He had always worked Construction, but when the housing market crashed, so did his livelihood. He couldn’t find work anywhere. His [sort of] wife was out of work as well. He got depressed and was started on Paxil 10 mg by a nurse practitioner. When it looked like he was going to lose his house, he went into the breaking and entering business for the first time in his life. After some early successes, he got caught in the act and found himself with no [sort of] wife, no house, and a five year prison sentence. I asked how the Paxil dose had gone from 10 to 60 milligrams. He asked me if I’d been to prison [first time I’ve ever been asked that]. But what he wanted to explain to me was how boring prison life can be and wondered if I already knew.He said, "It’s like a grammar school playground. A bunch of guys with nothing to do except watch t.v., eat, and get in fights with each other. When you get in a fight, you end up on solitary for a few days. And I got really depressed in solitary so the doc increased my meds." That happened several times, and up went the medication dose. I asked if they gave him medications on solitary, but that was what he’d already figured out on his own – that it was withdrawal symptoms. "But by the time I figured it out, I was on 60 —-ing milligrams." The Remeron had been started because of insomnia, something he had never had before. His description of the withdrawal symptoms was classic, down to the brain zaps [for which he had a more colorful but less printable name]. He had tried to come down on the Paxil dose, but invariably got the symptoms late in the day and so he took the skipped pills. He would squirrel away a half pill here and there to build a "stash" in case of getting sent to solitary, and he had definitely learned to avoid fights. He was terrified that he wouldn’t be able to get the medication. The withdrawal symptoms were that bad. And he was convinced that he’d never sleep again without the Remeron.
He had already given a few hints along the way about how to proceed. He was on two drugs with withdrawal syndrome possibilities, one he knew about – Paxil. So Paxil seemed the place to start. His own attempts failed at "the end of the day." With the short acting drugs, people taking them only once a day often get evening symptoms and I even wondered if that was part of why the dose was so high [and maybe even wondered if that had something to do with the Remeron addition]. Something I’ve learned is that if one comes on too strong with the tapering meme, the patients get scared go elsewhere to someone who will just write the refills. So I suggested that the first order of business was to get him to a twice daily Paxil dosing. Move a half pill to the afternoon every week or two. When I explained why, he liked to idea. Once we got to a twice daily dose [30 mg twice a day], we could start a taper with less fear of evening withdrawal symptoms. And if half a pill doesn’t work, I told him to try moving by quarters. But the real point is that he seemed to be on-board once he felt comfortable I wasn’t going to "cut him off."
He seems pleased as punch to be out of prison and I doubt he’ll ever go back [even as I wrote that, I remembered that my track record predicting criminality has not been stellar]. But I’d bet the house that his illness started as situational and is now iatrogenic [caused by his medications]. I know nothing about SSRI being associated with non-violent crime, but who knows if that Paxil had something to do with his later life new profession?
Thanks again, Mickey, for your care and attention to the risk of withdrawal syndrome.
My hypothesis is that people who have been on and off psychiatric drugs before, particularly with abrupt discontinuations (including cold switches), finally have a bad time going off.
The physical nervous system is not as resilient as drug-based psychiatry would like it to be.
Escalating dosage and polypharmacy doesn’t help, for sure.
People find that moving the second half of a split dose later by a couple of hours each day reduces any upset the change in dosage might cause. When someone is taking as high a dose as 60mg Paxil, cutting that in half could cause withdrawal symptoms within hours.
Paxil can be a bear to go off at any rate. Here’s some info about tapering http://survivingantidepressants.org/index.php?/topic/405-tips-for-tapering-off-paxil-paroxetine/
It sounds like the increase in Paxil caused this poor man’s insomnia.
Disinhibition has been reported as an adverse effect of SSRIs.
Thanks Alto,
You’ve been a great help in learning about this. The “half a pill” reference is a 20mg pill, not a 60mg. So I’m talking about ½ pill = 10mg and ¼ pill = 5mg. So that would mean going from 60mg in the morning to 30mg twice daily in six weeks or so before even thinking about tapering. Another post on this coming soon.
Now try that with opioids, and you have one of my average days.
Two new reviews of SSRI withdrawal symptoms have just appeared in print here and here.
I’m on Paxil. Been on 40mg/day for almost 15 years (tried a slow taper over 2 years, but crashed at 7,5mg/day) I upped to 20mg/day, and there I will stay until it is commonly known what Paxil causes. I can’t taper with the whole World denying the indescribable horror of withdrawal.
I am similar to the man in the article, Everything lost from the first day I took my pill. Been to prison for a violent crime (no other criminal record, never even thought about prison as a Young man, I knew I was never going there…)
But i also know that Paxil causes “obsessions”. Some obsessions might lead to other criminal activity than violence. If the criminal offense is out of a behaviour that started after Paxil, Believe me, I will blame paxil.
It is a mind-altering drug that made me the opposite of the happy, caring, calm, thoughtful and sympathetic man I was Before. And it alters the users mind so that he can’t see the Changes himself. You become accepting of change, no matter how ludacris the behaviour can seem to the outside, to you it seems OK.
Plz tell this man, that far more than he Thinks, can be an alteration made by the chemical in the pill. No Matter What the “experts” say.
Ove/ Sweden
Thanks SO MUCH for sharing this man’s story! We’re currently hearing a whole lot about “the mentally ill in prison” and psychiatric treatment as an alternative to prison or a way to prevent people from breaking the law.
I always thought I would be so happy when this was finally acknowledged, especially given the number of people who have been imprisoned for life and even executed for crimes committed in a delusional or other crisis state. But now that it’s suddenly OK and mainstream to “discover” this issues, I worry.
I worry most because of what I know about the psychiatric experience of those already in prison. Some people go in with longstanding and perhaps constitutional “mental illness.” Many others go in with problems like those of your good patient. Neither type of prison inmate gets much real treatment — but more and more they get pills. Oh boy do they get pills. And meanwhile the callous disregard of humanity, and total lack of opportunities for reform, still prevail, so that many DEVELOP “mental illness” in prison.
They are all lumped together in the ever-escalating estimates of the number of people trapped in our prison system who “Have Mental Illness.” If we think more psychiatry is the way out of this inhuman system, let’s have a good look at the complicity of psychiatrists in creating this dismal state of affairs. We now have a modest black market in Seroquel — Seroquel! — in this country, and it’s largely fueled by prison and the army.
And yes, I agree that getting on SSRI’s may have made it easier for him to become a thief when hard times made that look like a possible survival strategy. A certain numbing to the consequences of your actions, moral and practical, is very common, and much harder to spot than dramatic outbursts of violence or paranoia. Paxil has more FDA reports of “shoplifting” as a side effect than any other antidepressant — on a par with some of the dopamine agonists that cause compulsive gambling, porn-viewing, etc.