SSRIHelp: Introduction

[SSRIHelp]

I have been on antidepressants since I was in middle school. I was not informed about withdrawal or tapering until years later, specifically only when I was ill advised to quit cold turkey. I was taking Paroxetine for seven years and stopped around the 16th of March this year. The medicine worked great but I had to gradually increase the dose over time because I felt it was losing effectiveness. At some point, the dose was upped too high, and I experienced a rapid beating heart, weakness, and chest pain. When I went back to the previous dose, the symptoms slowly subsided. I believe this dose was 40mg, although I can't remember for certain, this is just the last pill bottle of Paxil I still have. Since the Paxil was no longer working, my primary physician switched me directly to Celexa 10mg 16th of March). Around the 30th of March, the dose was increased to 20mg. Around the 9th of April, the stomach pain began (constant upper central abdominal pain and full feeling, loss of appetite, early satiety—greasy/fatty foods hurt the most but any food tends to cause discomfort).

 

I assumed the pain came from the increased dose of Celexa, so I went back down to 10mg for a week and then went off of it around the 13th of June and switched to Cymbalta. I only stayed on the Cymbalta for about a week because it had caused my skin to break out with rashes. The stomach pain still persists. I have had several tests that came out normal (endoscopy with biopsies to rule out h.pylori and celiac disease, barium swallow, CT scan, ultrasound). Looking back at the calendar, it was only a little over three weeks of stopping the Paxil did the pain start, so I'm now thinking I am experiencing withdrawals. A lot of members on this site seem to have similar digestive issues. I had been on the Paxil for years and my doctor switched me off of it abruptly. However, I've never experienced brain zaps or other symptoms that I can think of.

 

The only other medication I was on at the time of the stomach issues starting was birth control (Sprintec), however, I do not notice any difference when on the placebo week so I do not think it is the cause. I started it months before the pain began. I tried over the counter nexium for a few weeks but it didn't help. I was then prescribed Famotidine, Pantoprazole, and Sulcralfate which did not help either. I was then prescribed Amitriptyline 25mg. I feel it may have taken the edge off the pain but it didn't do much beyond that. So what I am currently taking now is 40mg Pantoprazole, 25mg Amitriptyline and Sprintec. I would like to stop taking the PPI because I've read that it can make things worse (most people with GERD tend to have low stomach acid) and I don't want to stay on the Amitriptyline because it is another antidepressant I could get dependent on, but I'm afraid of the pain getting beyond unbearable again.

 

I have reinstated 5mg of Paxil starting from the 3rd of this month (July). Although it is hard to say for certain, I believe I may have gotten a tiny bit of relief. I was able to go out for an extended period of time with minimal pain while usually there is constant abdominal pain. The pain can be debilitating and mentally exhausting, causing me to sit around all day when I am not at work. Oddly, the pain is also more noticeable when I am standing rather than sitting. It feels like there's a giant rock weighing down my gut. I will continue to take the 5mg to see if there is any more improvement, and may increase a small amount soon. So far, I haven't gotten any adverse effects from reinstating, but I will remain cautious.

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  Yes, it is quite possible that your stomach pain could be from the recent drug changes.  You may be experiencing a combination of adverse effects and withdrawal. 

 

Can you please give us specific date information (as best you can remember, say early/mid/late month if you don't remember the day) in your signature about your drug history for all drugs and supplements you are on and have been on, especially for the past 18-24 months?  That way, it will be seen with each and every post, so we don't have to read through your past posts to find the information.  Please read the link below for instructions.  

 

How to List Your Drug History in Your Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses: 

 

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

 

 

Please read this link on reinstatement.  I'm glad that it seems to be helping you a little bit.  

17 hours ago, SSRIHelp said:

I will continue to take the 5mg to see if there is any more improvement, and may increase a small amount soon

I would not suggest increasing your dose just yet.  Every time we change a dose of our psych meds, it tends to destabilize and confuse our nervous system, and is likely to make the problem worse.  Making frequent dosage changes, and drug starts and stops, is not a good idea, barring a severe adverse reaction. 

 

Keep It Simple, Slow, and Stable

 

It can take a month or two for a reinstatement to become fully effective.  Also, a reinstatement is not a magic fix, and will probably not take away all your symptoms, but should reduce them and make them bearable.  

 

When I see specific dates on your various drugs - the dates you started and stopped, and each date you made a dose change, I might be able to give more suggestions.  

 

 

Edited July 11, 2023 by getofflex

[getofflex]

P.S.  I'm glad you stopped the Cymbalta after a week.  That can be a nasty drug to withdraw from. 

 

At what dose of Paxil did you have the adverse reaction (fast heart rate, chest pain, etc)?  Was it the 40 mg dose, or a higher dose?  

Edited July 11, 2023 by getofflex

[SSRIHelp]

On 7/11/2023 at 1:32 PM, getofflex said:

P.S.  I'm glad you stopped the Cymbalta after a week.  That can be a nasty drug to withdraw from. 

 

At what dose of Paxil did you have the adverse reaction (fast heart rate, chest pain, etc)?  Was it the 40 mg dose, or a higher dose?  

 

Hello getofflex, I'm sorry I took so long to respond, and I'll try to update my signature soon. I can't remember for sure what dosage caused the reaction. The 40mg is the last pill bottle I have kept which makes me think it is likely the dose that caused the reaction. The pain subsided after going back down.

 

As per your suggestion, I haven't increased the dosage yet and have continued to take the 5mg. I had a gastric emptying study that revealed I had gastroparesis (27% of food was still in my stomach after four hours). Since the symptoms happened three weeks after stopping the Paxil, and because reinstatement has caused moderate improvement, I believe the withdrawal is what caused this. I am so far managing with eating smaller meals more frequently and avoiding trigger foods (fatty/greasy meals). 

 

I've been struggling with depression and anhedonia since all of this happened, but I know I lot of people struggle through much worse than I have so I try to stay positive.

[CloudyToday]

Hi @SSRIHelp,

I'm also withdrawing from paxil and having similar GI issues. I would say your digestive issues are from stopping paxil abruptly. 

What tests did you have that confirmed gastroparesis?  

[SSRIHelp]

Hello @CloudyToday,

I had a test called the gastric emptying study. Essentially, you eat a bit of food with a tracer in it and then get pictures taken every hour for four hours. 90% of the food should be digested by the four hour mark, but my test showed only 73%. 

[Altostrata]

On 7/28/2023 at 11:31 AM, SSRIHelp said:

I've been struggling with depression and anhedonia since all of this happened,

 

@SSRIHelp emotional anesthesia is a very common consequence of antidepressant use. We've seen it very slowly fade.

 

It sounds like your digestive symptoms are somewhat resolving. Good idea to hold on the dose for a while. 

 

Please put ALL your current drugs in this Interactions Checker and post the report or a link to it in this topic.

[CloudyToday]

SSRIHelp - 

Understood. Did the GP symptoms lessen after you reinstated? In my case I was just tapering slowly and got the GI issues almost overnight.

I hope you are feeling better now.

[SSRIHelp]

CloudyToday-

Yes, the symptoms of GP have somewhat improved. The worst symptom I get is an abdominal pain that used to be constant. It would get significantly worse after eating. This severely limited what I was able to eat because I got full very fast and was afraid of the pain getting worse. Now, I am able to eat things I couldn't before. Sometimes there's a bit of discomfort or naseau if I over do it, but it hasn't gotten as bad as it was before. I'm now able to eat ice cream again in moderation, which I'm pretty ecstatic about since its one of my favorite things to eat. I'm definitely far from normal and still have some bad days, but I'm optimistic that over time, my body will be able to heal. I'm sorry you are experiencing similar issues with your tapering, but hopefully since you didn't abruptly switch medications (essentially dropping Paxil cold turkey) like I did, you'll be able to adjust much quicker.

[CloudyToday]

SSRIHelp ,

Thanks for sharing. I'm glad that your pain  is less prominent now. It is encouraging that your GP symptoms got better and I'm sure it will clear up over time. Mine got better too. I think processed foods and gluten makes me feel sick so I'm eliminating these.

Be careful with the Amitriptyline as I've read some members here got nasty withdrawals from it. 

 

Take care,

Cloudy

[PurpleRein]

Has your doctor checked your Vitamin D?  Low Vitamin D can cause gastroparesis (so can Cymbalta).  Normal is 50

Here's a study on low Vit D and gastroparesis.

https://n.neurology.org/content/78/1_Supplement/P05.198#:~:text=Conclusions%3A Vitamin D levels correlate,and symptoms related to it.

 

[Altostrata]

Many people need vitamin D3 supplementation but low vitamin D is not the cause of everything. Always a good idea to have vitamin D level checked.

[SSRIHelp]

On 8/5/2023 at 5:11 AM, PurpleRein said:

Has your doctor checked your Vitamin D?  Low Vitamin D can cause gastroparesis (so can Cymbalta).  Normal is 50

Here's a study on low Vit D and gastroparesis.

https://n.neurology.org/content/78/1_Supplement/P05.198#:~:text=Conclusions%3A Vitamin D levels correlate,and symptoms related to it.

 

PurpleRein, I don't think vitamin deficiencies or the Cymbalta was the cause of the gastroparesis. Prior to the digestive issues starting, I had already started taking a vitamin D supplement. I also had blood work done recently in the ER that would have likely spotted any concerns. In regards to the Cymbalta, I was only taking it for about a week, and it was after the stomach issues started. The symptoms of gastroparesis started about three weeks into taking the Celexa and stopping the Paroxetine.

[Ma205]

H

On 8/3/2023 at 6:01 PM, SSRIHelp said:

CloudyToday-

Yes, the symptoms of GP have somewhat improved. The worst symptom I get is an abdominal pain that used to be constant. It would get significantly worse after eating. This severely limited what I was able to eat because I got full very fast and was afraid of the pain getting worse. Now, I am able to eat things I couldn't before. Sometimes there's a bit of discomfort or naseau if I over do it, but it hasn't gotten as bad as it was before. I'm now able to eat ice cream again in moderation, which I'm pretty ecstatic about since its one of my favorite things to eat. I'm definitely far from normal and still have some bad days, but I'm optimistic that over time, my body will be able to heal. I'm sorry you are experiencing similar issues with your tapering, but hopefully since you didn't abruptly switch medications (essentially dropping Paxil cold turkey) like I did, you'll be able to adjust much quicker.

hi has this gotten better? I’m experiencing pretty awful GP during a minimal taper. I have so far to go and I don’t know what to do. It’s been 3 weeks since the taper and it’s not getting any better. 

[SSRIHelp]

@Ma205

 

I'm sorry for responding so late! My gastroparesis has not fully gone away, however, it's become a lot more bearable. Here lately, the pain has been pretty minimal. I have hope that I will continue to improve. Since you are tapering and didn't cold turkey like I did, you may find some relief sooner than I did. If you are still experiencing the symptoms, you could try going back up a dose until you stabilize a bit. However, I'm not an expert on the matter and I'd ask one of the moderators for more experienced advice.