CloudyToday: Paxil tapering - not sure if I'm ready to start

[CloudyToday]

Hello everyone,

 

I'm 47, male. I've started to take Paxet (Paxil) 20 mg about a year and a half ago. Since I didn't feel it was doing much I decided to stop taking it. I also did not experience side effects while I was on the drug.

 

I taper fast from 20 mg to 10 mg. Felt OK. Then I was down to 7.5 mg for 2 weeks, 5 mg for 2 weeks and then to 0 mg. 

 

2 days after I was off this drug I started to feel bad. Mostly I felt dizzy, I was shaky, and nauseous. 

 

I reinstated back to 10 mg. All WD symptoms were gone except that my appetite became low. I'm not losing weight, but definitely I don't have the same appetite as before. I eat "soft" food like Ensure drinks. 

 

Today I had some panic attacks, not sure if it is because the WD or it is just me who realizes that I'm stuck with a dangerous drug.

 

My question is whether it is OK for me to start the 10% taper schedule. 

 

Appreciate any feedback. 

 

[CloudyToday]

Appetite is getting worse, I threw up in the mornings. Can't hold my food down ☹️

[Frogie]

@CloudyToday

 

Welcome to SA. We are a volunteer ran site helping people tapering psychiatric medications or have tapered off and are now healing.

 

This is your introduction page where you will receive information, ask questions and meet other members. We ask that you only have one introduction page so we can keep all your information on one place. You may want to bookmark this page so it easy for you to find in the future.

 

First can you please create a signature.

 

How to List Drug History in Signature

 

 

I'm going to provide you with some useful links for you to read:

 

Why taper by 10% of my dosage?

Tips for tapering off paroxetine (Paxil, Seroxat)

 

What is withdrawal syndrome?

 

The Windows and Waves Pattern of Stabilization

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

 

 

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications:

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

 

How long has it been since you reinstated the 10 mg? If it has been a short while, you should hold until you stabilize. Nausea is the worst wd symptom. Try to drink protein shakes like you are, crackers, light protein (chicken), crackers, just nothing greasy.

 

Weight Gain, Weight Lose and Appetite Changes

 

What to Do for Nausea, Queasiness

 

Digestive Problems

 

 

 

You need to feel "Wd Normal" before you should begin your taper. Here are some topics on this:

 

Stabilising After a Reduction - What Does That Mean?

Withdrawal Normal Description

 

 

 

We don't suggest supplements as they can be stimulating to an already sensitized nervous system except 2. If you want to try one try a small amount and wait a few days before introducing the other.

 

Magnesium

Omega 3 Fish Oil

 

 

After you have read the links provided, please reach out with any questions you may have.

 

 

 

 

 

 

 

 

 

[Frogie]

13 hours ago, CloudyToday said:

Appetite is getting worse, I threw up in the mornings. Can't hold my food down ☹️

Please read the links that I provided and hopefully you will find some releif.

[CloudyToday]

Thank you Frogie for your warm welcome and for sharing these great sources. 

 

Just an update, I try to manage myself day by day. My withdrawal symptoms are mainly "waves"-like feelings of anxiety that crosses my body, and appetite loss.

 

I do get some windows of relief throughout the day, especially during the afternoon, where I take my 9 yr son to the local swimming pool. I find that being in the pool together with my son has a calming effect. 

 

I think I will wait a while before starting to taper off the drug, in the hope to become more stable.

 

thanks again!!

 

 

[CloudyToday]

Hi Frogie,

 

Quote

How long has it been since you reinstated the 10 mg? If it has been a short while, you should hold until you stabilize. Nausea is the worst wd symptom. Try to drink protein shakes like you are, crackers, light protein (chicken), crackers, just nothing greasy.

 

Apologies, I missed that part.

 

I ended my fast taper on 6/28 and was hit by withdrawals on 7/1. on 7/4 I reinstated the 10 mg, so basically ~1.5 months since my reinstatement. 

I don't feel like I want to vomit, it is more like food doesn't appeal to me.

 

I've started to take magnesium, and I think my anxiety waves are improving.

 

Would you recommend holding on for now?

[CloudyToday]

Frogie, Alto, I really need your advice. 

 

I'm  8 weeks into my reinstatement of 10 mg. Yesterday I started tapering 10%.

 

My sleep quality goes now in the wrong direction and I feel very hyper active throughout the day. I used to take a nap in the afternoon before my fast taper but now I don't feel tired anymore.

 

Could be that 10 mg is too high for me now? Is it too late to lower my dose? Should I lower my dose of reinstatement to 5 mg?

 

Apologies for my English.

[CloudyToday]

Hi Frogie, 

 

It has been a while since my last post and things had changed over the last couple of months.

 

My nausea is gone for now and I'm slowly getting back my appetite.

 

Since last week I've had tinnitus in both ears. It sounds like steam or a static TV. The volume is not loud but it is pretty constant throughout the day. I do get some relief on some days, with the hope that it won't return, but then it is back on the next day. 

 

My next reduction is coming soon and I just wanted your advice on whether I should continue with my tapering schedule regardless the tinnitus, or should I hold my current dose (6.6 mg) with the hope that the tinnitus will fade?

 

[CloudyToday]

Hi @Frogie

 

About a week ago I made another drop to 5.4 mg. Within 2 days I got nausea again (didn't have it for the last 1.5 months). I panicked and up dosed back to 6 mg.

 

Just wondering how to proceed from here? Should I wait till nausea is gone? It is somewhat mild but it bothers me. It lasts the whole day. In the evening I get some relief.

 

I'm also considering to switch to the Brassmonkey method.

 

[CloudyToday]

My nausea got very intense and debilitating. It also affects my sleep.

 

[CloudyToday]

Hi @Altostrata
Apologies for the tagging but I really need advice for my situation.

As mentioned in my signature I up-dosed to 6 mg Paxil due to debilitating nausea. My nausea is so strong that I can't concentrate at work and it affects my sleep too. 

 

I'm starting to think maybe bridging to another SSRI is my best option.

 

I tolerated Zoloft well in the past. Do you think it is worth trying to switch to Zoloft? Or some other SSRI?

If so, what would be the switch schedule and doses?

 

thank you!

 

[Altostrata]

How did the updose to 6mg affect you?

[CloudyToday]

@Altostrata,

I upsosed 2 days after getting to 5.4

 

The up dose didn't help. I still have nausea and now it is 24/7.

[CloudyToday]

My nausea is relentless today. I haven't had it so strongly since the beginning of my withdrawals. I just took zofran 4mg to try to alleviate it.

 

My main concern is that it is now present during the night, something I did not have before.

[Altostrata]

It appears that nausea is your sign for paroxetine withdrawal syndrome. 

 

Paroxetine is a very difficult drug to go off. Some people do find that substituting another SSRI resolves withdrawal, and with that "bridge", they can continue to taper. Usually, the bridge is Prozac, see The Prozac switch or "bridging" with fluoxetine 

 

Citalopram has a half-life longer than other SSRIs but shorter than fluoxetine, so you may wish to substitute citalopram instead, since if it causes adverse effects of its own, they will not last as long as they would with fluoxetine.

 

You will need to consider whether taking the risks of substituting another drug are worth possibly alleviating your current withdrawal syndrome.

[CloudyToday]

Thanks @Altostrata

 

The thing is I was totally stable 3 weeks ago, before my reduction and up-dose. Now I'm sick to my stomach 24/7. It is terrifying.

 

Before doing the switch would you recommend to hold on my current dose till I will be more stable? It is 3 weeks now since I was in this withdrawal.  

 

Also, regarding the switch schedule, is the plan below reasonable? 

day 1: 1mg citalopram + 6mg paroxetine
day 4: 2mg citalopram + 6mg paroxetine
day 7: 3mg citalopram + 4mg paroxetine
day 11: 4mg citalopram + 3mg paroxetine
day 15: 5mg citalopram + 1mg paroxetine
day 18: 6mg citalopram (no paroxetine)

 

[CloudyToday]

Hi @Hanna72,

 

Apologies for my multiple questions, but I'm in despair 🙁

 

I'm starting to think that bridging is my only option (see above).

 

I'm curious, why did you decide to do the switch from paroxetine eventually? Were you in a "stable" state before you did it?

 

 

[Altostrata]

As I said, paroxetine is particularly difficult to go off. We often see that, after paroxetine withdrawal starts, updoses are not effective.

 

8 hours ago, CloudyToday said:

day 1: 1mg citalopram + 6mg paroxetine
day 4: 2mg citalopram + 6mg paroxetine
day 7: 3mg citalopram + 4mg paroxetine
day 11: 4mg citalopram + 3mg paroxetine
day 15: 5mg citalopram + 1mg paroxetine
day 18: 6mg citalopram (no paroxetine)

 

By day 4-7, you should have a sense of what the citalopram is doing.

 

This is a good plan, but I would stay at 5mg citalopram and drop the 1mg paroxetine a few days later. Please let us know how you're doing.

[CloudyToday]

Thank you Alto.

 

I will hold a bit now in the hope that the nausea will subside and I'll continue from there.

[CloudyToday]

24 minutes ago, Altostrata said:

By day 4-7, you should have a sense of what the citalopram is doing.

 

@Altostrata, could you please elaborate on this? Do you mean by that time, if I feel worse that I should stop the bridging and go back to paroxetine? 
 

[Altostrata]

2 hours ago, CloudyToday said:

@Altostrata, could you please elaborate on this? Do you mean by that time, if I feel worse that I should stop the bridging and go back to paroxetine? 
 

 

You'll have to take stock and see how you feel. What you do depends on *how* you feel better or worse.

[Hanna72]

Hi @CloudyToday

So sorry to see you are struggling💕 I pray this will subside for you soon. 
To answer your questions; 

13 hours ago, CloudyToday said:

I'm curious, why did you decide to do the switch from paroxetine eventually?

I had talked to my doctor and told her I wanted off the paroxtine but I was stuck at 10 mg. Was afraid to go lower because of well obviously horrible withdrawals. She was surprisingly the one who told me about the bridge ( so doctors do know huh !) She said ( I will never forget) did you know that this is used to get off of Paroxetine!!!

And I immediately jumped on board, I wanted so badly to be drug free.

14 hours ago, CloudyToday said:

Were you in a "stable" state before you did it?

I was functional. 

I see you are thinking about a bridge. I can honestly say that for me personally it worked and I am glad I did it. I was finally rid of paroxetine.

How ever it was not a smooth sailing, it was hard and rocky at times, but with resilience, positivity and a whole lot of stubbornness I came through. 

Stay focused, know it might get bumpy, and tell yourself this is going to work for me, 

if you choose to do this.

I am rooting for you🙏

[CloudyToday]

@Hanna72, thank you for you kind words. It gives my strength and hope. 

[CloudyToday]

Thank you @Altostrata

 

I found a psychiatrist who acknowledges withdrawals from AD. I will discuss with her today, but in the initial phone call she mentioned prozac as the bridging target.

 

Should I change anything in my plan schedule and doses if I will bridge to prozac?

 

Also, do you think that in addition to getting rid of paroxetine, there is a chance that the switch can bring me relief from my symptoms?

 

[CloudyToday]

@Altostrata,

Since I'm really suffering, would it be a good idea to upsose to 6.6mg, hold a bit, and continue the switch from there?

[CloudyToday]

Sorry Alto, please ignore my question regarding the up-dose. You already gave me an answer 

[Altostrata]

You'll have to discuss your psychiatrist's bridging plan with her. Read The Prozac switch or "bridging" with fluoxetine 

 

On 1/24/2023 at 2:50 AM, CloudyToday said:

Also, do you think that in addition to getting rid of paroxetine, there is a chance that the switch can bring me relief from my symptoms?

 

What symptoms do you mean? The method is supposed to relieve withdrawal from paroxetine by substituting fluoxetine (or citalopram) and tapering that.

 

If you think this psychiatrist knows what she's doing, please add her contact information to Recommended doctors, therapists, and clinics

[CloudyToday]

6 hours ago, Altostrata said:

You'll have to discuss your psychiatrist's bridging plan

She doesn't know much about good bridging strategies. She is just aware of withdrawals. I showed her the plan above and she agreed with it.

6 hours ago, Altostrata said:

What symptoms do you mean?

My only symptom is intense nausea 24/7. 

 

[Altostrata]

It's your decision about what you want to do.

[CloudyToday]

Hi @Altostrata,

I'm still waiting to stabilize on the 6mg before I will try the citalopram bridge, but it is already a month that I'm having non-stop debilitating nausea.

 

Is it true that when getting to a low dose of paroxetine, up-doses don't work? 

 

My biggest fear from switching to citalopram is that I might be stuck with the nausea for a very long time.

 

Years ago when I took ecitalopram (cipralex), I had severe nausea for the first 3 months (I did not know it was from the med until I had nausea from paroxetine).

 

Are there any SA members who found relief (specifically from nausea) after they switched to another med? 

[Altostrata]

Going off paroxetine has a lot of unpredictability. Sometimes an updose works, sometimes it doesn't. Sometimes a switch to another SSRI eliminates paroxetine withdrawal symptoms, sometimes it doesn't. You have to decide whether the risk is greater if you continue on it versus switching to another drug.

[CloudyToday]

@Altostrata, Hi,

When I was on 7 mg paroxetine my nausea wasn't that bad.

 

Could it be that my dose is too low now and I'm getting inter-dose withdrawal nausea? In this case, would it be better to split the dose to 3mg twice daily (morning/evening)?

[Altostrata]

Is the nausea worse at any particular times of day?

[CloudyToday]

It eases a bit in the night before bed time. It ramps up again at 2-3 pm.
I'm taking the drug at 09:30.

[Altostrata]

Do you feel better after you take paroxetine, then the nausea gets worse about 2-3 p.m. and continues until bedtime? How do you feel in the morning, before you take paroxetine?

[CloudyToday]

Sorry, I meant 2-3 AM. This is when the nausea wakes me up. 

It is a bit difficult to follow since I feel awful most of the day.

   

Honestly, I don't think there is a difference in the morning before and after I take paroxetine (9:30 am).

 

I think the worst hours are between 2 PM - 11 PM