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Paxil Withdrawal Insomnia Chest Tightening
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Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
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MedHelp Member's Question

Paxil Withdrawal Insomnia Chest Tightening

by SleeplessDonna, May 21, 2006 12:00AM
I was on Paxil for 11 years. I tried 9 years ago to get off it but had extreme side affects. At the time, my doctors told me I was crazy and making up symptoms (electric zaps). Of course now these symptoms are fully documented. I have been off Paxil completely for 4 weeks. I was originally on 40 mg and have dropped 10 mg every 3 weeks. The withdrawal has been horrendous (especially the drop to 0 mg of Paxil) and haven’t worked (& have now lost my job). Most of the symptoms have gone away except for the electric zaps and insomnia. (The electric zaps seem to occur when I don’t sleep enough). The insomnia is a strange one. It started when I dropped to 10 mg of Paxil In the beginning I was actually sleeping from 11:00pm to 6:00am with the help of melatonin & calcium. But at 6:00 am my chest, neck and upper back would tighten, I would feel crawling worms across my chest & would often wake up gasping for air.  It was so uncomfortable that I would force myself to get up even though I wanted to sleep longer. If I tried to take a nap during the day the same chest constriction would occur and I couldn’t fall asleep. The last 2 weeks it has gotten to the point where I sleep for ½ hour then up all night and then manage another ½ hour of miserable sleep. I’m now at a point where I’m afraid to go to sleep. Last night not only did I have the chest constriction but also when I was awake I was totally anxious (racing thoughts). As soon as I fall asleep the constriction & crawling starts. Has anyone heard of this? Is there a cure? Will it eventually go away? If so, how long will it take? I do not want to go back on Paxil or any other antidepressant. My doctor recommends valium and trazadone (antidepressant) for 2 weeks, then cut it in half for 1 week, then try sleeping without it the last week. I am extremely nervous about taking any more drugs. I am even nervous about taking melatonin for the rest of my life. But I am desperate for sleep. I also have pain in my neck/shoulder which is getting worse due to the lack of sleep. 3 days ago I met with an herbalist and have started drinking an herb mixture twice per day. I’ve tried valerian root (which I don’t think helped) and acupuncture as well. The acupuncture has helped me relax but has not changed the insomnia.

Doctor's Answer

by Roger Gould, M.D., May 27, 2006 12:00AM
Something like what your doctor recommended sounds right to me. It will give you the sleep you need, and it is not addicting in the same way. Alternatively you can ask your doctor about a straightforward sleeping pill like ambien.
Member Comments (26)

by shade, May 21, 2006 12:00AM
I took the trazadone a few years back when I was in a similar situation.  It worked.  If you want to keep off meds long term, a short term small dose of Trazodone might help because if you continue to not sleep for too long, you might get really run down and have no choice but to stay on meds.

by SleeplessDonna, May 22, 2006 12:00AM
To Too Big:



Thanks for your response. Did you have the same chest tightening? I'm really starting to lose my mind. I stopped the herbs because you're not supposed to mix the herbs with Western medicine. Did you have to go back on meds? If so, what? I don't want to go back on Paxil. Maybe Cymbalta because I heard it also deals with pain. Do you know anything about 5-HTP (hydroxylating Tryptophan) or SAMe as a replacement for meds?

by SleeplessDonna, May 23, 2006 12:00AM
To: To Too Big
Thanks for your response. Did you have the same chest tightening? I'm really starting to lose my mind. I stopped the herbs because you're not supposed to mix the herbs with Western medicine. Did you have to go back on meds? If so, what? I don't want to go back on Paxil. Maybe Cymbalta because I heard it also deals with pain. Do you know anything about 5-HTP (hydroxylating Tryptophan) or SAMe as a replacement for meds?

by andie3330, May 23, 2006 12:00AM
To: sleeplessdonna
I have an idea of what you are going through. I've been on Paxil for about 10 years. Had been on 60 mg/day but have recently started to wean off of it and I'm now down to 40 mg/day. I've read that the last 10 mg drop is the most difficult and that often people have to reduce the dose by only about 2.5 mg per couple weeks or so to get from 10mg to zero.  I know you said that you don't want to take Paxil again, but it may be worth it to take a very small dose - maybe 5mg per day for a couple more weeks and then 2.5 for a few weeks. It might make a big difference in how you are able to sleep and function and really, what's another month or so on Paxil anyway?  I read an excellent new book recently about SSRI withdrawal called "The Antideppressant Solution". It talked about a lot of different withdrawal symptoms - maybe yours would be mentioned. Personally, I haven't had the skin crawling thing - my most distessing symptom has been these very intense and confusing de ja vue episodes - it is like my brain looses track of the current day and time - and these episodes happen as I am trying to wake up from sleep. If you want to start another SSRI (instead of continuing the Paxil), maybe it would help to start it sooner rather than later - I know that my dr suggested that I take a low dose of Prozac when I get down to a very low dose of Paxil because it can ease the withdrawal symptom from Paxil - and because of Prozac's long half-life - it doesn't cause many withdrawal problems itself.



Your brain has been adapted to living with Paxil for a long time and it sounds to me that you discontinued it a little too abruptly.  I don't think you are doing yourself any favors by trying to tough it out cold turkey - be gentle with yourself and give your brain more time to adjust to living with less  Paxil -I think you'd feel much better if you start taking 5 or 10mg of Paxil a day and then take it down even more gradually than you did. Take care, Andrea

by SleeplessDonna, May 24, 2006 12:00AM
To: andie3330
Last night I actually slept straight through from 11:00pm-6:30am with the help of 5 mg valium & 50 mg trazadone but when I woke up I still had the chest tightening. I can't tell you how terrifying it is. The last 5 days have been horrible. Terrible anxiety, can't stop racing thoughts and have been contemplating suicide. I promised my fmaily & therapist I wouldn't do it until I saw a psychiatrist. At this point I'm waiting for an appointment. Things are so bad that I can't be alone. But I'm afraid to miss the phone call from the psych. I think I have no choice but to go back on meds. Yesterday I started Cymbalta. Cymbalta is supposed to help with pain. All of this (the last 5 months of depression) started with neck pain. Of course the chest tightening is creating more pain. By the way I have the book "Antidepressant Solution" and there is no mention of chest tightening. But I think what is happening is that I'm having anxiety attacks when I'm asleep. In terms of coming off Paxil too quickly...the chest tightening started when I dropped to 10 mg. I have a feeling it wouldn't have made a difference dropping slower only because it didn't go away at all during the 10 mg drop. If you have any more advice it would be greatly appreciated. Thanks for you info and concern. Donna

P.S. I'm so angry about all of this. I was never told about how addictive this stuff is and all of the side effects being on it and getting off it. I'm so afraid that this chest thing is a permenant condition. Have you heard of any side effects that are permanent?

by shade, May 24, 2006 12:00AM
Hi There,



What an awful time you've had.  Since Paxil, I've been on:  serzone, prozac, Celexa, Effexor, Lithium.  After the horror of getting off Paxil, I had to realize that I was a "lifer" on meds.  I'm also a librarian by trade and have done a ton of research, though I'm obviously no doctor.



I'm currently on Effexor/Lithium.  Effexor is a great drug because it's not just an SSRI, it also works on a whole other part of the brain too.



Personally, I hate lithium.  I want to get off it and replace it with Wellbutrin.  Wellbutrin also works on dopamine.

by andie3330, May 24, 2006 12:00AM
To: SleeplessDonna
My psychiatrist, along with my sister (who is a pharmacist)reassured me that NONE of the withdrawal side effects are permanent - they may take weeks to fully resolve - but you will get better and back to normal. Your theory about your chest tightening being related to panic attacks while asleep makes a lot of sense to me - I also have had many years of dealing with panic and anxiety attacks and I know they can definitely happen while asleep and they can absolutly cause severe chest tightening and pain. I've experienced the chest