Question
Hello, I have been on paroxetine for nearly 10 years. First at 30mg and more than a year ago I proposed my doctor a dosis of 20mg which he said try it and see what happens. So far nothing. I drink wine and the occasional beer with no negative effects that I know of. I’m now thinking to reduce to 10mg. This WITHOUT consulting my doctor. I do yoga meditation and on the few occasions I feel a little anxiety, breathing does wonders. So, what is your opinion. Please note I feel fine with no depressive symptoms. Thank you.
Answer:
Hello,
First, let me congratulate you for taking the initiative to taper your medication and mastering the non-pharmacological techniques of addressing anxiety! That’s the kind of “active” patient I like best. That said, when someone sitting in front of me in my office states something similar, I always make sure to asses several questions before giving a definite answer:
- What was the medication originally prescribed for? As you know, antidepressants such as paroxetine have various indications, such as depression and anxiety (social, generalized anxiety, panic disorder), the most obvious, but also posttraumatic stress disorder or obsessive-compulsive disorder, as well as the so-called “off-label” use (not approved by FDA or other regulatory agencies, but widely used, such as chronic pain).
- How has the original disorder evolved? Was it completely resolved with the antidepressant? Did it ever recur? When?
- Has the patient done psychotherapy as part of the treatment? Did it help? Still useful?
- What was the rationale for the duration of the medication? What were the goals of treatment? Were they met?
- Has there been any attempt to taper the medication? When? Was it successful? Was the medication restarted again?
- Why does the patient want to decrease the dose right now? Are there any troublesome side effects that weren’t important before and have become an issue now? For example, pretty typical of paroxetine, weight gain, sexual side effects (lack of sex drive, erectile dysfunction, anorgasmia).
- Is this the right time to try? Are there any vital changes coming, such a different job/city/country, interpersonal relationships losses/gains? A sound principle is to modify one variable at a time, in order to know which one is responsible for the success/the culprit in case it goes wrong.
- Have the patient ever experimented any withdrawal symptoms? From missed doses, for instance, or on a trip when they forgot their medication. Withdrawal symptoms can get very nasty.
- What is the best approach to the tapering? Are 10 mg-decrements for paroxetine enough to avoid withdrawal symptoms? Do we need other strategies?
- Is there a “plan B” in place should the tapering fail? Patients often need reassurance, a change of approach maybe, other measures.
So, as you can see, it’s not as easy an answer as yes, go ahead! Or no, don’t try it at home! My best advice is indeed do tell your doctor, and follow their instructions, or contact another doctor if the first one is not available.
I wish you all the very best.
Abouth the author
Alicia Fraile is a psychiatrist at SINEWS, Madrid with more than 20 years of experience in general clinical psychiatry. She has worked in brain damage, Mental Health Centers, occupational psychiatry, work accidents and their repercussion in psychiatry (post-traumatic stress disorder, adaptive disorders), patients with chronic health problems and of course with the most frequent pictures of our field: anxiety, depression, insomnia, obsessive-compulsive disorder.
