I've been on Paxil for about three years now at 10 mg a day. I also go to cognitive-behavioral psychotherapy once a month. I'm scared to stop both, but I really want to. It took me a long time to decide to take any kind of medicine, but now I don't know if I can live without it. Still, I worry about any long-term effects. Can you give me any advice?

-- Tina

My advice is to talk with your psychiatrist (or the physician who's prescribing your Paxil) and your therapist about your wish to stop both the medication and therapy. They can help you evaluate whether that's a good choice for you right now, and if so, how you might best accomplish that goal.

Never stop psychotropic medication abruptly unless it's under the advice of a physician, nurse practitioner, or, possibly, a pharmacist. Withdrawal symptoms have been reported by some people stopping drugs like Paxil or Prozac abruptly. The physician can discuss with you how you might taper off the medication -- if, of course, that's what he'd recommend.

Some people do stay on medication such as Paxil for years, and some may be advised to stay on it for the rest of their lives. But since Paxil and its cousins -- Prozac, Zoloft and other "newer" types of antidepressants -- have only been around for a decade or so, we really don't know what the consequences might be of staying on such medications for a really long time, much less a lifetime. I'm not aware of any research into the effects of long-term use of these newer antidepressants, but then, that's not my area of expertise. (As a clinical psychologist, I'm not trained or licensed to prescribe.) Your physician and pharmacist may have pertinent information on pharmaceutical research.

Psychotherapy, however, IS my area, and I can tell you that the ultimate goal of psychotherapy is for the individual to live a fulfilling life. I recommend discussing with your therapist what your goals for therapy have been and whether you've achieved them. I'd also process with your therapist your fears about stopping both medication and therapy.

Actually, it might be easier on you if you didn't stop both at once. If you and your physician agree that it's wise to stop the Paxil, how about doing that under your physician's tutelage and continuing to see your therapist a few more times to monitor your progress and address any issues that might come up? You can also develop a plan with your therapist for what you might do if you feel a return of the feelings or issues that brought you into treatment in the first place.