Help with paxil withdrawal for family member

[Ribena_Girl]

Good day all, I have a dilemma I would really like some advice on.

Earlier this last month my younger sister was hospitalized against her will for depression.  Reasons for this was because she was in medical school and hadn't been attending classes for a while so the school itself came to find out why she wasn't coming. Requested her for an interview and apparently determined that the best thing for her was to lock her up in the mental ward.

Me and my family did everything we could to get her out and succeeded the following day (the school kept fighting us on this) because we felt their solution wasn't for the best, being in the hospital just made her feel worse and she kept refusing to eat while being there.  Anyway, when we did discharge her finally she was giving Paxil medication to take at 40mg everyday for two weeks. A decision i regret not researching before hand. The two weeks ended and she was finally done takin the pills but for the past 4 days she has been experiencing severe symptons.

Uncontrolled hiccuping,  nausea,  loss of appetite and she cant keep anything down.  She vomits around 5 times a day and we're incredibly worried.

Please forgive us for taking so long to realize that these are withdrawal symptons.  For one thing we're not from a first world country and these drugs were a bit expensive (although it doesnt matter as all we just want is to get her better and will do anything it takes), and we can't take her to the same doctors as before as we don't want her to be forcefully hospitalized once again.  I've just been doing a lot of googling on the drug today and seeing most of its atttibutes now.

What can we do to help her is what i am here to ask. Is there a known period for when her withdrawal systems would eventually stop? (giving her dosage of 40mg/day for 2 weeks), can we do anything to help her symptoms?  (especially her vomitting so she can keep her food down at least),  I saw a lot of posts on weening but is that really the best method?  Keeping her continuously on the drug even if its to taper her off would just mean its staying longer in her system than necessary.  I am no medical practitioner though so i do know i have no expertise on the matter.

Would appreciate hearing from all experiences regarding this drug and with shorter medication times rather than the longer period like years.

[specialmom]

So, psychiatrists do not admit for involuntary hold someone for not going to classes.  They do that when someone has indicated they are a danger to themselves or others.  Suicide threats, for example.  I'm guessing your sister has not shared what has fully been going on and that her presentation was such that she warranted that hold.  Please be open to that for her own benefit.  

Paxil like all drugs in that class is not a 2 week medication.  It's a long term medication and does not reach therapeutic benefit until 6 to 8 weeks.  There ARE start up side effects called transient side effects.  They subside. There are other longer term side effects though although, as a class, the SSRI's are fairly well tolerated.  She's been on it briefly, but in general, the rule of thumb is to titrate up slowly (increase the dose over time slowly) and to titrate slowly back down.

Your sister is in crisis.  I'm afraid the family is not recognizing that.  I'm afraid for your sister if she does not receive strong psychiatric intervention. good luck

[Ribena_Girl]

Yes she is in a crisis and Yes she did have suicidal thougts but dont think we arent recognizing that.  We are working towards helping her as a family and we have been doing so for the past month. We had found out the reason when she was hospitalized and it was relating to the fact she felt a lot of pressure and that this course wasnt right for her. She really hated the idea of spending the rest of her life being a doctor. And we have agreed to withdraw her from school and have her Change courses.

But that doesnt Change the fact that what the school did was wrong. They held her against both her and her family's will despite the fact that the has a problem with the course medicine and being in a hospital.  Because i didnt feel the need to mention all this doesnt mean you should assume we don't Care enough to truly help my Sister get better.  She felt a lot better at home and i think we would know her needs better than any stranger would. If she wants to see a psychiatrist then there is no problem with that. But we will monitor her for now and do the best we can, if outside help is needed then we will contact whoever is necessary.

[specialmom]

I know you care about your sister and are trying to help her.  The issue is that depression that leads someone to withdraw from life in the way she did, that she conveyed she was having thoughts of ending her life, and that she refused to eat in the hospital are all signs of a very significant psychiatric issue that maybe was triggered by an issue with her course of study and unhappiness about it or fear of failure in it.  But the end result of what happened to her was to protect her.  Involuntary holds are necessary and often DO save the life of someone in your sister's mental state.  It's hard.  It's humiliating in a way.  It's difficult to think of someone needing that kind of care when it's deemed that they will not get it on their own. but it is only done when it is feared the best way to intervene to make sure someone is safe.  Especially on a college or university campus where someone who is unstable could not only be a danger to themselves but others.  So, I'm not defending the school (they just suggested evaluation, it was the evaluator that made this call)---  and really don't know all the particulars.  But every time I've seen someone held involuntarily, it was a wake up call for all involved at how at risk the person was.  Not saying this is your sister, I don't know her or you or the situation other than the bit you've written here.  But am writing in general.

Trying to help her on your own is risky.  She's been so low, so depressed she's had people think she was going to harm herself.  I'm glad you are following up on her psychiatric care.  Realize that simply taking her out of her medical school program may be a start to simplifying her life but the mental health reaction she had needs to be dealt with. It didn't cause her to be in this situation.  It was a trigger, but it was her psychiatric predisposition that led to the extreme situation.  

I know for sure you want the very best for her.  And I hope that this all works out well.  A young lady's life is at stake.  I'd stay focused on that rather than the institution acting in a way that their protocol probably mandates.  (in the United States, many things are mandatory report and mandatory hold based on certain criteria.  Once the criteria is met, they HAVE to act.  For example, your sister meets the criteria and they do nothing . . . your sister kills herself and the family knows they knew ahead of time there was a threat of this and did nothing.  They can't have that either.)

This is hard stuff and I'm glad your sister has you to help her.  good luck

[Ribena_Girl]

Okay thank you for your comment.
I do know in the end there is only so much we can do,  and it definitely was a wake up call to us that there was a serious problem at hand.

For the most part we are really just trying to communicate with her and let her know she can communicate with us at any point.

We know it won't be an easy journey but it will all be worth it as long as she is happy in the end.

I think sometime this month we will still end up taking her to talk to someone besides us for a session.  To see if she really is getting better, and its not as though we want to self medicate her per se,  we just didnt think the way the school went about things was the right. If we can find a better option that she is comfortable with then we are definitely open to it.

[Paxiled]

If I can chime in here, what SpecialMom is saying is, when depression reaches the level of suicidal thoughts and hospitalization, medication is  going to almost inevitably be necessary to calm the situation down.  All meds have a startup problem of side effects happening before the effects start to kick in.  Some meds work, some don't.  Some are easier to take and quit than others.  Anyone who has been hospitalized and is suicidal will be put on meds until the situation stabilizes.  Anyone.  Also, as to treatment, going to medical school and being unhappy about the decision does not cause depression.  Depression is an illness, not a response to life's stresses.  Sadness and regret are responses to a bad decision, not depression.  Nobody knows what causes depression yet, but it's a bear to tame.  It may be a life-long struggle.  It might resolve itself tomorrow.  It can be caused by physiological problems and by seemingly nothing at all.  Your statement that this was caused by her not wanting to be a doctor and feeling pressure is probably not right -- again, that might make her very unhappy, but not depressed.  There is a difference.  I hope this goes well, but think of this as a broken leg or cancer -- it's an illness, not an emotion.  Emotions come and go, but depression when it gets to that level doesn't.  And again, I'm absolutely floored by your steadfast involvement -- do I ever wish my family had cared this much!  I think you will crack this nut, because I don't think you'll stop until you do.  Peace.

[Ribena_Girl]

Hello everyone. I'm happy to say that my sister is no more suffering from the side effects of the medicine.  She is feeling better physically for now.

And thank you both for your comments,  you guys are right in that her depression is an illness rather than an emotion,  we will take precaution in how we do things but I do seriously believe we can help her beat it as a family.

We took her to an outside specialist the other day and while we do still have a way to go but she isn't closing up as bad as before now and that just means we're moving forward.

Once again,  thank you all for your kind comments. Until now I don't think we ever fully understand how important mental health is and this experience has definitely been an eye opener.

We just pray everything turns out well now that we have more awareness about the situation

[Paxiled]

Paxil is the hardest drug out there to stop taking, but before I start here, being on it for just two weeks would not usually result in a withdrawal -- she hasn't even been taking it long enough for it to start working yet.  But assuming it is withdrawal, and it might be, people react very differently to drugs, the only way to deal with this is to go back on the Paxil at the last dose at which she felt fine and to taper off more slowly.  You can hope this will pass, and given she was only on it for two weeks,  it really should pass, but if you don't think it's going to go away and become a protracted withdrawal, then going back on it and tapering off more slowly is the only known way to deal with it.  Those are your two choices:  hope it stops or go back on it and taper off slowly.  No third choice.  Now, as to the underlying issue, don't overestimate first world countries.  We're just as clueless as everyone when it comes to these meds.  Nobody ever told me about the dangers of stopping Paxil when they put me on it and didn't tell me it was destroying my life with withdrawal when I stopped it.  This is done because drug companies control the information flow and most doctors are horrible at their jobs the world over.  Just as most people aren't that great at what they do for a living.  It is what it is.  The other underlying problem is the hospitalization.  Why was she hospitalized?  Why did they choose that particular medication?  What was the diagnosis?  A psychiatrist saw here at that hospital no matter the country, so some diagnosis was made.  What was it?  What behaviors is she manifesting?  This is important, because Paxil won't treat psychosis.  It treats depression and anxiety.  It's actually a pretty effective drug when it's absorbed well, but the stopping problem is severe.  Most psychiatrists don't start with that drug, given there are others out there.  But you do have to know what's going on with her in order to know if her treatment makes sense.  Kudos to you for caring -- nobody in my family has done a thing for me -- and all the best in this, but if your sister is suffering from mental illness, something does have to be done, whether it's therapy or lifestyle changes or medication.  All medications have side effects, not just Paxil, it's just worse for many people.    

[Paxiled]

Also, having a drug in your system doesn't cause withdrawal, it's having it out of your system that causes it.  This drug doesn't actually stay in your system very long.  The problem lies in the brain working artificially when on medication, and having to go back to working naturally when the med is stopped.  For some this happens easily, for some it doesn't.

[Ribena_Girl]

Thank you a lot for your answer.

We will wait it out for two or three more days and if things dont get better then continue with the medication and taper her off slowly.


She was hospitalized for having severe Depression and suicidal thoughts. My sister is a very private person so while we try our best to be there for her she doesnt talk to us much about issues she is facing.

She has high anxiety and she puts herself down a lot thinking she is just being a burden and not good enough. She is the youngest so maybe she also felt like she wasnt doing enough to help with the house which we keep telling her is not supposed to be her problem.

We have talked to her and it seems she felt a lot of pressure to ve successful a become a doctor even though thats not what she truly wants. I am guessing the pressure has been building up and really hit hard this time in her fourth year where they actually do shifts at the hospital full time now.
I wish she talked to us earlier but it is has happened and now we know where to move forward from. The idea of hospitals and being a doctor just started to compound on her and it seemed to really disturb her up to the point she started purposely skipping shifts (despite how diligent a person she is).

Now that we see this issue we have withdrawn her from school and want to leave her to spend some time doing things that will make her happy instead.  She loves art so i was planning to take her to a design class once her medication was up (because she was also given sleep medication and she slept a lot during the day within that period) but with this week she has been feeling very ill due to thr withdrawal (i really think that this is why,  because she didnt feel this way till after she stopped the medication and ive never seen her experience this before). All in all, i cant really stand seeing her suffering and not doing anything. But we will heed your advice on this though.

We just want to help her get better and support her anyway she can,  whatever she needs we will try and provide. And i especially will try and help her realize her potential so she can live a life that she wants happily