Paxil CR

I’d like to share with you the terrible experience I had while taking an SSRI.  I hope to educate the medical community and the public to be on the lookout for adverse reactions. If someone, anyone, had recognized the clear signs I had, it would have saved me from so much pain, emotional trauma, and shame.  Also, my family and friends were caused undue stress and hurt.
Please read the following letter that I recently wrote to my family doctor where I had been a patient for over 10 years:
You prescribed Paxil CR to me in November of 2002.  I wanted to follow up with you and tell you the horrific experience I had as a result of taking the medication. I am not writing this letter to point blame. I am writing to educate you on the medication’s possible side effects.  Also I am recommending that you ask patients who are taking this drug specific questions to determine if they are having a manic reaction.
As you may know, I went to a psychotherapist in fall 2002, who suggested that I ask my family doctor to prescribe Paxil for the treatment of depression and social anxiety.  At the time, I was in an excellent financial situation, a home-owner, and had a wonderful secure job where I had been employed over 5 years.  After taking Paxil for a couple of weeks, I felt extremely happy and had an inflated self-esteem. I thought that since I was no longer depressed nor socially anxious that the medicine was working. 
I was living alone and was not around friends who I had long-term relationships with.  When I was on Paxil, I made impulsive and irrational decisions, such as taking a trip to Cancun.  My spending became out of control.  I used to be very cautious and analytical when making decisions, but while I was on Paxil, I was incapable of making sound decisions and yet I had child-like optimism.  My sex drive skyrocketed.  Previously, I had always been very shy and had a low sex drive, but when I took Paxil, I suddenly became very promiscuous.  Up until when I took Paxil (age 28), I had a total of 7 sex partners. In 2003 alone, I had 27 different partners.  I felt like something was wrong with me, but when I went to a counselor, she told me I was young and having fun and should just set boundaries for myself. But nothing worked. I continued using very poor judgment and felt my life was out of control. I never wanted to be at home. I felt like I had attention deficit and difficulty concentrating. I took serious health risks such as unsafe sex.
In Fall 2003, I had met a guy who seemed the very “opposite” of who I had become.  He was very low-key and not very sexual. As an escape from my wild life, I decided I would marry him, hoping it would force me to calm down.  I sold my house in DC, quit my job, moved to Charlotte and got married.  Shortly thereafter, I began having an affair and my life was spiraling downward.  Counselors I sought out did not know how to help me. My debt increased significantly.  Six months later, I knew the decisions I had made were mistakes.  I moved back to DC, separated from my husband, sought out another job, and got off of Paxil at my husband’s request.  From there, I hit an all-time low where I could think of nothing but killing myself.  Due to taking Paxil, I lost my self-respect, my reputation, my closest friends, and the relationships I had with family members.  Financially, I took an enormous loss from divorce legal fees, I’m over my head in credit card debt due to irresponsible spending, I lost a job in which I’d worked my way up to a senior level position, and lost over $100k from poor real estate decisions.  The ramifications of the years I was on Paxil continuously haunt me.  My husband, from whom I am soon to be divorced, hacked my computer and read my on-line journal from the past 5 years. He emailed excerpts to the people who had been closest to me, exposing the promiscuous lifestyle I had, manic thoughts, and choices I made.  
In Fall 2005, I ran out of money to continue counseling.  I was referred to The Commission for Women where I met with an intern for therapy.  She told me my behavior was manic and that I needed to meet with a psychiatrist to get appropriate medication.  She told me that some people need to take a mood stabilizer in conjunction with an SSRI to prevent mania.  Until that point, I didn't even know what "mania" meant.   Apparently, in Spring of 2004, Paxil placed a warning label in its literature warning that it could cause the onset of mania.  Unfortunately, I was unaware of the warning and continued in a state of mania until the middle of 2005.
I am writing all this to ask all doctors and therapists please monitor patients who are taking SSRIs. 
“To diagnose a manic episode, it is necessary to demonstrate the expansive mood and three of the below associated features and the marked impairment in functioning.

A manic episode is noticeable by a lack of impulse control and rational thinking - the brain is not signaling correctly.  The unwarranted optimism, grandiosity and poor judgment shown by people experiencing a manic episode often lead to highly dangerous or risky behavior. Promiscuity, buying sprees, reckless driving and other foolish and high-risk behavior is common and can have devastating effects on the person's life. In many cases, the consequences of manic behavior is more destructive to the person's life than are the consequences of depression (except in cases of suicide, of course).”
“The social disability of mania can be severe, with disinhibited behavior leading to significant debts (from overspending and over-generosity), lost relationships (from promiscuity), social ostracism and lost employment (from reckless or disinhibited behavior).  Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.”
Above is from:
By definition, the presence of psychotic features constitutes marked impairment in functioning.
I encourage you to closely monitor patients who are taking SSRIs to detect if they are responding with a manic episode as I had been.  Just asking a patient if they are “feeling ok” or if the medicine “seems to be working” is not sufficient. Please pass this information along to your colleagues to avoid other patients from having to endure the horrible 2 and half years I went through and the years I have ahead to deal with the consequences.
In my opinion, anti-depressant medication should only be administered by a psychiatrist. 
Thank you for taking the time to educate yourself on this issue. Please pass this around to others in your field.

Jen M.

Paxil_warning_May2004.pdf Paxil_warning_May2004.pdf