Withdrawal: Paxil > Zoloft > Prozac

Looks like the serotonin anti-depressants (ie. SSRIs and agonists) might create physical dependence, and thus can cause some serious withdrawal. Surprise, surprise! This article from the NYT points out that since serotonin is used throughout the body, including in the digestive system, there can be some very strange withdrawal effects. Interesting point about how drugs with a longer half-life produce less severe withdrawal because they leave the system more gradually.
[Edited 11/2006 to rectify incorrect use of addiction-dependence terminology -Neville]

Click Read More for the whole article.

May 25, 2004
THE CONSUMER
How to Stop Depression Medications: Very Slowly
By MARY DUENWALD

Now that the Food and Drug Administration has warned Americans taking antidepressants to be on the lookout for potentially harmful side effects, including severe restlessness and suicidal thinking, some people may end up stopping the drugs. But going off antidepressants can bring its own problems.

Stopping cold turkey can cause an array of troublesome symptoms, the most common being dizziness, which can last for days on end. Flu-like feelings, including nausea, headache and fatigue, are also common, as are intense feelings of anxiety, irritability or sadness. Some patients experience alarming sensations of tingling or burning in various parts of the body; ringing in the ears; blurred vision; or flashing lights before the eyes. Some people even describe a feeling of shock waves pulsing through their arms and legs, as if they had been zapped with a jolt of electricity, a condition sometimes called lightning-bolt syndrome.

“The feeling can be really abrupt, like a quick jerk of the muscle,” said Dr. Richard C. Shelton, a professor of psychiatry at Vanderbilt University. “It’s not painful, but it can be very frightening to people.”

Internet bulletin boards and Web sites devoted to antidepressant withdrawal chronicle the crying spells, vertigo and nightmares that people sometimes experience.

“I feel like my brain is floating in Jell-O, slamming into the sides of my skull every time I move my head or my eyes,” one person wrote.

Another described palpitations, night sweats and “bloody hideous nightmares.”

To avoid such symptoms, or at least hold them to a minimum, the drugs need to be tapered gradually in most cases, and that means quitting under a doctor’s supervision. Psychiatrists say it is unwise for people who are taking antidepressants simply to quit on their own.

In its warning, issued in March, the F.D.A. urged doctors to closely monitor patients taking antidepressants, especially during the first weeks of therapy or when changing dosage. Signs of trouble, the agency said, could include suicidal thoughts, severe restlessness, anxiety, hostility or insomnia. Though an association between antidepressants and suicidal thinking or behavior has not been proved, unpublished studies suggesting the possibility of such a link in children and adolescents have caused concern. The F.D.A. is still investigating the issue.

The drugs most likely to produce withdrawal symptoms act on the brain chemical serotonin. These drugs work by blocking the action of a protein in the brain that normally transports serotonin out of the synapses, the spaces between brain cells. With the transporter protein blocked, serotonin lingers in the synapses, and that can have a positive effect on mood.

When the drug is taken away, there is suddenly less serotonin in the synapses. Serotonin receptors in the brain, accustomed to a larger supply of the neurotransmitter, may take days or weeks to adjust, said Dr. Ephrain C. Azmitia, a psychopharmacologist at New York University.

“You get a precipitous drop in all the things that serotonin does in the brain, including its effects on appetite, sleep, sensory perception and emotions,” Dr. Shelton said.

Not everyone experiences withdrawal symptoms. Studies suggest that only 10 to 20 percent of patients have significant problems, said Dr. Jerrold F. Rosenbaum, chief of psychiatry at Massachusetts General Hospital in Boston. And some patients find the effects less intense or bothersome than others.

Doctors say people who have been taking especially large doses of a drug for many years may be somewhat more vulnerable. Which drug a patient is taking also makes a difference. Some are stronger than others, and some are metabolized by the body more quickly.

The longer a drug’s half-life – the time it takes for half the amount of drug in the body to be eliminated – the less likely it is to cause withdrawal problems. Eli Lilly’s Prozac, for example, has a long half-life, remaining in the body for days or even weeks after someone stops taking it. As a result, people who take it are less likely to experience withdrawal effects.

“With Prozac, it can take six weeks for any symptoms to occur,” Dr. Rosenbaum said, and even then the effects are mild, with about 5 to 6 percent of people experiencing mild dizziness.

GlaxoSmithKline’s Paxil, on the other hand, generally leaves the body in a day or two. Effexor, made by Wyeth, disappears faster still.

“When you look at these drugs with a very short half-life, almost everybody who quits abruptly experiences at least some symptoms, some dizziness,” Dr. Shelton said. “And about half of people have more significant symptoms.”

For this reason, psychiatrists advise patients taking antidepressants to avoid skipping doses. People who take Paxil or Effexor sometimes experience withdrawal symptoms when they forget to take their pill for a day or two.

“With Effexor, if you miss your morning dose, you can be in withdrawal by the afternoon,” said Dr. Joseph P. Glenmullen, a psychiatrist at Harvard and the author of “Prozac Backlash.”

Zoloft, made by Pfizer, is somewhere in the middle – more likely than Prozac to cause withdrawal symptoms, but much less likely to do so than Paxil and Effexor. Celexa and Lexapro, antidepressants that are made by Forrest Laboratories and that act on serotonin, are also somewhere in the intermediate range, Dr. Rosenbaum said.

Cymbalta, a new antidepressant from Lilly that is expected to win F.D.A. approval later this year, will probably also fall in the middle, he said.

Wellbutrin, an antidepressant also marketed as Zyban, does not work directly on serotonin in the brain. As a result, doctors say, the drug, made by GlaxoSmithKline, does not seem to cause withdrawal symptoms when patients stop taking it.

The withdrawal symptoms do not mean that antidepressants are addictive, experts say. People who are coming off the drug do not crave it, as addicts might crave heroin or cocaine, and they do not seek higher and higher doses over time.

“There’s a lot of misperception about that,” said Dr. Alan F. Schatzberg, a psychopharmacologist who is chairman of psychiatry at Stanford University School of Medicine.

For that reason, many doctors describe the effects produced by stopping antidepressants as a “discontinuation syndrome” rather than as withdrawal.

Yet the symptoms can be troublesome enough to prompt some patients to go back on their medications.

To help patients stop taking an antidepressant, most doctors use a strategy of gradually tapering the drug over time. With Prozac, stepping down the dosage for a week to 10 days may be enough to get patients off it comfortably, Dr. Shelton said.

With Paxil or Effexor, on the other hand, the process may take many weeks or months. Dr. Shelton said he often brings his patients down from the drugs in five-milligram increments, with each stage lasting from five days to a week. A person taking 50 milligrams of Paxil, for example, would be advised to go down to 45 milligrams for one week, then step down to 40 milligrams, and so on.

The riskiest period, Dr. Schatzberg said, comes at the end, when even small increments of tapering can have a big impact on serotonin.

“The taper at the bottom end often needs to go slower than it does at the top end,” Dr. Schatzberg said.

For people who are having difficulty withdrawing from Paxil or Effexor, doctors sometimes prescribe a three-day dose of Prozac toward the end of the withdrawal period. With its longer half-life, Prozac can ensure that serotonin levels readjust more gradually.

Even when patients are entirely off the drugs, they may still experience some symptoms, but usually only for a few days and rarely for more than two weeks, doctors say.

Sadness and anxiety that persist longer than that may be signs that a patient is experiencing a return of the depression. So it is important to distinguish withdrawal from a relapse of illness.

“Just because you’re stopping a drug,” Dr. Rosenbaum said, “doesn’t mean you don’t need it.”

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220 thoughts on “Withdrawal: Paxil > Zoloft > Prozac

  1. I have been on prozac for years and recently – with the supervision of a psychiatrist – tried tapering down my dose. I went from 20 to 10 and then to 10 mg 6 days a week and none 1 day of the week. I have been going through a horrendous amount of stress in my life. Then a few days ago I began experiencing vertigo – a sensation of going up and down, particularly when walking. This was exacerbated by a plane ride I took though I believe the sensations started before the plane ride.

    I went through a similar situation a few years ago during a period of stress – I think I had also decreased my prozac dose at about the same time.

    I am back to 20 mg daily of prozac. It’s been a week and the symptoms are still there. I am really hoping they subside soon. I’m not 100% sure that they are due to the SSRI withdrawal, but I think that there’s a good chance.

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  2. Im a 22 year old who’s been on paxil for a month.I’m getting head throbbs lack of sleep and im dreaming every night.Is dat normal to dream every night?It’s most definitely the paxil,should I stop? I’m feeling so bad.I think I would want to deal with trying to mamange my own feelings by breathing and relaxing.Im taking half of 40 mg,It still seem to take over my body I need help!! Im so irritated can sumbody give me advice please……

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  3. Janae,

    Why were you put on Paxil in the first place? Speak with your doctor immediately about the side effects.

    After had been on the meds for over 13 years, my advise is that if you can tough out the depression or anxiety or find some natural ways of dealing then do that instead.

    I quit zoloft for almost 5 wks now. I am still alive!! I’ve been keeping a log of my symptoms everyday since day 1. Things do get better. I occasionally still get anxious but I would go for a walk and then it will get better. My left eyelid has been twitching for a week and I dont know if thats a withdrawal symptom or from something else. Besides that, I have not gotten any brain zaps at all(I used to get them when I was on high dosages comings down. My sleep started getting better about 2 wks ago. I havnt had any nightmares. I used to have night sweats but that has been gone completely eversince I quit. I used to get the wooshing feeling in my head a lot whenever I move my eyeballs or turn my head but that has been decreasing in frequency as well. I havnt felt depressed at all.

    I’ll post in another month or so and see I am back to normal or no.

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  4. I found this website by googling abrupt withdrawal of Zoloft. I am shocked at what I have read. I was on Zoloft 5omg a day for about 3 months and got this excruciating head pain on one side of my head. I went to the ER, and told them I was on Zoloft 50mg daily. They did a CT scan, drug screen, and blood work. Everything was normal. That day I stopped taking the Zoloft. Two days later I started feeling nauseated,dizzy,and light headed every time I got up or moved around, started having numbness and tingling in my face and lips, brain zaps, fast heartbeat (120-130) when I just stood up, thinking I saw things out the corners of my eyes, blurry vision to the point I could not wear my glasses, and like the inside of my head just had thick clouds or jello in it. Have followed up with my Dr. twice and his “Clinical Diagnosis” as of 2 days ago is “Multiple Sclerosis” and am scheduled to see a neurologist in the next 3 wks.- now if I had health insurance I am sure I would have had an appt. sooner, but anyway….I am a nurse and had no idea about these withdrawals being this severe until reading the stories on here. I will never take another one of these types of drugs. Today is the best I have felt in the last 3 wks, only couple of episodes of dizziness and face tingling that left as quick as it came. I do intend to contact my Dr. next wk, because I have a strong suspicion his diagnosis of “MS” is actually Zoloft withdrawal. I am and always have been fairly healthy with the exception of being overweight, and there is no history of any family member ever having MS-not that there would have to be. The FDA needs to be reading these stories and so should the Dr.’s prescribing these meds, because I can’t imagine my Dr. would prescribe this med if he knew how severe the withdrawals were. I wonder if anyone has ever filed complaints with the FDA?

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  5. Been off PROZAC for 7weeks not had a nasty time coming off this time.
    Tried coming off in the past and symptoms of the illness forced me to run to the WONDER DRUG and lets face it the wonders of this drug are totally life enhansing, and a life saver on many many occasions.
    Hopefully tho I will one day be able to put the illness behind me and its treatment but if I really cant and my symptoms return to dog my life then I will be the first in the que to sing aloud its praises.
    Thankyou PROZAC for all you have done to save and improve my life so far.

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  6. My twitching in the eyelid was pretty much all gone since I quit the nicotine losenge which I had been on for 3 years since qiutting smoking. I started having ringing in my left ear and that whooshing feeling in the head came back along with it 10 days ago. I emailed DR. shipko, who is an expert in SSRI’s, Benzo withdrawls,and panic/anxiety attacks, he said that withdrawl symptoms can come in waves and are self-limiting with time. He said most people are out of the withdrawl within 3 months but some can last up to a year or more. I hope I am not the unlucky one. Even if that’s the case, I am just going to tough it out because there is no way to turn back. Restarting the SSRI can cause new side effects.

    I also want to say that everyone is different. Many people gained weight during the ssri’s but I remembered that I lost a bit of weight when I first started it. In fact, the last couple of months I’ve gained at least 5 lbs with the same level of activity and eating. Either way, I am gonna have to deal with the weight thing after I am feeling completely well.

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  7. Today is the 59th day off zoloft and to be honest with you, I am not sure if I am still having withdrawl or I am done. I still having ringing in my ear but my mom has that too and she’s never had 1 zoloft in her life. I sleep pretty ok most of the time and out of the past 30 days there were 7 days that I didnt sleep well. 2 days I woke up having anxious dreams(not nightmares, but unpleaasnt dreams)but didnt have any anxiety attacks. Havnt been depressed, if anything, people around me think I have been amazingly strong considering I have been suffering from chronic shoulder pain for a year.

    All in all, no doubt the withdrawl process has been hard. I am not sure that if I am close to being done or have a long way to go. I think a lot of times we just might focus too much on the symptoms themselves. Coming down on the dosages were not that hard for me because I was just busy with other things.

    If you have something/someone that you love, just hold on to that thought and maybe that will pull you through it. Good luck to all.

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  8. I started reading Paxilprogress.org and I think it’s terrible. There are a lot of people on there who have been suffering from withdrawls for more than 2 years. I am sure some people are like that but I also found that some people are so discouraging. There was one guy who got through w/d within 1 wk or so after being on 7 years of Paxil. Wasnt that a great? I found other people attacking him saying that “oh, you will get it in a month or so.” and some people saying that,”oh, you must not be human”. I personally know someone who came out of withdrawl in 3,4 wks and it’s been 4 years and hes totally fine.

    The terrible stuff people talked about could happpen but you dont know their living habits like alchohol, illegal drugs, other meds, and exercise habits. I’ve also noticed that a lot of people are taking many other meds along with SSRI’s. Maybe the person did heroin or drank on a regular basis. What i know for sure is that if I was still drinking like how I was before(half bottle of wine to a bottle a night), there’s no way I couldve pulled out of this. There are so many variables and online posts can only be as good as those lavalife ads. Things can be exaggerated and omitted. Who knows?

    I just know that if there’s a determination and the right cause, we can do it.

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  9. What an eye opener this has been. I was put on Lexipro because of mild anxiety/depression. A year later, I was experiencing fatigue, nausia, mood intability, night sweats, etc. Finally out of desperation I went to my local urgent care for fatigue. They found my thyroid was low. After taking the thyroid meds, it seemed to help for a while. After the thereputic level was reached my other symptions came back, with a vengence. It was summer, being a teacher, I thought maybe the stress was too much so summer should take care of that. Things continued to get worse until I thought I had reach my limit. My doc said to double my Lexipro to 20mg because the lower dose must not be working. From there it has been a black spiril downward. After taking 20mg I was with some dear friends for a vacation we have done every year for the last 11 years. I cried off and on the whole trip. They were great about saying, cry when you need to, we are ok with it. When we came home from vacation, my husband looked up just night sweats. One of the leading causes-Lexipro. He looked up the side effects. Of the major 10 I hit 11! What damage I have been doing to myself because, in the am I would hurry up and take my Lexipro to think it would get me through the day. Today is the first day I am cutting back to 10mg. I feel like hell. Why did I think this was a good idea in the first place? This hell is worse than anything I have ever experienced. I can barely hold it together. My mother came over with a bottle of wine. Having a glass has calmed enough to write and not just cry. How am I going to teach? The fear and responsibility is overwhelming. I will continue this week with 10mg then down to five, and so on. I don’t want to trade one dependance for another. I know that wine is not the answer, I just can’t seem to get it together. I am exausted from the nightly sweats. I have three changes setting out at night, this is my routine. How can this be normal? I feel some hope from reading others coming through this. Right now, this just sucks. I will never be dependent on a SSRI again.

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  10. It’s been 4 months and half since I had my last zoloft. I’ve been keeping a log of my symptoms everyday. It also includes how I sleep, and how my mood is that day. I have not had any caffein, nicotine, or alcohol. Although I have been suffering from shoulder pain, I havnt taken any pain meds that contain codein either. I am getting my sugery next week and I am quite nervous. I have been having some anxiety symptoms the past couple of days.

    The ringing in my ear reduced down to only when I first wake up and when I go to sleep a month ago. Since I got a noisy aquarium installed a couple of weeks ago, I dont hear the ringing anymore at all. My eyelid twitching came back twice. Last time it lasted for a week. This time about the same and I am not too worried about it because I know it will go away again. So those were the physical symptoms that are still there.

    Emotionally, I started feeling depressed because of my shoulder. It’s been debilitating and painful. I am not sure if it was withdrawl or not. I feel like I might still have a bit of ways to go to be completely fine. The symptoms get milder and milder though.

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  11. One of the leading causes-Lexipro. He looked up the side effects. Of the major 10 I hit 11! What damage I have been doing to myself because, in the am I would hurry up and take my Lexipro to think it would get me through the day. Today is the first day I am cutting back to 10mg. I feel like hell. Why did I think this was a good idea in the first place? This hell is worse than anything I have ever experienced. I can barely hold it together. My mother came over with a bottle of wine. Having a glass has calmed enough to write and not just cry. How am I going to teach? The fear and responsibility is overwhelming. I will continue this week with 10mg then down to five, and so on. I don’t want to trade one dependance for another.http//www.bodypaintcostarica.com

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  12. I have been off prozac 20 mg cold turkey now for 9 days. I was gaining weight and feeling no sex drive for the last 3 years. The only side effect I am noticing is itchy skin. All day and all night with no relief from lotions or benadryl. Is this common has anyone else experienced this side effect? Also I have upped my garlic, Vit D 3 and multiple vitamin and started walking more.
    tam

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  13. I have been taking the generic prozac for a week, and I just am overcome with nervousness, interrupted sleep, NO appetite, as well as diarhhea, although there is nothing left inside me to poop! I am wondering if I will have any withdrawals after taking it for only one week?? I just don’t think it’s right for me, and I am worse off now than when I started taking it. Please reply if you have an answer for me!

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  14. I didn’t read all of the posts since this blog started in 2004, but I’m glad to see it’s still going in 2009.

    Brief background: I had a stroke just over 2 years ago and began 10 mg Lexapro for severe depression about a month after the stroke. After about 5 months of Lexapro (and major life changes…), I talked to my doc about feeling like it wasn’t working well anymore, so he doubled the dosage. I ended up in the hospital. I saw a neurologist in the hospital who transitioned me from Lexapro to 75 mg of Zoloft. That was about 1 1/2 years ago.

    Over the past year and 1/2, I have generally been lethargic and have had an extremely difficult time concentrating. I guess the best description is that my mind was muddled. I assumed it was a result of the stroke.

    So, I began doing some research on my own and found that about 90% of the symptoms I was experiencing matched up with side effects of Zoloft. I decided it was time for a change so, like a good boy, I talked to my doc about going off the med. Although he was not absolutely against the idea, he advised against it and suggested that the symptoms I was experiencing were a result of the stroke. (I provided him with a list of side effects and the things I was experiencing.)

    The bottom line is that I decided to taper off the med anyway, which I have been doing in increments over the past month or so. I got to the point of taking the last of the med about 3 days ago.

    The major symptom I’ve experienced has been a “pinging” in my brain, which seems to be associated with vertigo. I’m hopeful that this will end before long. Although I still have bouts of lethargy, the cloudiness in my brain is much better.

    I guess the bottom line for me is questioning what role the medical folks play in all of this. To tell you the truth, I’m not too sure about the docs’ understanding of the impact of antidepressants and, at least in my case, don’t seem to be dialed into what I have been experiencing. As I scanned the posts, I noticed one person who was diagnosed with MS and wonder if the doc has even pursued the thought that her experience may a result of the antidepressant.

    As I was told, I consulted my doc about discontinuing the med. I was being told not to “self-medicate” or, in my case, not to self un-medicate, but I’m not real sure what the alternative is. Any recommendations are certainly appreciated! The knowledge I have about the side effects of antidepressants and withdrawal (say what you want, but I still call it withdrawal…), not to mention stroke, has come from reading on the Internet. So, if that is “self-medicating”, then so be it.

    OK, I’ve vented now. I’m still “in process” but feeling much better, thank you.

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  15. I had seratonin syndrome twice from zoloft and paxil. Had to stop taking it and quit cold turkey. doctor did not monitor me, and now i am having sever muscle loss from discontinuation syndrome. anyone know when this will stop?

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  16. I was on Effexor XR for a month or so and my symptoms started to worsen so my Doc switched me to Paxil. I was on Paxil for 22 days, and I stopped taking it cold turkey. WARNING: PAXIL IS THE DEVIL. I have been having the worst zaps all over my body, all hours of the day and night. Trouble sleeping and a heightened sense of awareness of everything around me round out my withdrawal symptoms. I started taking the drugs because I am going through a nasty divorce and my anxiety and depression were affecting everything I did. Trust me, I’d rather have the anxiety and depression than these withdrawal symptoms!

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  17. MMY WIFE HAS BEEN SUFFERING FOR YEARS FROM WITHDRAWAL SYMPTOMS FROM ZOLOFT. ONE OF HER WORST SYMPTOMS IS EYE DIZZINESS AND PAIN BEHIND HER EYE WHEN SHE TRIES TO FOCUS ON A DETAIL ITEM. HAS ANY ONE HAD THIS AND HOW LONG HAS IT LASTED?

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  18. I have been taking these horrible pills for too many yrs. I recommend that everyone get a detox kit and take plenty of vitamin B12 and D-3 research the effects of vitamins like B12 and D3 on line and you will find out why you have depression. Good luck to everyone.

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  19. I’ve been taking prozac for 15 years and stopped about 5 months ago because I thought I didn’t need them anymore. I also was experiencing tremors & nightmares, so I thought there was no need to
    continue them, was I wrong!!! It took time for the old me to come back, but the depression, emptyness, and total lack of joy and increase in anxiety – all the things I thought were gone
    are back with a vengence. I now know, I need this medication to live like others need water to live
    life without prozac is just too painful to endure, so my fellow readers I go back on prozac again
    because even though I couldn’t enjoy sex life on prozac without prozac I am completely uninterested
    and not very appealing, so tremors & nightmares, here I come again

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  20. To start I have been on Paxil for almost 8 years I was put on Paxil 20mg for anxiety and mood swings which I now believe was caused from my anxiety.
    After years of my family asking me to get off of Paxil because I was a Zombie with no sex drive the pill was not letting me be me a mom, wife, family member and friend I have gained wieght that I cant lose because I dont even have the motivation to get out of bed or get off the couch I have no drive for all the things I once did laughing crying anything all I do is sleep or stay awake for days and then nobody can wake me up once I fall asleep.
    So after getting over the fear of withdrawls and really seeing how much I was actually being affected by the medication I have decided to Quit with help from my doctor I am on day 3 on 10mg for one week so far all I am experiencing is anxiety wich I think is more mental then anything because I am antisipating the day I will actually go thru withdrawls. So in the mean time I have been going for walks cleaning house cupboards and all LoL grocery shopping any thing to keep busy and my mind off the whole thing.
    I will be writing on this site every day for a way to express my self and read back on later. I have a great support system with family friends and a great doctor who said she doesnt care what time of day it is call her with out all of this I dont think I could have started my journey to a new life!

    Like

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