Adventures in Paxil Dosing

I’ve been popping Paxil (Paroxetine Hydrochloride) for about seven  years now.  Formally, this selective serotonin reuptake inhibitor is ‘approved’ to treat the symptoms of many fantastic problems – including and, thus far, limited to, depression, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, generalized anxiety disorder (GAD), social phobia/social anxiety disorder, and premenstrual dysphoric disorder (PMDD).  Due to my symptoms and family history, I was summarily diagnosed with OCD, depression and generalized anxiety disorder.  I had experienced a colossally disheartening gamut of crippling symptoms . . .   Total nervous breakdowns, relentless emotional self-sabotage, planning suicides as a relief method, incapacitating obsessions; all pretty good stuff, really.  A good mix, and a near death-sentence for my otherwise wonderful relationship with my wife (to whom I am still wedded, by the way).

The International Union of Pure and Applied Chemistry names Paroxetine Hydrochloride like so:

(3S-trans)-3-((1,3-Benzodioxol-5-yloxy)methyl)-
4-(4-fluorophenyl)-piperidine. 

Great, huh?  Anyway . . .

At the height of my personal dosing, I was swallowing 75 milligrams of Paxil CR once a day.  If you haven’t any personal experience with Paxil, 75 milligrams (three 25mg pills) is quite a bit.  Granted, 15 milligrams of the 75 is the drug component responsible for the“Controlled” element of the “Controlled Release,” so, for you purists, I was ingesting only 60mg of actual, ‘raw’ Paroxetine Hydrochloride.  Nevertheless, I had been instructed to stuff myself full of what is described as ‘the most potent SSRI’ on the market today.  And I did so; both out of carefully manufactured habit and fear of my own maligned brain.

Prior to the prescribed “CR” I was taking that aforementioned 60mg of ‘raw’ Paxil, which I am still taking today, but in a much smaller portion – 10mg.  Digressing:  After lamenting – to my psychiatrist - over my experiencing a particularly delectable and pandemic side-effect known as “apathy,” I was prescribed a second drug to serve as a partner in neurological meddling to my already high dosage of Paxil.  This drug, according to the pharmacist on duty at the time of the initial pickup, was commonly paired with Paxil.  My brain doctor described Wellbutrin as something that would help “take the edge off” of Paxil (that’s a direct quote).  He was using a cliché of course, but not appropriately, because Paxil had – and has – no edge; it is a dull, dull blade.  So dull, in fact, that I’ve read other dosers’ accounts of Paxil making showering seem like an incredible chore.  I find myself flowing through that particular vein as well.  Wellbutrin, though, was supposed to help grind an edge back onto that blade – it was supposed to give Paxil – or the state of Paxil, so to speak – an edge, not take it off.  However one may describe it, Wellbutrin certainly did something, but the edge it shaped was serrated and a bit rusty, in fact . . .   

Wellbutrin is a ‘brand-name’ of Bupropion, and it is a norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist.  It is mainly prescribed as an antidepressant and has been found to be an effective smoking cessation aid.  And, in fact, the name ‘Wellbutrin’ solicited many “isn’t that for quitting smoking?” questions whenever I mentioned I was taking it.  Wellbutrin’s coupling with other antidepressants to ‘increase energy’ is common and has been relatively successful in this role.

When I’m taking Paxil regularly, creative efforts and tasks that are not completely necessary or have not previously established themselves as blind, deeply-rooted habits are nearly impossible to see through to fruition.  And this is ironic in the sense that, if I can’t be creative (I write, paint, make music, among too many other damned worthless things) I become quite depressed and even anxious about my state of being – two symptoms treated with Paroxetine.  So, regrettably, Paxil, while it has removed many obstacles from my life, it has implanted some new and altogether unsettling ones.  Full-circle to defeat, it seems; but I’m working on it – sort of.

I discontinued Wellbutrin (specifically Wellbutrin XL) without the consent of my psychiatrist after experiencing rapidly-occurring, extreme emotional highs and lows in response to relatively tepid stimuli; as well as a feeling of shortness of breath.  Although the emotional turmoil was erratic and unpredictable, the shortness of breath was, at its height, chronic...  Both, however, were distressing enough to push me to stop the drug altogether.  A general practitioner, in fact, brought to my attention the correlation between the high dose of Wellbutrin XL – 300mg – and the high dose of Paxil CR – 75mg – and my severe mood swings and emotional surges.  I had also found testimonial evidence online supporting shortness of breath as a side-effect.  If you’d like to know more about Wellbutrin, there are plenty of online sources and the Wikipedia entry on Bupropion is quite good, and rich in citations.

Dosing . . . 

Sometimes, like most people that take any kind of drug regularly, I just run out of pills, and this is, of course, usually a distressing problem, as the apathy caused by Paroxetine is usually the main reason I run out...  Most of the time, I just don’t drop off my prescription after an appointment because, you know, who wants to stop at the pharmacy that’s on the way home?  Not me, apparently . . .   I’d have to park, get out of the car, go into the store, drop off the prescription, get back into my car – just too much for me . . .  

And I’m always missing doses, so, whenever I remember to make it to my psych’ appointment, I still have a bunch of pills; even though my appointment should coincide exactly with my running out of drugs.  It never does.  I always have more drugs at home.  As a result of my apathy and flippant lack of focus, that little white prescription sheet hangs taped to my back door or sits folded beneath a paperweight on a windowsill in my kitchen.  Whatever the reason, I’ve gone without my pills for days at a time.  Unintentional withdrawals during inopportune times are always bad.

But, lately (perhaps the past year or so) I’ve taken to purposely missing doses, and I’ve discovered the art of manipulating the onset of my withdrawal symptoms.  Although I haven’t perfected this cynical ballet of carelessly toying with my brain, I’ve achieved some intriguing results.  Recently, my wife became pregnant (and we were trying so this is a wonderful development).  As is a common occurrence during the first trimester (and sometimes beyond), sex has exited stage left.  My wife is tired, nauseous and miserable most of the time; and this is to be expected.  So, in lieu of sex, we’ve been having no sex.  Fair enough, this has given me the opportunity to alter my paroxetine dosing.  Why?  Well...

The sexual side effects of SSRIs are infamous and abound across the spectrum of dosers.  Some people experience ‘severe’ problems with their libido and their respective biological equipment.  Any manner of sexual dysfunction can take place; diminished libido, erectile dysfunction and anorgasmia are the most common.  Interestingly, and perhaps funnily, my having started Paxil when I was in my very early twenties resulted in a sexual side-effect that I might describe as “controlled libido.”  As many young males would attest to, your capacity for multiple acts of coitus in relatively rapid succession (that is, with remarkably little “down time” in between) is fairly vast.  I knew a time like this once, long ago.  Now, with Paroxetine as a third partner in the bedroom, It’s a good half-hour to an hour before I’m “ready” for a second go; which – when and if a delightfully voracious mood peeks out from behind my wife’s eyes – can be very disconcerting.  I’m usually game for one good and long encounter...  After that, she’s barking up a decidedly flaccid tree.

The reason I mention her current disinterest in sex is because when I decide to embrace the feelings that go along with discontinuing Paroxetine for a while, I am a sexual mess.  That is to say, a stiff breeze could pull the trigger...

Before taking Paxil, I hadn’t any sexual problems.  Beyond the double-time libido, I was in perfectly acceptable form (I don’t intend to complement myself, so have no fear).  As I described, Paxil brought on the “controlled libido” phenomenon; however, it seems as though there is a vast, desolate plain of fumbling ineptitude between Paxil and no Paxil.  The withdrawals that I am so humbly attempting to selectively employ include something known clinically as “Post SSRI Sexual Dysfunction” or “PSSD.”  One of the symptoms of PSSD that I am so heartily afflicted with upon my discontinuing Paroxetine is the acutely distressing ‘premature ejaculation.’  Pretty great, eh?  So, as I’m sure you can surmise through simple logic, if you want to discontinue SSRIs – in my case, Paroxetine – and you want to do it “cold turkey,” so to speak, you’d be well advised to not have anyone relying on you for a decent screw during your withdrawals.  Hence  the opportune time created by my sexually disinterested, pregnant wife.

So, since I’m clearly not “selectively employing” SSRI withdrawals in order to reap the benefits of shootin’ too quick, what am I looking for, exactly..?

Between one and two days after I discontinue Paroxetine, a little window slides open.  This window is what I am looking to see through.  And through this window I find a state of mind that I relish as I do a sexually interested wife: greatly.  This window isn’t open for very long – maybe two or three days at most; but during that time, I am productive, ambitious, energized, excitable and altogether electrified.  The strange emotional extremes I once only erratically experienced on Wellbutrin are now regularly occurring, and, oddly enough, completely exhilarating, as opposed to their former status of ‘upsetting.’ 

Any number of things can fire this emotional conduit – music, films, literature, even conversation revolving around a topic I feel passionate about can choke me up in a flashing instant.  And a good portion of the respondent ‘exhilaration’ comes from the fact that these fervent swells are almost universally disproportionate to the catalytic media.  I am fully charged when that tiny little window is open.  For example, as I write this, I am off of Paroxetine; and I have been for just two days now.  It is 1:19 in the morning and I have to get up for work tomorrow.  My son, without fail, will rise, bright-eyed and bouncing at 6:30am and so then must I.  But, I can’t stop myself from writing these words because that charge is there.

If I were to take a pill – a Paroxetine pill, of course – right now, soon enough I’d be a lump again, staring at this screen, unable to construct a sentence without my mind wandering aimlessly into nothings.  But, if I continue my lack of dosing, I’ll slip into the next stage of my personal SSRI withdrawals – depression and irritability.  As soon as that comparatively mammoth window opens up, that little tiny one I love oh so much will slam shut and disappear.  I’m then left with a view of the greyest doldrums; and so, the next dose is taken out of desperation. 

Obviously this cannot be my dosing life’s end, or its permanent path, as it were; but in order to really change anything, I’ve got to slip past that apathy barrier and through that tiny little window of ambition.  And when I do, I need to have some money in my checking account so I can pay the “no-show” fees I’ve managed to accrue over the years.  These fees, I imagine, will have to be paid in order to really leave my current psychiatrist and seek a fresh perspective.  I imagine not paying money owed to a crackpot medical doctor before walking out the door permanently will have an altogether negative effect on the label the next crackpot medical doctor will pin on me.

This is quite clearly an unhealthy set of practices . . .  I know this.  I can only imagine what kind of damage I’m doing to my neurological entanglement.  The fact that – at the rate of about 40 label indications per month – new warnings and side-effects are placed on the bottles of drugs that have already been approved is a foreboding reminder of just how little we ridiculous, violent apes know about the chemicals we regularly introduce into our bodies.  The vast majority of the dosing population swallows their little handfuls without question . . .  They do, after all, only want to alleviate whatever debilitating affliction they’ve been assured they probably have.  I am one of those people and so, perhaps, are you.

I can’t say drugs like Paxil are bad.  I would more quickly dub them good, in fact; but, due to my own personal dosing experience, I can’t laud their miraculous healing powers either.  Specifically, if you’re taking Paroxetine and you’ve experienced the dreadful apathy I’ve scornfully described, I’d find some other damned pill to pop; and do it before the pit is so deep and black, and the sides so slick that it seems easier to just sit down.  Then, let me know when you find one that works, ‘cause I haven’t even tried yet.

- JS