Sunday, January 27, 2008

One problem with Paxil...

and Prozac, Zoloft, Celexa, and Lexapro

Several years ago, I treated a teenager with Paxil for show-stopping anxiety. He came back two weeks later no longer feeling much anxiety. In fact, he wasn't feeling much of anything. In his words:

I couldn't get my shoes tied this morning. It wasn't that I didn't know how to tie my shoes, I just didn't much care whether they were tied or not. It seemed like too much trouble.

This blah sort of feeling (other patients have variably described it as a lack of emotions, loss of joy, inability to cry, being wrapped in cotton, and viewing life from a fishbowl) is a big problem with this class of drugs known as SSRIs or selective serotonin reuptake inhibitors. My psychiatrist colleagues tell me as many as 40% of patients will experience this dulling of emotion.

While patients may initially welcome the resolution of depression and anxiety, this inability to feel quickly becomes a problem. My patient who called me a saint post-Cymbalta prescription had this problem as well with the SSRIs. More later on why Cymbalta and Effexor are not so dulling, and why Cymbalta may have it over Effexor.


Elaine said...

I took a very low dose zoloft years ago after the death of a family member. Though I wasn't totally zoned out it did get me over the initial hump and left me in the "blah" zone, which is not me! I took myself off it 3 months later.

Mauigirl said...

I don't find that I'm all that blah on Prozac but I take a very low dose (10 mg.). Perhaps my "highs" are a little less high but it is worth it not to have the lows.