Are there any non-activating anti-depressants? I have anxiety issues too so prozac, effexor, and lexapro made me nervous when i increased dosages. What else is there to take?

[T_MD]

Sure. Paxil, Remeron, Serzone are not activating (just don't stop the Paxil suddenly.)

[Dolfin]

I quit Paxil CR (75mg/day) cold turkey because it was causing my mania, per my prior pdoc's advice. Was he wrong for telling me to do this?

Jenn

[CamW]

Dolfin - There is a risk of serotonergic withdrawl syndrome with stopping SSRIs and SNRIs cold turkey. Sometimes overriding factors can make it necessary to stop these drugs abruptly; one being the emergence of mania.

Serotonergic withdrawl syndrome is also known as Antidepressant Discontinuation Syndrome . This link describes what can happen. There are some good links at the bottom of the page, as well. The withdrawl syndrome is not to be feared, but it is something to be aware of when taking antidepressants.

Serotonergic withdrawl syndrome is more common in antidepressants with short half-lifes. It is more commonly seen in the SSRIs like regular Paxil (paroxetine) and Luvox (fluvoxamine). I saw it quite often when people missed doses of the old regular Effexor, and is still seen if those who stop Effexor XR abruptly, or even miss taking the drug for a day or two. This syndrome is not as medically serious as benzodiazepine withdrawl syndrome, but it is not innocuous and can be quite unpleasant.

The brain adapts to the presense of the antidepressant, mainly due to the downregulation of certain neurotransmitter receptors. With Effexor (as well as the XR version) symptoms appear 8 to 24 hours after the last dose or 2 to 12 hours after a missed dose. Serotonergic withdrawl syndrome can be confirmed by taking a missed dose as soon as possible and having the symptoms resolve within 8 to 12 hours.

I use the pneumonic, FLUSH to remember the symptoms of serotonergic withdrawl syndrome:

F: flu-like symptoms (fatigue, myalgia or muscle pain, loose stools, nausea, sinus congestion).

L: lightheadedness, dizziness.

U: uneasiness, restlessness.

S: sleeplessness, sensory disturbances (feel abnormal, tinnitus or ringing in the ears).

H: headache.

The Paxil CR is a longer-acting version of Paxil, so a withdrawl syndrome isn't as likely to occur. You may have had some minor symptoms, but getting the mania under control would probably been more of a concern than serotonergic withdrawl syndrome.

I hope that this is of some help. - Cam