Opiate Addiction Withdrawl vs. SSRI Discontinuation Syndrome

[MaddieMay]

What are the best materials to use to prove to someone that Paxil is not addictive simply because of discontinuation syndrome?

What about the best text or book to read to understand physical and psychological addiction/dependence/habituation and withdrawal?

Thanks, you guys.

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[whopper]

Ahem, cough cough.....

Paroxetine IMHO is one of the worst SSRIs to prescribe to a patient.

All SSRIs are equally efficacious in the treatment of depression on a first time basis for a new patient. So given that, you pick the SSRI based on which seems to fit the patient's profile the best.

Cost, side effects, other benefits the patients want/need/

Paroxetine has the most amount of unpleasant side effects out of all the SSRIs, and also has the highest rates of discontinuation syndrome due to its extremely short half life.

I really don't know why any clinician would prescribe it as a first or even 2nd choice SSRI unless it was the only one that seemed to work after several others were tried with other clinicians.

and in terms of price it and Citalopram & Fluoxetine are the same price at Wal-Mart or Target. Citalopram has much lesser unpleasant side effects.

Paroxetine is not addicting in the medical sense of the definition because addiction means that

Pattern of compulsive drug use characterised by a continued craving for an opioid and the need to use the opioid for effects other than pain relief. (Psychological dependence).

Yes you can get Discontinuation Syndrome from it, but patients do not seek to compulsively use Paroxetine. When patients are weaned off of paroxetine or other SSRIs, there is no psychological dependence they must overcome, as is the case with drugs of abuse.

but again-Paxil certainly ain't a good first choice med either.

 

[Chrismander]

Paroxetine IMHO is one of the worst SSRIs to prescribe to a patient.

This is what i've heard from every psych attending & resident i've ever worked with (granted, that's only like 3 months worth of rotations, but still...). But man, on my last rotation (ambulatory medicine) I saw Paxil given as the first antidepressant at least 3-4 times, more than any other (new) antidepressant. the medicine attending (when I gently asked one time) said that it was better for anxiety symptoms than the other SSRIs since it was sedating and that his patient had an anxiety component. When i asked about side effects/discontinuation syndrome, he mentioned that's why he was giving Paxil CR instead of the generic. ::Shudder:: what's citalopram or fluoxetine now, like 4 bucks at one of the superstores? Jay-sus. sometimes I think our profession almost deserves HMO's and their formularies....

 

[Anasazi23]

What are the best materials to use to prove to someone that Paxil is not addictive simply because of discontinuation syndrome?

What about the best text or book to read to understand physical and psychological addiction/dependence/habituation and withdrawal?

Thanks, you guys.

A physiologic rebound does not equate with addiction. You can physiologically withdraw off Hershey bars, but it may not make you a Hershey bar addict. SSRI discontinuation is the process of receptor site re-regulation and upregulation or down-regulation of neurochemical substrates. The effects are felt as sensations...in the case of SSRIs, as headache, electrical shock sensations, or others.

Opiate, in contrast, require increasing doses to achieve the same effect after dependence is reached, and more often than not, causes marked social impairment according to DSM definitions of addiction. There may be rebound effects from abruptly stopping beta blockers, anti-epileptic drugs, or antihyperglycemics. This doesn't equate to addiction.

There are lots of texts on addiction which will explain the process in much more depth. You could try this. And the APPI has lots more.

 

[MaddieMay]

Oh, you are my new favorite person on SDN. Thank you so much, I really appreciate the explanation and the reference to some materials.

 

[Therapist4Chnge]

I really don't know why any clinician would prescribe it as a first or even 2nd choice SSRI unless it was the only one that seemed to work after several others were tried with other clinicians.

I'd think most would go out of class after 2 tries, as the research doesn't support staying in class, and with the exception of some of the anxiolytic properties, it really isn't that great compared to some other choices.....though don't tell Glaxo!

 

[whopper]

saw Paxil given as the first antidepressant at least 3-4 times, more than any other (new) antidepressant. the medicine attending (when I gently asked one time) said that it was better for anxiety symptoms than the other SSRIs since it was sedating and that his patient had an anxiety component.

Is Paxil sedating? Yes.

Can that help with anxiety? Yes.

However it also has the most amount of side effects for any SSRI. Most amount of weight gain, discontinuation syndrome etc.

Paxil CR is better but guess what? Its not available as a cheap $4 generic.

Given that, I don't know why someone would given Paxil (or Paxil CR) over Citalopram which is also $4/month and equally efficacious under the conditions I mentioned. Citalopram has the 2nd least amount of side effects. Escitalopram (Lexapro) has the least but its also not available as a generic. Citalopram is a great choice given its cheap price, lesser amt of side effects, efficicy even for those that can afford Lexapro.

I'm not going to point out that doctor you mentioned because I don't have the chance to talk to him/her & discuss this, but, and I hate saying this, several docs tend to give meds out of habit, not because its the best med.

E.g. several older psychiatrists still give tricyclics--as a first line.

Again, I don't have the oppurtunity to talk to this doctor, but I still don't see any logical reason why he picks it as a first line. He's not the first either. I've seen several give it first line and most of those docs are non-psychiatrists that are not up to date on the latest data.

I had a patient who was a new onset schizoaffective DO depressed type. She told me she did not want to gain weight & wanted meds that did not cause weight gain. I chose for her Citalopram & Geodon. She was in our inpatient unit & after a 1 week was discharged, greatly improved & feeling better.

Her outpatient doctor changed her meds to Paxil & Zyprexa. That poor girl mushroomed. She went back to inpatient about 4 months later + 80 lbs. I even called that doc asking why she was switched when the first set of meds were working & she said strongly how she didn't want to gain weight. Zyprexa & Paxil are the worst in their class for unwanted weight gain! I tried to be diplomatic.

Well this attending really had no explanation other than that's what she gives everyone. She also did not like being corrected by a resident when I asked if she knew that the different meds have differential levels of weight gain.

Not a pleasant call.

That's what I give everyone

I hate saying this but several docs will have this as their real only answer.

 

[Therapist4Chnge]

Her outpatient doctor changed her meds to Paxil & Zyprexa. That poor girl mushroomed.

Wow. With all of the talk of excessive weight gain around Zyprexa, that is pretty sad. It isn't like there hasn't been data floating out there for awhile.