Glaxo Is Testing Paxil on 7-Year-Olds Despite Well Known Suicide Risks

The only word for this news is “Criminal!” I hope they are watching these children 24-7 to keep them from committingsuicide or homicide while in the study. I recall the seven year old boy on Paxil I worked with who wanted to cut the baby out of his mother’s belly and the 17 year old who impulsively jumped off an overpass in front of a semi-truck to end his life. Then there was the 10 year old brother and 15 year old sister, both on Paxil, who stabbed their 7 year old brother and buried him in the back yard. Sounds like a great drug for kids, doesn’t it?
I just finished a court report (I have been testifying as an expert in these cases for almost two decades) on a Paxil case and noted that 18 of the listed side effects were indicators of mania. If Glaxo had labeled those effects for what really are instead of the labels they gave those reactions then no one would be surprised to know that in children the rate of Bipolar Disorder increased 4000% from 1996-2004.
As for Paxil being beneficial apparently someone missed the news that came out just over two years ago where the original studies done on SSRI antidepressants finally surfaced – many the FDA had never seen – indicating that the drugs offer no more benefit than a placebo. So if even the worst drugs perform better than placebo, where does that leave the SSRI antidepressants?
Ann Blake-Tracy, Executive Director
International Coalition for Drug Awareness
www.drugawareness.orgwww.ssristories.drugawareness.org

Glaxo Is Testing Paxil on 7-Year-Olds Despite WellKnown Suicide Risks

By Jim Edwards | May 21, 2010

It was established years ago that Paxil carries a risk of suicide in children and teens, but GlaxoSmithKline (GSK) has for the last 18 months been conducting a study of the antidepressant in kids as young as seven — in Japan. It’s not clear why the company would want to draw more attention to its already controversial pill, but it appears as if GSK might be hoping to see a reduced suicide risk in a small population of users — a result the company could use to cast doubt on the Paxil-equals-teen-suicide meme that dominates discussion of the drug.

GSK didn’t immediately respond to a request for comment. A staffer on GSK’s trials hotline confirmed the study was ongoing, however. The drug carries a “black box” warning on its patient information sheet, warning doctors and consumers that the antidepressant is twice as likely to generate lethal thoughts than a placebo.

The trial criteria listed on ClinicalTrials.gov, however, provide an interesting lesson in how managers can carefully design drug trials designed to flatter their products — something good companies don’t do.

The primary aim of the study is not to find out why Paxil makes some children kill themselves. Rather, it’s yet another efficacy study, which the drug doesn’t need because it was approved years ago — we already know the drug works.

Paxil is being tested against a placebo, so the results won’t be very surprising — even terrible drugs work better than sugar pills.

To what degree Paxil triggers suicide is only a secondary aim of the study. If the results suggest a lower suicide risk, expect GSK to play them up. If they’re bad, expect the company to dismiss them in favor of the primary endpoint results.

About 130 children have been enrolled, according to ClinicalTrials.gov, which puts about 65 patients in each arm. That means the results won’t be too statistically robust — there only need to be two or three outlier results to skew the numbers by several percentage points.

The trial will wrap up in September.

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PAXIL: Catholic Priest Commits Suicide: IN Lawsuit

Paragraph three reads:  “Father Rick Tucker, who took Paxil because he was upset about the way his parish ignored a child abuse scandal, may have committed suicide because of side effects from the drug and not the stress from the cover-up, a federal judge ruled. Judge David H. Hamilton of Indiana’s federal court found that Tucker’s sister Debra could sue GSK over the death of her brother, who shot himself to death in September 2002.”

http://industry.bnet.com/pharma/10007579/glaxo-paxil-and-the-catholic-church-sex-abuse-cover-up-drug-implicated-in-suicide-of-priest/

Glaxo, Paxil and the Catholic Church Sex Abuse Cover-up: Drug Implicated in Suicide of Priest

By Jim Edwards | Apr 7, 2010

GlaxoSmithKline (GSK), which was already the focus of controversy over whether it ignored thesuicide risk of its antidepressant Paxil, has found itself linked to the Catholic Church’s cover-up of child abuse in the death of a priest who took the drug.

The case seems bound to become a further PR headache for GSK, which in 2008 was accused of obscuring the suicide risk of Paxil in studies for 15 years.

Father Rick Tucker, who took Paxil because he was upset about the way his parish ignored a child abuse scandal, may have committed suicide because of side effects from the drug and not the stress from the cover-up, a federal judge ruled. Judge David H. Hamilton of Indiana’s federal court found that Tucker’s sister Debra could sue GSK over the death of her brother, who shot himself to death inSeptember 2002.

The Tucker case stems from 1966, when Debra Tucker was 10 years old and attended the St. Lawrence Parish church in the Diocese of Lafayette-in-Indiana. At the same time, Rick attended St. Mary’s Seminary in the same parish. Between 1966 and 1968, Debra was raped two to four times a month by St. Lawrence’s children’s choir instruction, a lay employee of the church, she alleges. In1968, Tucker had an abortion at the abuser’s behest, and then her family  including Rick, who had no idea what was going on  moved house and the abuse stopped. Debra remained in the area and over the years the abuser painted her house and attended the funerals of both her parents, she alleges.

In July 2000, after Debra discovered that the abuser had also allegedly assaulted his own children, she attended a meeting with Father Tucker, St. Lawrence’s Monsignor Robert Sell and other church officials. She claims that Sell and the church agreed to ensure that the abuser had no further contact with children in the parish and in return she would not sue the church.

After learning that Sell and the church allegedly did nothing about the man, Debra Tucker sued for breach of contract in a separate case not involving GSK.

The parish dragged its feet over the lawsuit, and as Father Tucker waited for word over whether his employers would settle his sister’s case, he became increasingly anxious. He was also worried about an upcoming audit by the diocese because, the judge wrote, he had “advanced himself some monies” and the Church would discover these “irregularities.”

However, his anxieties were misplaced: the audit did not uncover any irregularities in Father Tucker’s bookkeeping, the ruling says. The Tucker family’s lawyer said that the amounts involved were in the $50 range  and thus proof that Father Tucker’s anxiety was a product of the drug and not the situation he was in.

After taking Paxil, Tucker went into a sudden depressive tailspin. His diary for Aug. 30, 2002, just two days after he was prescribed the pill, says:

“Things have gotten behind and I do not know how to catch up. I want to live, but I want out of the pain. I feel like I am in an ocean and I can’t swim to the top for air. . . . I can see no way out of it. I know that if I follow through with the thoughts that come to my mind, there will be people hurt. … Debra I am sorry.”

Father Tucker killed himself on Sept. 18.

Debra Tucker alleges in her complaint against GSK that the company knew as early as 1990 thatPaxil potentially had an increased risk of suicide, and that the company failed to warn patients of the risk of akathisia, psychosis or violent self harm. Akathisia is a profound state of anxiety in which patients, unable to rest, believe they are doomed.

GSK had asked the judge to summarily dismiss the case based because the expert witnesses who testified that Father Tucker’s death was triggered by the Paxil and not the other stresses in his life were inadequate. The judge ruled there was a case to answer.

GSK and Msgr. Sell did not immediately respond to emails and a voicemail requesting comment. I’ve decided not to name the alleged abuser  although his name is published in Debra Tucker’s complaint against the church because I could not reach him for comment.

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Understanding Paxil Birth Defects

Ann Blake-Tracy says:

Your comment is awaiting moderation.

After two decades of tracking mothers and babies exposed to SSRI
antidepressants during pregnancy I shutter to ever see a mother take one of
these drugs. If those adverse effects listed in this article are not bad enough
to consider exposing a baby to, we have yet to witness the full effects of these
drugs upon offspring. These babies brains will not be fully developed until they
are in their 20’s. The full negative effects upon that developing brain will not
be known until then. Knowing what I know after 20 years of researching these
drugs and tracking patients who have taken them, I DO NOT WANT TO SEE WHAT IS
COMING!!

Ann Blake-Tracy, Executive Director,
International Coalition for Drug
Awareness
http://www.drugawareness.org & http://www.ssristories.drugawareness.org

Understanding Paxil Birth Defects

In December 2005, GlaxoSmithKline (GSK) posted its Paxil findings on its
website regarding pregnant women taking antidepressants. In this announcement,
GSK noted that it was revising its pregnancy precaution category from C to D.
This revision was based on recent studies that indicated positive evidence of
human fetal risk. In addition, GSK was placing this information in the WARNINGS
section of the Paxil label.
The FDA then advised pregnant women to switch from Paxil to another SSRI
drug, such as Prozac or Zoloft. This warning was based on the results of an
analysis of Sweden’s birth registry that showed women who took Paxil were 1.5 to
2 times more likely to give birth to a baby with heart defects than women who
took other selective serotonin reuptake inhibitors (SSRIs) or no antidepressant
at all.
Studies also showed that complications were reported for babies born to
mothers who had taken antidepressants such as Paxil in the third month of
pregnancy. Such complications included breathing difficulties, turning blue,
seizures, changing body temperature, feeding problems, vomiting, low blood
sugar, stiffness, tremor, irritability or constant crying. In other words, just
like adults, newborn babies of mothers who have taken Paxil while pregnant,
experience similar withdrawal symptoms. Because of this, tube feeding, help with
breathing and longer hospitalization may be needed. Premature births in pregnant
women exposed to SSRIs such as Paxil have also been reported.
Based on such reports obstetricians went so far as to recommend that
women avoid Paxil and reconsider using any SSRI antidepressant during pregnancy.
Still, other physicians maintain that the benefits of mothers getting treatment
for their depression outweigh the risks to the fetus.
The most common birth defects caused by antidepressants have been found
to be holes or other malformations in the chambers of the heart. Often the

defects heal on their own, but more severe cases need surgical procedures. GSK
is investigating how Paxil could be causing such defects.
In addition, antidepressant drugs are known to imbalance blood sugar
metabolism thereby worsening gestational diabetes. However, it is doubtful that
this is explained to expectant mothers who are given such drugs.
Medical professionals in women’s mental health point out that it is
important to aptly gauge the timing of medications prescribed for women who are
pregnant. Paxil is currently one of the most popular antidepressants in the
world, and roughly 25 percent of its users are women of childbearing age —
between 18 and 45.

Nick Johnson serves as lead counsel with Johnson Law Group, with principal
offices located in Houston, Texas. Johnson represents plaintiffs with injury
cases involving Defective Drugs. Contact Nick Johnson at 1-888-311-5522 or visit
http://www.johnsonlawgroup.com

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PAXIL: Robbery: Fan Stole Famous Musician’s Guitar: England

Paragraphs 8 & 9 read:  Mr White said: “ ‘I’m
disgusted with the whole thing. There’s a victim here. I can’t reconcile myself
with the ­behaviour of that night’.”

“The court heard that Mr White,
who has no previous convictions, had been prescribed the antidepressant
Seroxat  [Paxil
] at the time of the incident. This combined with
alcohol had lessened his inhibitions,
­magistrates were
told.”

http://www.islingtontribune.com/news/2010/feb/hand-it-over-fan-who-stole-smiths-star%E2%80%99s-guitar-says-%E2%80%98i%E2%80%99m-sorry%E2%80%99

Hand it over! The fan who stole Smiths star’s guitar says, ‘I’m
sorry’

Man apologises to musician for snatching instrument after gig and keeping
it for 10 years

Published: 18 February 2010
by JOSH
LOEB

FOR 10 years, music fan Stephen White secretly held all the
answers to a musical mystery that  had mystified one of Britain’s most
revered guitarists.

Every time he looked at the shiny 1964 Cherry Red
Gibson SG guitar hidden in his flat, he gulped at the memory of how he had
stolen it from Johnny Marr, the musician who shot to fame with cult rock group
The Smiths.

On Tuesday, a decade after pinching the £30,000 instrument
backstage after a gig at the Scala nightclub in King’s Cross, Mr White, a
38-year-old carer, owned up to the theft in court.

He told Highbury
­Corner Magistrates’ Court that he was “disgusted” with himself.

Mr
White had been in the crowd packed inside the Scala to see Marr’s band Johnny
Marr and the Healers in 2000 on the night he walked off with the

guitar.

The court heard how he occasionally played it at home and at one
stage took it to the Tin Pan Alley guitar shops in Denmark Street, Bloomsbury,
to have it repaired after he ­accidentally stood on it.

Police
recovered the instrument after acting on a tip-off.

Mr White said: “I’m
disgusted with the whole thing. There’s a victim here. I can’t reconcile myself
with the ­behaviour of that night.”

The court heard that Mr White,
who has no previous convictions, had been prescribed the antidepressant Seroxat
at the time of the incident. This combined with alcohol had lessened his
inhibitions, ­magistrates were told.

After watching Marr perform, Mr
White went backstage to meet the musician and noticed a stage entrance was open.
On discovering the guitar unattended, he made what his counsel, Oliver Dean,
described as “a spur of the moment decision”. He picked up the guitar, walked
out with it via a fire escape and took it home in a taxi. It is believed the
guitar was found at Mr White’s Enfield home with the ticket from the gig in 2000
attached to it.

Marr, a renowned ­guitar collector famous for his
songwriting ­partnership with singer Morrissey, was reported at the time as
being “very upset” by the ­disappearance of the instrument and offered a
reward for information leading to its safe return.

Mr Dean said his
client felt extremely guilty about taking the guitar and had expressed a wish to
write and ­apologise to Mr Marr.

Police Constable Christopher Swain
said Mr Marr, who is ­currently on tour in New Zealand, was “ecstatic” about
the instrument’s return, adding: “He bears no malice towards the
defendant.”

PC Swain said: “The guitar did have a high sentimental
value to him. Initially he though he had been targeted by a professional thief
but when the details came to light he said he didn’t want the matter to go
further.”

Prosecutor Dorothy Thomas said that although the guitar would
normally have been worth around £6,000, it had been ­estimated as having a
value of £30,000 because of its association with Marr, who now plays with The
Cribs.

Mr White  was sentenced to 200 hours of community
­service. A spokes­man for Mr Marr said last night (Wed­nesday): “He
is obviously very happy to have his guitar

returned.”

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SSRIs: Withdrawal is Sometimes More Severe Than the Original Problem.

NOTE FROM Ann Blake-Tracy (www.drugawareness.org):

Although this article at least acknowledges the problem with
rebound where the initial problem seems like nothing compared to the withdrawal

effects and rebound effects, it does not address the seriousness of withdrawal.
What is described here sounds like a piece of cake compared to what so many go
through in antidepressant withdrawal!

The FDA warns that abrupt withdrawal can possibly lead to
suicide, hostility or psychosis – generally a manic psychosis. Those are hardly

the milder withdrawal effects mentioned below! ALWAYS withdraw very, very
gradually so that you only have to deal with these milder withdrawal
effects.

________________________________
Paragraph two reads:  “It seems hard to imagine that

stopping a medicine could trigger the same symptoms it was
supposed to treat.
Sometimes the reaction is actually
more severe than the original problem.

Paragraph nine
reads:  “Another class of medications that can trigger withdrawal

includes antidepressants such as Celexa, Effexor, Paxil and
Pristiq.
Many people who quit these drugs experience  ‘brain
zaps,’  dizziness or the sensation of having their  ‘head in a
blender,’ along with shivers, high blood pressure or rapid heart rate.”

http://www.sgvtribune.com/living/ci_13913666

Rebound symptoms may keep many on drugs

Posted: 12/02/2009 10:46:51 PM PST

When people take
certain drugs for anxiety, insomnia, heartburn or headache, they are trying to
ease their discomfort. They surely don’t intend to make things worse, yet
sometimes that is what happens when they go off the medication.

It seems
hard to imagine that stopping a medicine could trigger the same symptoms it was
supposed to treat. Sometimes the reaction is actually more severe than the

original problem.

Doctors occasionally have difficulty recognizing this
rebound effect, because they may assume that the patients’ difficulties are
simply the return of the original symptoms.

During the 1970s, Valium and
Librium were two of the most commonly prescribed drugs in America. These popular
tranquilizers eased anxiety and helped people sleep.

When they were
stopped abruptly, however, some people developed withdrawal symptoms that
included severe anxiety, agitation, poor concentration, nightmares and insomnia.
Many doctors just couldn’t imagine that such symptoms might persist for weeks,
since these drugs are gone from the body within several days. Nowadays, the

withdrawal syndrome from benzodiazepines like Ativan (lorazepam), Valium
(diazepam) and Xanax (alprazolam) is well-recognized.

Other drugs also
may cause unexpected withdrawal problems. Quite a few people have trouble
stopping certain heartburn drugs. Here’s an example from one reader: “I have
been taking Protonix for heartburn for about six months. After learning of

potential ill effects from long-term use, I tried to stop taking it. After
about a week, I had to start taking it again due to severe heartburn – the
rebound effect, I suppose. I asked my provider how I should go about
discontinuing its use, but she did not know.”

Many physicians assumed
that severe heartburn upon discontinuation was the reappearance of the

underlying digestive problem. In the case of medications such as Aciphex,
Nexium, Prevacid, Prilosec and Protonix, however, an innovative study
demonstrated that perfectly healthy people suffer significant heartburn symptoms
they’d never had before when they go off one of these drugs after two months of
taking them (Gastroenterology, July 2009).

In addition to
benzodiazepines and heartburn medicines, other drugs can cause this type of
rebound phenomenon. Decongestant nasal sprays are notorious for causing rebound
congestion if used longer than three or four days. We have heard from people who
got hooked and used them several times a day for years.

Another class of
medications that can trigger withdrawal includes antidepressants such as Celexa,
Effexor, Paxil and Pristiq. Many people who quit these drugs experience “brain
zaps,” dizziness or the sensation of having their “head in a blender,” along
with shivers, high blood pressure or rapid heart rate.

All these
medications have two things in common: Stopping suddenly triggers a rebound with
symptoms similar to those of the original problem, and providers have very
little information on how to ease their patients’ withdrawal difficulties.

Patients deserve a warning before starting a drug that may be difficult
to stop. Providers should learn how to help patients stop a medication when they
no longer need it.

Joe Graedon is a pharmacologist. Teresa Graedon holds
a doctorate in medical anthropology and is a nutrition expert. Write to them in
care of their Web site: www.PeoplesPharmacy.com

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PAXIL: Birth Defect Case: Test Case for Over 600 Lawsuit: USA- Pennsylvania

First two paragraphs read:  “GlaxoSmithKline P.L.C., the
world’s second-biggest drugmaker, begins a trial in Philadelphia next week in
what may be a test case for more than 600
lawsuits
over claims that the company’s antidepressant drug Paxil causes birth defects.”

“Patients and their parents say internal company documents
show Glaxo failed to warn consumers about the risks of Paxil until forced
to do so in 2005 by the Food and Drug Administration.
In the trial set
to start Monday, Michelle David blames the drug for causing life-threatening
heart defects in her son, Lyam Kilker, now age 3.”

http://www.philly.com/inquirer/business/20090912_Glaxo_trial_opens_here_Monday_in_what_could_be_Paxil_test_case.html

Posted on Sat, Sep. 12, 2009

Glaxo trial opens here Monday in what could be Paxil test
case

By Sophia Pearson and Margaret Cronin Fisk

Bloomberg News
GlaxoSmithKline P.L.C., the world’s second-biggest
drugmaker, begins a trial in Philadelphia next week in what may be a test case
for more than 600 lawsuits over claims that the company’s antidepressant drug

Paxil causes birth defects.

Patients and their parents say internal
company documents show Glaxo failed to warn consumers about the risks of Paxil
until forced to do so in 2005 by the Food and Drug Administration. In the trial
set to start Monday, Michelle David blames the drug for causing life-threatening
heart defects in her son, Lyam Kilker, now age 3.

The company, based in
London and with major operations in Philadelphia and its suburbs, faces two more
such trials each month from October through January in state court in
Philadelphia.

“The early cases set the parameters for any global
settlement negotiations,” said David Logan, dean and professor of law at Roger
Williams University in Bristol, R.I.

Paxil, approved by the FDA in 1992,
generated about $942 million in sales last year, 2.1 percent of the total for

the company.

Glaxo has settled other Paxil-related cases, including a
suit brought by the New York Attorney General’s Office accusing the company of
withholding safety data about the antidepressant.

The drugmaker isn’t
liable for Lyam Kilker’s heart defects, and it acted responsibly in testing
Paxil and updating safety information, Kevin Colgan, a Glaxo spokesman, said in
an e-mail.

“The scientific evidence simply does not establish that
exposure to Paxil during pregnancy caused Lyam Kilker’s condition,” Colgan said.
“Very unfortunately, birth defects occur in 3 to 5 percent of all live births,
whether or not the mother was taking medication during pregnancy.”

The
FDA said in an alert to doctors on Dec. 8, 2005, that preliminary studies
suggested Paxil might contribute to heart defects in infants when taken in the
first three months of pregnancy. The government asked the company to update the
label enclosed with the medicine, changing its birthdefect warning.

The
FDA’s action does not prove any connection between Paxil use and birth defects,
Glaxo said in court filings in July.

“GlaxoSmithKline will show it acted
properly and responsibly in conducting its clinical trial program for Paxil, in
marketing the medicine, in monitoring its safety once it was approved for use
and in updating pregnancy information in the medicine’s label as new information
became available,” Glaxo’s Colgan said.

Lawyers for patients say Glaxo
documents show the company had known since 1980 that Paxil could raise the risk
of birth defects.

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Effexor: Insomnia & Night Sweats + Withdrawal & Brain Zaps: Peoples Pharmacy

Paragraph two reads:  “After cutting my dose in
half,
I have had brain zaps (impossible to explain) and
pressure in my ears.”

http://www2.timesdispatch.com/rtd/lifestyles/local_other/article/S-PHAR06_20090902-190006/290023/

Q:I have been taking Effexor XR for two
years. At first I was pleased that it relieved the anxiety, depression and
excessive worrying I had been suffering. Then I began experiencing insomnia and

night sweats and decided to taper off this antidepressant.

After cutting
my dose in half, I have had brain zaps (impossible to explain) and pressure in
my ears.

Answer: Many people find that antidepressants such as Effexor
(venlafaxine), Cymbalta (duloxetine), Lexapro (escitalopram), Paxil (paroxetine)
and Zoloft (sertraline) are helpful for depression. But there can be a dark
side.

Stopping this type of drug can lead to withdrawal symptoms such as
dizziness, headaches, insomnia, anxiety, sweating, visual disturbances and
difficulty concentrating. Many people complain of shocklike sensations in their
head (brainzaps” or “shivers”).

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PAXIL: Postpartum: Mother Has Worsening Depression with 2nd Baby

PAXIL:   PostpartumMother Has
Worsening Depression with 2nd Baby After Taking Antidepressants:  Had

Postpartum with 1st Baby and Recovered With No Meds:
U.S.A.

Sentences three through seven read:  ” I went through postpartum depression with my first baby eight years ago but at
that time I didn’t have anxiety and I didn’t take any medication.
And I started getting better after 3½ months itself. But now it’s
been three months that I am going through this. I have been
taking medications (Paxil 20 mg, Buspar 10 mg) and getting counseling but
it’s not helping much. I still don’t feel myself and am having unwanted
thoughts.”

http://www.cnn.com/2009/HEALTH/expert.q.a/09/08/postpartum.depression.raison/

Expert Q&A

updated 10:03 a.m. EDT, Tue September 8,
2009

How long will my postpartum depression last?

Asked by Sheeza Ashraf, Fremont, California

I have a
4-month-old baby. I am going through postpartum depression with a lot of anxiety
and panic attacks. I went through postpartum depression with my first baby eight
years ago but at that time I didn’t have anxiety and I didn’t take any
medication. And I started getting better after 3½ months itself. But now it’s
been three months that I am going through this. I have been taking medications
(Paxil 20 mg, Buspar 10 mg) and getting counseling but it’s not helping much. I
still don’t feel myself and am having unwanted thoughts. How long does

postpartum depression last? Is this temporary? Will this anxiety and depression
ever go away? Should I stop the medications and try it on my own? Does exercise
help to get out of the depression? Will I ever be normal like I was
before?

Mental Health Expert Dr.
Charles Raison
Psychiatrist,
Emory University Medical School

Expert answer

Dear Sheeza,

I am sorry to hear of your difficulties —
you are far from alone in your struggles with postpartum depression. Indeed, up
to 20 percent of women become depressed in the six months following delivery,
but company doesn’t help much when it comes to depression — or at least the
company we typically provide in the U.S. Traditional cultures understood the
vulnerability of new mothers and would often surround them with family and
friends to help with the significant emotional and practical burdens of coping

with the newborn.

I am going to make some general recommendations about
what you might want to consider doing, based only on the information you have
provided above. As always, this should not be taken as specific advice for your
actual situation. That kind of advice can come only from a clinician who knows
you and is involved in your care.

First and most important, it is very
important to continue medication when one is still depressed, so given what you
describe, I would counsel against stopping the antidepressant. It is not clear
how long you have been on the Paxil (generic: paroxetine), but let’s assume
you’ve been on it for at least six weeks. You are on a low dose. A reasonable
first step would be to talk with your doctor about raising the dose to 40 mg a
day and trying this dose for at least several weeks.

If you see no
benefit, there are in general two paths your doctor might recommend (and I say
doctor in the generic sense, given that many folks nowadays see physician
assistants or nurse practitioners who often — in my experience — do a better
job diagnosing and treating depression than do MDs). First, your doctor might
add a second antidepressant or an atypical antipsychotic to your Paxil. Although
they are called “antipsychotics,” these agents (for example Seroquel, Abilify,
Zyprexa) are also widely used to help with severe depression and anxiety and are
often quite effective. Second, your doctor might switch you from the Paxil to
another antidepressant. Unfortunately, we have no scientific way of knowing
which agent you should switch to — our best data suggest that they are all
about equal. But one thing is clear: Many people who don’t do well with one
antidepressant will have a great response to a different one.

Anxiety and
panic are quite common when one has a bad depression, and they can be more
miserable to endure than the feeling of depression itself. It is unlikely that
the low dose of Buspar (generic: buspirone) you are taking is of much benefit.
You might want to discuss with your doctor raising the dose to at least 10 mg
three times a day or discontinuing it. The best immediate way to relieve
disabling anxiety is through the use of benzodiazepines (for example lorazepam
or clonazepam). These medications can be lifesavers, but if you take them for
more than three or four weeks your body will become dependent upon them, and
should you want to stop, you will have to reduce them slowly under the
supervision of a doctor.

Let me say a word about exercise. Yes, exercise

has been shown in many studies not only to raise a person’s mood immediately,
but also to work over time as an antidepressant. Therefore, I strongly recommend
adding regular exercise to your treatment regimen. Try to exercise in the
morning, especially when it is sunny. To get the best effect you will need to
work up a sweat. I find that it is even better if you can exercise in a place
with some natural beauty — as being in nature is itself quite comforting for
most of us.

I don’t have an answer to your question about how long the
depression will last and whether it will ever go away. Everyone is different. We
do know, however, that the longer one stays depressed and/or the more episodes
one has had, the harder it is to treat the condition. This is just the
frightening truth of the disease, and it really highlights how important it is
for you to really get aggressive about your treatment. My sincere hope is that
whatever specific treatment route you follow, you will start feeling like
yourself again as quickly as possible.

Finally, whenever I talk about
specific pharmacologic treatments I need to disclose that in addition to my
academic work I have given lectures for two pharmaceutical companies in the last
year: Lilly and Wyeth. I have also served on an advisory board for Lilly in the
last 12 months.
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