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Is It Necessary To Take Paxil When Suffering From Stomach Problems?

Posted on Mon, 10 Feb 2014

Question: Hi again, I've been taking 10 mgs of paxil for two days but can't stand it any longer, my stomach hurts everytime I take it. I was going to stay on ten for a week then go to five. I'm honestly so distraught over the stomach problems that I don't know if I can feel any lower other than jumping off a bridge. If I stop it now, do you think I will have horrendous withdrawal symptoms? My Dr. gave me Viibryd to get me off the paxil because of the stomach problems. I took it one day and I felt terrible, head zaps shaking. I don't think SSRI's are for my brain. I would like to have my stomach removed at this point, stomavh issues are the worst. Thank you Dr. Parakh!!

Answered by Dr. Preeti Parakh (24 hours later)

Brief Answer: No problem in stopping Paxil now. Detailed Answer: Hi XXXXXXX Welcome back! Hope you had a nice Christmas. Since the stomach is troubling you so much, just stop Paxil immediately. Ten mg is not too high a dose and I do not expect that there will be any serious withdrawal symptoms. Even if you have some, I do not expect them to be more severe than the discomfort you are already feeling. The other thing you can do is to take 5 mg for one or two days and then stop completely. You do not need to be on this dose for a week before stopping. Viibryd (vilazodone) is a less popular SSRI than others. It is possible that some of the others may suit you better. There are also antidepressants other than SSRIs that could perhaps serve you better. When you are feeling somewhat better, please take some time out and list the medicines that you have tried so far for anxiety. I will try to find what alternatives you can try. Please do not worry. Things will get better. Enjoy the festive season. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (5 minutes later)

I hope you had a great Christmas as well!!! So, I only took the viibryd for one day and knew it was not for me. What I am experiencing now after taking Klonopin for 3 days are terrible headaches. The only thing that doesn't plague me is headaches so I'm pretty sure it's the K. What do you think? Nothing is making it go away. I wish you were close to me so I could have you treat me, you are awesome!

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: Explained below Detailed Answer: Thanks, XXXXXXX I too had a great Christmas! It is true than Klonopin can cause headaches as a side effect, but there are so many other things that too can cause head aches, ranging from anxiety itself, gastric problems, hypertension, exposure to cold weather etc. I think you can be sure by slightly lowering the dose of Klonopin and seeing if it reduces the headache. But that can cause an increase in anxiety so it will be better not to reduce the overall dosage at first. For example, if you were taking 0.5 mg twice daily and experiencing headache after each dosage, try taking 0.25 mg in the morning, 0.25 mg in the afternoon and 0.5 mg as previously at night. If you notice that the headache is less after taking lower dosage in the morning and the afternoon, then you can continue with this regimen or consider lowering your total daily dose, depending on how severe your anxiety is. I remember you were planning to try duloxetine (Cymbalta). Have you done it? Whenever you try a new drug, make sure you start at the lowest possible dose since you are prone to side effects. You can then gradually build up the dosage as required. Usually gastro-intestinal side effects of all anti-depressants last only for a few days and are usually gone by two weeks. If you start with very low dosages (less than what is the recommended starting dose), then I think you may find that you are able to continue on the medicine long enough for the side effects to wear off. Apart from Cymbalta, Lexapro (escitalopram) or Celexa (citalopram) may also be tried. Citalopram and Escitalopram have lesser gastric side effects than other SSRIs and are better tolerated than the others. Please also try to find some time for the relaxation exercises. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (16 minutes later)

I have not tried cymbalta yet as I was tested and told I have high norepinephrine. From what I know that drug keeps the NE from leaving and I do not want anymore problems. Correct me if I'm wrong please. I'll try the splitting of klonopin for a couple days to see if that works. If not I guess I'll have to go back to Ativan, no headaches with that but more gastric pain. Do you think the sublingual Ativan would bypass my stomach? I think I would like to try Lexapro, an Oncologist I know says that is a really good one he gives his patients. I'm really super scared of medication now because that is how I got in this situation with my stomach and the steroid that was prescribed. I have an app that helps you breath so I'll try that again for relaxation. Ty

Answered by Dr. Preeti Parakh (2 hours later)

Brief Answer: Explained below Detailed Answer: Hi XXXXXXX If you have high norepinephrine levels, then it is possible that SNRIs like Cymbalta may not suit you as they increase the amount of norepinephrine available at the nerve endings. Can you give me more details about the test and its results? Lexapro may be given a chance, but it will be better to try it at a time when the stomach is not otherwise irritated. Also it will be prudent to start with 2.5 mg per day instead of the usually recommended 10 mg per day. The app will be good to begin with but later try to do more elaborate relaxation exercises. They are safe and effective and cost you nothing. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 hours later)

I have been having postural hypotension and was in the hospital because my tachcardia was really bad upon standing. The Dr. had me do a standing norepinephrin test after ten minutes of walking and then they drew the blood for the test. He was trying to establish if I have POTS syndrome. One of the markers for that is high NE and the test results came back at the top of the range. It's hard for me to do much but concentrate in my stomach as it always hurts, but I'll try my best. Ty

Answered by Dr. Preeti Parakh (1 hour later)

Brief Answer: Explained below. Detailed Answer: Hi XXXXXXX Now that I know you were being evaluated for POTS, it is clear that you were prescribed fludrocortisone for POTS. It is also likely that your gastric symptoms and headaches are to some extent due to POTS and not entirely due to adverse effects of medicines. It is also of importance to note that both SSRIs and SNRIs (surprisingly yes, even in people with high norepinephrine levels) have been found to help in people with POTS who have not found adequate relief from fludrocortisone. The beneficial effect of both Cymbalta and Lexapro in POTS is well-known and you can try whichever you wish. Another thing is that some people with POTS, especially those with high norepinephrine levels, benefit from anti-adrenergic medicines like clonidine, propranolol, labetalol etc which counter the effects of norepinephrine. They also reduce the physiological signs of anxiety as well as prevent throbbing type of headaches. If you have not tried any of these before, they are another option for you and you can discuss with your doctor if he would like to add any of these to your treatment. You had asked about sublingual Ativan and I agree that most of it should enter the blood circulation bypassing the stomach. So it should not cause you any gastric problem. Klonopin is also available in sublingual forms. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (30 minutes later)

You are so well versed in so many medical matters. I say this because, I can't tell you how many MD's I have seen that have no idea what POTS is or have never heard of it. After my diagnoses some even say I don't have it. I honestly don't feel that I have POTS but something underlying. The Cardiologists and Electrophysiologists I have seen say my stomach problems are well beyond what they have seen. I am not getting better on any of the medications and have tried many. I took the Florinef for one month as a trial and something happened in my body after I withdrew. My stomach feels tight all the time and one Dr. said something is going on with my pyloric valve with spasms but gave me no help. I actually have spasms all over my body that I never had before, even in my esophagus. Please don't think I'm crazy, I just know there is something missing. I'm sorry if I am taking too much of your time.

Answered by Dr. Preeti Parakh (1 hour later)

Brief Answer: Explained below. Detailed Answer: Hi XXXXXXX It is true that many doctors haven't heard of POTS. It is a relatively recent concept and not yet part of standard text books on medicine. It is quite possible that your POTS symptoms may be associated with some underlying pathology as you fear. POTS is secondary to other medical illnesses in many people. You can read up more about POTS on http://www.potsuk.org/ which is a site for lay persons and contains simply explained information, which can help you understand your symptoms better. XXXXXXX I do not think you are crazy. The human body is very complex and there are so many things about it that we do not understand. Your gastric problems are severe and may be related to your high norepinephrine levels. Excess norepinephrine can inhibit gastric motility, which can be corrected by medicines like propranolol, which block norepinephrine receptors. Since POTS is not very well-understood, one is forced to find the best possible treatment by trial and error. I do not know why stopping Florinef led to a worsening of your symptoms. But there is no other option than trying different treatments to find out what helps you best. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (18 minutes later)

Thank you!

Answered by Dr. Preeti Parakh (7 hours later)

Brief Answer: You are always welcome! Detailed Answer: XXXXXXX You are always welcome! Also do not ever feel that you are taking too much time or not making sense. Each and every patient teaches something to the doctor. One of the reasons why I am on this site is that I have learnt many new things after I joined. It is only through people like yourself who share their problems and give me a reason to read up on the latest research and update my knowledge. So please always feel free to discuss things openly.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (10 minutes later)

Thank you for saying that! I do need your advice on something. You may or may not know. The only time in the last 9 months that I have felt well without stomach pain was when I was on zantac and a low dose of cipro for 5 days, they wanted to see if it would help and it did but the Dr. Would not give me anymore, go figure. I do not have the same response with just zantac. I do know that research is being done on antibiotics and their use in inflamation. I know they can harm your stomacih more but at this point I'm not getting well from anything else. I literally had no pain when taking those two together. I'm thinking if they give low dose to people with cystitis then maybe I can try them again and take probiotics for a while so I can get my strength back. I also had quite a bit less anxiety during those days. By the way, I took quarter k pills today and do not have a headache

Answered by Dr. Preeti Parakh (18 minutes later)

Brief Answer: Likely to be H pylori. Detailed Answer: Hi XXXXXXX If your pain was much better when you were on ciprofloxacin and zantac (ranitidine), then the implication is that you are most probably suffering from peptic ulcer disease that is secondary to Helicobacter pylori (H. pylori) infection. Ciprofloxacin reduces this infection and ameliorates the symptoms. Ranitidine helps by reducing the acid production which helps the ulcers heal. I do not know if you have been seen by a gastroenterologist or not. There are many tests which can be used to diagnose the presence of H. pylori. There are blood tests and breath tests and of course, there is upper gastro-intestinal endoscopy to take a look into what is wrong inside the stomach. Probably your doctors have done most of these, but if not, please discuss these with your doctor. There are regimens containing antibiotics, bismuth and antacids to eradicate H. pylori. Even if it is not H pylori, but some other inflammatory disease, a proper diagnosis will help you get the best treatment. Since you are better with the lower dose of Klonopin, then you should continue on it. Try reducing even the night dose to 0.25 mg and see if that is enough for you. It is best to take the least possible dosage for all benzodiazepines. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (14 minutes later)

I have had blood and biopsies for h pylori but all negative. Have not had breath test. I have gastritis and mild esophagitis per egd. I'm sure I got this from taking the steroid for a month that started my pain. I know the combo worked and my mom could not believe I left the house and went to the store with her. Then boom after cipro done, right back to hell. I'm going to a university hospital tomorrow because this is too much for me to take. I read about the poor girl in Bangalore who took her life from stomach pain recently. Very sad!!! I don't understand why it's so hard to heal.

Answered by Dr. Preeti Parakh (24 minutes later)

Brief Answer: As below. Detailed Answer: Hi XXXXXXX I agree that going to a university hospital appears to be a good idea. It is clear that things are worse than expected and a fresh look must be taken to find out what is wrong. Even if they cannot find evidence of infection, they might be willing to give you a presumptive course of antibiotics. Do not worry. It is indeed a bad time but you must not lose courage. Just hang on. Things will get better. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (21 minutes later)

I'm going to sleep, have a great productive day!!!

Answered by Dr. Preeti Parakh (2 minutes later)

Brief Answer: You too! Detailed Answer: You too, XXXX! Sleep well and may the next morning be a brighter one!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (15 days later)

Hi Dr. Parakh, I'm terrible, just spent a week in the behavioral health center of the hospital voluntarily. I'm physically sick and I can't get any help. I finally got a couple of abnormal tests and the Dr's just don't care. My 24 hour urine test says I'm excreting too much sodium a lot more than is normal as well as a spot test that says the same thing. I'm going insane because I feel I have an electrolyte problem but no help for Brooke. Also my BUN keeps coming back low saying I'm overhydrated but again they don't care even though my heart rate and blood pressure are all over the place. Thank you for asking! I hope you are well!!

Answered by Dr. Preeti Parakh (3 hours later)

Brief Answer: Please send me all the reports. Detailed Answer: Dear XXXXXXX Please calm down. I understand you are very worried, but can you please give me some more details, so that I can understand better what is wrong. Just let me know: 1) The names of the medicines you are taking or have taken in the last month. 2) What symptoms you are feeling now and why were these tests done? As a routine or because of some particular symptom? I also want to know if you are producing less urine than usual. 3) Please let me know the values of all your blood/urine tests, including the normal ones, and the reference range given by the lab. For 24 hour urine sodium, the usual normal range is 40-220 mEq/L/24 hours but it varies from lab to lab. To avoid typing all the values, you can just take a snap of your reports or scan them and upload them. There is a link with the query which you can use to upload. I especially wish to know the results of: Serum sodium, potassium, chloride, and bicarbonate Plasma osmolality Serum creatinine Blood urea nitrogen Blood glucose Urine osmolality Serum uric acid Serum cortisol Thyroid-stimulating hormone Most probably, the abnormalities are due to some medicine you might have taken. Or it might be SIADH (Syndrome of Inappropriate Diuretic Hormone Secretion). I'll be able to say better when I see the other reports. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (24 minutes later)

I'm trying to calm down. just feel so sick for the last year. I'm losing my fight at the moment. I can only give you numbers because I don't have the energy to upload. 24 hour urine 303 Spot urine 100 Potassium 138 Sodium 136 Bun two times low, nurse said I'm probably overhydrated. Stomach and ribs feel swollen and sides like my whole upper part is filled up. Cortisol 12 morning Urine osmolality 514 Think top was 530. Tsh 1.22 Creatinine .80 Plasma osmolality 266 Blood glucose 93 Co2 I think was 25 Chloride not sure I am not urinating very much and I am not thirsty at all. I'm feeling very anxiety ridden and my body will not calm down. Zantac Florinef Paxil Ativan Norco sometimes Loss of appetite, no clear thinking, weak, sad, feel like my chest is filled. My face seems filled with water as my skin is usually not so soft. No oedema in legs or hands. I asked the Nephrologist about the high sodium output but she wasn't interested said she was looking for diabetes insipidus. Sorry I'm just so scared after losing 25 lbs and my mind and not getting proper help. Normally every morning before this happened I would urinate straight away in the morning and drink water right after. Not doing either at the moment. :)

Answered by Dr. Preeti Parakh (55 minutes later)

Brief Answer: Appears to be SIADH to me. Detailed Answer: Dear XXXXXXX I cannot presume to know more than your nephrologist about all this, but it appears to me you are suffering from mild SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone Secretion). It is characterized by retention of water in the body while the urine that is produced is very concentrated and has high amounts of sodium. The amount of sodium in the blood is low, though in your case, it is on the lower limit of normal range. Your potassium cannot be 138, as it usually is between 3.5 to 5.5. Plasma osmolality < 280 and urine osmolality > 100 supports the diagnosis of SIADH. Diabetes insipidus is the opposite with excretion of large amounts of dilute urine and is due to a deficiency of ADH (Anti-Diuretic Hormone). I do not know if you have been advised to take lots of fluids over the last few days, but if you have done so, you might have worsened if you are indeed having SIADH. For mild cases of SIADH, wherein the serum sodium level is not too low, as in your case, the treatment is just to restrict the water intake to less than 1 litre per day. You can read more about both SIADH and Diabetes Insipidus on wikipedia. I wish you could talk to your nephrologist or maybe your family doctor and discuss this. I may be wrong as it is not my area of expertise but I would really like it if someone more knowledgeable could take a look at my views. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (8 hours later)

Thank you, Yes potassium 3.8, sorry. I'm feeling so ill and I just can't believe that florinef would make me this ill although that is what started this whole mess. I think I had the problem already and it made it worse because the Florinef does not behave the same as it should for other people. I can't stop it until I figure this out because I guess it's keeping some of my salt in. I've had the most extreme response. I'm going to push this until I get it figured out because I'm so scared and sick of taking medications I don't think I need. I have been restricting water and it appears my heart rate is a bit better not so high. Does the Siadh cause anxiety and unable to think very well from low salt?

Answered by Dr. Preeti Parakh (26 minutes later)

Brief Answer: Yes. Detailed Answer: Hi XXXXXXX Yes, you are right about Florinef. It does reduce the salt loss from the body but it does not help in SIADH. I also do not know if it can cause SIADH. On the other hand, SSRIs are a well-known cause of SIADH. Low salt in the blood and higher than required water content, both affect the cognitive faculties adversely. In severe hyponatremia (low salt in blood), there can even be seizures and death. Your nephrologist will be able to guide you better. You also need repeat blood tests (particularly serum sodium levels) every day or at least every alternate day. I hope your doctor has advised you regarding this and made arrangements for the same. Please take good care of yourself. I hope you are not alone and have family with you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (3 minutes later)

No, my Dr's have not advised me and say that I am fine. Guess I'll have to look for a new one. I'm with my family but they don't see how much I'm suffering in my abdomen and head. I'm going to try my best. Thank you so much

Answered by Dr. Preeti Parakh (20 minutes later)

Brief Answer: As below. Detailed Answer: Hi XXXXXXX I am worried that you are not being supervised well. The reports that you have mentioned are probably a few days old. There is no way of knowing if things have improved or not. I would be very much relieved if you can find a doctor who will keep an eye on you and do the needful. With the kind of reports you had, you need to repeat at least your serum electrolyte levels frequently, to ensure that the serum sodium levels do not fall much. I would also prefer that someone more knowledgeable than I takes a look at your reports and tries to find out what is wrong. Though SIADH is very common and I have seen many people with it, I cannot be sure that this is what is happening with you because I cannot understand a nephrologist missing this diagnosis. I am sorry that I cannot do more for you. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (6 minutes later)

I am very worried for my health as well. I feel like I need a diuretic of some sort because my stomach and rib cage feel so wrong. I have to tell you that the Nephrologist I saw was only concerned with diagnosing DI as that's what my primary asked of her. Unfortunately, I do not have anyone to help me until Monday and don't feel confident in the help. I'll try to stay alive until then. :)

Answered by Dr. Preeti Parakh (8 minutes later)

Brief Answer: Just hold on. Detailed Answer: Hi XXXXXXX Yes, a diuretic would help, especially a loop diuretic like furosemide (Lasix). It is one of the modes of treating SIADH. Just hold on till tomorrow and I hope things will get better. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (4 days later)

These are the results where my serum osmolarity is low and my sodium is not being excreted. I do not have all the results for the 24 hour over excretion of sodium. I spoke to my primary and Psyc doc yesterday and the psych Dr. says I have no physical problem. Primary says I do have a problem because I'm excreting too much sodium when the florinef should be keeping it in and improving my bp but he doesn't know what it means. The attached test results are off of Florinef. I am leaving to another state today and am going to see a couple new Dr's. Thank you for trying to help me.

Answered by Dr. Preeti Parakh (8 hours later)

Brief Answer: Need to repeat the tests. Detailed Answer: Hi XXXXXXX The reports that you uploaded are dated Nov 25th, 2013. Since that was more than one and a half months back, you should get your blood and urine tested again before any interpretation is made. I also noticed that in this report, the urine (spot) sodium content was not high, but the plasma osmolality was indeed low. I am sure the doctors who you will be seeing now will get all tests repeated before taking any decision. Do let me know what happens. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (11 hours later)

The 24 hour test showing over excretion was not sent to me but just remember some of the numbers, it was done two weeks ago. I'm not a Dr., but I think I have some type of alkalosis and ADH problem. Who knows, I never get any closer just losing weight and sick everyday. Ty

Answered by Dr. Preeti Parakh (56 minutes later)

Brief Answer: As below. Detailed Answer: Hi XXXXXXX Please do not worry. Ask your doctor to repeat all your tests and this time, take a snap with your phone immediately so that you can have a record if you wish a second opinion. I hope things work out well for you. You have been ill for so long. Best wishes. Dr Preeti Parakh MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Preeti Parakh (27 hours later)

Please explain one test to me. The urine osmolality levels are 500-800. Does 500 mean low or high concentration? Thanks