Question:

Hello Sinews, My name is Mercedes, my consultation with the doctor is about my current state. I have been taking paroxetine for two years. The first year and a half of 20mg. And the last 6 months 10mg. In the last months of taking it I felt tired … Barely exercising. Another symptom was very heavy legs, cramps and tingling. I did an analysis to figure out what that fatigue was and they came out well. I consulted to the psychiatrist and he sent me to change my medication, I took Brintelly 5mg.

I have been on this new medication for 20 days. From there, more or less, I began to have severe headache, I’ve been with them for 11 days, the GP has seen me, the treatment they gave me has hardly done anything to me, I continue with headaches.
I spoke to the psychiatrist and stopped taking Brintelly 5mg. Now I do not take any antidepressants (I have been without anything for about 8 days).

Today I had a head tac and everything is fine. I have been diagnosed with a migraine. But my question is whether all of these headaches could be from withdrawal of paroxetine, and related to any withdrawal syndrome, after having it taken two years or with the taking of Brintelly. I would be very grateful to know your opinion. THANK YOU.

Answer:

Hello,
I am so sorry you are having such a hard time and thank you for your confidence. It is already a great relief that the CT scan and neurological exam came back normal. The symptoms you are describing very well may be related to a Paroxetine withdrawal syndrome. In fact, up to 20% of patients suffer intense physical symptoms with withdrawal from drugs in this family (SSRI type Antidepressants) and most especially Paroxetine.

Serotonin reuptake inhibitor (SSRI) withdrawal syndrome or withdrawal syndrome can occur when the antidepressant is stopped abruptly or taken irregularly. Generally, the patient must have taken the medication for at least one month for this situation to occur. This disorder usually begins between twenty-four and forty-eight hours after discontinuation of the drug. Symptoms peak on the fifth day and usually resolve within two to three weeks.

The main symptoms, as you describe so well, are dizziness, vertigo, headache, nausea, and flu-like symptoms, as well as anxiety, confusion, irritability, paresthesias, excessive dreams and insomnia. The risk factors that are often emphasized are poor compliance with treatment, previous withdrawal syndrome with another drug, concomitant medication, and alcohol consumption. The symptoms are uncomfortable, but do not pose any medical danger.

When a withdrawal syndrome occurs, we usually reintroduce the drug and then gradually withdraw it. Depending on the patient’s history, we will gradually reduce the medication, sometimes even only reducing a quarter tablet every three weeks, always keeping the patient’s well-being in mind. Also, avoid alcohol, stay hydrated and try to rest.

In your case, I recommend you talk to your doctor and evaluate your symptoms. If you still have the headache, it is perfectly possible to talk about the possibility of resuming the medication to lower it very, very slowly. Since you have been taking it for two years, your body is used to and reacts to the change in concentration of the medication.
Brintelly can be a relief because it is from the same pharmacological group, but I will take 10 mg for at least 3 weeks before slowly lowering it, the same lowering process as with Paroxetine.

Sometimes it helps to switch to Paroxetine in drop form, which allows this process to be managed and adapted very precisely, reducing the dose so slowly that the body does not notice the change.

In most cases, withdrawal symptoms are mild and disappear within several days, but in rare, severe and prolonged cases, the only treatment is, unfortunately, to restart the medication.

Also, if you ever need an antidepressant again, please let your doctor know if you have experienced any withdrawal symptoms, so he or she can make an informed decision. He or she will evaluate the risk and benefit of continuing to take the same medication or switching to another medication. Fortunately, there are many options available to secure the help you need.

My advice here should not substitute for follow-up with your regular psychiatrist, because after all, I don’t know you or your situation well enough to give you personalized recommendations. I can only tell you about my experience with patients suffering from withdrawal syndrome.
I sincerely hope I have been of help, and I send you my warmest regards.

Division of Medicine
Dra. Alma Moser
Psychiatrist
Children, adolescents and adults
Languages: English, German, French and Spanish
See Resumé