[curlyq]

Hi Cam,
How's it going? I hope well.

I was taking 20 mg.of paxil a day and recently went up to 30. I'm wondering what the therapeutic dose is and also what is the highest dose you've heard of for Paxil. I was reading in the pocket PDR that you should't go over 40mg. Will the higher dose give a person more energy again. I sure need it.

Thanks in advance, Cam.

<font color=orange>Peace to you.
curlyq/CQ</font color=orange>

<font color=blue>"We are not human beings on a spiritual journey. We are spiritual beings on a human journey." Stephen Covey </font color=blue>

<font color=purple>"Always laugh when you can. It is cheap medicine." Lord Byron</font color=purple>

[curlyq]

Just bumping this up so Cam may see it whenever he comes around.

<font color=orange>Peace to you.
curlyq/CQ</font color=orange>

<font color=blue>"We are not human beings on a spiritual journey. We are spiritual beings on a human journey." Stephen Covey </font color=blue>

<font color=purple>"Always laugh when you can. It is cheap medicine." Lord Byron</font color=purple>

[CamW]

Hi CQ - Sorry, I've been out of town or busy running to appointments for the last couple of weeks. I even forget how to turn on my computer. I am about 80 posts behind, so I'll keep my answer short and to the point. I hope that it is understandable.

SSRIs, including Paxilª (paroxetine) have a dose-response curve that flattens out. That means that after a certain dose (which is different for everyone) if you take more of the the drug you will not get any more antidepressant (anti-anxiety, anti-OCD, etc.) response. With Paxil this occurs at about 40mg to 60mg. You are only able to block the serotonin reuptake mechanism so much.

Some of our pdocs up here do use 60mg of Paxil, but not very often. Usually they will add another antidepressant (or other drug) to the mix rather than raising the Paxil dose above 40mg/day. They will usually add Wellbutrin SRª (bupropion) or Remeronª (mirtazapine) or even Effexor XRª (venlafaxine).

As a note, Effexor's dose-response curve is more or less linear to at least 450mg/day. Still, most pdocs will add another medication than raise it's dose above 300mg/day.

I hope that this helps. - Cam

<font color=blue>"Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing happened." - Winston Churchill</font color=blue>

[curlyq]

Thanks Cam, I appreciate your answer. I hope all is well with you.

I'm currently at 30 mg. and I noticed it is making me sleepy so I divided the dose to 20 ealy in the morn and 10 late at night. Seems a bit better. I'm hoping the tiredness will be replaced with huge bursts of energy in time! Dream on, huh? lol.

Thanks again.

<font color=orange>Peace to you.
curlyq/CQ</font color=orange>

<font color=blue>"We are not human beings on a spiritual journey. We are spiritual beings on a human journey." Stephen Covey </font color=blue>

<font color=purple>"Always laugh when you can. It is cheap medicine." Lord Byron</font color=purple>

[ksunflower]

Do I have the answer for you!!! I have taken Paxil for 3 years and am totally convinved it is a highly addictive drug. I still take and will have very "physical" withdrawls if I stop. I will throw up and get a headache if I would forget to take my 30mg dose. Last week I started therapy and a new psychiatrist. On top of my 30Mg paxil I am now taking Wellbutrin and Zyprexa. I was not feeling the effects of the Paxil anymore. My advise is to see your doctor regularly while taking Paxil. And try therapy with it. I wish I would not have waited so long to talk to someone.

[curlyq]

Thanks for the suggestions. I've been through a lot of therapy but now am just getting case management and finding resources for my problems. I've taken Paxil before and never had the addiction problem with it. I went off it okay once before. I did not do well on wellbutrin or Zyprexa. I gained about 60 # on the Z. I'm still adjusting to the paxil and may go up to 40. I take Risperdal with it. I also take ativan sometimes. I'm doing okay now.

<font color=orange>Peace to you.
curlyq/CQ</font color=orange>

<font color=blue>"We are not human beings on a spiritual journey. We are spiritual beings on a human journey." Stephen Covey </font color=blue>

<font color=purple>"Always laugh when you can. It is cheap medicine." Lord Byron</font color=purple>

[CamW]

Oooooh CQ, you said the "a" word. Technically, withdrawl syndromes are not exclusive to psychotropic medication (a minor detail that the folks at "PROZAC-BUSTERS.ORG", or "PAXILMADEMEIMPOTENTSOMYWIFELEFTMEFORMYBESTFRIENDSDAUGHTER.com fail to mention; and these withdrawl symptoms are really only signals your body is sending that something has upset the balance (homeostasis, or status quo).

In the case of SSRIs; in some people, when you stop these drugs abruptly and the body is not able to fully compensate for the missing serotonin, hence withdrawl symptoms.

In the case of §-blockers; stop taking this drug abruptly and your blood pressure goes through the roof. No one ever has set up a "I HATE INDERAL" site. That's probably because those who experience §-blocker withdraw have bigger problems than those who having problems withdrawing from Paxil. Even many of the 'lucky ones' in the §-blocker-withdrawl group are recovering from heart attacks and strokes.

Now it's time too metaphorize this concept (À - sounds like an "android with glasses" - bptoo, you consider yourself a wordsmith ... what word was I looking for). Let's say that you really, really liked prunes. You began to eat them morning, noon, and night; pounds and pounds per day. When you first start eating prunes, you notice that, when going to the toilet, you often pass softer stools. But, as the months and years scream by, there is a strike by the prune pickers (well, I guess that they would technically be plum pickers). The union, the PP&PU (Prune Pickers & Packers Union), forces a shutdown of the local plant and bans the import foreign prunes. You have to stop the prunes cold turkey. What happens to you? Well, two weeks later you realize that you haven't had a bowel movement. Your body adapts .... to a certain extent - to the various pressures and stresses that we apply to it. The longer and more often we do something, eat something, produce something the easier it gets (ie. practice makes perfect).

A major part of addiction is craving. Junkies end up patterning their life around drug use. A small group of cells in the junkie's brain likes being bathed in dopamine; the nucleus accumbens - and interconnected structures - are involved in sexual gratification, mood, and vigilence.

Many of the drugs of abuse affect the level of dopamine in the nucleus accumbens, artificially raising the levels resulting in being more active, greater mood swings. If you stop giving the drug, dopamine levels in the nucleus accumbens plummet, and withdrawl effects will appear.

Addiction and withdrawl symptoms are often seen together, but these terms are not mutually exclusive. Each concept can be understood on it's own.

- Cam (now stepping down from his soapbox and giving CQ a big hug for jumping all over her about the SSRI/addiction scandal).

<font color=blue>"Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing happened." - Winston Churchill</font color=blue>

[curlyq]

Funny Cam but I didn't even feel jumped on! . But what A word did I say? I don't get something here.

<font color=blue>Peace to you.
CQ</font color=blue>

<font color=red>"The worst sin toward our fellow creatures is not to hate them, but to be indifferent to them: that's the essense of inhumanity." George Bernard Shaw (1856 - 1950), "The Devil's Disciple" (1901), act II.</font color=red>

[CamW]

CQ - Sorry, the "A" word is addiction ... caused by SSRIs. I am constantly trying to explain the difference between addiction and the changes induced in a neurotransmitter system causing withdrawl symptoms. Withdrawl symptoms are not exclusive to addiction, but many people say that they are.

The only point that I was trying to make is that:

withdrawl * addiction

Sorry for any confusion. - Cam

<font color=blue>"Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing happened." - Winston Churchill</font color=blue>