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Q: How Long to Expect Cycling after Paxil is Dc'd ?
Dr Phelps,
Recently, I built up on Effexor (to 150 mgs.) and got off Paxil (taper off of
20 mgs.)over 4 months and care of a very good psych.
How long should one expect mood swings after stopping an SSRI, like Paxil?
How
long can it take for brain chemistry to balance?
Blessings,
Bill
Dear Bill --
Well, Effexor is an antidepressant as you know. There is a sliver of
evidence, mostly anecdotal amongst doc's who use it quite a bit in bipolar
disorder, that for some people at least Effexor may be the best routinely used
antidepressant to use in bipolar depression. Routinely meaning as opposed
to MAOI's, which may be the best themselves, but because of their required
dietary restrictions are not routinely used.
However, if you're hoping that you'll cycle less or not
at all on Effexor as opposed to Paxil.... Maybe your doc' has done this before
and learned something I don't know, that's very possible. Generally in my
experience I've been shooting for zero antidepressants if cycling is happening;
then if I'm absolutely forced into it, which has been rare, I'll add back an
antidepressant -- and Effexor is the one I'm using for that these days, if
Wellbutrin hasn't worked out or if there's already problematic insomnia and I
can't bear the thought of adding Wellbutrin under those circumstances.
If you were to ask: how long does it take for cycling
to stop after withdrawing an antidepressant, leaving a patient on a mood
stabilizer only -- well, I should have an answer for that, as I do it fairly
frequently. But I learned from the Harvard bipolar guru that when stopping
antidepressants, it seems to work out better if one takes as much as 4 months to
taper to zero. Since I've been doing that, I seem to be getting better
results: smoother tapers, no "wobble" of mood seemingly induced
by stopping. But the result is that I can't answer your question, you
see. Somewhere in that 4 month period of time, things seem to get slowly
and subtly better, i.e. less mood swings.
More than you were after, perhaps. Good luck with
your current efforts.
Dr. Phelps
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