Quit antidepressants? Easier said than done

When Gina O'Brien decided she no longer needed drugs to quell heranxiety and panic attacks, she followed doctor's orders by slowlytapering her dose of the antidepressant Paxil.

The gradual withdrawal was supposed to prevent unpleasant symptomsthat can result from stopping antidepressants cold turkey. But itdidn't work.

"I felt so sick that I couldn't get off my couch," O'Brien said."I couldn't stop crying."

Overwhelmed by nausea and uncontrollable crying, she felt she hadno choice but to start taking the pills again. More than a year laterthe Michigan woman still takes Paxil, and expects to be on it for therest of her life.

MANY SUFFER 'BRAIN ZAPS'

In the almost two decades since Prozac -- the first of theantidepressants known as SRIs, or serotonin reuptake inhibitors --hit the market, a number of patients have reported extreme reactionsto discontinuing the drugs. Two of the best-selling antidepressants -- Effexor and Paxil -- have led to so many complaints that somedoctors avoid prescribing them altogether.

"It's not that we never use it, but in the end I will tend not toprescribe Effexor or Paxil," said Dr. Richard C. Shelton, apsychiatrist at the Vanderbilt University School of Medicine. Sheltonhas received grant support from the makers of both drugs andconsulted for a number of other pharmaceutical companies.

Patients report experiencing all sorts of symptoms, sometimeswithin hours of stopping their medication. They can suffer from flu-like nausea, muscle aches, uncontrollable crying, dizziness anddiarrhea. Many patients suffer "brain zaps," bizarre and brieflyoverwhelming electrical sensations that propagate from the back ofthe head.

DOCTORS' KNOWLEDGE LIMITED

Though not exactly painful, they are briefly disorienting and canbe terrifying to patients who don't know what they are experiencing.There are case reports of people who have just quit antidepressantsshowing up in hospital emergency rooms, thinking they are sufferingfrom seizures.

Yet surprisingly few doctors know enough about SRI discontinuationto manage it effectively. A 1997 survey of English doctors found that28 percent of psychiatrists and 70 percent of general practitionershad no idea that patients might have problems after discontinuinganti- depressants.

The condition's prevalence is equally mysterious. Studies put therate at anywhere from 17 percent to 78 percent for the mostproblematic drugs.

'THEY SHOULD BE PAYING ME'

So little is known about it that researchers aren't even exactlysure what causes the symptoms. It may be related to the fact that thebrain chemical affected by most of the antidepressants on the markettoday, serotonin, does a lot more than regulate mood. It is alsoinvolved in sleep, balance, digestion and other physiologicalprocesses. So when you throw the brain's serotonin system out ofwhack, which is essentially what you're doing by either starting ordiscontinuing an antidepressant, virtually the whole body can beaffected.

Having to keep taking Paxil makes O'Brien angry because she feelsat the mercy of GlaxoSmithKline, the company that makes it.

Though a GSK spokesperson said the symptoms associated withdiscontinuing Paxil are generally mild and manageable, in O'Brien'seyes the company is profiting by having hooked her on one of itsdrugs.

"If they ever did quit making Paxil, I'd be in so much trouble,"O'Brien said. "What really makes me mad is if I can't get off it, whyam I paying them? They should be paying me."