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Paxil’s Long Term Effects

Question. Two years ago, I was diagnosed with borderline clinical atypical depression. I’ve been on 20 mg/day of Paxil ever since. Six months ago, I discontinued the treatment to see the results. Going cold turkey, I experienced severe withdraw symptoms such as intense fatigue, spaceyness, and hangover-like symptoms for three days. My physician says that lifetime treatment may be a reality. What other long-term effects might I experience?

Answer. First of all, I think it’s important to separate the issue of “withdrawal symptoms” from “long-term effects” of a medication. Many medications – including many used outside of psychiatry – lead to long-term adaptations by the body, on a cellular level. For example, beta blockers – used in the treatment of angina and hypertension – can lead to gradual adaptation of the nervous system, such that suddenly stopping the medicine (“going cold turkey”) can lead to serious withdrawal symptoms (rebound angina, or hypertension).

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This does not imply that beta blockers cause long-term injurious effects – it simply means that your body/nervous system does not like sudden “shocks” of any kind. The withdrawal symptoms that you experienced after suddenly stopping Paxil are well-described in the literature, and would not surprise most psychiatrists. This does not necessarily mean that Paxil would cause any long-term harmful effects. It does mean that patients take a big risk whenever they stop a psychotropic medication suddenly. Having said that, it must be conceded that we do not yet know the long-term effects of Paxil or related agents (called SSRIs, and include Prozac and Zoloft), if by long-term, you mean, “after 10 or more years of use.” These agents are still too “new” to generate that kind of data. So far as I am aware, there are no convincing studies showing any serious long-term effects from the chronic use of Prozac, which is a closely related medication used since about 1988.

There have been reports of some abnormal movements resulting from SSRIs; e.g., muscle twitches or stiffness. In theory, long-term use of these agents might – I emphasize might – predispose some individuals to such abnormal movements. But this theoretical risk, in my opinion, must be weighed against the debilitating effects of severe (major) depression – which has a 15% mortality rate. Of course, there are other classes of antidepressants that have been around much longer, and which do not seem to pose these theoretical risks – i.e., tricyclic antidepressants. But these are also much more potentially toxic than the SSRIs, and have their own side effects. So, all in all, I think the risks of taking Paxil indefinitely are probably quite small, but the jury is still out. You may want to write to the company that manufactures Paxil (Smith-Kline-Beecham, 1 Franklin Plaza, Box 7929, Phil PA 19101) and pose the question to them.

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