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Whyclef: Cross Taper Nortriptyline to SSRI Paxil


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I have been experiencing severe anxiety and anxiety attacks after tapering from a high dose of Prednisone to treat Crohn's Disease.  Symptoms have become debilitating and resulted in agoraphobia other than work which has even resulted in some days being missed.  DR has prescribed 20mg Paxil and wants me to reduce Nortriptyline dose to 10mg when I begin Paxil which is imminent.  I have been on Nortriptyline for 4+ years off label to help with Crohn's pain.  I have to reduce Nortriptyline dose due to Paxil interfering with metabolizaiton of Nortriptyline.  So...


1.  If I reduce Nortriptyline by 10mg, but start 20mg Paxil should I still expect to experience withdrawal side effects?


2.  Would it be ok to follow the 10% taper method with Nortriptyline while taking the Paxil since the 20mg dose of Nortriptyline is a lower dose?

Current Medications: 20mg Nortriptyline (active), 20mg Paxil (prescribed, inactive)

Taper History: (2015) After 12 months on Prednisone and tapering, I experienced ongoing tachycardia.  DR attributed it to Nortriptyline 40mg and had me taper to 20mg.  Guided to taper by 10mg per month over 2 months to reach 20mg total dose.  Experienced significant increase in anxiety and headaches.   (2016) DR wants me to cut Nortriptyline dose in half immediately and start 20mg Paxil.

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  • Moderator Emeritus

Whyclef -- Welcome to Surviving Antidepressants (SA)
I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly?

  • Any drugs prior to that can just be listed with start and stop years.
  • You don't need to include symptoms or diagnoses other than the initial condition that led to prescribing the first drug.
  • We ask for this information in your signature so that we can see it at a glance. A list is easier to understand than one or multiple paragraphs.
  • You can find instructions in this topic: Please put your withdrawal history in signature

Your questions:
If I reduce Nortriptyline by 10mg, but start 20mg Paxil should I still expect to experience withdrawal side effects?

It is possible that you will have withdrawal symptoms. Nortryiptyline is a tricyclic antidepressant (AD) and Paxil is an SSRI. People can have withdrawal symptoms when switching to another drug of the same type.  I would think that a switch from one class of AD to another increases the risk of symptoms.

Would it be ok to follow the 10% taper method with Nortriptyline while taking the Paxil since the 20mg dose of Nortriptyline is a lower dose?


In a word, no. 10 mg Nortriptyline is a maintenance dose, as is 20 mg Paxil.  Cross-overs usually have fast-taper (25% or 50% per week) the first drug while increasing dose of the new one to avoid serotonin toxicity/serotonin syndrome.


The most common is cross-over is to Prozac.  Although it refers to Prozac, you may find it informative to read about different switch/cross-over/bridge timeframes and tactics in this topic:

Prozac switch or bridge


Word to the wise:


If you think you might want to taper off Paxil in the future, please ask your doctor about prescribing a medication other than Paxil (generic name paroxetine). Paxil is can be an absolute BEAR to taper; Lexapro (escitalopram) seems to be the same.


Please ask questions, if any, here in your introduction topic. Let us know how you are doing.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.
1997-1999 Effexor; 2002-2005 Effexor XR 37.5 mg linear taper, dropping same #beads/week with bad results

Cymbalta 60 mg 2012 - 2015; 2016: 20 mg to 7 mg exact doses and dates in this post; 2017: 6.3 mg to  0.0 mg  Aug. 12; details here

scallywag's Introduction
Online spreadsheet for dose taper calculations and nz11's THE WORKS spreadsheet

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  • 1 year later...

Whyclef any update?

Thought for the day: Lets stand up, and let’s speak out , together. G Olsen

We have until the 14th. Feb 2018. 

URGENT REQUEST Please consider submitting  for the petition on Prescribed Drug Dependence and Withdrawal currently awaiting its third consideration at the Scottish Parliament. You don't even have to be from Scotland. By clicking on the link below you can read some of the previous submissions but be warned many of them are quite harrowing.


Please tell them about your problems taking and withdrawing from antidepressants and/or benzos.

Send by email to petitions@parliament.scot and quote PE01651 in the subject heading. Keep to a maximum of 3 sides of A4 and you can't name for legal reasons any doctor you have consulted. Tell them if you wish to remain anonymous. We need the numbers to help convince the committee members we are not isolated cases. You have until mid February. Thank you

Recovering paxil addict

None of the published articles shed light on what ssri's ... actually do or what their hazards might be. Healy 2013. 

This is so true, with anything you get on these drugs, dependance, tapering, withdrawal symptoms, side effects, just silent. And if there is something mentioned then their is a serious disconnect between what is said and reality! 

  "Every time I read of a multi-person shooting, I always presume that person had just started a SSRI or had just stopped."  Dr Mosher. Me too! 

Over two decades later, the number of antidepressant prescriptions a year is slightly more than the number of people in the Western world. Most (nine out of 10) prescriptions are for patients who faced difficulties on stopping, equating to about a tenth of the population. These patients are often advised to continue treatment because their difficulties indicate they need ongoing treatment, just as a person with diabetes needs insulin. Healy 2015

I believe the ssri era will soon stand as one of the most shameful in the history of medicine. Healy 2015

Let people help people ... in a natural, kind, non-addictive (and non-big pharma) way. J Broadley 2017



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