would increase the dosage of the Paxil if it has worked in the past.

Paxil and weight gain
Question: I have been on 15 mg of Paxil and 0.5 mg of Klonopin three times a day for 3 years. I have gained 50 lbs. despite exercise and diet changes. I was at 175 lbs., which is a normal weight for a 5'11", 39 year old male, when I started taking the combo of drugs. What can I do to lose the weight? Paxil and Klonopin have been great for depression and anxiety, and except for the weight gain, there have been few side effects.

Answer: A lot of people are trying St. John's Wort(hypericum). However, its not clear about the weight issue. It is clear that many patients gain weight on SRI antidepressants. If you can't stop the Paxil, it might be worth trying Serzone, Wellbutrin, etc. That is, newer antidepressants which are not of the SRI type to see if you can maintain your benefits without the weight gain. This is a tough problem.

Question: I need to know about paroxetine and its side effects.

Answer: Paroxetine hydrochloride(paxil) is a relatively newer class of antidepressant. This drug belongs to the class called SRI (serotonin reuptake inhibitor). Common side effects are headache, dry mouth, constipation, weight gain/loss, nausea, diarrhea, decreased sexual drive, absent ejaculation, sleep disorders. There are others, but this is the most common list.

Question: I have been taking Paxil at 20mg/day. It seems to effect me in that I have trouble reaching orgasm. Is this possible, and if so is there a good replacement for paxil?

Answer: A common problem with Paxil and all the SRI antidepressants. Serzone will occasionally help. Also, Wellbutrin and Effexor should be tried. There have been reports of increased sexual drive and performance while taking small amounts of amphetamines and the SRI antidepressants. This should be a last resort, but it seems to be somewhat effective.

Question: Gene is a 76-year old inpatient in a 'typical' nursing home-- not too great, not too terrifying. His 100% Service-connected disability is 'severe clinical depression', for which he has been institutionalized on-and-off for 30 years. In 1995, after 10 years in a nursing home, his 72-year old wife brought him home to attempt to take care of him he just returned to the home in May. He is understanding and lucid, but extremely quiet, sleeps or is in bed 20 hrs/day, is completely incontinent, is ~5'10" and currently weighs 130 lbs, down from 148 lbs on his admission in mid May. The nursing home psychiatrist wishes to prescribe Paxil "to make him smile a little". My concerns are potential side effects of gut irritability and loss of appetite, and the lack of physician oversight while he is on the meds--he is only seen by an MD twice/month, and by his psychiatrist once/month. Other concerns are his age and lack of positive response to other meds, including Prozac. I would greatly appreciate your feedback on my concerns about Paxil and Gene. Also, he is injected in the gluteus with what my mother in law spelled out as "detotestosterone", but is not listed in DrugInfoNet. A nurse said it was "for his appetite" and that he had received about 4 shots since his admission. Would you provide a correct spelling and input as to the action of this drug, and comment on when you might expect to see improvement in appetite with use of this drug?

Answer: Paxil is of a similar family as is Prozac. I would doubt that you'll get much results. You might try wellbutrin or other classes of antidepressants. Depotesterone is the drug your dad is getting, I suspect. This is a sustained release testerone. Testerone is the male steroid hormone and is useful if he has a deficiency. However, there is no reason to give anyone testerone unless he has a deficiency of testerone. It will only add to the cost. Secondly, IM injections are to be avoided in bedridden patients due to the possibility of bedsores. Testerone(if necessary)can be administered by skin patch administration, but it does cost more.

Question: My wife has been taking Paxil for approximately 2 1/2 years. During this time she has complained of a loss of emotion effect. Recently, she stopped taking the drug cold turkey and refuses to resume. This has brought on irritability and depression to the point that I am searching for help from you. I should also add that at this time she is refusing to seek counseling, as she insists she will deal with the problems. Will things come back to "normal" after a period of getting used to living without the drug? Are there any other adverse reactions we can expect?

Answer: I doubt that the Paxil is responsible for the loss of emotional affect; rather, she was probably depressed or emotionally labile prior to treatment. I suspect stopping the drug has unmasked her underlying depression. Consequently, I doubt that she will "return to normal". Since it doesn't sound as if she has any perception of her problem, you are probably fighting a losing battle. However, she might try an herbal treatment. St. John' Wort(available in health food stores) is touted as a treatment for depression without the side effects. I would discuss this with her.

Question: Can paxil also be used for panic attacks after Cocaine Abuse?

Answer: Usually the SRI antidepressants like Paxil are helpful in any situation where panic attacks occur.

Paxil and Anorexia / Bulimia
Question: For the last year and a half I have been suffering with both anorexia and recently bulimia. I was diagnosed last summer as depressed and prescribed Paxil to aid in the depression. I have been taking Paxil for about 10 months. Although it has helped a great deal with my depression, my eating disorders are still pretty bad. I have been seeing various counselors, psychologists, etc., since the beginning and I recall one of them mentioning that anti-depressants help in getting rid of eating disorders. Well, I knew it wouldn't be a "cure" but it doesn't seem to have helped at all. Any conclusions? My mom would like me to "ween" me off the anti-depressants. Currently, I am taking 30 mg once each day of Paxil. I know if I miss it for a few days I get extremely depressed. I don't feel I am ready to go off them yet, but my mom believes otherwise. Suggestions? I'm tired a lot of the time. I know this probably has quite a bit to do with my eating disorders and the fluctuation of metabolism, electrolytes, etc., but my parents think it's a sin to have a nap in the afternoon when there could be other "productive" things I could be doing. Aside from the eating disorders, is tiredness a side effect from the Paxil? I am 18 years old. I am a very active person as I go to school part time and I also compete across Ontario (where I live) with my horses in show jumping, eventing and dressage competitions.

Answer: These drugs usually help, but are not a cure all. Ensure that your dosage has been pushed to the point of side effects before giving up on them. Also, try Serzone or another similar drug which is structurally different. Don't listen to your mom. Listen to your body, your needs, and your physician. Occasionally, are you having trouble sleeping with the Paxil? This is a common side effect.

Question: Is Paxil safe to take for anxiety?

Answer: Paxil belongs to a group of anti-depressants called Serotonin Reuptake Inhibitors. These are used extensively to treat depression because of the short onset of action, minimal side effects and overall effectiveness. They are also used in other conditions besides depression, especially Manic/Depressive Disease and Anxiety Disorders. They may be very effective in anxiety and panic disorders. Side effects include headache, abdominal pain, palpitations, sweating, nausea, dry mouth, constipation, diarrhea, sleepiness, vertigo, tremors and difficulties with ejaculation and sexual drive. In general, these drugs appear to be very safe. My patients generally tolerate them well, with the major complaint being a lack of sexual interest. No major long term side effects have been reported to date.

Question: I am currently taking Paxil and have noticed a difference in my dreams. I used to always be able to direct my dreams. Now, my dreams are much clearer, and I never know I am dreaming. Also, I seem to be dreaming about people from my past and people I have never dreamed about before. Are there any pertinent findings on the relationship between Paxil and dreams?

Answer: Although there is no good documentation of changes in dreams, there is little direct documentation on the types or changes in dreams on Paxil. Often, people will report strange dreams of different dreams, but there is little direct study on types of dreams.

Anxiety Attack
Question: I've been taking 20 mg of Paxil per day (irregularly) for about a year. I recently stopped taking it altogether, and I have just experienced a brief, but excruciating anxiety attack. My doctor tells me the my options are to resume taking Paxil or try a regular dosage of Klonopin (and Melloril if necessary). Could my anxiety attack be a reaction to stopping the Paxil or is it more likely to be a recurrence of the problems for which I was prescribed Paxil in the first place? If the former, I would have serious reservations about resuming a course of Paxil. If the latter, it would be worth putting up with the side effects to prevent another recurrence.

Answer: Paxil is an excellent treatment for anxiety and panic disorders. I suspect that it is not due to stopping the drug , but to lack of treatment of an underlying problem. Anxiety attacks tend to occur in clusters and then be absent for long periods of time. I usually tell my patients to occasionally taper and stop the medicine to see if they are experiencing a hiatus of the anxiety. Some will need it daily for the rest of their life. Others less so. Long term side effects so far appear to be minimal.

Question: I have been on Paxil (20 mg) for a year now and seems like it has not been doing much good lately. I mentioned this to my doctor and he switched me to Prozac (20 mg). He said I could just stop the Paxil immediately and take the Prozac. He also said the Prozac would not start working well until about 4 weeks into my system. Whenever I have run out of Paxil or forgotten to take one, I seemed to become very unpleasant (mean and angry). This gets even worse in the period of getting the Prozac into my system. Does this sound right? Could I take a Paxil and a Prozac during this time to help my mood change for the better?

Answer: Both of these drugs are similar and I doubt that one would be markedly superior. However, you are really taking very small doses. Most patients need to be on 40 to 60 mg and even doses of 80 or 100 are not uncommon. Sometimes small doses of amphetamines will markedly improve the performance of this class of drugs.

Alternative to Paxil
Question:My son has taken Paxil, but can not really afford it, and neither can we. It is derived from Tryptophan, is it not? Can he take Tryptophan instead? The doctor who gave him Paxil just tried it to see if it would help his depression. It did, but as I said, he can't really afford it. Tryptophan is available through a German connection, and he did take it years ago when it was still available in the US. It also helped. What concerns me is that a pharmacist in Nebraska told my husband that taking Tryptophan instead of Paxil could be very detrimental to our son. [His age is 24.] Any suggestions? Are there social agencies that help with the purchase of necessary drugs?

Answer:Taking tryptophan will do no good at all with your son's depression. This drug is a serotonin reuptake inhibitor(SRI), which tryptophan is clearly not. There are several drugs in this class and usually using zoloft, prozac, etc will have similar results. Many drug companies will treat patients with free medicines if the patients physician will certify that the physician is not being paid-hence, a true charity case. I would discuss billing etc. with your physician, I have several patients who are on these programs.

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