MarliesDutch Dutchie tapering Paroxetine (/Paxil) 14yrs

[MarliesDutch]

@Shep
Well, the thing is that I have no short term intensions to taper Paroxetine any further.

Maybe not even until next year. Maybe not even going of an AD at all. Want to discuss that with the psychiatrist.

(please don’t judge this decision…)

(Also: Paroxetine for me felt like more sedating then stimulating.)

 

About sleep: I had no problems sleeping (ever) untill the last Paroxetine taper. That dose (2,5mg) isn’t changed since March 25. 

Then came oxa/Lora. I don’t have real sleepingproblems (at least, with Lora I don’t have sleepingproblems, don’t know what happens if I would taper). Just last days; the last 1,5 hour of my sleepcycle. And last night falling asleep.

 

My head seems ‘chemically’ busy with thoughts I can’t grab (like ‘popcornstyle’), fantasy/real life mixing. Maybe already for a few days, but getting worse since yesterday.

And next to that:

- since today: losing apetite again, diarrhea, little tremble in hands

- since yesterday: flu-ish feeling in head and neck, obsessive behavior searching for info, chest pressure, very emotional and depressed again

(all those symptoms I had before starting Lora 0,75mg two weeks ago).

 

 

So, at this point the question maybe isn’t: how to taper/which to taper?

But: what am I experiencing? Why do these symptoms return? 
 

 

 

 

[Altostrata]

Thank you, @MedRN, for your help.

 

@MarliesDutch if I understand correctly, since you last posted here April 22, you sought medical care and increased the lorazepam according to the doctors' instructions.

 

This has not been going well? Why do you not go back to that medical team and ask their assistance?

 

You had not been very attentive to our suggestions before. We had proposed a way to gradually decrease the benzo, which you did not follow. Why are you asking us what to do now?

[MarliesDutch]

Hi @Altostrata,

 

I did seek medical assistance because I almost took my life at that point.

I gave up and gave in to their suggestion to get a bit more stable.

Which I’m partly thankfull for, because I’m still here. But with another problem: Lora.

 

The first two weeks on Lora were good; I felt way more stable, mental and physical symptoms decreased by 80-90%. So, I had perspective again.

 

But, what the crisisteam does is just: make you stable soon as possible. So: pills. And conversations till you have an outpatient psychiatrist who will help you for the long run (May 25th).

 

And now, after two weeks, things are changing again in symptoms. Tomorrow I have a conversation with them about this situation. What is this? What can we do? So I want to be prepared, being in a better shape than suicidal two weeks ago. And that’s why I came here.

 

I think the reason for not being very attentative as you describe, is because I was so lost already. And getting completely different advices from GP/psych here and at this forum. Plus: time difference made me make choices, because there wasn’t a reaction on my question due to time differences. 
I found it (and still find) it hard to navigate between such opposites. Especially when I’m experiencing depressed/suicidal/anxious thoughts. And: I guess withdrawl makes me super obsessive, cautious, ‘not making choices’ (can’t find the proper English word right now), racing mind. Isn’t really helping.

 

 

 

 

[Altostrata]

It appears that you do not appear to be ready to taper anything.

 

To go off your drugs, you must be able to manage upsets without going into crisis. Tapering might cause odd or disturbing symptoms. As online peer counselors, we cannot be available for emergencies.

 

It does not make any sense for us to donate our time to coach you in tapering if you keep bouncing back on the drugs. Earlier in this topic, you showed this inclination, and you've done it again -- even though we repeatedly cautioned you against escalating your benzo dosing, given that taking benzos often makes more problems than it solves.

 

You have been advised before:

 

On 4/15/2023 at 2:42 PM, Shep said:

 

You'll need to decide which path to take. Please note we are not doctors or medical professionals here, so if you're going to add in new drugs and create a new drug cocktail, you'll need to work with your doctor. We cannot help you with that. 

....

Since you were varying your oxazepam from 5 - 40 mg, that may have been causing a lot of your symptoms. 

 

We would have advised getting on the same dose of oxazepam every day and the same time(s) of the day and stabilizing before beginning your taper. 

 

Work with your doctor until you are stable and ready to taper. And then we can help you. We do not need to see your drug and symptoms journal until you are ready to taper, which likely will be in several weeks to several months after doing this switch. 

 

On 4/17/2023 at 2:59 PM, Altostrata said:

 

Hello, not sure what's going on here. This is a site for minimizing drugs, you're going in the direction of increasing drugs, which is what psychiatrists usually want to do.

....

 

 

I understand that you feel caught between your conviction, shared by your doctors, that drugs can rescue you versus your desire to go off the drugs. We cannot resolve that. On your own, you will need to come to the decision that you are ready to stop using the drugs as a safety net.

 

We also do not offer medication monitoring services as a unpaid adjunct to medical care. If you have started drugs or increased dosage, you need to discuss any issues that arise with your prescriber.

 

Please let us know when you are prepared to taper off your drugs.

[LotusRising]

@MarliesDutch

 

I can certainly relate to your confusion about what to do. Mixed messaging can sometimes make it even harder to make a decision, especially in a society where the adage of  "doctors know best" is prevalent. It sounds like you did what you thought was best for your health at the time, but when you are ready to taper, I can assure you that the harm reduction approach offered on this site, will help you minimize symptoms as you taper. 

 

I would however, caution against going up any more on the benzo. It can add to your taper journey, and can sometimes make things worse. 

 

I like that you're thinking ahead and want to have a plan before seeing the psychiatrist. I would be firm about this, as a psychiatrist may push you to go faster than you want. Thankfully, I had one that allowed me to go at my own pace. Certainly makes a world of difference.

 

Best of luck 💗

[MarliesDutch]

Hi all,

 

my last post was May 8th. That was the beginning of what turned out to be a ‘wave’-week from tapering Paroxetine earlier this year. Very similar symptoms. 

After that week I had 5-6 good weeks. Realy felt like having my life back. Had perspective again.

 

In the meantime I was tapering Lorazepam and came to a point where I was going to fast I guess. Earlier steps without any problems.

Since June 20th experiencing withdrawal symptoms. Intensity like 70% of the ones I had in March-April. Slightly different though, so I would say this isn’t a Paroxetine-wave.

Since June 20th stabilising on 0,375-0,375-0,50mg Lorazepam daily (stared with 3x 1,0mg daily).

 

At this point the tablets are not suitable for splitting anymore, for smaller steps. So I need a new plan.

 

What would your advise be?

- Replacing tablets for suspension/drink, that would be €65,- per month

- In the Netherlands we can order taperingstrips (min. steps of 0,05mg), that would be €400,- per month

- Over to Diazepam (Ashton Manual style) and taper slowly on (eventually) 1 daily dose of Diazepam

- at what pace? 

I have a new psychiatrist who seems willing to think together; informed consent and close monitoring. So happy with that!

 

[Shep]

23 hours ago, MarliesDutch said:

my last post was May 8th. That was the beginning of what turned out to be a ‘wave’-week from tapering Paroxetine earlier this year. Very similar symptoms. 

After that week I had 5-6 good weeks. Realy felt like having my life back. Had perspective again.

 

In the meantime I was tapering Lorazepam and came to a point where I was going to fast I guess. Earlier steps without any problems.

Since June 20th experiencing withdrawal symptoms. Intensity like 70% of the ones I had in March-April. Slightly different though, so I would say this isn’t a Paroxetine-wave.

Since June 20th stabilising on 0,375-0,375-0,50mg Lorazepam daily (stared with 3x 1,0mg daily).

 

Marlies, I'm looking at your signature - on April 23, you were on 3 X 1 mg for a total of 3 mg and then on April 27, you were at 3 X .75 mg Lorazepam, which would total 2.25 mg. That's a 25% reduction. 

 

On June 20, you were down to .375 + .375 + .50, which is 1.25 mg in total.

 

Going from 3 mg down to 1.25 mg is a 58% reduction in a little over two months. Is this correct? If not, please let us know your taper rate over the past few months. 

[MarliesDutch]

That’s true indeed. 

Want to bump my head against the wall seeing the percentages…. My god. I truely didn’t see it this way.

 

I thought: 0,25mg per month and slowing down at the end or when first symptoms would occur.

Omg, could cry right know. Stept in the same sh*tty hole again.

Everyone telling me, that those steps would be small enough.

 

I thought the 25% was okay, just being at 3mg total for four days.

 

Okay. This is a very stupid and important lesson….

 

Stabilizing since june 20th and seeing some improvement. 
 

July 12th meeting with the psych.

 

[Sebas]

On 7/3/2023 at 7:42 PM, MarliesDutch said:

At this point the tablets are not suitable for splitting anymore, for smaller steps. So I need a new plan.

 

What would your advise be?

- Replacing tablets for suspension/drink, that would be €65,- per month

- In the Netherlands we can order taperingstrips (min. steps of 0,05mg), that would be €400,- per month

- Over to Diazepam (Ashton Manual style) and taper slowly on (eventually) 1 daily dose of Diazepam

* Suspension could be an option, €65 month seems reasonable concerning health issues. However this would ideally require a transition/switch and may cause an upset in WD (due to different excipients).

 

* Switch (back) to diazepam will probably cause an upset in WD and risk of kindling and lora withdrawal.

 

* Taperingstrips seem unreasonably expensive and question is whether the product is homogeneous (same supplier).

 

* Don't know if lora can be made into homemade liquid with water. Read more about it in the "making your own liquid" section. This protocol may also be helpful with future paxil tapering. You will be less dependant from pharmacie etc.

 

First wait what @shep would recommend.

 

2 hours ago, MarliesDutch said:

Everyone telling me, that those steps would be small enough.

Everyone: "people with zero practical experience"  

[Shep]

@MarliesDutch Do you feel an updose in the Lorazepam would help? 

 

With benzos, updoses work best within 2 - 4 weeks of the last reduction, so you may not want to updose much since your nervous system is already starting to adapt to the decrease. However, if symptoms are severe, it may be worth going back up a little to see if it helps.

 

Removing a benzo while on an SSRI can be risky. If your goal is to remove the benzo in order to reduce your overall drug burden and stay on Paxil, that may or may not work. Once your nervous system becomes destabilized, even drugs we previously tolerated (without a benzo) may cause problems. 

 

If your goal is to remove both drugs, I would come off the Paxil first. It's your call, of course, but this advice is based on what we've seen on this forum and on the benzo forums. 

 

Taking multiple psych drugs? Which drug to taper first?

[MarliesDutch]

@Shep thanks for the advice.

I was down to 0,25-0,25-0,50 for two weeks and did a little updose to 0,375-0,375-0,50. That did help with managing symptoms.

It’s my idea to continue on 2,5mg Paxil. Not planning to taper in the next year (or two, or maybe even five).

Want to taper and eventually quit the benzo. That’s the only goal.

 

@Sebas what do you mean by ‘require a transition/switch’ if I want to go from Lora-tablets to Lora-suspension? Do you mean not to replace the one for the other in one go?

 

I hear many good things going from Lora to Dia, but: only with a smooth transition that takes up to 4-6 weeks.
I read it’s frequently done to help with the taper (longer half life is one of the reasons). 

But indeed: I don’t know the risk of adding another benzo to the system (after oxa first, then lora).

[Sebas]

11 hours ago, MarliesDutch said:

what do you mean by ‘require a transition/switch’ if I want to go from Lora-tablets to Lora-suspension? Do you mean not to replace the one for the other in one go?

 

Nope any change in meds would require a smooth crossover a.k.a. #transition or #switch: 

 

[Shep]

14 hours ago, MarliesDutch said:

hear many good things going from Lora to Dia, but: only with a smooth transition that takes up to 4-6 weeks.
I read it’s frequently done to help with the taper (longer half life is one of the reasons). 

But indeed: I don’t know the risk of adding another benzo to the system (after oxa first, then lora).

 

If you feel like you're getting interdose withdrawal from lorazepam, you can split out your doses more. You'll want to keep the total daily amount the same, but you can take smaller amounts that total that amount more frequently. This can be easier on your nervous system than introducing a new benzo, especially since this would make the 3rd benzo in the past few months. I would be concerned about hypersensitivity and kindling from all of the changes. 

 

It sounds like your gut instinct is to not do a valium crossover, as you noted, it is an unknown risk. Very true. 

[MarliesDutch]

@Shep I don’t feel like I have interdose withdrawal, so staying on Lora would be my first choice. Also because switching to dia seems to be a huge step. Although it has it’s plus like longer halflife.
 

@Sebas good to know that slow transition is key.

 

And starting at -10% as first step?

 

If I would use Lora suspension, is it possible to switch to do Dia later on in the process? 

 

[MarliesDutch]

Oh! And another question.

If I continue with Lora with 3 daily doses, which one to start with and how to proceed with 3 doses?

10% 14 days afternoon, followed by 10% 14 days morning, followed by 

10% 14 days evening and so on?

 

And what to do when I start experiencing symptoms (mine seem to turn up min after 5/6 days) Is there a max limit time to stabilize? 

 

[Shep]

21 hours ago, MarliesDutch said:

And starting at -10% as first step?

 

If you're unsure how your nervous system will react, you could start at a lower taper rate to test the waters.

 

15 hours ago, MarliesDutch said:

If I continue with Lora with 3 daily doses, which one to start with and how to proceed with 3 doses?

 

It depends. If you find that lorazepam helps with sleep, you could reduce the daytime doses first. You could do that evenly off the two earliest does. 

 

If it doesn't help with sleep, you could reduce all three doses evenly (so the total daily reduction is 10% or less off the prior month's dose). 

 

15 hours ago, MarliesDutch said:

And what to do when I start experiencing symptoms (mine seem to turn up min after 5/6 days) Is there a max limit time to stabilize? 

 

If you see a pattern of upticks in symptoms that are too severe, then you'll want to slow your taper rate. Your symptoms will be your teachers and guides so you know how fast to go. But I wouldn't go faster than 10% a month off the prior month's dose (not the original prescribed amount).

 

Why taper by 10% of my dosage?

 

For information on non-drug ways of handling symptoms, please see:

 

Non-drug techniques to cope with emotional symptoms

 

21 hours ago, MarliesDutch said:

If I would use Lora suspension, is it possible to switch to do Dia later on in the process? 

 

You stated you're not having interdose withdrawal from the benzo you're on, so why would you want to switch to diazepam? Many people struggle to get off that drug, too. The more you switch your drugs around, the more likely you are to kindle your nervous system. The slow taper is the best way we know to get off. 

 

[MarliesDutch]

5 hours ago, Shep said:

It depends. If you find that lorazepam helps with sleep, you could reduce the daytime doses first. You could do that evenly off the two earliest does. 

 

If it doesn't help with sleep, you could reduce all three doses evenly (so the total daily reduction is 10% or less off the prior month's dose). 

 

You stated you're not having interdose withdrawal from the benzo you're on, so why would you want to switch to diazepam? 

 

Hi @Shep,

Your info is very helpfull, thanks!

 

In reaction on your reply: 

1) Maybe I don’t understand you correctly, so checking. Do you mean, taper the daytimes dosis fully before tapering the eveningdose? Wouldn’t that trigger interdose withdrawal or too many highs en lows during the day?

 

2) Would you recommend to spread the 10% reduction evenly over the 3 doses? Like parallel? 
Or could I also choose to go down with 10% with dose 1, followed by 10% with dose two few weeks later etc. 

 

3) About the option to switch to diazepam. I hear many stories about the pro’s of the longer halflife (and with that less chance to experience symptoms) and eventually going to 1 dose per day. In the Netherlands this is a frequently used way to taper of benzo’s. But I’m hestitant to switch to Dia, not knowing what that will do to my nervous system.
 

And my last question for now:

At this point I’m on:

08.15: 0,375mg (2,5 weeks now)

15.45: 0,375mg (4 weeks now 

23.15: 0,5mg (for almost 7 weeks now)

 

It seems wise to taper the eveningdose first, ‘till I’m at 0,375 like the other doses. And then go down evenly.

But does that increase the risk of tolerance-withdrawl with the other two doses, because I’m on the same dose for too long? 

I’m in a Dutch supportgroup and they advice not to stabilize any longer than 14, max 30 days to decrease the risk. Does that make sense?

 

 

[Shep]

18 hours ago, MarliesDutch said:

1) Maybe I don’t understand you correctly, so checking. Do you mean, taper the daytimes dosis fully before tapering the eveningdose? Wouldn’t that trigger interdose withdrawal or too many highs en lows during the day?

 

2) Would you recommend to spread the 10% reduction evenly over the 3 doses? Like parallel? 
Or could I also choose to go down with 10% with dose 1, followed by 10% with dose two few weeks later etc. 

 

 

 

It may create interdose withdrawal. This is why we recommend tapering the nighttime dose last for people who find this drug helpful for sleep. By having a decent night's sleep, they are able to get through the day, even with upticks in symptoms due to interdose withdrawal. Also, not everyone has interdose withdrawal Lorazepam's half-life is 10 - 20 hours, so if you're a slow metabolizer, you may not feel much interdose withdrawal. To help with this, if you don't want to taper the nighttime dose last, you can either taper all of the doses evenly or remove the middle dose first and dose once in the morning and once in the evening so you're not going more than 12 hours in between doses. 

 

There are a number of ways to do this. You will be the best judge because you know how this drug affects your brain and body. If you're finding yourself struggling a lot in between doses and feel a lot of relief after each dose, you may be metabolizing this drug quickly and will want to taper the best way to prevent interdose withdrawal, which would be the even reductions off of each dose. 

 

18 hours ago, MarliesDutch said:

3) About the option to switch to diazepam. I hear many stories about the pro’s of the longer halflife (and with that less chance to experience symptoms) and eventually going to 1 dose per day. In the Netherlands this is a frequently used way to taper of benzo’s. But I’m hestitant to switch to Dia, not knowing what that will do to my nervous system.

 

If you're hesitant to switch, I wouldn't switch, especially with all of the benzo changes you're already had.  

 

18 hours ago, MarliesDutch said:

And my last question for now:

At this point I’m on:

08.15: 0,375mg (2,5 weeks now)

15.45: 0,375mg (4 weeks now 

23.15: 0,5mg (for almost 7 weeks now)

 

It seems wise to taper the eveningdose first, ‘till I’m at 0,375 like the other doses. And then go down evenly.

But does that increase the risk of tolerance-withdrawl with the other two doses, because I’m on the same dose for too long? 

I’m in a Dutch supportgroup and they advice not to stabilize any longer than 14, max 30 days to decrease the risk. Does that make sense?

 

No, this doesn't make sense. You are perfectly comfortable staying on Paxil, which can also cause tolerance issues (see Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”), but you're afraid of tolerance for a few months of taking benzos (I'm including the time you were on Oxazepam). Keep in mind many people stay on the same dose and type of benzo for decades, so we really don't know a time frame for when tolerance sets in and what it looks like for everyone. 

 

If you're going to follow the Dutch support group, please work exclusively with that group. If you read through your thread, you'll see you've ignored our advice and have switched benzos, are tapering a benzo while still on a SSRI, and now what to do a taper that may be more rapid than your nervous system can handle under some arbitrary deadline of not holding more than 30 days. 

 

That thread was started by a moderator who is tapering multiple drugs, including benzos and a z-drug, and is having a much better go of it by tapering all these drugs slowly. 

The slowness of slow tapers

 

I would look at all your options and then stick with the withdrawal group that supports your path. 

[MarliesDutch]

Thanks @Shep, this is really helpfull.

I totally agree with you on my previous steps an being ‘all over the place’. Panicmode was through the roof and I heard so many completely opposite advices.

I’m feeling more stable right now, although having symptoms. 

 

I follow the Dutch group, purely for daily support and reading along (cause no delay in time and same language). Not for advice. I like to stick to this group for advice (learned the hard way….).

 

So my plan will be to stick to Lorazepam. Taper and go down very slow and evenly. Maybe tapering according to the Brassmonkey method. 
Also looking in to resolving tablets, so I can avoid switching to liquid Lorazepam. 

[Shep]

@MarliesDutch I'm glad you've found a support group with people who speak the same language. That's important. The Brasmonkey slide off your current benzo sounds like a good plan. Please let us know if you have any questions. 

[MarliesDutch]

Just a check, because I want to start filing the pills to the correct dose in stead of splitting (never correct enough, so needs a lot of manual correction every time).

 

1 pill of Lorazepam 0,5mg is 0,052 gram pillweight.

So 0,375mg lorazepam would be 0,039 gram pillweight?

And 0,25mg would be 0,026 gram pillweight? And so on…

 

Is this correct or am I missing something important, like additives in the pill etc.

[Shep]

19 hours ago, MarliesDutch said:

1 pill of Lorazepam 0,5mg is 0,052 gram pillweight.

So 0,375mg lorazepam would be 0,039 gram pillweight?

And 0,25mg would be 0,026 gram pillweight? And so on…

 

Is this correct or am I missing something important, like additives in the pill etc.

 

Yes, your math is correct. 

[MarliesDutch]

So, I made a schedule in excel for tapering. Per month I would do:

- Week 1: minus 5%
- Week 2: minus 5%
- Week 3+4: holding

At least 2 months to see how that pace works for me.

 

But, as I look down the months to come I have 3 questions:

 

A- check: calculation of -5% of the Lora mg and not the pillweight, right?

 

B- I won’t be able to make the proper cuts further down, cause the pillweight stays the same (scale: 0,000). What can I do with that problem? (tried to insert a photo, but won’t work…)

 

C- in the Netherlands they say the ‘jumpdose’ is 0,05mg. Is that per dose or per day (3 dose per day combined)?

 

 

[Shep]

14 hours ago, MarliesDutch said:

A- check: calculation of -5% of the Lora mg and not the pillweight, right?

 

You will need to get the pill weight first and then remove 5% from that amount. It may help to look at videos of using a scale to taper. 

 

This is a video of someone tapering Klonopin, but it will also work for any benzo, such as your lorazepam. He's doing a batch of 7 pills by getting an average, but you can do one pill at a time, if it's easier. The method is the same. 

 

Micro tapering Benzodiazapine, Klonopin  video (9.5 minutes)

 

Please note: each tablet will weigh a slightly different amount, as each tablet has slightly differing amounts of fillers. 

 

For more on using a scale, please see:

 

Using a scale to weigh and measure doses

 

14 hours ago, MarliesDutch said:

B- I won’t be able to make the proper cuts further down, cause the pillweight stays the same (scale: 0,000). What can I do with that problem? (tried to insert a photo, but won’t work…)

 

I'm not sure what you're asking. What type of scale are you using? Please post the brand name. If you're able to link to what you purchased online, that will be helpful. 

 

14 hours ago, MarliesDutch said:

C- in the Netherlands they say the ‘jumpdose’ is 0,05mg. Is that per dose or per day (3 dose per day combined)?

 

The guide of 0.05 mg is the total daily dose (3 doses combined). However, I wouldn't go by a specific dose. The 0.05 mg is probably coming from a benzo forum that is using the Ashton Manual as a guide, which is an older guide that many people find tapers too quickly and doesn't go low enough. When you get to 0.05 mg, if you're still having symptoms, you'll want to taper lower. Please don't feel you have to stop at 0.05 mg if you're still struggling. It's okay to go lower. The less symptoms you have when you stop your drug, the easier your recovery will be. 

[Shep]

1 minute ago, Shep said:

The guide of 0.05 mg is the total daily dose (3 doses combined). However, I wouldn't go by a specific dose. The 0.05 mg is probably coming from a benzo forum that is using the Ashton Manual as a guide, which is an older guide that many people find tapers too quickly and doesn't go low enough. When you get to 0.05 mg, if you're still having symptoms, you'll want to taper lower. Please don't feel you have to stop at 0.05 mg if you're still struggling. It's okay to go lower. The less symptoms you have when you stop your drug, the easier your recovery will be. 

 

@MarliesDutch I forgot to add to this that as you get down to these lower doses, it's important to realize that some of your symptoms may not just be lorazepam withdrawal - as the benzo dose is lowered, you may have some side effects of the Paxil coming through that was being masked by the benzo. You can re-read your thread for more information about that, as we discussed this earlier, but I wanted to draw attention to this since you mentioned the end game of the benzo taper. 

[MarliesDutch]

56 minutes ago, Shep said:

 

@MarliesDutch I forgot to add to this that as you get down to these lower doses, it's important to realize that some of your symptoms may not just be lorazepam withdrawal - as the benzo dose is lowered, you may have some side effects of the Paxil coming through that was being masked by the benzo. You can re-read your thread for more information about that, as we discussed this earlier, but I wanted to draw attention to this since you mentioned the end game of the benzo taper. 

Thank you Shep, I have some questions about this (I re-read my thread yesterday twice).

I you say ‘some side effects of the Paxil coming through’. Do you mean: 

 

- effect of the lower dose of Paxil, so less filtering of feelings and emotions? Effects that now are being masked by a benzo. 

- or withdrawal of the Paxil, masked by a benzo? Even when reaching lower levels of the benzo in about 1,5 years or so?

 

 

Having a hard day today, very emotional, only seeing doom scenario’s for tapering, little burning sensations again and had some palpitations… Always makes me scared of things escalating.

Haven’t had any changes in meds since June 20, so worried now.

Just a wave? Tolerance (how can one now?)? Benzo? Paroxetine?

Maybe I should give it a few days, not panicing about this immediately. Sigh…

 

[MarliesDutch]

And a different question/scenario.

I would like to have some thoughts on this by members of the forum here.

Long read….

 

 

BACKGROUND
I have GAD and a phobia since I was a kid. Later also diagnosed with personality disorder. This was always present in daily life, sometimes more, sometimes less. For some periods of time it was debilitating. 
Despite that I managed to get through school and graduated as an occupational therapist.

START PAROXETINE

But in 2007 I crashed hard. My anxiety was sky high and I developed OCD-like behaviour, this was a process of 6 months I guess. All of this made me lose weight, at my deepest it was 46kg (with 1.78m). That was the start of Paroxetine. 
It brought me back on my feet (starting was hell though…). 
After appr. a year we tapered the Paroxetine (the wrong way I know now), without any problems. 
About 10 (?) months later the same thing as in 2007 happened. So in 2009 started Paroxetine again, this time with less problems.

Since that never had any side effects with Paroxetine. I was like ‘some take a pill for bloodpressure, I take a pill to have a life that’s worth living’.

 

Between 2007-present I had lot’s of therapy. And I really mean: lot’s. I’ve tried everyone in the book.

 

And in winters I experience a slight uptick in anxiety and panic.

 

TAPERING 2021
At the beginning of 2021 I felt that I was sliding down. I felt down and had the feeling I couldn’t manage things anymore. Things where ‘too much’ quickly. No physical symptoms. I searched for therapy again.

In summer of 2021 I started tapering Paroxetine because I didn’t know what it was doing actually (“low dose”… I know better now) and I was reasonably stable. I also wanted to find out if my s*xuality would improve by tapering. Because it affects my relationships. But also not knowing if I could do without antidepressants. 

Tapering from 10-3mg went pretty good. Had withdrawal as I came to 2,8mg. Went back on 3mg and stopped tapering further. Withdrawal subsided after 1,5 week.

I noticed emotions where more present and intense. Sometimes that was hard, but also a good thing. They could guide me through life in stead of avoiding and ignoring them (which I guess, was part of my problem).

In oktober that year I called in sick at work for a few hours. In december for more hours. Work asked too much of me.

 

2022

And in feb 2022 they adviced to do a few months clinical therapy: affect phobia therapy. In order to get ‘better’ hopefully. So I did 5 months of therapy. After that it took recovering: mentally and physically due to all the stress.

 

2023 

This year had to be the year of further recovery and getting back to work. And in january I decided to taper the last bit of Paroxetine.

(Still don’t know why, because was in full recovery… Guess I wanted to see improvement in s*xuality so bad…).

 

And then I crashed when tapering; huge withdrawal because I was going way to fast (I know now). Became seriously suicidal and took oxa, followed by Lora. And know having withdrawal from Lora to complete ‘the package’….

 

QUESTION

Since the first taper of Paroxetine in 2021, it feels like I haven’t had a new ‘point zero’: a few months or more to see what the effect of tapering was. Because of therapy and ultimately withdrawal this year.
 

So: I don’t know if I can do ‘life’ without antidepressants?? 
 

THOUGHTS

Since end of May I have a new psychiatrist who is very willing to think with me and go as slow as I need. He’s not into the poly-drugging etc, more into acceptance&commitment/mindfulness/compassion. 

 

Together we figured it would be best to just ‘hold’ the benzo for two months. To see if more stability sets in and to see what my mood and emotions would be like.

 

But he also gave me the question: “can you go with just 2,5mg Paroxetine or without antidepressants? Cause if you want to go up in the future, it is best not to taper benzo’s till you’re stable on new/higher dose of antidepressants.”

 

And that’s a tough question. Cause I really don’t know. Wish I did.

But I can’t handle the thought of going back up or switching. Can’t handle more symptoms or dysregulation. For now just want off the Lorazepam. But at the same time I don’t know the right answer and that keeps me busy.

 

Anyone been in the same situation? Or shine a different light on the situation.

 

 

 

 

 

[Sebas]

2 hours ago, MarliesDutch said:

About 10 (?) months later the same thing as in 2007 happened.

Most likely to be delayed withdrawal.

 

2 hours ago, MarliesDutch said:

But in 2007 I crashed hard.

Why?

 

2 hours ago, MarliesDutch said:

At the beginning of 2021 I felt that I was sliding down. I felt down and had the feeling I couldn’t manage things anymore.

Paxil drug efficiency may 'poop out' after such a period.

 

2 hours ago, MarliesDutch said:

Tapering from 10-3mg went pretty good. Had withdrawal as I came to 2,8mg. Went back on 3mg and stopped tapering further. Withdrawal subsided after 1,5 week.

I noticed emotions where more present and intense. Sometimes that was hard, but also a good thing. They could guide me through life in stead of avoiding and ignoring them (which I guess, was part of my problem).

In oktober that year I called in sick at work for a few hours. In december for more hours. Work asked too much of me.

You probably went too fast from 10 to 3 mg. Possible rebounce in oktober/december.

 

2 hours ago, MarliesDutch said:

Guess I wanted to see improvement in s*xuality so bad…).

Pace is a bad counselor.

 

2 hours ago, MarliesDutch said:

I don’t know if I can do ‘life’ without antidepressants?? 

Of course you can. Though this will require facing difficult tapering symptoms with non drug ways of coping. 

 

2 hours ago, MarliesDutch said:

? Cause if you want to go up in the future, it is best not to taper benzo’s till you’re stable on new/higher dose of antidepressants.”

There's only one way and that's keeping steady or going down (and sometimes a tiny updose). This should be your strategic guideline. 

 

 

 

 

[Sebas]

8 hours ago, MarliesDutch said:

Having a hard day today, very emotional, only seeing doom scenario’s for tapering, little burning sensations again and had some palpitations… Always makes me scared of things escalating.

Haven’t had any changes in meds since June 20, so worried now.

Just a wave?

Lots of people on this forum have these troubled thoughts, palpations, anxiety and they are "just" symptoms of waves. You probably had something that interfered with your meds such as caffein, alcohol, chocolate, spices etc. 

 

 

[MarliesDutch]

1 hour ago, Sebas said:

Lots of people on this forum have these troubled thoughts, palpations, anxiety and they are "just" symptoms of waves. You probably had something that interfered with your meds such as caffein, alcohol, chocolate, spices etc. 

Thanks Sebas! I guess I won’t find out. Hoping for a better day tomorrow!

 

I’m staying away from things like caffein, alcohol. I can test if chocolate or spices have an effect.

How did you discover your specific food allergies?

[MarliesDutch]

2 hours ago, Sebas said:

“Most likely to be delayed withdrawal.” 
> Wow, didn’t know that was possible after so many months.

 

“Why?”

> Can only guess that stressfull things combined and that my weakest points flared up (anxiety, OCD, bad coping).

 

“Paxil drug efficiency may 'poop out' after such a period.”

> I read about that, but not sure if there’s a way to know that it’s in fact poop out or just ‘life’ taking a turn again?

 

“There's only one way and that's keeping steady or going down (and sometimes a tiny updose). This should be your strategic guideline.”

> You mean on Paroxetine or Lora?

Ar this point I can only oversee the route of keeping Paroxetine steady and tapering the Lora very slowly.

[Sebas]

9 hours ago, MarliesDutch said:

How did you discover your specific food allergies?

By trial and error. 

[Sebas]

9 hours ago, MarliesDutch said:

> I read about that, but not sure if there’s a way to know that it’s in fact poop out or just ‘life’ taking a turn again?

Life doesn't just suddenly take a turn without a clear cause.

 

9 hours ago, MarliesDutch said:

You mean on Paroxetine or Lora?

I meant paxil but same goes for lora.

 

[Shep]

10 hours ago, MarliesDutch said:

I’m staying away from things like caffein, alcohol. I can test if chocolate or spices have an effect.

How did you discover your specific food allergies?

 

You may want to do an elimination diet and / or keep track of your food and any upticks in symptoms. 

 

Food sensitivities

 

Elimination or exclusion diets for reactions to food (food intolerance)

 

[MarliesDutch]

Thank you for all the input and thoughts @Shep and @Sebas! 

Also read the links you posted and some journals on this website (and a lot of science articles earlier this year).

Makes me go foreward in my process of getting more knowledge and making a decision. 

 

I know there is no ‘best’ decision: one way or the other, things are going to be (very) hard. But I want to make the decision that is most doable for me. That I can function for a bit (like I can right now) and not constantly get stuck. 

 

I think I have two scenario’s.

A- no further tapering of Paroxetine. Going to taper Lorazepam first, as slow as I need. After that, deciding about further tapering Paroxetine. This feels like my way to go.

B- tapering Paroxetine. When off, stabilizing until in ‘safe zone’ and continue with tapering Lorazepam. Could mean I’m on benzo’s for many years to come. 

Some questions to go with those scenario’s:

1- Which of the two medicines gives a greater/quicker risk of tolerance (and withdrawal to go with that)? 

2- Which medicine is more suitable for holding and slighty updosing if needed? 

3- How can I be sure I pooped-out on Paroxetine? And when experiencing this, is this the same (symptoms) as withdrawal of Paroxetine? Or is it ‘just’ not working anymore? Couldn’t find a lot of info about this.

4- “When tapering Lorazepam, side effects of Paroxetine can come through” (quoting Shep). Are these side effects of the lower dose of Paroxetine I reached when tapering prior? Or the withdrawal coming through? Also when I’m (for example) 1,5 years into Lorazepam tapering? 

 

All this takes a lot of headspace. I want to make a decision that feels manageable. I’m very sad about the whole taperingprocess, knowing it’s going to be hard. Just tired a.f. Been trying to ger back up since beginning 2021.

 

And I also try to see that there’s a group of people not on this site or ‘leaving’ because their process is going relatively well. So that there are more experiences which I do not know of. To keep myself going.

 

(And I want to acknowledge that by introducing Lora despite your advice, I made it more difficult for myself. But without I probably would not be here anymore. And I’ll carry the consequences for that.

And still very thankful for your patience and answering the tons of questions I have 🙏🏻.) 

[Doctorsrcrap]

@MarliesDutch

Hi there. I'm not a mod so I can't give any advice but my question would be why do you want off the benzo first? Isn't paroxetine more activating? Wouldn't the benzo help soften the blow of the AD? 

I could be wrong and I dint want to overstep the mark, but just food for thought. 

Maybe @Shep or @Sebascan clarify my theory here.