MarliesDutch Dutchie tapering Paroxetine (/Paxil) 14yrs

[MarliesDutch]

Late January I’m going to start tapering my benzo after 10 months of use. Currently on 1,8mg a day (total of 3x 0,6mg).

 

I’m looking into different taperingmethodes. Earlier in the proces I tried a dry taper with scale and capsules. But I god irritated by the scale that sometimes wasn’t reliable enough (although it’s the scale recommended here on SA).

 

So there are two other options:

- tapering with the Lora liquid (1mg/ml = 0,05mg per drop), with the options of mixing drops with water, to get 0,025, 0,0125 etc.

- watertaper with solving Lora tablets of 0,5mg

 

With both options I can follow the same pace, but with the water taper I can make smaller steps along the way.

f.e. tablet of 0,5mg Lora solved in 300ml water, take 1ml out every day, means a gentle decline of 0,003mg every day and a total of 0,05mg a month. And ofcourse, I could go slower when needed.

(Although water taper is a bit of a hassle, 3x a day, whereever you go.)

 

Which options would be the most accurate and reliable way of tapering?

 

 

(after the holidays also going to the farmacist to see her point of view on this, like: are the options possible, ‘chemicle-wise’. But don’t know if she ever got a question like this before, so really appreciate the knowledge on SA).

 

 

[LotusRising]

4 hours ago, MarliesDutch said:

Which options would be the most accurate and reliable way of tapering?

 

It might come down to personal preference. Do you want the convenience of having the medication already made for you, or do you want to prep it yourself? Alternatively, can you get it compounded by your pharmacist where you are? This would be the most convenient and accurate, but I know this option isn't available for everyone.

[MarliesDutch]

@LotusRising thank you for replying so quick!

 

Unfortunately it’s not available in these small amounts (Netherlands). There are taperingstrips available, but the smallest amounts is 0,05mg. Same as the liquid. But liquid is cheaper than taperingstrips with 3 doses a day.

I’m investigating the option to go to Belgium for compounded dosing.

Have to look into that. I heard it’s possible over there, even the smallest amounts. 
 

But I guess I want to start with the options I described to see how that goes, before the Belgian-option. Also because it gives me most flexibility in dosing/stabilising when needed. That way I’m not dependant on the Belgian pharmacist. But yeah, it also brings inconvenience when preparing doses myself.

 

[MarliesDutch]

Can I ask you another question @LotusRising?

 

At december 25th I did my last updose of Paroxetine (2,9 to 3,0mg). Since then I’m back on my old dose, the dose before crashing because of tapering to rapidly exactly one year ago.

During the updoses (started in september) I slowly felt better and more stable. During the updoses I had some wavy days/week without a clear pattern (like: not standard xx days after the updose) and symptoms like some muscle twitches, an incidental ring in the ear, loose stool, more crying and feeling depressed, shivers, knot in the stomach. But all doable and letting me function.
 

Now, 6 weeks after the last updose I had 1,5 week of some minor symptoms flare up (after having two realy good weeks): some burning sensations on the chest or in my legs for few hours, some loose stool now and then, palpitations now and then, a higher basic heartrate for a week, lower HRV (so Fitbit says), a little more sad and crying, feeling very tired (esp. physically).

 

My question is: how can I determine if this is a small wave from AD-recovery or if this is benzo-tolerance occurring ? 

 

My goal is to start the benzo-taper next week on Feb 1st. 
If this was a AD-wave, maybe I’ll have to take another month of letting things settle down? Or is it safe to start tapering?

If this is benzo-tolerance, I want to start Feb 1st to give the receptors a chance to heal, right?

 

I have an extensive spreadsheet that I use to track daily symptoms, ever since crashing a year ago. But I can’t seem to find the answer to my question above.

 

Does your experience and knowledge bring any tips or questions to help me figure it out? Or is it just: go and start slow? 
 

My first reduction would be 6,5% and see how that turns out and see what symptoms occur (and if they are different from AD symptoms).

 

[LotusRising]

Hi @MarliesDutch,

 

Sorry for the late response, I've been away. 

 

On 1/25/2024 at 3:07 PM, MarliesDutch said:

My question is: how can I determine if this is a small wave from AD-recovery or if this is benzo-tolerance occurring ? 

The short answer is that it would be difficult to tell since both can cause similar symptoms. 

 

On 1/25/2024 at 3:07 PM, MarliesDutch said:

My goal is to start the benzo-taper next week on Feb 1st. 

Is there a reason you want to start with the benzo? We usually recommend starting with the more activating drug first, which in your case would be paxil.

 

On 1/25/2024 at 3:07 PM, MarliesDutch said:

If this was a AD-wave, maybe I’ll have to take another month of letting things settle down? Or is it safe to start tapering?

If this is benzo-tolerance, I want to start Feb 1st to give the receptors a chance to heal, right?

You should start tapering when you feel stability. This link will help you understand what this means Stability

 

Yes, the idea is that you're giving your receptors a chance to upregulate, after being downregulated from use of the drug. 

 

[MarliesDutch]

Hi all!

a little update and questions about how to proceed my benzo-taper.

Currently on 3x 0,522mg a day of Lorazepam. Not experiencing interdose problems. Idealy I want to take a step every 3 weeks, but had to postpone twice already.

A summary of the last months:

 

Feb 1: 0,566 -> 0,544 = 4%
Week 1 and 2: symptoms started day 4, lot of bodypain, stiffness, muscle twitches, cortisolrush, more emotional, waves of anxiety, higher heartrate, low HRV

Week 3: fatique, burning sensations, pressure stomach, brainfog, sore throat

Week 4: sudden onset of severe depression, suic. ideation, shivers, flushed head

All ‘normal’ again at day 28 before next step.

 

March 3: 0,544 -> 0,533 = 2%

Week 1: pretty okay week, minor cortisolrush, burning sensations, real symptoms started day 6/7

Week 2 and 3: feeling bit flu-ish, burning sensations, fatigue, stiffness unwell when waking up, cortisolrush, last few hours of sleep are restless

All ‘normal’ again at day 19.

 

March 24: 0,533 -> 0,522 = 2%
Week 1: pretty okay week, anxiety, less spontaneous appetite, real symptoms started day 6/7

Week 2: higher heartrate, low HRV, stiffness, chest pressure, fatigue

Week 3: nightmares, last hours of sleep restless

Week 3 and 4: intens pressure stomach, severe pain mid-back or pelvis, dread, obsessive, frustration, crying, severe depression, suic ideation -> seem to get worse last few days

Week 4: wobbly/ dizzy feeling in head

 

Up untill the last two weeks I was coping pretty okay, with ups and downs. But the last few weeks are really difficult and I don’t know what to do in the short term.

Sunday would be ‘end of week 4’ and time for my next reduction.

 

- Should I wait ‘till symptoms clear?

- Should I taper further, scared for symptoms to keep building?

- Should I hold, but scared for tolerance-withdrawal?

- Should I taper with an even smaller percentage (1%)?

- Should I start a microtaper (current dilution is 0,022mg in 0,4ml which is 40 stripes on the syringe (next to a 0,5mg tablet))?

 

And any idea why my symptoms seem to turn op pretty late after a dose reduction, given the fact that Lorazepam is short(er) acting / short halflife? 

 

Hope for some support and wisdom! Thanks in advance!! 🌻

 

[LotusRising]

7 hours ago, MarliesDutch said:

Week 1: pretty okay week, anxiety, less spontaneous appetite, real symptoms started day 6/7

Week 2: higher heartrate, low HRV, stiffness, chest pressure, fatigue

Week 3: nightmares, last hours of sleep restless

Week 3 and 4: intens pressure stomach, severe pain mid-back or pelvis, dread, obsessive, frustration, crying, severe depression, suic ideation -> seem to get worse last few days

Week 4: wobbly/ dizzy feeling in head

It sounds to me like the symptoms are a little worse this last cut. If it were me, I would hold another week and see if they settle out. 

 

7 hours ago, MarliesDutch said:

And any idea why my symptoms seem to turn op pretty late after a dose reduction, given the fact that Lorazepam is short(er) acting / short halflife? 

I can't say for sure, but I know the nervous system heals in patches, so it moves around to different areas. It could be that yours is working in a certain area, and then needs to move to another to do some work there too. That was my experience.

 

If you feel the symptoms are too difficult, you could certainly try a microtaper. Or, you could just give yourself more time in between your cuts. I don't think you need to worry about tolerance withdrawal with holding an extra week.

 

 

[MarliesDutch]

@LotusRising thank you Lotus! Appreciate your quick response!

It’s so weird. I just seem to get worse last 2/3 weeks. Since 2/3 days more symptoms like wobbly head on the left, panic in the left side of my body, feeling ‘revved up’, falling asleep is worse, loops with music and constant depression and suid ideation. 
I’m Just really scared.

Scared it get’s worse, scared this is tolerance and I’m stuck. 😞