PeerCBH: second try discontinuing Paxil

[Onmyway]

Hi @PeerCBH

Looks like you have thought this through. Here we aim to provide information but you as the person going through this also have a lot of information and better one at that regarding yourself so don't be shy to use that in decision making. In the end, the consequences will be bourne by you. 

 

I am really glad you have tried and tested tools for managing difficult emotional states and that they work. Withdrawal is hard and you will need all the tools you can get. I personally tried DBT but it didn't quite jive with me though certain tools from it are quite useful (opposite action ftw). I have found internal family systems - IFS therapy very useful (this is not an SA recommendation just personal experience). I like Derek Scott's videos on it on YouTube if you want to check them. 

 

 

[PeerCBH]

1 hour ago, Onmyway said:

Hi @PeerCBH

Looks like you have thought this through. Here we aim to provide information but you as the person going through this also have a lot of information and better one at that regarding yourself so don't be shy to use that in decision making. In the end, the consequences will be bourne by you. 

 

I am really glad you have tried and tested tools for managing difficult emotional states and that they work. Withdrawal is hard and you will need all the tools you can get. I personally tried DBT but it didn't quite jive with me though certain tools from it are quite useful (opposite action ftw). I have found internal family systems - IFS therapy very useful (this is not an SA recommendation just personal experience). I like Derek Scott's videos on it on YouTube if you want to check them. 

 

 

Thank you! Also, I'm starting Krav Maga, as soon as i recover a bit from this withdrawal. My mind is shot. I'm exhausted. 

[PeerCBH]

15 hours ago, Onmyway said:

Hi @PeerCBH

Looks like you have thought this through. Here we aim to provide information but you as the person going through this also have a lot of information and better one at that regarding yourself so don't be shy to use that in decision making. In the end, the consequences will be bourne by you. 

 

I am really glad you have tried and tested tools for managing difficult emotional states and that they work. Withdrawal is hard and you will need all the tools you can get. I personally tried DBT but it didn't quite jive with me though certain tools from it are quite useful (opposite action ftw). I have found internal family systems - IFS therapy very useful (this is not an SA recommendation just personal experience). I like Derek Scott's videos on it on YouTube if you want to check them. 

 

 

Did I make the right decision? Should I have just endured the withdrawal?

[PeerCBH]

It may have been a mistake to go up to 17mg. I still feel anxious and irritable, occasional dizziness, no appetite. Sleep is better. Some nausea. I can only figure two things: I can't tolerate fluoxetine side effects OR the switch wasn't clean and fluoxetine doesn't completely eliminate paroxetine's withdrawal.

 

I'm going back down. 17mg seems too activating. I don't know what the hell I'm doing. It would be nice if the information wasn't so scattered on this site, and there was like a step by step guide with do's and don'ts. I feel like these questions could have been answered if people weren't so hung up on my signature. The information you need is in previous replies, and at the time I had only one page on my thread.

 

If my withdrawal is significant, do I just let it go on and endure it, or do I updose? What would be the consequences of going back down to 15mg?

[Onmyway]

Hi @PeerCBH, I went through your thread and had a look to see if we didn't do right by you but noticed that when you came to us you didn't mention a prozac bridge, you only talked about it after you had already started it. We generally discourage this prozac bridge because prozac doesn't cover the Paxil withdrawal and it can go wrong. We can recommend it as a last resort when people have failed proper SA style tapers which you haven't done.

 

WE care about the signature because it's clear and succinct. Stories can obscure drug history and frankly we don't have time and energy to sift through that. We are volunteers here and all have jobs/families/own withdrawal. Your doc gets paid hundreds of $ for bad advice but we don't. If there is any blame to go around it should really go to your doc who has outsourced your care to us in a very irresponsible way. He could learn the things we do here (we did) and care properly for you instead of setting you on a path of suffering for possibly years. 

 

We can't really predict what your reaction will be to an updose or lowering. No one can as every body is different and withdrawal sensitizes us in different ways. Withdrawal can be activating and so can adding new drugs to a body in withdrawal. We can't know which it is in your case. Have a look at the kindling thread in the Symptoms forum. Also look up the prozac bridge.

 

I don't know that there is a right answer to the question of whether you have made the right decision (and it doesn't matter as it's now done). We generally advise that you don't jump around and aim at stability but that's just our general principle. What people choose to do with that information is up to them.

 

omw

[manymoretodays]

6 hours ago, PeerCBH said:

I'm going back down. 17mg seems too activating. I don't know what the hell I'm doing. It would be nice if the information wasn't so scattered on this site, and there was like a step by step guide with do's and don'ts. I feel like these questions could have been answered if people weren't so hung up on my signature. The information you need is in previous replies, and at the time I had only one page on my thread.

 

If my withdrawal is significant, do I just let it go on and endure it, or do I updose? What would be the consequences of going back down to 15mg?

 

Well, I don't get it......why you ask and then next say........ you are going back down.

The 18th was when you went up from 15 mg Prozac to 17 mg Prozac.

Today is the 26th, and so just 8 days later.

Me, if it was me.........I would stay put for longer than 8 days with any change in Prozac. 

 

How long have you had the increase in symptoms?  If it's just for one day, I would never advise a drug change on a change in symptoms of just a days duration.  Not unless that symptom change was horrible.  Can you mitigate the anxious, irritable with non-drug coping?  Can you eat when your appetite is down?

 

  And then you also had improvement in some symptoms too, well the all important sleep factor.  Sleep is important.

:

6 hours ago, PeerCBH said:

It may have been a mistake to go up to 17mg. I still feel anxious and irritable, occasional dizziness, no appetite. Sleep is better. Some nausea. I can only figure two things: I can't tolerate fluoxetine side effects OR the switch wasn't clean and fluoxetine doesn't completely eliminate paroxetine's withdrawal.

 

I would try not to overanalyze all of your choices, and what might be what now.

If you'd like, do NOTES, then post.......that can keep the objective objective.

Notes, drug and symptom logs, recording drug schedule and symptoms to track patterns and progress

the first post, has a quote box to open that will show you how to do one, and then you could post a couple days at once once you have them

 

Always a good idea to post notes when asking a question of us.  A couple days worth even better.  Get times on the left, drugs by name and dose on the right, symptoms as they occur through the day, on the right(you can rate symptoms too).

 

So that is my 2 cents PeerCBH.  Hang on.  Hoping you are better than you think or feel a window coming on momentarily.

 

Best, L, P, H, and G,

mmt

[PeerCBH]

My brain is not working, at all. I am anxious and irritable. It got better with the increase, the dizziness/vertigo lessened and I can sleep. Im only nauseous sometimes as opposed to all the time. My mind is playing tricks on me though. I don't know whats real. 

 

My psychiatrist sucks. She told me my symptoms are not real and keeps pushing a fast taper that would have me at 0mg in two months. She's fired. My PCP doesn't understand my situation but he'll at least let me do it my way. Just prescribe the liquid and let me try it the SA way.

 

In any case I think i should sign off for a week or two. I am way too angry and reactive. If my signature is mentioned one more time I'm going to lose my mind. Thanks everyone for your help.

[PeerCBH]

Guys I'm so sorry. I don't mean to go off like that. I'm experiencing the waves and windows thing bad. I'll go a few hours feeling totally fine, then my brain will get hit with a hurricane. God when it hits it can be overwhelming. Currently living with PTSD doesn't help.

 

My only concern is sensitization. If I let this go on am I priming myself for more intense withdrawal? If so, I'm updosing. If not, I may try to endure this. I just don't need to make any of this harder than it's already been. In any case, I'll heed the advice of this site and hold for at least 2 weeks at this dose. I'm at a much lower dose than equivalent even at 17mg

 

Thank you for helping me in this awful time. You've all been great and I appreciate you. That's all I'll say then I'm bouncing until I can get ahold of my anger/irritability/agitation/anxiety.

[ChessieCat]

On 10/20/2022 at 3:35 PM, ChessieCat said:

Prozac, it can take 2 weeks for a dose to get to a steady level in the blood and longer for it to register in the brain.

 

Prozac has a very long half life and changing the dose too soon after a decrease or increase is not a good idea.  You need to allow the amount of drug to get to a steady level in the body and for the dose change to register in the brain.

[mstimc]

11 hours ago, PeerCBH said:

Guys I'm so sorry. I don't mean to go off like that. I'm experiencing the waves and windows thing bad. I'll go a few hours feeling totally fine, then my brain will get hit with a hurricane. God when it hits it can be overwhelming. Currently living with PTSD doesn't help.

 

My only concern is sensitization. If I let this go on am I priming myself for more intense withdrawal? If so, I'm updosing. If not, I may try to endure this. I just don't need to make any of this harder than it's already been. In any case, I'll heed the advice of this site and hold for at least 2 weeks at this dose. I'm at a much lower dose than equivalent even at 17mg

 

Thank you for helping me in this awful time. You've all been great and I appreciate you. That's all I'll say then I'm bouncing until I can get ahold of my anger/irritability/agitation/anxiety.

No need to apologize, Peer.  Remember, that was the WD and anxiety talking, not you.  The fact you recognize it means you are still you!  When you get hit by a hurricane, It may help to practice some grounding techniques to divert your thoughts.  Look around your room to find something you can focus on, and then internally describe it to yourself in as much detail as possible: color, texture, size, etc.  What do you like about it?  That will short-circuit the emotional thinking.  Also, remind yourself random, temporary thoughts are not who you are. The thoughts and feelings will come, but don't judge yourself by them.  Recovery may be slow, but it will come.

[Onmyway]

Hi @PeerCBH

The sensitization happens from going up and down in dose, not from going through the withdrawal itself. I think this worrying and panic (very familiar) is also a WD symptom. Read up on neuroemotions and emotional spirals. 

 

ARe you taking magnesium? I'd recommend mag citrate. it helps calm things down. Whatever equivalent dose you are taking is fine right now. Just hold for a few months or until your symptoms are better for at least a couple of weeks and then you can start tapering.

 

Anger and irritability are normal too. You'll get through this. Keep it simple, keep it stable.

 

OmW

 

[PeerCBH]

Oh my God you guys are awesome. I know I said I was taking a break but just wanted to come back on to thank you.

I'm sure it's withdrawal. I'm on considerably less than equivalent fluoxetine dose. But it's not terrible. Not earth shattering like my previous attempts. It just sucks. I'm going to hang out here on this dose. For one, I feel very activated (manic, agitated, irritable, anxious) and an increase would most likely make some of that worse. Fluoxetine itself is activating so the effect of the drug may send my activation in a tailspin. Though other symptoms have improved. I can actually fall asleep. So maybe going up to 17mg wasn't a terrible idea, but I need to stay right here. 

I'll use my coping skills for the rest. 

 

[PeerCBH]

Okay, so I thought I'd get a little more specific about what led me to my decision to updose. While digging around in this forum, I happened upon this: 

 

Myths about withdrawal symptoms you might hear from your doctor

• "You'll get over it."
  Doctors tend to believe that all withdrawal symptoms are trivial and transitory and will tell you to just wait and they'll go away. This is not true.
  
  Withdrawal symptoms of any type show your nervous system is in distress. If they go on for any length of time, they cause neurological dysregulation -- neurological damage that can last many months. There's no way to fix this, your nervous system will need to repair itself over time.
  
  If you are suffering from significant withdrawal symptoms, the official advice included in most antidepressant drug package inserts is to to reinstate a partial dose of the medication and taper more slowly.
  
  If you are in the midst of tapering and you get withdrawal symptoms that last more than a couple of days, you're reducing too fast. (NEVER alternate doses to taper.) Increase your dosage a bit, wait until symptoms pass, and then reduce in smaller amounts at a slower rate. Some people can reduce by only a fraction of a milligram per month.
  
  You have significant withdrawal symptoms that need attention if any of these apply:
  • You immediately suffer severe symptoms while reducing or after quitting.
  • Your symptoms increase over a week or two.
  • Your symptoms don't decrease over a couple of weeks.
  • You find your symptoms interfere with your daily functioning.
  • You experience brain zaps, insomnia, depersonalization, mania, hypomania, or unusually dire thoughts.
     

According to this, updosing was the right thing to do, as symptoms were significant. So this leads me to 3 questions:

1. Should I tolerate symptoms of any significance or duration longer than "a couple days", or should I reinstate?
2. What if it is literally impossible to avoid significant withdrawal, with any reduction in dose, no matter how small, causing significant symptoms? 
3. How long do I stay at my current dose before tapering? What is the minimum amount of time? I do not have the luxury of doing a long hold. 

Thanks guys. I'm just trying to craft a coherent game plan moving forward, so that I'm not stuck making a big decision and not knowing what to do. I need a clear path moving forward. 

 

[Onmyway]

@PeerCBH

There are many aspects to withdrawal. 1. Right now you most likely have withdrawal from Paxil because prozac doesn't cover it. If you follow the above then you would have to reinstate a small dose of Paxil but reinstatement is recommended within a month or so. I don't know if a tiny bit of Paxil (0.25mg) may help a bit. You're still within the first month of withdrawal but the fact that you're on prozac also complicates things. Let me check with the other mods. (This is where the signature comes in handy for me to check when you started/stopped things).

 

2. When you are in withdrawal (from Paxil) your nervous system is sensitized. That means adding new things (such as prozac) can make things worse. And even if Prozac was ok, the amount of it may not be. And we have no way of knowing what the right dose is for you. These equivalency tables are approximate.

 

3. When you come to the portion of the path where you are already dysregulated, what the brain wants is calm, i.e. no more changes and use non-drug techniques and supplements like magnesium to calm as much as you can. Tolerating is not *an* option, it's the only option. Withdrawal does not care if you can wait or hold, that's the only thing that helps, the more you tinker with things the harder it is to come back to homeostasis because of the sensitization.

 

Plan:

1. possible reinstatement (will check with mods)

2. Non-drug techniques to manage this situation you find yourself in until you feel more stable

 

In the meantime, what will help us is if you can post your daily symptoms with the times you take your drugs. Try to remember for a couple of days at least. And keep doing it for a couple of more days.

 

Like this example:

7am Wake up 

8 am prozac 17mg with breakfast

9 am anxiety and nausea

10 am feeling a bit better reading

11 am a sandwich, nausea worse, 150mg magnesium vit C

12 ruminating etc

.

.

.

9 pm feeling much better, calm, 1m melatonin

10 pm fell asleep, 

 

[PeerCBH]

1 hour ago, Onmyway said:

@PeerCBH

There are many aspects to withdrawal. 1. Right now you most likely have withdrawal from Paxil because prozac doesn't cover it. If you follow the above then you would have to reinstate a small dose of Paxil but reinstatement is recommended within a month or so. I don't know if a tiny bit of Paxil (0.25mg) may help a bit. You're still within the first month of withdrawal but the fact that you're on prozac also complicates things. Let me check with the other mods. (This is where the signature comes in handy for me to check when you started/stopped things).

 

2. When you are in withdrawal (from Paxil) your nervous system is sensitized. That means adding new things (such as prozac) can make things worse. And even if Prozac was ok, the amount of it may not be. And we have no way of knowing what the right dose is for you. These equivalency tables are approximate.

 

3. When you come to the portion of the path where you are already dysregulated, what the brain wants is calm, i.e. no more changes and use non-drug techniques and supplements like magnesium to calm as much as you can. Tolerating is not *an* option, it's the only option. Withdrawal does not care if you can wait or hold, that's the only thing that helps, the more you tinker with things the harder it is to come back to homeostasis because of the sensitization.

 

Plan:

1. possible reinstatement (will check with mods)

2. Non-drug techniques to manage this situation you find yourself in until you feel more stable

 

In the meantime, what will help us is if you can post your daily symptoms with the times you take your drugs. Try to remember for a couple of days at least. And keep doing it for a couple of more days.

 

Like this example:

7am Wake up 

8 am prozac 17mg with breakfast

9 am anxiety and nausea

10 am feeling a bit better reading

11 am a sandwich, nausea worse, 150mg magnesium vit C

12 ruminating etc

.

.

.

9 pm feeling much better, calm, 1m melatonin

10 pm fell asleep, 

 

Thank you so much. The knowledge you all have is astounding. Far better than most of the (very bad) tapering advice from the medical community. I just know because I've tried it their way and nearly died. You all haven't been wrong yet.

I need to be patient. I guess I'm in a hurry because of the reasons I'm discontinuing; Unpleasant adverse reactions that built over the years I was on Paxil. Nothing dangerous, but unpleasant. That's why my doc is pushing hard for a quick discontinuation (half, half, then off). I'm just not playing that game anymore. I went off on her, told her I'm doing it my way or she's losing a patient, and that's it. Several months ago I consulted a psychiatrist who advised a slow taper and referred me here. 

Patience. Patience. Patience. I threw my CNS way off with my switch to Prozac. I did so because I didn't want to mess around with the notoriously difficult Paxil withdrawal. I know they all cause withdrawal, but a long half life at least buys my CNS some time to adjust and adapt when I make a dose change. This taper has to happen, and I want to give myself the best chances. 

[manymoretodays]

On 10/29/2022 at 7:09 PM, PeerCBH said:

According to this, updosing was the right thing to do, as symptoms were significant. So this leads me to 3 questions:

1. Should I tolerate symptoms of any significance or duration longer than "a couple days", or should I reinstate?
2. What if it is literally impossible to avoid significant withdrawal, with any reduction in dose, no matter how small, causing significant symptoms? 
3. How long do I stay at my current dose before tapering? What is the minimum amount of time? I do not have the luxury of doing a long hold. 

 

I'll take a try at your questions PeerCBH.

3.  I'll ask why you do not have the luxury of doing a long hold?  And I think when you identify your own WD stable, and then are at that point for at least a month or 6 weeks, then might be the time to begin a taper.  And it is really case by case oftentimes.  So hard to give a set answer for all cases.

 

2.  I love this.  And personally, I do believe that for some, yes, it is possible to avoid significant WD.  I turned your question around a little, as you might have noticed.

For those who have had significant WD set in......they may need to tolerate minimal WD symptoms for their remaining taper and even beyond, while still healing.  Some might opt to stay on a small dose indefinitely.  Some have.  And then if and when, they may later decide to taper off completely.

 

1. I think we have answered that a couple times now, at least concerning the Prozac.  That sometimes symptoms from your taper won't be readily or immediately noted, and then when and if they occur(WD symptoms).......if they ARE tolerable that you might wait a full week, or more, while doing no further tapers, to see if they abate at least somewhat.

And then you know about Windows and Waves, right?

 

And that is just what I think.  I'm not a textbook, or leading authority, or even a professional in this regard.  So.....opinions may vary.

How is today?  Did you have a happy healthy Halloween?

 

L, P, H, and G,

mmt

[PeerCBH]

On 11/2/2022 at 6:08 PM, manymoretodays said:

 

I'll take a try at your questions PeerCBH.

3.  I'll ask why you do not have the luxury of doing a long hold?  And I think when you identify your own WD stable, and then are at that point for at least a month or 6 weeks, then might be the time to begin a taper.  And it is really case by case oftentimes.  So hard to give a set answer for all cases.

 

2.  I love this.  And personally, I do believe that for some, yes, it is possible to avoid significant WD.  I turned your question around a little, as you might have noticed.

For those who have had significant WD set in......they may need to tolerate minimal WD symptoms for their remaining taper and even beyond, while still healing.  Some might opt to stay on a small dose indefinitely.  Some have.  And then if and when, they may later decide to taper off completely.

 

1. I think we have answered that a couple times now, at least concerning the Prozac.  That sometimes symptoms from your taper won't be readily or immediately noted, and then when and if they occur(WD symptoms).......if they ARE tolerable that you might wait a full week, or more, while doing no further tapers, to see if they abate at least somewhat.

And then you know about Windows and Waves, right?

 

And that is just what I think.  I'm not a textbook, or leading authority, or even a professional in this regard.  So.....opinions may vary.

How is today?  Did you have a happy healthy Halloween?

 

L, P, H, and G,

mmt

You're right, you have answered that question. I'm sorry, my brain is mush. Thanks for answering again. 

An update, I seem to have settled into this dose. The more noticeable and distressing withdrawal symptoms have subsided, but you're right in that prozac and paxil are not a clean switch. For the most part they hit the same spots, but paxil clearly does things prozac doesn't do and vice versa. I've noticed a considerable mental shift. Not necessarily bad, but different. I've noticed my obsessions and compulsions are worse, which is sometimes a withdrawal symptom for me. 

I'm tapering due to adverse effects that built over time. Not dangerous, but I do need to get the taper going as soon as i can. I want to sit on this dose for a little while to see if things clear up, but at some point I'm going to have to get on with it.

[manymoretodays]

That's a good update PeerCBH.  Thanks.

17 hours ago, PeerCBH said:

The more noticeable and distressing withdrawal symptoms have subsided, but you're right in that prozac and paxil are not a clean switch.

 

17 hours ago, PeerCBH said:

I'm tapering due to adverse effects that built over time. Not dangerous, but I do need to get the taper going as soon as i can. I want to sit on this dose for a little while to see if things clear up, but at some point I'm going to have to get on with it.

 

I know, but not at the risk of further unbalancing things.  October 18th was your updose.  Can you sit with that until November 15th?  That would be a nice 4 weeks of staying put.  And.......that may do more for you than you might be thinking now.........just sitting tight with one dose, no changes can often help more than anything.

 

So glad distressing WD symptoms subsided. 

 

And yes, the OCD around tapering and WD symptoms can be such a bear.  Do you have the "luxury" of any therapist that won't instantly negate or not wish to talk about WD, that could help you to pause before making drug changes, or help you shift out of the "worry, worry......I have to do something" mode?

 

And links to helpful topics here:

Obsessive compulsive disorder ;Repetitive intrusive thoughts, compulsive behaviors

Health anxiety, hypochondria, and symptom obsession

Even if these were not part of your original complaints, the same modalities to treat them can help......the non-drug stuff.

If therapy is not an option, or you just can't mesh with that now........many pursue online options which can be effective.

 

Alright.  Good enough for now, is good enough for now.

 

Best, L, P, H, and G,

mmt

[ChessieCat]

https://www.getselfhelp.co.uk/ocd-self-help/

 

https://www.getselfhelp.co.uk/health-anxiety-self-help/

[PeerCBH]

4 hours ago, manymoretodays said:

That's a good update PeerCBH.  Thanks.

 

 

I know, but not at the risk of further unbalancing things.  October 18th was your updose.  Can you sit with that until November 15th?  That would be a nice 4 weeks of staying put.  And.......that may do more for you than you might be thinking now.........just sitting tight with one dose, no changes can often help more than anything.

 

So glad distressing WD symptoms subsided. 

 

And yes, the OCD around tapering and WD symptoms can be such a bear.  Do you have the "luxury" of any therapist that won't instantly negate or not wish to talk about WD, that could help you to pause before making drug changes, or help you shift out of the "worry, worry......I have to do something" mode?

 

And links to helpful topics here:

Obsessive compulsive disorder ;Repetitive intrusive thoughts, compulsive behaviors

Health anxiety, hypochondria, and symptom obsession

Even if these were not part of your original complaints, the same modalities to treat them can help......the non-drug stuff.

If therapy is not an option, or you just can't mesh with that now........many pursue online options which can be effective.

 

Alright.  Good enough for now, is good enough for now.

 

Best, L, P, H, and G,

mmt

The Paxil began causing mania, episodes getting progressively worse over time. The lower I go the better it gets. It's at a point now where it's manageable, I think. It's at least stabilized. I can hold for that long at least, probably quite a bit longer. It's all a balancing act. I do realize that tapering while wd symptoms are not stable poses it's own issues.

[PeerCBH]

3 hours ago, ChessieCat said:

https://www.getselfhelp.co.uk/ocd-self-help/

 

https://www.getselfhelp.co.uk/health-anxiety-self-help/

Thank you!

[Onmyway]

19 hours ago, PeerCBH said:

The Paxil began causing mania, episodes getting progressively worse over time. The lower I go the better it gets. It's at a point now where it's manageable, I think. It's at least stabilized. I can hold for that long at least, probably quite a bit longer. It's all a balancing act. I do realize that tapering while wd symptoms are not stable poses it's own issues.

@PeerCBH, I will reiterate that holding is a good idea regardless of the external circumstances that are causing the taper - unless of course the external circumstances are life-threatening which doesn't seem to be the case now. As you saw the last couple of weeks withdrawal symptoms can be quite severe and yours weren't the worst that we have seen. I would urge caution and holding until you feel stable. 

OMW

[ChessieCat]

I needed to reduce my dose quickly because I was experiencing mild serotonin toxicity.  Unfortunately I tried to reduce by 50% and ended up with very bad withdrawal symptoms which is when I researched and found SA.  Thankfully I was able to updose and got myself on track.  But I did try to reduce too soon after the updose and had to do a tiny increase to get rid of the withdrawal symptoms.  It was a case of balancing the withdrawal and the adverse effects.

 

Because the adverse effects are generally dose related, once I got to 50mg (which here in Australia is the lowest dose of Pristiq) I stayed on that dose for 3 months to give my brain a chance to make the changes that it needed.  When I got to 20mg I had capsules left over so I did a 7 week hold instead of 4 weeks so that I had a more stable foundation before I continued my taper.  I also held for longer when I hurt my back in 2020, and extended my reductions at the end because I was diagnosed with diabetes and changed my diet and didn't want to confuse any symptoms.

[PeerCBH]

7 hours ago, Onmyway said:

@PeerCBH, I will reiterate that holding is a good idea regardless of the external circumstances that are causing the taper - unless of course the external circumstances are life-threatening which doesn't seem to be the case now. As you saw the last couple of weeks withdrawal symptoms can be quite severe and yours weren't the worst that we have seen. I would urge caution and holding until you feel stable. 

OMW

Thank you.

At this point things seem to be leveling out. I'll hold until I feel 100% stable or close to it. I realize that as unpleasant as the adverse effects are, tapering while unstable will compound my problems. Especially given my impulsiveness when in distress.

[PeerCBH]

Hi all,

 

So given that my symptoms are mostly stable, with only the occasional wave, I've decided to take 5% off my current fluoxetine dose to test the waters.

 

Let me know what you think. Good idea? Bad idea? Too soon?

 

Thanks.

[PeerCBH]

I did have a question: do you think the reason Paxil is so hard to discontinue, and why it isn't a "clean" switch to fluoxetine or even other SSRIs, is because it's potently anticholinergic, while the others are not? 

 

I admit I don't know too much about that mechanism, I do know that anticholinergic drugs have a withdrawal of their own. It's possible that with Paxil one experiences both withdrawals simultaneously. 

 

I will say, while I have no obvious withdrawal symptoms, since the Paxil to prozac switch I still feel..... off. Not quite myself. I think I will give it at least a few more weeks before I begin tapering.

[PeerCBH]

Hey all.

 

I think I may have jumped the gun.

 

2 months after my Switch to prozac (12/10) I tapered by 10%. 18 days in I felt a surge of symptoms, which dissipated over 6 days. Since then, things haven't been "right." I've been experiencing waves of anxiety and OCD-like symptoms, along with irritability. 

 

I think I pushed it too fast, especially given that just 2 months ago I basically c/t'd Paxil. I felt okay, like I was good to start tapering. I may have been wrong.

 

I'm considering going up just a smidge. I tapered by 1.6mg, I'm thinking go up .2 or .4. Or I could stay here and grind it out.

 

I'll update my signature momentarily.

[PeerCBH]

I have another comment

 

I have a pattern of second guessing my decisions. I have a low distress tolerance, severe anxiety, and question everything I'm doing when things go bad. This leads to a lot of impulsive decisions.

 

I'm using DBT/Mindfulness to try to manage this.

 

In any case, I'd like to taper slower than 10%. I'd like to go 5% or lower. I appear to be sensitive to this ish. Meh.

[mstimc]

Hi Peer

 

Second guessing and doubting is a classic symptom of WD.  There's a Chinse proverb that says having anxiety is like being stuck on a rock in the middle of swiftly moving river.  Its a terrible place to be but it feels safer than plunging into the river if you don't know what's downstream.  So you stay stuck where you are even though you hate it. Try doing some reality testing.  Is what you perceive as "going bad" really all that bad or is your anxious mind telling you its bad?  Anxiety only has power over us if it can control the way we think and react.  It needs fear to survive. Keeping you in an anxious state is what it wants.

 

There are very few decisions that can't be changed. If you make a mistake, big deal.  At least you tried to make a change, and you learned a lesson.  Time to try something else. Listen to your thoughts and try to see them as if you were talking to a friend.  What would you recommend?  if it didn't work, would you berate your friend for screwing up?  Or would you say, "Well, you gave it your best shot and it didn't work out as planned. What'll you try next?" Lose the guilt, keep the wisdom.

[Onmyway]

Hi @PeerCBH

Regardless of whether that decision was right or wrong you're in this situation now and the right decision now is to stay put. Please don't charge anything. Your body craves stability.

 

It seems to me the issue you are struggling with is the illusion of control - you want to make the right decision and get the right outcome. You are under the illusion that there is ONE right decision and it's under your control to find it. The problem though is that even if you make the right decision (right based on some criteria) you don't know the outcome and you may discover that the criteria were wrong to begin with. None of the decisions we make guarantee the right outcome - if we knew the outcome perfectly, i.e. there was no uncertainty - there would be no room for a difficult decision. We would just pick the outcome we want. This is where the idea that we have control of our lives is an illusion imho. We do the best we can with what we have but the majority of the outcome is out of our hands! It may be easy to wish we had picked A over B or B over C after the fact but in truth we have no idea what the right choice is. So please let yourself off the hook. You did the best you could in the situation you found yourself in.

 

Regarding distress tolerance, that's the biggest gift that withdrawal gave me. I was scared of any difficult feelings or distress as you call it. But when there is no way out -  in withdrawal you just get through it and realize it is temporary and is not as bad as you imagined. And even when it is worse than you imagined you have it in you to get through it. You will be OK. 

 

OMW 

[PeerCBH]

1 hour ago, Onmyway said:

Hi @PeerCBH

Regardless of whether that decision was right or wrong you're in this situation now and the right decision now is to stay put. Please don't charge anything. Your body craves stability.

 

It seems to me the issue you are struggling with is the illusion of control - you want to make the right decision and get the right outcome. You are under the illusion that there is ONE right decision and it's under your control to find it. The problem though is that even if you make the right decision (right based on some criteria) you don't know the outcome and you may discover that the criteria were wrong to begin with. None of the decisions we make guarantee the right outcome - if we knew the outcome perfectly, i.e. there was no uncertainty - there would be no room for a difficult decision. We would just pick the outcome we want. This is where the idea that we have control of our lives is an illusion imho. We do the best we can with what we have but the majority of the outcome is out of our hands! It may be easy to wish we had picked A over B or B over C after the fact but in truth we have no idea what the right choice is. So please let yourself off the hook. You did the best you could in the situation you found yourself in.

 

Regarding distress tolerance, that's the biggest gift that withdrawal gave me. I was scared of any difficult feelings or distress as you call it. But when there is no way out -  in withdrawal you just get through it and realize it is temporary and is not as bad as you imagined. And even when it is worse than you imagined you have it in you to get through it. You will be OK. 

 

OMW 

I went up slightly and things stabilized. I did it before I read this.

 

It's so difficult for me to tolerate the mind **** that is withdrawal. The anxiety/panic and scary obsessive/intrusive thoughts make me feel like I'm going insane. It's terrifying. I'm already in a compromised state from trauma as it is. Illusion of control is something I'll have to work out in therapy. The intense fear that goes with not being in control. All that. You're 100% right.

 

For now I'm going to taper more slowly. Somewhere in the 3-5% range. I've read on this site of people who've had to do so. 

[PeerCBH]

Question: what can you tell me about serotonin saturation, namely, why for some people tapering is easy until they hit a certain point?

 

I feel with me, I had almost no withdrawal symptoms from 40mg to 20mg, then to 17mg, but past that it all hit me at once. Suddenly I'm tapering at less than 3%.

 

I know the oh oh point. But I don't think that fully explains why I took a 50% drop with no problems at all, and now I can't go above 3%. Will it continue getting harder? Will I have to taper by .5%, then .01%, etc, or does it tend to level out at a certain point, in terms of tapering percentage?

[Gridley]

39 minutes ago, PeerCBH said:

what can you tell me about serotonin saturation, namely, why for some people tapering is easy until they hit a certain point?

 

This link has several good explanation why this is happens.

 

Why taper paper: dose-occupancy curves

 

Here are a couple of member comments I saved a while back that I thought were helpful.

 

"I read the serotonin transporter occupancy study I think back before even starting my taper and I immediately saved it as a PDF! It helped me understand the impact of dropping to zero and how the decline is exponential when one reaches 4, 3, 2,  and <1mg. The study was groundbreaking in my opinion in terms of explaining patterns as it seems to corroborate the anecdotal evidence from people here experiencing a shock when they hit the low doses and zero."

 

and

 

"Basically, a study they did in 2004 found that the Serotonin Transporter Occupancy was about 80% when taking a 20mg dose and still nearly 50% at a 3mg dose.   Even at a 1mg dose, the occupancy was nearly 25%!"

 

39 minutes ago, PeerCBH said:

 

I feel with me, I had almost no withdrawal symptoms from 40mg to 20mg, then to 17mg, but past that it all hit me at once.

 

The above link is a good explanation why.  And we're all different with where the reduction starts to bite.

 

39 minutes ago, PeerCBH said:

Will it continue getting harder? Will I have to taper by .5%, then .01%, etc

 

No way to say.  We do say, the lower you go, the slower you go, which is what you've been experiencing.  I'd guess you won't have to shave your reductions down as radically as you fear, but you'll just have to feel it out step-by-step as you get there. 

 

 

 

Edited March 3, 2023 by Gridley

[PeerCBH]

I think I'm going to stop using this site

 

Not because I'm dissatisfied with the support I've received. Quite the contrary. Thank you all so much.

 

But because I use this site primarily to seek reassurance for my anxiety. My therapist and I are moving away from such behavior, as in the long rum it only intensifies my anxiety.

 

Now I'm working on sitting with my anxiety and coping in more healthy ways. I suppose if I have a legitimate question, I'll post. But for the most part I'll be reviewing other content on the site to answer my questions.

 

Thank you everyone.

[PeerCBH]

Hi all,

I know I said I wouldn't post, but I do have a genuine non-reassurance question:

Can someone recommend a good 1ml oral syringe, one that's accurate and it's easy to read dosages? Right now I'm using Brandzig. I have some concern that some liquid gets "stuck" in the syringe, and thus I'm not getting an accurate dose. It's also difficult to read exact dosages.

Thanks.

[Onmyway]

Hi @PeerCBH

I use a generic syringe to dilute my medicine 1:1200. I first put 120 ml of water in a jar.  Then take 0.1ml of my medicine and deposit it into the receptacle (jar) where i already have the 1200ml water and will make the dilution.  Then take water from the 1:1200 solution in the medicine syringe and put it back into the solution. I draw water in and out a few times more to 'wash out' the syringe of any residue.  I draw water from the solution and deposit it back into the solution so it all goes into the solution.  

 

This is good enough.  I keep my two syringes the same until they're unusable.  The goal is not perfection but consistency. 

 

I've heard people who had access to lab equipment use graduated scientific pipettes. But syringes are good enough.

 

The key is not to turn this into something to obsess about as our minds are easy to hijack in this process.

 

OMW

Edited April 4, 2023 by Onmyway