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Sunday, Nov 8, 2009
This sounds like a major brain trauma to me. I would definitely have her checked for a brain tumor, bleeding on the brain, or some other biological cause for this major shift in behavoir. I sincerely doubt merely withdrawing from Paxil would cause this magnitude of a reaction.
I do hope you can get to the bottom of this.
Sorry for the slip (in edit/blog mode most of the time so I lost track).
Of course, people know that when they write to Cary (and his advice alone is brilliant) we're all part of the package. After all, the column is judged in part by how many letters - good, bad, critical and supportive - each question draws (hence the early demise of whatever that week was).
I'll just drop this in and maybe it'll help. Maybe/hopefully somebody has already said this and I'm just repeating the advice.
I used to work for GSK, so I know a little about Paxil. In general, it seems to be a bad idea to stop taking the drug suddenly. Many folks have reported a myriad of bad symptoms after quitting suddenly - suicidal thoughts/actions in teens have been widely reported, but issues seem to be pervasive among the rest of the population as well.
She needs to see her doc and get herself sorted out again. If she wants to quit Paxil, there may be a way to do that; but I don't think any psych. familiar with the drug would recommend quitting w/o stepping down the dosage.
DISCLAIMER: I'm in no way a medical expert and I don't at all represent GSK. If pushed, I might be able to come up with material support for some of these suggestions, but I'd just be google searching like the rest of you.
My $.02...
Chris
I was on Paxil a few years ago (prescribed by my GP for anxiety!) However, it didn't help, so we decided to taper my dose. My GP thought I could drop down to nothing in a week. Yeah right!
With a few days, I had all sorts of problems - including having thoughts that it'd be interesting to drive my call into a wall. I've never had thoughts like that before or since. Happily, I was able to resist the intrusive thoughts and went back up to my prior dose.
Overall, it took 6 months to very very gradually taper down to nothing. That was one of the worst periods of my life.
Since then, the FDA has imposed a "black box" warning on Paxil (their toughest level of warning) on Paxil about increased risk of suicidal thinking and behavior.
Largely as a result of a lawsuit, GlaxoSmithCline warned to not discontinue Paxil suddenly, but to taper. In general, the longer you've been taking it and the more you've been taking, the harder it is to safely get off Paxil. (My problem was surprising as my dose wasn't that high & I'd been taking it for months, not years.)
GlaxoSmithCline argues that it's "discontinuation syndrome" rather than "withdrawal" because you don't need more and more to get the same effect. However, the attempted distinction is just annoying to someone going through that hell.
I had a similar problem and was unable to get help from the psychiatrist.
I live in a middle class town in Massachusetts. My daughter's best friend in kindergarten through second grade was from a broken family - mom and three daughters - who were living in one of the very few rental units in our middle class town. They were quite poor but so sweet. Their poverty made them needy and my wife and I helped them out a great deal. Because of this we grew quite close to the mother - a strong, smart, streetwise woman with an air of sadness around her. We loved her a great deal.
Suddenly things started getting really strange. She tore into my driveway one summer afternoon and told me that she knew I was having my friends follow her and she wanted me to call them off. A few days later, I got a call from the police station asking me to come help them. She had barricaded herself in her car in the parking lot of the police station after "being followed" and she wanted help from the police, but she couldn't trust them because they wanted to get her, too... Things like this happened over the course of a couple of weeks.
It came to a head when her daughter was at our home playing with our daughter and she came to pick her up - crazed, agitated and visibly high (she had had substance abuse problems in the past but was long since "clean"). My wife and I didn't want to let her daughter go with her and it turned into a huge argument that ended with her speeding off in her car with her daughter.
I had given her rides a number of times over the previous years when she was carless. I knew that she saw a psychiatrist and I knew who he was, where his office was, etc. I also knew that she had been taking medication prescribed by him and she told me at some point during this crazy time that she had stopped taking it.
So I tried desperately to involve the doctor who was shielded from the public by his secretary. "Your patient, so-and-so, is really having some problems. Can you please have the doctor contact this person... ask how she's doing?" I begged and pleaded and never got anywhere. I was told, emphatically, by his staff that he was ethically forbidden to reach out to her as a result of somebody calling him, concerned. I pushed the issue hard and I it was maddening that I couldn't get anywhere.
Eventually a neighbor called the police on her for some public disturbance and she was hospitalized and examined and put back on her meds. She never completely recovered, in my opinion. We reached out to her but she was clearly embarrassed about her behavior from before and never responded to our overtures of friendship. Eventually she packed her daughters up and moved away.
Having the doctor intervene might not have saved our friendship, but that's not important. Had he intervened perhaps she would have gotten better faster - or not descended as deeply into her manic funk. Perhaps her young daughters could have been spared any number of uncomfortable moments watching their mom fall apart in front of their eyes. Perhaps the neighbor would have never have had to call the police and the experience of being taken away in handcuffs would never have happened.
I hope this letter writer's mother's daughter will respond.
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