If you are taking Paxil (Paroxetine) and plan on discontinuing treatment, it is important to be informed as to how you should taper off it. Back when I had originally taken Paxil in 2003, my doctor was completely unaware of any potential withdrawals. At the time, he had advised me to quit cold turkey and said that I may experience symptoms for a few days, but should return to normal within a couple weeks.
Not only was this advice purely ignorant, but it lead me through my own personal hell. The next year or two would be spent trying to figure out why I was so dizzy, had headaches for no reason, and was more depressed than prior to taking the Paxil. As a teenager, I had become a hypochondriac due to the fact that I was experiencing withdrawal symptoms, but was told they were “all in my head” and not from withdrawal.
The reality was that although they were all “in my head” they were stemming from the withdrawal, and ended up lasting at least 8 months before they improved. This made it extremely difficult to cope with high-school classes, let alone trying to socialize and make friends. My doctor kept telling me that these symptoms I was describing may be a potentially undiagnosed psychiatric condition. After time has passed, I am now able to distinguish withdrawal symptoms from mental illness, but it took several years to reach this level of awareness.
Reflecting on this experience, I know am well aware that I was basically experiencing a post-acute SSRI withdrawal from one of the most difficult SSRIs to withdraw from… Paxil. If you’d like to read more about my experience, consider checking out the article, “Quitting Paxil Cold Turkey: A Journey Through Hell.” If you are here, hopefully you haven’t yet taken the plunge and quit the drug cold turkey like I had done a decade ago.
How to Taper off of Paxil (Paroxetine): The “Weaning” Process
These days doctors (and especially psychiatrists) are a bit more informed than they were back in the early 2000s. Now, most understand that when a person quits a psychiatric drug cold turkey (or abruptly) they can experience what is referred to as “antidepressant discontinuation syndrome.” In order to avoid this “syndrome” a.k.a. an array of nightmarish neurological symptoms it is highly recommended to consult with a medical professional and set up a personalized tapering protocol.
1. Decide when you want to taper
Before you begin your taper, you’ll need to decide when you want to start the taper. Perhaps a good time to begin your taper would be a holiday or some sort of vacation from work. Ideally, you’ll want to have minimal stress in your environment so that you get off to a good start.
Although it’s probably going to be difficult to minimize stress throughout your entire withdrawal, do your best to keep it low whenever you plan on reducing your dosage. If you cannot think of a perfect time to begin your taper, consider starting it on a weekend so you won’t freak out during work if you experience anything strange for the first time.
2. Determine a “tapering rate”
The rate at which you taper is completely up to you. A multitude of factors may need to be taken into account such as: whether you taking other medications, if you are planning on switching medications, and how comfortable you feel with the suggested rate by your physician. The length of time over which you have been taking Paxil as well as your current dosage will likely play a role in how quickly you taper.
Someone that has only been taking the drug for a couple months may be advised to conduct a much quicker taper than someone who has been taking it for years. Obviously individual circumstances such as pregnancy may warrant a more abrupt discontinuation rate than the general population; this is done to protect the baby. Work with your doctor or psychiatrist to come up with a feasible rate at which you are going to taper.
3. Recommended tapering rate (~10% per month)
It is recommended by most sources to be highly conservative when tapering off of Paxil. Obviously the rate at which you taper should be individualized based on numerous factors including: whether you take any other medications that may buffer withdrawal symptoms, how long you’ve been on Paxil, as well as the dosage of Paxil that you’ve been taking. In general, it is recommended to taper at a rate of 10% (or less) per month.
- Cutting Paxil: In order to taper off of Paxil, you’ll want to purchase a pill cutter. You can order one of these online or get one from your local drug store (i.e. Walgreens). A pill cutter is highly recommended as opposed to using a cooking knife or attempting to break a pill via some other method. Pill cutters are precise and will ensure that you are taking the correct amount for your taper.
- Paxil CR: The “CR” version are coated with a substance that allows them to be slowly released over a 24 hour period; hence being called “controlled release.” These tablets are NOT meant to be cut and cutting them will result in detrimental/dangerous rates of absorption. If you are on the CR version, it is recommended to switch to regular Paxil in order to start your taper.
- Paxil oral suspension liquid: A method of tapering off of Paxil that can make life easier is by using its liquid formulation. By using the liquid formulation of Paxil, you can easily measure out how much of the drug you’re taking. Some believe that this is the optimal way for people to taper off of the medication. The liquid Paxil comes in dosing of 10 mg/5ml. If prescribed, your doctor should advise you as to how you can use a syringe, measure the formula, and take the designated amount for your taper.
- Digital scale: If you want to be as precise as possible, you could resort to purchasing a scale to weight the pills that you’ve cut. If they all weigh the same, you know you’re getting the same amount of the Paxil. If there are slight discrepancies, you can make more cuts so that you are taking the correct amount. For most people, being this specific isn’t really necessary.
An example: Let’s say that I had been taking 37.5 mg of Paxil CR. If I’m tapering at a rate of 10% each month, my first month of tapering I would drop down to 33.75 mg. Since 10% of 37.5 mg is 3.75, I would subtract that from my existing dose and that would be my new dose. Since I know the CR pills are not meant to be cut, I would ask my doctor for the standard version of Paxil that would allow me to cut my pills and formulate this exact amount. For the next month I would taper down to roughly 30 mg of Paxil to keep the 10% strategy in place.
4. Alternative: Prozac method
For people who are having significant difficulty tapering due to the array of Paxil withdrawal symptoms that ensue, an alternative method is to switch over to Prozac. Many doctors will use Prozac as an SSRI-replacement option for the Paxil because it has a longer half life. The idea behind this method is to switch a person over to Prozac, which will effectively absorb the severe withdrawal that would’ve stemmed from the Paxil discontinuation.
After stabilizing on the Prozac, a person will then eventually taper off of the Prozac. Tapering off of Prozac is thought to be much easier than that of Paxil. In large part, this is because Prozac has the longest half-life of any SSRI, whereas the half-life of Paxil is extremely short. The longer the half life (in general), the easier time people have coping with withdrawal symptoms.
It is important to note that not everyone has an easy time with this method. While it can be highly effective for some people, others may have an even tougher time. This is because their brain is attempting to adjust to withdrawal from the Paxil and simultaneously attempting to readjust to the effects of the Prozac.
5. Adjust tapering rate to fit individual needs
Sometimes people don’t respond well to the rate at which they are tapering. Although a 10% dose reduction may not seem like a lot, for someone that’s been on the drug for years even a small reduction could feel like a huge drop. As a rule of thumb, the longer you’ve been on the drug, the slower the rate at which you should likely taper.
- Slower: Some people may need to reduce their tapering rate even from 10% a month down to 5% a month. If you feel like you can’t handle a 10% drop in dosing, make it a smaller increment so that you can still reduce some of your medication.
- Faster: Others may feel like 10% a month is a little bit too slow of a taper. If everything is going smoothly and no withdrawal symptoms are experienced, some people may want to reduce by 15% or 20% (depending on how they feel). You should be warned that if you do taper at a faster rate, you may need to eventually slow back down.
- Maintain existing rate: If your tapering rate seems fine, you can simply maintain it throughout the entire process. If at any time your current rate seems too quick or too slow, simply adjust it.
6. Discomfort is inevitable
It is important to understand that discomfort during withdrawal is inevitable. This is a medication that you’ve been taking for an extended period of time, and possibly become reliant upon for daily functioning. Of all SSRIs, Paxil is arguably the worst to withdraw from and even tapering is likely to cause a variety of neurological symptoms. It should be mentioned that the quicker you taper, the greater the initial severity of symptoms you’ll experience.
It should also be mentioned that if you taper at a fast rate or quit cold turkey, there is a chance that this will essentially “shock” your nervous system. This means that you will experience so many severe withdrawal symptoms, that you’ll have a nervous breakdown or be unable to cope. This can make the withdrawal period significantly longer than if you were to conduct a gradual taper.
Below are some commonly asked questions in regards to Paxil withdrawal. If you have any other questions that you’d like answered, feel free to ask in the comments section below.
How do I taper off of Paxil CR?
Paxil CR is a bit different than standard Paxil (Paroxetine) in that it is “controlled release.” In other words, the pill is coated so that the drug is released steadily over a 24 hour period. Standard versions of Paxil generally are released all at once and don’t have a special coating to control the release. Since cutting Paxil CR will disrupt the way it is absorbed, it is recommended to switch to standard Paxil for withdrawal.
Could I use Paxil liquid formulation to help taper?
Yes. Once you are down to a fairly low dosing of Paxil, you can request the liquid formulation to help with your taper. This involves measuring out a specific amount of the drug in the form of a liquid prescription and drinking it to avoid jumping from 2.5 mg to nothing. Many people prefer using the liquid format because it is more accurate and easy to measure.
Could I just take Paxil every other day?
No. Not only will this result in a variety of unwanted symptoms, you will induce a state of chaos within your brain and nervous system. If it gets the drug one day, then withdraws from it the next, then gets the drug again, it will be stuck in a state of limbo. This is an extremely ill-advised strategy and one that should be avoided at all costs.
Always consult a medical professional for tapering advice
Understand that this website is providing information with the intention of helping people taper off of Paxil, but should not be used to replace the advice of a medical professional. Always consult your physician or psychiatrist to come up with a strategy for tapering. It is never recommended to simply quit a medication on your own without any professional help or support.
Re-learning to function without Paxil
It can be incredibly difficult to function without a drug that your brain and body had become reliant upon. You’ll experience an array of withdrawal symptoms and life will get difficult; there’s no sugar-coating how difficult the withdrawal is. However, it is possible to re-learn to function without the need for Paxil. I have been off of this medication for nearly 10 years now, and know it’s possible to live without this drug even if readjustment is extremely difficult.