Paxil “poop out” refers to when someone is taking Paxil (Paroxetine) for a period of time with success and it all of a sudden stops working or “poops out.” This can result in a lot of discomfort as well as an increase in symptoms that caused the person to initially go on Paxil. When I was initially prescribed Paxil, it worked great for treating my social anxiety and depression. However after a period of about 8 months, the drug stopped working and I was left with no relief from the drug.
Many people take Paxil and other antidepressants for years before they experience some sort of “poop out.” And some people are able to tolerate taking these medications for life without any “poop out” or decrease in overall effectiveness. It all depends on the person taking the medication and their unique physiology and experience. Some people have reported taking it for over a decade before they experienced a “poop out” while others like myself experienced one within the first year of being medicated.
Paxil Poop Out Symptoms
There are a variety of symptoms that people experience during the “poop out” phase. My hypothesis is that “poop out” is caused by the SSRI medication altering the serotonin system in the brain. This is why when one medication poops out, many times an individual will try an array of other SSRI’s and experience no relief from symptoms – it is likely because all of the benefit was used up by the first medication.
- Anxiety spikes: When Paxil is working, it tends to do a great job at reducing symptoms of anxiety. When it stops working a person may experience increases in anxiety and/or panic attacks. In my experience while Paxil was working, it managed my anxiety to a level that allowed me to socialize and actually experience life. When it stopped working, the anxiety became so severe that I retreated back into my shell.
- Feel very depressed: Most people notice that when Paxil stops working, they feel depressed again. In other words, their depression comes creeping back even though they are on medication. In some cases, the depression may feel even more intense and extreme than pre-Paxil. In my experience it was very difficult to cope with the depression I felt when this medication stopped working.
- Mood swings: You may notice that your mood swings a lot following Paxil poop out. Not only will you become frustrated with the fact that the drug isn’t working, you aren’t getting any relief from symptoms. This may cause you to feel angry, aggressive, and may really make you feel deflated. While it was working your life was good, and then you get thrown out into a harsh reality where it doesn’t work.
- Side effects: During the poop out phase, unfavorable side effects can become more prominent and noticeable. For example you may now notice that you have a headache all the time or that you feel irritable more often. Additionally you may feel dizzy or just uncomfortable because you aren’t finding the medication effective anymore.
What doctors will do when Paxil poops out…
If your Paxil stops working, most doctors will increase the dosage. Like any drug, people build up tolerance to antidepressants. Just because they are not illicit drugs doesn’t mean that people can’t build up a tolerance or have horrible withdrawals. If your Paxil stops working, a doctor will probably bump up the dosage to the next highest available increment. So if you are at 10 mg, your doctor may bump you up to 20 mg. If you are at 20 mg, your doctor may bump you up to 40 mg.
The problem with increasing like this is that you are essentially doubling the dosage of Paroxetine. For most individuals, the dose doesn’t need to be doubled. Rather the dose needs to be increased in smaller increments such as either 2.5 mg or 5 mg. A gradual upwards titration could be conducted to determine the effectiveness of a dose that is 2.5 mg more than the current dose, as well as a 5 mg increase.
If that doesn’t work, continue titrating upwards until a person experiences relief. If the upwards titration doesn’t work and or produces a worsening of side effects, it is recommended to simply withdraw from the medication altogether. Certain SSRI’s just end up losing their effectiveness after awhile.
What causes Paxil to stop working? Tolerance + CNS Changes
There are a variety of different factors that could potentially cause Paxil to stop working. My guess is that it has something to do with tolerance as well as changes to the nervous system. Paxil is known to change the way our nervous system works – causing slowed metabolism and fatigue. It has a different impact on everyone that takes it, but in general people take it for awhile, the drug changes them, and they no longer get relief.
- Changes: Taking antidepressants like Paxil for an extended period of time is thought to lead to “poop out.” The drug changes the way your brain works, the hormones in your body, and levels of various neurotransmitters. If you take Paxil for a long period of time, it will have changed you into a different person than you were when you first started taking it.
- Dependence: Some people can become dependent on Paxil for everyday functioning. This is similar to an alcoholic drinking every day and relying on alcohol for functioning or a person taking Adderall to perform well on the job. Eventually the consistent usage of the drug is going to catch up with the person – causing them to get no relief from the drug.
- Neurotransmitter levels: It is hypothesized that SSRI’s like Paxil cause your neurotransmitter levels to drop over the long term. Your brain becomes accustomed to receiving the Paroxetine dose each day and this inhibits the reuptake of serotonin. Eventually your neurotransmitters will compensate for the drug – causing it to have less effect or no effect at all.
- Physiology: Certain people have a different response to taking Paxil. In some people the drug works pretty well for years and they experience no poop out. Others take it for less than a year and the antidepressant and anxiolytic effect tends to wear off. In my experience, Paxil was effective for about 8 months and it suddenly “pooped out” and stopped working.
- Tolerance: When Paxil stops working, a person tends to have built up a tolerance. If it initially was effective, it may just be that your brain and nervous system has become so accustomed to the medication, that it no longer does anything for you.
Does Paxil “poop out” mean the drug will never work again?
Just because Paxil poops out and stops working doesn’t mean that it will never work again. You need to give your brain and body time to recover from this drug. If it stops working, I would recommend staying off of it for at least a year before trying it again. In my experience, this is similar to a drug user building up tolerance to their drug of choice and then wondering why it stops working at the same dose. It is because they have built up a physiological tolerance to the substance that they are taking.
Although most people will not want to try Paxil after they experience the hellacious withdrawal symptoms associated with coming off of this drug, this may be the only effective medication for some. Read more about my experience quitting Paxil cold turkey. In my experience it was the only SSRI that I responded to for social anxiety and depression. After I was on Paxil I tried all of the popular SSRI and SNRI’s and never found any sort of relief as I did while on Paxil. Just like coming off of alcohol or other drugs, you need to let your body reset itself back to homeostasis.
I believe that once homeostasis is achieved (e.g. how you felt pre-Paxil), that it will work again. In my experience I stayed off of it for over 6 years, tried it again and found it to work towards reducing anxiety and depression symptoms. Don’t get discouraged if this medication doesn’t work again for awhile. After you are on one SSRI for awhile, your serotonin system becomes altered and needs a lengthy detoxification period before it is properly reset.