Length of Cycling after Paxil is Dc'd?
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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


   Published June, 2002

 

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