. To read an answer, simply click on the
question title. After reading BBS to interact
with others visitors
The SSRI's (Paxil, Zoloft, Luvox, Prozac, Celexa) are often considered the first medication of choice for panic disorder due to their "low side effect" profile. This profile may not be as low as previously thought
The selective serotonin reuptake inhibitors (SSRI's) were initially developed to treat depression with greater receptor specificity and reduced side effects when compared to existing medications. When SSRI's first appeared a decade ago, their favorable side effect profile was a key selling point. Experience has shown that some side effects are more common and problematic than initially expected. Some people do very well on these medications, however common side effects are still relatively unknown among many prescribing physicians. The commonly described side effects are nausea, diarrhea, headache, agitation and insomnia. Other side effects have not been widely described. My information comes from clinical observation of my patients and the many letters I receive. The standard dosages seem to initially heighten anxiety and induce attacks of greater severity than the attacks being treated. After a period of initial weight loss, a rapid and persistent period of weight gain may occur. Some patients complain of memory and concentration loss. Disinterest in sex and sexual dysfunction are extremely common, especially with Paxil and Zoloft. Another common side effect is referred to by the patients as "zaps." A zap is something like the sensation of tingling you get in your arm when you hit your "funny bone". These can occur anywhere in the body, but tend to occur on the head, neck and shoulder. Tolerance may develop to the dosage, which then needs to be increased. Tolerance may develop to the point where the medication is no longer effective. When stopping the medication, a withdrawal syndrome may occur which includes a severe vertigo described as "visual lag". That is, the brain is lagging behind the processing of visual input. This is subjectively experienced as a vertigo so strong that bed rest is needed. Also the zaps may occur with greater frequency and
intensity. Another consideration is the observation that the withdrawal symptoms may last for several months. Also, sexual dysfunction and memory impairment may persist indefinitely even after discontinuation of the medication. I have 4 patients who stopped Zoloft or Paxil and have had persistent sexual disinterest and anorgasmia for over a year since stopping the medications. One patient has had continued short term memory loss. Another patient has described 6 months of the "zaps" while yet another has described the onset of severe ringing of the ears ("tinnitus") that is not remitting. To be sure, many patients have no side effects and no withdrawal effects, however patients need to be warned of all possible side effects of these medications before they start them. All to often the medication is prescribed and the patient is told that it has "almost no side effects" or only the nausea and diarrhea may be mentioned. Make sure you are fully informed before you start these deceptively powerful medications
