Pianca, Paxil and Prozac

[Pianca]

It’s always so hard for me to start and it’s even harder now because of the state I’m in, but I’ll do my best…

 

The good:

Around 2014 I’ve been put on Paxil 20mg due to anxiety and my first panic attack. Well, it was a miracle pill for me, can’t deny that. After roughly two years (2016) my doc suggested that it might be a good idea to get off the meds since I was doing so well - sure, let’s do it! - I said. The taper plan she gave me was minus 5mg each week, so from 20mg to 0mg in a month. I did that and as you may suspect, it wasn’t the most pleasant experience. Took me around three months to get back “from the dead”, but I managed. Didn’t have much obligations at that time, so it wasn’t so stressful since I could just spend my days in zombie mode and not care.

 

The bad:
Shortly after my revival something… hit the fan and due to extreme anxiety I had to go back to meds. In my ignorance, stupidity and fear I asked my doctor to reinstate Paxil, because hey, it worked wonders previously and I didn’t feel like experimenting. It worked again, sadly, taking me hostage for the next eight years. 
Why I say hostage? Because from that time my life changed quite a bit, adulthood hit hard. I couldn’t allow myself to take a few months break just to get off the meds. I tried a few times, but I simply couldn’t handle the reduction, no matter how slow I tapered. I  started to wonder if I may need to stay on it for life. It worked, so where’s the harm I asked? 
But I’ve decided to give it a one last try, especially since I’ve been in a pretty good moment in my life. The final push - and that’s the moment my life falls apart. 

The ugly:

June 2023, I went from 20mg > 17.5 mg. Some heightened anxiety, waking up a bit earlier than usual, no biggie. I’ll give it a month and go down again. 

July 2023, 17.5mg > 15mg. First two weeks were pretty consistent, a little more of insomnia, anxiety and anhedonia. I noticed that I probably should stay on that dose a bit longer than a month. Fine, I said, but life had a surprise for me and this is where things start to get hectic and blurry…

 

Around week 3 on 15mg I woke up with SEVERE brain fog, anhedonia and fatigue. At first I brushed it off on a bad nights sleep, but next day I slept much worse and my condition did not improve. Okay, this’ll pass soon, a bump on the road I thought. Guess what, it started to get worse. 

Panic and anxiety started to slowly creep into my life. I’ve lost my edge, become dumb in a very short time - if that’s not a reason to panic then I don’t know what is. So I’ve started searching, could this be withdrawal? Turned out it could, so I went back to 17.5. No improvement, hell, it’s getting worse! Back to 20mg. For a few days I’ve felt a bit more clear headed, but it faded away quickly. At this point I’ve stumbled upon a paper linking Paxil and its anticholinergic effects to dementia. One word. Panic. Consulted this with my dr, she upped me to 30mg because yeah, I’ve been on 20mg for quite some time. This helped for like three weeks and started to dive rapidly. At this point I’ve been through some major diagnostics like brain imaging and extensive bloodwork. All came back without issues, except for the neuropsychological testing that confirmed that I’m indeed lightly cognitively impaired. I wanted out from Paxil immediately, because the thought of each day on it adding a fraction to the chance of dementia literally made me puke, but I knew that cold turkey is not a way to do it. It’d probably kill me and as you may suspect, I was already a mess.

Prozac bridge emerged on the horizon, appearing to be the only reasonable way out of this impasse. My doc approved the idea and I started the transition from 30mg Paxil to 30mg Prozac, 5mg each week. That took me about 1.5 months. Rough months during which I’ve experienced a plethora of symptoms that fueled my health anxiety like nothing else could. The main things were paresthesias in my body’s right side, tinnitus, insomnia, fatigue and brain fog. Not to mention the anxiety, mood swings and crying spells. I went to the doc and described how I’ve been feeling. Their response? Let’s up Prozac to 40mg, this should help! Craving any relief I did as instructed and here I am now, second week on 40mg Prozac, one month paroxetine free with brain fog, fatigue, muscle aches in my right side of the body, dry heaving each morning, zero appetite and constant diarrhea paired with anhedonia. Sure, the anxiety has been mostly clubbed by Prozac after upping the dose, but I don’t think I feel alive and I don’t know what to do. I thought about staying on 40mg for some time to stabilize, but there’s this pressure in me saying “drop to 30mg, it’ll make you feel better!”. I don’t know what to do anymore and I’m scared and tired as hell. 

 

[Altostrata]

Welcome, @Pianca

 

Paxil can be very difficult to quit. You are under the care of a doctor who has substituted Prozac, and you say that the increase in dosage to 40mg has reduced your withdrawal symptoms. What is your question for peer support here?

[Pianca]

Hi @Altostrata, thanks for your reply. I’m not entirely sure if Prozac reduced my symptoms, because I feel worse now, but I guess there’s no way of telling if those are side effects of Prozac or WD from paroxetine. I thought about staying on 40mg Prozac for some time to stabilize, what do you think? Seems like the only option from what I’ve read on the forum. 

[getofflex]

2 hours ago, Pianca said:

I guess there’s no way of telling if those are side effects of Prozac or WD from paroxetine.

There is one way to tell if you are having side effects, otherwise known as adverse effects, to the prozac.  Keep a daily journal of your daily drug dosing, and your symptoms from hour to hour, and see if you feel worse in the hours after your take your prozac. 

 

To see if there is an adverse reaction going on, please do a daily drug and symptoms journal.  Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug. Please do this for 24 hours, and post an entry in here for each 24 hour period.  Here is an example: 

 

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

Edited January 12, 2023 by getofflex

[getofflex]

Welcome to SA.  

2 hours ago, Pianca said:

I thought about staying on 40mg Prozac for some time to stabilize, what do you think?

 

If after you do the journaling for several days, you realize that you are not having a significant adverse reaction to prozac then yes, that is what I would do.  

 

Here are some links to some important topics that will help you understand what is going on.  This first link is especially important, to help you understand why slow tapering is so essential: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

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

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

[Hanna72]

Hi @Pianca and welcome from me also. Glad you found this site, this community has loads of information and support.

My case is similar to yours as I used also a bridge with fluoxetine to get rid of Paxil. I was also told to up my dose to 40 mg as my symptoms did not get better. However at 40 mg I became zombie like so that dosage was not suitable for me, not to say you shouldn’t stay at this dose.

We are all different, what works for one might not work for another.

Anyways I also want to add that getting off Paxil is really hard and even though you might still feel a lot of withdrawals symptoms, be patient it will settle. Took me few months to get somewhat “normal “ after the bridge. Never thought I could taper again, but here I am once again trying with good results so far.

Hang in there, and believe in this process. There is loads of success stories in here that are full of motivation and hope.

 

All the best to you🙏

[getofflex]

Just a couple of more comments.     

 

The Vitamin D3 can cause insomnia in some people.  You may want to eliminate that.  This is a quote from our topic on Vitamin D3: 

 

On 3/13/2011 at 9:33 PM, Altostrata said:

NOTE: Vitamin D is a daytime vitamin. Even if you take it in the morning, it can keep you awake at night. Be sure to start low and don't take too much.

 

Here is the link to the topic: 

 

Vitamin D3

 

I see you also take pregabalin 75 mg on occasion for sleep.  How often on average would you say you take this per week, or per month?  

 

Taking any kind of psychoactive drug like this on and off can also further destabilize an already sensitized nervous system.  

 

Here are some non drug tips to help with sleep. 

 

Withdrawal Insomnia

 

Gridley's Post About Insomnia

 

And, here is what I did to try to improve my sleep and circadian rhythm.  This takes time, it is not a quick fix.  

 

1) don't get overly anxious about it.  Realize that eventually, your sleep will improve.  Insomnia won't kill you, although it can make you pretty dang miserable.  Anxiety about sleep just makes the problem worse.  I know, easier said than done. I don't always do this, but I try.  Practice acceptance.

 

2)listen to very soft relaxing music at a very low volume.  

 

3)don't worry about what time it is.  Don't look at the clock.  

 

4) I try to stay active during the first half of the day.  I take a walk (mine is one hour) after breakfast every day.  Then, as the day goes on, gradually slow down.  Several hours before bed, I only do very relaxing things, like read, or just sit and relax.  This helps to set our circadian rhythm.  Try to get outside and get some light exposure during the day, too. 

 

5) Avoid toxic, negative people.  Avoid stress when possible, although I know a lot of stressors are unavoidable.   For me, this can really help me to relax better.  

 

6) I stay away from MSG and aspartame.  These are exitotoxins which overstimulate the nervous system.  They are in a lot of our modern processed foods.  I try to eat more whole and natural, and not as many processed foods.  Also avoid processed meats with sodium nitrate, etc , such as hotdogs, ham, bacon, and sausage.  These can keep you up at night too.

 

7) avoid eating large amounts of sugar and processed carbohydrates.  This causes your blood glucose to spike up, which causes your pancreas to create insulin to control your blood sugar, which then causes your blood sugar to drop too low, and then your to create adrenaline to try to regulate your blood sugar.  Adrenaline keeps you awake because it is an activating hormone.

 

9) too much sodium (salt) can cause your blood pressure and heart rate to rise, and make it hard to sleep.

 

Edited January 12, 2023 by getofflex

[Pianca]

Thank you getofflex for the links, appreciate. 
I’m wondering about the journaling, because I’m taking my Prozac at night, so that sounds a bit counterintuitive in my head. Usually feeling better until noon though, crashing later in the day. 

I’m trying to take pregabalin as rarely as I can, only when the insomnia is bothering me for a longer period. I’d say it’s 3-4 days in a month in general, never consecutively. 
 

I’ve ditched the d3 for now, even though I’m severely deficient and yeah, I feel like the lack of it helps me sleep better. 
 

@Hanna72 Thank you so much for the reassurance. Tell me, were you also feeling the fatigue/anhedonia around the time of your switch? 

[Altostrata]

Hello, @Pianca We want to see 24 hours of notes at a time. This covers your sleep pattern after you take Prozac and anything else.

[Pianca]

06:30 woke up tired after going to bed at midnight, tinnitus spike since yesterday, some dry heaving 

07:30 laid down again, no sleep just tossing and turning

9:00 took magnesium and fish oil, back to tossing and turning

12:00 still really tired, ate some light meal 

18:00 tired, dinner supper 

19:00 feeling a slightly better mood, probably due to a hot bath 

21:00 took Prozac

22:30 took magnesium and 0.5mg melatonin

23:30 went to bed, mood slightly elevated before

7:00 woke up, tossed and turned till 8, slightly better tinnitus 

[Altostrata]

Please include the dosage of your drugs in your daily notes.

 

Highly likely that taking 40mg Prozac before bed interferes with your sleep. I suggest you move it by 2 hours per day until you are taking it in the morning.

 

How long have you been taking 40mg Prozac?

[Pianca]

7:00 woke up, woke up maybe once in the night, tossed and turned till 8, slightly better tinnitus 

9:00 tinnitus worse again, took magnesium and fish oil

10:30 ate breakfast due to hunger kicking in

11:00 felt a wave of tiredness, laid down for 40mins, did not sleep, slight headache

12:40 weak coffee

13:40 idk if it’s coffee but my moods elevated, 

17:30 headache and tinnitus continue, though it’s been pretty productive day at work

19:00 headache subsided after supper

21:00 Prozac 40mg

22:00 Magnesium glycyniate 300mg and melatonin 0.75mg

23:30 went to sleep

07:00 woke up. Tinnitus still there, but I did not wake up in the middle of the night 
 

Hi Alto, it’s been 3 weeks since the doc upped my dose to 40mg. I just recently, like a week ago, switched to takin Prozac in the evening. So far I think it works better than in the morning 

[Altostrata]

Suggest you go back to 30mg first before moving it earlier by a couple hours each day until you're taking it in the morning.

[Pianca]

Yeah, I plan to decrease the dose, just not now since it’s been only 3 weeks. I’m gonna give it 4-5 more weeks to stabilize and see where I’ll go from there (especially since I’ve started to feel a bit better lately). Thanks Alto! 

[Pianca]

Four weeks on Prozac 40mg, six weeks Paxil free. It started to get just a lil better like a week ago, but now I’m crashing again, ugh. I have a strong suspicion that increased tinnitus and the downward slope has been a result of having an orgasm - like all the chemicals released during it caused me to destabilize again. Well, ain’t that just ironic. 

[Pianca]

I’ve only started week 5 on Prozac 40mg, but I’m already wondering what to tell my psych at the beginning of Feb. They were eager already to switch Prozac for something else during my visit two weeks ago, but I managed to talk them into giving it a bit more time since I was beginning to feel a tad better. Unfortunately I’m a wreck again and the improvement was only temporary (on the bright side, at least no diarrhea this time, yay). I’m trying my best to listen to my body, but I just can’t understand what it wants or what would be the safest way to proceed at least. One thing I know is that upping the dose is out of question. I don’t think I’m having an adverse reaction to Prozac, because logic suggests that there would be no improvement in the symptoms at all. 
I know everyone’s different, but basing on your extensive knowledge, what would you suggest? 

[Altostrata]

On 1/16/2023 at 11:10 PM, Altostrata said:

Suggest you go back to 30mg first before moving it earlier by a couple hours each day until you're taking it in the morning.

 

Prozac has a long half-life and it takes about 4 weeks for it to take full effect. Most likely, the dose helped at first until it ramped up and now the effect is too strong, causing an adverse reaction.

 

I gave you my best advice last week. This is a site for tapering off psychiatric drugs. If you are committed to staying on an antidepressant, please talk to your doctor about next steps. BTW, as a patient you have the right to refuse a drug change or addition.

[Pianca]

@Altostrata Hey Alto, yeah I know and thank you for that advice. I was just thinking out loud, because I want to taper, but I also want to do it in best way possible. Changing drugs is probably not a smart choice and I think I’ll just have to stick to Prozac and taper it. 

[Pianca]

Oh and a question regarding your advice - should I just jump from 40mg to 30mg or taper/fast taper? 

[Altostrata]

On 1/23/2023 at 5:08 AM, Pianca said:

Oh and a question regarding your advice - should I just jump from 40mg to 30mg or taper/fast taper? 

 

How long has it been since you increased to 40mg?

[Pianca]

It’s been five weeks today. 

[Altostrata]

Unfortunately, if you've been taking the increased amount for more than a month, there is an increased risk of withdrawal symptoms if you drop directly from 40mg to 30mg. 

 

You may recall from 11 days ago:

On 1/16/2023 at 11:10 PM, Altostrata said:

Suggest you go back to 30mg first before moving it earlier by a couple hours each day until you're taking it in the morning.

 

Up to you if you want to risk decrease by 10mg. Otherwise, I would taper the extra 10mg by 2.5mg every week over 4 weeks.

[Pianca]

1 hour ago, Altostrata said:

Unfortunately, if you've been taking the increased amount for more than a month, there is an increased risk of withdrawal symptoms if you drop directly from 40mg to 30mg. 

 

You may recall from 11 days ago:

 

Up to you if you want to risk decrease by 10mg. Otherwise, I would taper the extra 10mg by 2.5mg every week over 4 weeks.

Nah, I’m not gonna risk it, I’ve had enough of risky, sudden changes already, gonna take it slow from now on. 2.5mg each week sounds reasonable, thank you Alto.