PANES case 4 & 5 - persistent pains in the legs 3 months after withdrawal,

Mrs D., a 49 year old health professional was prescribed 20 mg paroxetine daily in April 2000 for a depressive disorder. This relieved the depression, but aftr three months the patient started to develop paresthesiae in the right hand, and some weeks later experienced her fingers being 'fumbly'. She visited her GP and complained that although her mood was satisfactory there were unpleasant side effects. He asked her to reduce the dose to 10 mg daily. Mrs D began to experience painful, restless legs at night and vivid dreams. The tingling in her hand spread into her body and head. After a week of the 10 mg dose the patient discontinued the paroxetine altogether in the belief that the paroxetine would be out of her system in a few days and her symptoms would subside. The symptoms however persisted. She took a week off work, but the following symptoms persisted for the next three months:




paraesthesiae in hands and feet spreading up arms and legs intermittently

stiffness in calf muscles

unsteadiness on her feet with wide gait

clumsy fingers

loose bowels

disinhibited mood

These symptoms appeared worst at the end of the day, following heavy physical work,and with even small amounts of alcohol. By December, four months after discontinuing the paroxetine most of the symptoms had reduced in severity to near normal.







Mrs E., a 48 year old woman was prescribed citalopram by her GP for eleven months. The indication for the prescription was chronic anxiety. For fifteen months folowing the discontinuation of this therapy she suffered headaches and dizziness. She also complained of a fluttering sensation across her scalp. To date there has been little improvement.