Paxil side effects question

For years, I was on Paxil for minor depression, lasting from 1996 to at least 200. When I was taken off of it, I was taking 120mg or so, and I was taken off of it cold turkey. Since then, I've been diagnosed with Dysthymia and Major Depression, among other things, and I'm trying to file for disability for them, but I'm wondering now if I should also file my Paxil use under it, as well; I've read the side effects associated with Paxil, and I know I not only suffered with them while taking them and wile being taken off of them, but I'm still suffering through them, mainly the physical side-effects (heart palpitations, breathing issues, vomiting, diarrhea, headaches, etc.).

Does anyone have any experience with this medication that could tell me if I'm correct on this assessment?

Hey there! Let's see if i can help.
First off, any other medications taken with/while on Paxil?
Second, 120mgs!?!?! Paxil (Paroxetine Hydrocholride) has a MAXIMUM LEGAL DOSAGE of 20-60mg/daily (25-75 in controlled release form) I truly hope that was a typo. (My source for that information, is "The Pill Book" by Bantam Books, 14th edition)
Thirdly, such a huge dosage over four years may have given you something called "Serotonin Syndrome". This is usually associated with taking a new medication, or upping the dosage of one you already are taking. Serotonin Syndrome has proven to be a rather rare illness, but your case is most assuredly an atypical case. Common symptoms of this syndrome are
* Confusion
* Agitation or restlessness
* Dilated pupils
* Headache
* Changes in blood pressure and/or temperature
* Nausea and/or vomiting
* Diarrhea
* Rapid heart rate
* Loss of muscle coordination or twitching muscles
* Shivering and goose bumps
* Heavy sweating
for legal dosages exceeding no more than 50-60mg/daily
Those symptoms look familiar? And these are the common symptoms, not the Severe Serotonin Syndrome symptoms.
What with 120mgs/daily, and the way you were taken off (Cold turkey is a terrible system for weening off an SSRI, possibly the worst aside from instantly starting an MAOI after you quit said SSRI), that can alter the odds of developing this syndrome quite significantly.

"I've read the side effects associated with Paxil, and I know I not only suffered with them while taking them and wile being taken off of them, but I'm still suffering through them, mainly the physical side-effects"
This statement speaks volumes to me. Since the syndrome is most commonly developed after starting to take an SSRI, or after upping a dosage, that seems to fit what you said in your post. I'd bet money that your symptoms developed after your dosage was increased to a level your body couldn't tolerate. I'm a clinical psychology student in college, and i know better than to prescribe 120mgs/daily and to quit cold turkey. The combination of the two could easily trigger this syndrome.
Call your Doctor, and demand to know why you were prescribed 120mgs/daily when MAXIMUM is 75mgs/daily in controlled release pill form. Also, pick up a copy of "The Pill Book" by Bantam Books, 14th edition
I will check back early and often for your response, and truly hope i am wrong. Remember, this is not a diagnosis, just me doing detective work.
Take care, look forward to hearing from you,
~Robert
Edit: Spelling and Grammar checks

Well, it wasn't for four years that I was on that high of a dose, but it was at least one; I'll need to pinpoint the exact timeline I was on. I'm also trying to find out what other medications I was on with Paxil, since I know I was on some.

And after reading the symptoms for Serotonin syndrome...I think I have a mild to medium case of it. The vomiting, diarrhea, headaches, hypmania, mild hallucinations, confusion, agitation, twitching muscles, and change in blood pressure all seem to fit (I was warned that I could have elevated blood pressure with my generic prozac, given my physiology, so that should be a good indicator). I've really noticed that I regained these symptoms after I started taking Prozac, so you may be on to something. If this is the case, I've got to convince SSI and'/or medicaid to pay for a full physical on me, to be sure.

This is definitely something that should be addressed sooner than later if you think it is possible you may have it. Way better to err on the side of caution. Since you were on other medications while taking that huge dosage of Paxil, that too increases your chance of developing this syndrome. Forget calling SSI or medicaid, I'd get a lawyer and go after that doctor that prescribed you that dangerous amount. That was pure negligence on the doctor's part. I learned the maximum legal dosage in about 45 seconds after opening my copy of "The Pill Book". Have you described these side effects to your doctor (i use that term loosely) that prescribed you the meds in the first place? If so, what was the response?

A year is still a very long time for such a hugely high dosage. Even more problematic, is the fact that there were other medications. We can't be sure that you were on correct dosages for those, too

Those symptoms are very indicative of SS (Serotonin Syndrome), although the manias and the hallucinations are pointing to a more serious version of SS, or could be medications you are on now that are conflicting and giving bad side effects (Such as SS). What medications are you on now? Just Prozac, or am i reading your post incorrectly?

"I've really noticed that I regained these symptoms after I started taking Prozac, so you may be on to something."
Regained symptoms after starting taking an SSRI again? Thats the calling card of Serotonin Syndrome.

A physical is a terrific idea. Again, sooner rather than later. If you can't get the visit payed for by insurance or SSI, soon, I'd suggest paying out of pocket for now. Although, sadly, there is no conclusive test for SS. It's treated by a collection of symptoms that are associated with it. Still, you told me those symptoms started up again after starting Prozac, and those symptoms you said you had should more than warrant a closer look at whats going on. That should be more than enough for any doctor worth their salt to realize that there is something going on. Get a second opinion from a different doctor. Explain dosages, medications taken together, how long you took each dose, and the symptoms you are having and when you get them.

A few more questions to clarify, so I know we are on the same page:
It was the doctor's idea to take 120mgs/daily of paxil, yes?
It was the doctor's idea to quit cold turkey as well?
You experience the symptoms while completely off any type of medication for your mental disorders, correct?

I hope everything goes as well as it can. I'll still be here. Take care,
~Robert

Clinpsych wrote:This is definitely something that should be addressed sooner than later if you think it is possible you may have it. Way better to err on the side of caution. Since you were on other medications while taking that huge dosage of Paxil, that too increases your chance of developing this syndrome. Forget calling SSI or medicaid, I'd get a lawyer and go after that doctor that prescribed you that dangerous amount. That was pure negligence on the doctor's part. I learned the maximum legal dosage in about 45 seconds after opening my copy of "The Pill Book". Have you described these side effects to your doctor (i use that term loosely) that prescribed you the meds in the first place? If so, what was the response?

A year is still a very long time for such a hugely high dosage. Even more problematic, is the fact that there were other medications. We can't be sure that you were on correct dosages for those, too

Those symptoms are very indicative of SS (Serotonin Syndrome), although the manias and the hallucinations are pointing to a more serious version of SS, or could be medications you are on now that are conflicting and giving bad side effects (Such as SS). What medications are you on now? Just Prozac, or am i reading your post incorrectly?

"I've really noticed that I regained these symptoms after I started taking Prozac, so you may be on to something."
Regained symptoms after starting taking an SSRI again? Thats the calling card of Serotonin Syndrome.

A physical is a terrific idea. Again, sooner rather than later. If you can't get the visit payed for by insurance or SSI, soon, I'd suggest paying out of pocket for now. Although, sadly, there is no conclusive test for SS. It's treated by a collection of symptoms that are associated with it. Still, you told me those symptoms started up again after starting Prozac, and those symptoms you said you had should more than warrant a closer look at whats going on. That should be more than enough for any doctor worth their salt to realize that there is something going on. Get a second opinion from a different doctor. Explain dosages, medications taken together, how long you took each dose, and the symptoms you are having and when you get them.

A few more questions to clarify, so I know we are on the same page:
It was the doctor's idea to take 120mgs/daily of paxil, yes?
It was the doctor's idea to quit cold turkey as well?
You experience the symptoms while completely off any type of medication for your mental disorders, correct?

I hope everything goes as well as it can. I'll still be here. Take care,
~Robert

Unfortunately, I don't remember which doc decided to put me on that dosage, though I'm getting the paperwork from my time in the psych ward for my disability case, so that should help me make a better case. Also, I can't get a physical until I can get SSI or Medicaid to pay for it, but I've got an appointment with my psychiatrist next month, so I'll be talking with him, as well.

As for your questions, yes, it was the doctor's idea to go that high and to quit cold turkey, and while I can't say for sure that I experience the symptoms while completely off any medications, I'm really experiencing them now that I'm on Fluxotine (generic Prozac, 60 mg per day). They kept upping my dose, since I didn't seem to get any better with the lower dosages, and cut me off completely once they realized that no amount of Paxil was doing any good, and I'm starting to get that feeling here, too (started at 20 mg of prozac, then 40, now on 60). I am definitely going to be talking with the doc I'm currently seeing about it when I next see him, and I'll be telling Voc Rehab and SSI my concerns, as well. Hopefully that, along with the medical records I'm getting in, will convince them to look more into it.

One thing I do have to ask is whether or not sleeplessness or abnormal sleep patterns are a sign of serotonin syndrome, as well, because I've noticed I've been much more lethargic and gotten less sleep while I'm on my prozac, and there was a time in the past when my sleep schedule cycled through all hours of the day for about a month, between the times I was taken off Paxil and when I was put on Prozac. My mate also noticed that I suffered from nausea, vomiting, and diarrhea long before i was on Prozac, but I'm not sure if that's due to the syndrome or my diet. I do know that I have an annoying involuntary habit to wiggle my foot during the day (I've read that the clonus associated with the syndrome is often centered around the ankles), sometimes get twitches in my legs, often have twitches around the eyes, and sometimes when I go into a deep exhaustion stretch, one or both of my shins cramp up. Again, I'm not sure how much of this could be attributed to SS, but as you said, better safe than sorry.

Hey again
Ok, your medical records will show who prescribed what, and that is going to be valuable information. Again, this was a clear cut case of neglect on your doctor's part.

Medical doctors, such as General practitioners and E.R. Doctors focus on the physical ailments, much more than the emotional/mental ones. Your doctor may not have known how badly he was screwing up in prescribing so much, and jerking your brain chemistry around by making you quit cold turkey.

However, ignorance is not an excuse. Especially when concerning powerful drugs such as these. I fear that the doctor that told you to go to 120mgs/daily of paxil, then cold turkey off it, is incompetent. Worse, he is probably using similar "treatments" on other patients. I encourage you to blow the whistle on this doctor with notifying your state medical board, the American Medical Association and your insurance carrier. If you do so ( i hope you do, for other patient's safety) an interview and proof of illegitimate practice by your doctor may be required. Explaining everything you've told us, plus your medical records, will be more than enough for an investigation. Again, I hope you take this course. Those types of neglectful mistakes should never happen. Even by accident. Like i've said before, I'm a college grad student in Clinical Psychology and minoring in chemistry, and i would never make that mistake. Understanding medications, dosages, and withdraw symptoms is nothing complicated or difficult. Every doctor has reference books for medications in their office, that completely explain every aspect of prescriptions. Even nurses have their own versions of said books. It's really basic and easy to use. Making the doctor's careless mistakes that much more unforgivable and damning.

Now that I've got that off my chest, you ask if whether or not sleeplessness or abnormal sleep patterns are a sign of serotonin syndrome. They are indeed, but they could also be a side effect of some medication your taking now. Muscle twitches, and "Medial Tibial Stress Syndrome" (a.k.a Shin splints) could very well be the SS, but may be the medications too. Heck, those cramps in your shins could even be attributed to not stretching those muscles, or not staying hydrated enough. The only way of eliminating the medication as culprits, sadly, is to change medications, wait roughly a month, and see if symptoms persist. If they do, good chance its SS. If not, its the meds. Not a great system, but pretty much the only one we have.

I am in no way telling you to stop taking your medications, and/or to start taking anything else. Stay on the plan you have set with your physician, until you decide differently.

And you are correct. It IS much better to be safe than sorry. There are no dumb questions when it comes to a situation like this, and indeed, it's often little clues like those that help Psychologists diagnose and treat properly. What information may seem trivial to you may be conclusive to a psychologist. Never be afraid to ask. It's your body! You only have one! Take care of it and understand it.

I'm going to stick around and check back on this regularly,
All the best,
~Robert

Oh, i forgot. Once you do get an appointment to check for Serotonin Syndrome, don't get frustrated. Usually, doctors will try and rule out infections, intoxicates, metabolic and hormone problems, and drug withdrawal before considering Serotonin Syndrome. All these other medical issues have clear cut tests that can give an answer of positive or negative. Serotonin Syndrome is considered last, due to no clear cut test that can prove if you have it or not. A good doctor will follow this process of elimination, while still keeping your opinion in mind. Don't get discouraged with the batteries of tests, they may take a while to complete and review.
Take care,
~Robert

Honestly, there's nothing I can do about it; I was on the meds during foster care, so I can't get a record of the doctors who perscribed them to me and I've gone past the cutoff date where I can sue them, anyway (believe me, I checked, and I'm over a decade too late with this). The only thing I can hope to achieve with this is to convince the doctors I have now that my pat Paxil use helped screw my body chemistry up.

I see, and that is truly unfortunate that we can't take a neglectful doctor off the streets. I wish you good luck and I am hoping for the best.
I'll be around if you'd like to chat about anything.
Take care,
Robert

Clinpsych wrote:I see, and that is truly unfortunate that we can't take a neglectful doctor off the streets. I wish you good luck and I am hoping for the best.
I'll be around if you'd like to chat about anything.
Take care,
Robert

Yeah, unfortunately I had about 7 years after the incident occurred to file a suit, and that's past long ago. Plus, I was bouncing around everywhere, so as I said, I couldn't remember or find which doctor gave me that douse of Paxil, even if I could.

Fortunately, I should be able to get a few of my old medical records, which'll list the amount of Paxil and what other medications I was on, at the time, so things should go more smoothly for me, after that.