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Occasionally symptoms can last up to one year. [3] They typically resolve within a day of restoring the medication. [20] Paroxetine and venlafaxine seem to be particularly difficult to discontinue, and prolonged withdrawal syndrome (post-acute-withdrawal syndrome, or PAWS) lasting over 18 months has been reported with paroxetine. [21] [22] [23]
Many prescription and legal nonprescription substances can also cause withdrawal symptoms when individuals stop consuming them, even if they were taken as directed by a physician. The route of administration, whether intravenous , intramuscular , oral , or otherwise can also play a role in determining the severity of withdrawal symptoms.
Paroxetine, sold under the brand name Paxil among others, is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class [7] used to treat major depressive disorder, obsessive–compulsive disorder (OCD), panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), generalized anxiety disorder, and premenstrual dysphoric disorder. [7]
Paroxetine was the first drug to be FDA-approved for this disorder. Its efficacy is considered beneficial, although not everyone responds favorably to the drug. Sertraline and fluvoxamine extended-release were later approved for it as well, while escitalopram is used off-label with acceptable efficiency.
Fluoxetine also has a long half-life which can reduce withdrawal symptoms which are characteristic for some SSRIs after abrupt discontinuation, but it also means that it takes a long time to clear the drug and its active metabolite after discontinuing fluoxetine treatment. [18] Figure 5 Chemical structure of (–)-(3S,4R)-paroxetine
Although anxiety can temporarily increase as a withdrawal symptom, there is evidence that a reduction or withdrawal from benzodiazepines can lead to a reduction of anxiety symptoms in the long run. [4] [5] Due to these increasing physical and mental symptoms from long-term use of benzodiazepines, slow withdrawal is recommended for long-term users.
Whether or not you can see that you have some work to do on yourself.” “But don’t you ever worry that we’re just telling you what you want to hear?” “I’ve been doing this a long time, Clancy. I think I can tell when someone is faking it. Do you feel like you have to fake something in order to show me that you’re ready to leave?”
Paroxetine was the first drug to be approved for social anxiety disorder and it is considered effective for this disorder; sertraline and fluvoxamine were later approved for it as well. Escitalopram and citalopram are used off-label with acceptable efficacy, while fluoxetine is not considered to be effective for this disorder. [ 22 ]