Psychiatrist Questions Psychiatrist

Anxiety question?

I've been taking paxil CR 12.5 for about 10 years for social anxiety. Absolutely no issues with the medication or any side effects, all of a sudden, on January 2022, I was at work and got this wave of pins and needles and heat running through my whole body felt like I was going to pass out and had to go use the bathroom right away after this happened. I have not been under any stress or anything I don't know what has caused this, my doctor upped my medicine to the next dosage and now I'm on the next dosage of 37.5 I think, still no relief from tremors 24/7 and increased anxiety for some reason. I was wondering if this could happen after years on this medication with no additional stress or anything or worry and I'm wondering if I should change my medication. She also gave me hydroxyzine as needed but that doesn't really do anything it just makes me tired.

Female | 45 years old
Complaint duration: 5 month
Medications: Paxil cr, bystolic, levoxyl
Conditions: Hyperthyroidism, hbpressure

3 Answers

I’m so very sorry to hear this happened. The first thing most physicians consider our medical causes that need to be ruled out. That would include a sudden increase in thyroid hormone, a sudden increase in certain chemicals that act like adrenaline, and so forth. So having a very very thorough medical exam including blood and EKG as well as thorough examination of your nervous system on a basic physical examination.
From a medication perspective, sometimes serotonin medicines actually do “poop out“. So sometimes an increase is necessary. Sometimes it may have been a poorly manufactured generic. Sometimes the body really needs a new and structurally different medication. While all these medical issues are being evaluated, would definitely strongly consider cognitive behavioral therapy with exposure response prevention. Really really really helps!

Lance Steinberg MD, Inc.
Assistant Clinical Professor
UCLA (Geffen) NPI
More than likely if you have been stable on this dose for a long time, it is not likely that is it due to the medication. It could have been a panic attack. Monitor your response to the new dose a little longer and talk with your doctor about it. Sometimes the effects of meds can wear off after a while though, so talk with them about whether a medication change would be appropriate.
You could consider either a further increase in your Paxil or a change in medication. It would be best to consult with your doctor.