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Wednesday, 1 July 2009

Dave Healy said "short half life of paroxetine and venlafaxine make these two drugs more problematic"

HOW TO WITHDRAW

If there are any hints of problems on withdrawal from SSRIs, the management
of withdrawal is something to be done in consultation with your physician. You
may wish to show this to your doctor. Over-rapid withdrawal may be
medically hazardous, particularly in older persons.
Many doctors suggest you withdraw by taking one pill every other day for a
few weeks before stopping. There is no guideline that advocates this or
evidence that supports it and the approach is misguided.
One of the first steps to consider is getting a liquid formulation of your
antidepressant. This can be done by asking your doctor to approach the local
primary care pharmacist who can make an application to one of the specialist
companies such as Martindales or Rosemount that can make up a liquid
formulation of almost any antidepressant you might be on see below.
There are 2 theories about what leads to dependence and withdrawal that
dictate slightly differing management plans.
One theory is that the relatively short half life of paroxetine and venlafaxine
make these two drugs more problematic. This leads to a withdrawal strategy
that advocates switching from paroxetine or other drugs to fluoxetine.
The second is that paroxetine and venlafaxine are relatively more potent
serotonin reuptake inhibitors and this theory leads to a switch to less potent
serotonin reuptake inhibitors such as citalopram or one of the older
antidepressants such as imipramine.

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