SSRIs, Akathisia and Suicide Risk

If you suffer from either of the following-  depression, obsessive-compulsive disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD). you may be prescribed a drug called Paxil, an SSRI. All explanations follow.

Paxil is one of a class of antidepressant drugs known as selective serotonin reuptake inhibitors or SSRI’s.  These have become some of the most commonly prescribed drugs in America and worldwide, offered to treat a wide range of emotional ills from grief to social anxiety.   But while many people find them helpful, they have long been known to make some patients irritable and anxious. (Healy’s blog)

{PAXIL (paroxetine hydrochloride) is an orally administered psychotropic drug. It is the hydrochloride salt of a phenylpiperidine compound identified chemically as (-)-trans-4R-(4’fluorophenyl)-3S-[(3′,4′-methylenedioxyphenoxy) methyl] piperidine hydrochloride hemihydrate and has the empirical formula of C19H20FNO3•HCl•½H2O. The molecular weight is 374.8 (329.4 as free base). The structural formula of paroxetine hydrochloride is:

Paroxetine hydrochloride is an odorless, off-white powder, having a melting point range of 120° to 138°C and a solubility of 5.4 mg/mL in water.

This information is taken from- this link (please click it for more information)}

Common side effects

You can read effects of this medicine by clicking here.

However, the common ones are- asthenia, constipation, diarrhea, dizziness, drowsiness, ejaculatory disorder, erectile dysfunction, insomnia, male genital disease, nausea, headache, decreased libido, delayed ejaculation, diaphoresis, and xerostomia.

Other side effects include: infection, blurred vision, female genital tract disease, impotence, lack of concentration, orgasm disturbance, tremor, vasodilatation, visual disturbance, anxiety, paresthesia, abnormal dreams, decreased appetite, and yawning.

In India Paxil sells under the brand names- Cinpar, Oxitine PR, Leparox, Deprox,Onbixin, Panex, Paradise-XR, Pari, Panex. For more names, please click here.


In extreme cases, this can advance to a state known as akathisia – an intense emotional turmoil and physical restlessness that can be so unbearable as to trigger suicide in those who suffer from it.

Here is a link to an organization that is working in the area of medicine induced suicide risk, created by the family of the person who actually committed the suicide and in whose memory the lawsuit was fought and won by the family.

Okay, this blog post is not going to be longer than this. Time ensures brevity. However recently Glaxo SmithKline lost a lawsuit in the US, for the death of a man who took this medicine for a very short span of time. David Healy has written an elaborate post on the subject and he is also an expert on SSRIs. You are welcome to read his pPlaceholder Imageost here (or the top link where I posted it).

Towards the end of his post he recommends that the FDA should put a suicide warning on the Paxil drug. My post is just joining the dots together and in case you are on Paxil or any of its derivatives, please understand in case you feel more restless and agitated after taking the drug…it is probably a side effect of it, and if the doctor does not change the medicine- PLEASE CONSIDER CHANGING THE DOCTOR!

Support in bipolar

There are may ways to support people with bipolar. One of the key things is to understand the relationship you are in with them. As well as your proximity.

There can be two different outcomes from bipolar support- one which produces a recovery, and one which creates a life long dependence and disability. You have to decide what sort of an outcome you want to create. Nobody who supports another can decide on any outcome actually; it is all dependent upon the person who is suffering. Are they going to accept it for the rest of their life that they are going to be ‘mentally ill’ and therefore dysfunctional or are they going to believe that ‘ok, this is how I am and not let me get on with the rest of the business.‘?


Can you please leave me alone?

There will be days when your loved one will be extremely functional and capable of doing everything, but there may be spells when the mood swings to another extreme and debilitates them. This is the time to support them and encourage them to do whatever little they can, trying to remain useful, even if not optimally so. Pushing them hard is never a solution, neither are your inspiring words. People who keep doing even a little everyday will eventually turn things around in their favour. Those who are protected by families in the belief that they are ill will become more and more ill and debilitated over time.

Your support does not mean that you have to try leading the person towards any outcome- they will produce their own outcomes. Just try not to guide them too much, except during phases when they lose self confidence, hope and courage, when anxiety overcomes them and makes the head go into a spin and fog engulfs the soul. Only on those days you need to offer courage and gentle support. Rest they will manage and accomplish everything they want in life-including professional competencies, relationships and you name it.

Never think anyone who has a mental illness label is a stupid person and they need your guidance or direction at any time, most of the time. Yes they may need it once in awhile- the courage that they have lost momentarily must come from the words of another. So kindly do not offer it, but sense the need for it and only then support them.

Understand the roots of your suffering

Several of the posts on this blog are going to be blog entries from my other blogs, which I have written in the past. Since this blog is meant to be a collective of all threads I have on the subject of mental illness, I intend re-posting them from wherever they are scattered in cyberspace, for the sake of order and access.

Someone asked me a question, in response to which I wrote the blog post that I am about to share. If the query interests you as well, please read the rest of the post by clicking the external link, provided ahead.

I have a question for you if that’s ok. When you mean you recovered, do you mean you understood the root of your depressions and manic states, your bipolar disorder? Was there meaning, trauma in your life that led to that? And do you not suffer from that anymore? I hope these are ok questions to ask you. (E.L.)

What our triggers are – are our vulnerabilities. If one can isolate that it is a great victory and the best way to identify that would be a therapeutic dialogue with a therapist who is kind, wise and non-leading. It is not so easy to find such a person and that is the greatest challenge really.

Dear E. suffering is a part of our human destiny- but it does not have to annihilate us completely- we can live with it peacefully, we can make sense of it on a day-to- day basis and we can find better ways to make sense of things, alternative worldviews and conceptualizations.

Please read it all here.

Not wanting to be treated for ‘bipolar’

If you have been given a diagnosis of bipolar or schizophrenia and you do not wish to take the medical road, you are not alone. There are many who take that path. However, that does not mean you should not create a plan for yourself.

What is seen as bipolar is basically distress and suffering due to life circumstances which made people have extreme reactions- including lack of sleep, incoherent talk, connecting too many dots while talking, sometimes ‘hallucinate’, eating less, have solutions for problems of others and not getting a grip on their own situation. There are scores of ‘symptoms’ which are classified as such by psychiatry, but I am not borrowing from their language excessively.

The reason I am writing to you is that I would like to share with you that among the people who refuse to take medication, there is a greater chance of recovery and return to the life of an average non-psychiatrized individual than someone who takes medication. A good part of people who accomplish recovery do so via getting off medication. so in case you decide early on itself that you do not want to take medication, it will actually save you from the side effects that all psychotropic drugs produce.

What you can do instead

I would recommend that you build an array of resources and support systems around you, including wherever possible your family (only if they are not the chief reasons for your distress), few friends, some exercise regimen, some art based work if you enjoy it, a career or goal that brings money through the door now or in future. So something that  you really want to do, and be happy. Moving away from sources of suffering is the key to dealing with any mental suffering. You must learn to deal with whatever suffering is coming to you as a part of being alive.

As long as you are satisfied with your work and domestic life, you will not have any distress or suffering. Your ‘symptoms’ will not appear again.

Along the way you can always connect with a therapist and talk out your problems and suffering, which you  may not have shared with anyone so far- childhood issues or family issues or anything you like.

Build your strength, increase your threshold for handling uncertainty and pain, come into your center and try dealing with situations with greater equanimity, and not flying off the handle, being reliable for others, and inviting that into your own life…and the keys to recovery. Take it from someone who has been there, done that.flower


Helping with OCD

In response to a question that I received today which asks me the way forward with OCD, I intend to write this blog post. Let me begin by quoting the question directly-

‘How do you control emotions, fears and illusions in a patient suffering from OCD?’

To my mind, OCD is no ‘illness’ at all and therefore one need not try to control anyone. However the behaviours which get called as ab-normal and therefore attract a diagnostic label are something which are often difficult to comprehend and deal with. Since we cannot understand how someone can make a mountain out of a molehill (in Hindi, Rai ka pahaad) people think and believe their loved ones are having an ‘illness’. Technically when you have an ‘illness’ you need a treatment for it- but where is the illness in this case? It is only a behaviour, a response to a stimulus. Please understand behaviours and do not go about accepting that behaviours need treatment.

I hope you agree that emotions are a part of being alive. So what sort of emotions are we referring to here? People have various emotions from joy, to sadness, anger, depression, withdrawal, tantrums and so forth. Some of these emotions are positive emotions and some are negative. Positive emotions make us happy and expansive, while negative emotions shrink our spirit considerably.

How are fears birthed?

No child at the time of its birth is afraid of anything. You can put a child in front of a lion, it will laugh and smile. It does not know that it should be afraid of the lion.

And yet as the child is growing up, it is socialized into developing fears. The primary teacher in this task is the parents, who in their attempt to protect and save the child from any untoward experiences, instill fears of different sorts; for example fear of the dark, fear of animals, fear of strangers, and of course in India the classic fear of examinations and tests! Once these fears enter into the consciousness of a person, they never leave them, no matter how old the person becomes.

If you want to, at some stage, help the person deal with their fears and emotions, you have to now reach to the bottom of the problem. Let them understand their fears, their apprehensions. This work can never be accomplished by psychiatrists- who would not have the patience to listen to a person’s story, nor the framework to analyze or dissect stories. They only know how to offer solace in the form of a pill. No matter how many pills you pop in for OCD, you can never deal with the ‘symptoms’, because the ‘symptoms’ are not coming from some underlying chemical deficit, but due to fears, which defying rational logic, are embedded deep down in the psychological architecture of the individual’s mental framework!

So please be patient with the ‘patient’ and instead of forcing pills down their throat, let them be heard by a helping non-medical professional. OCD is something one can easily recover from. Help your loved one gently.