cousteau: Long Seroxat user - Tapering questions

[cousteau]

A warm hello and thank you for all the great work you do,

 

I am a Greek, happily married, 36 years old male and I found you by googling 2 years ago and I must say coming in here is both frightening and eye opening for me. Please bare any spelling mistakes and feel free to edit if applicable. I will also try to keep this short, because I have so many questions and things in my head .

I was prescribed in 2011 with Seroxat 20mg for panic attacks, agoraphobia and anxiety disorder and I have been taking them since. I would also like to add here that I am a “huge” overthinker. Pills helped me a lot and still do (I suppose) with some really stressful life events. Approximately 2 years ago, whilst feeling at the top of my game, I decided to start cutting down on my doses without consulting my psychiatrist. I went down from 20mg to 10mg instantly and kept there for about 6 months. At the beginning I had some slight WD symptoms like blurry vision, dizziness and some anxiety spikes, but nothing major. I was also working in a new job, so I didn’t pay much attention to symptoms. I was feeling really great, more energetic, more playful, more “clearer” in my head if I could say. I also noticed a huge improvement in my sexual drive for those 6 months, so I decided to continue cutting down on my dose. I bought a pill cutter and tried to cut my 10mg pill in half. Some days it “looked” like half and some others not, but I kept going. It was when I noticed my symptoms getting slightly more intense, but I knew it was from the discontinuation. In less than 1 month I had a lot of severe symptoms and I didn’t know what to do. I won’t go down with the whole list of my symptoms, but it was a LOT. I called my psychiatrist (hadn’t talked to him for like 5 years) and he told me to start taking 20mg of Seroxat again along with 0,5 mg of Xanax per day for 2 weeks to help me with my sleep. As I found out here this is called the reinstatement process. Symptoms kept on going for like 1.5 year and the most frightening, for me at least, was that of derealisation/depersonalisation, because I had never felt it before. Back in 2015 I was also struck with sudden deafness from my one ear which left me with constant Tinnitus, which got pretty bad during the WD period. It was one of the worst periods of my life, having to deal with all these symptoms and not knowing if I am going to stabilize. Thankfully, I have a really supportive wife & family and my doctor kept reassuring me that everything is going to be alright.

So here I am today (a little bit anxious again for the past months) because I have been thinking of starting tapering my dosage hopefully the right way this time.

I have been reading a lot, watching a lot of Youtube videos for the past couple of years and I have gathered a lot of invaluable information about proper tapering antidepressants. The Brassmonkey method, Altostrata’s story, Chessiecat, Dr. Mark Horowitz, Outro, Claire Weekes books and many many more, but I have some basic questions for when the time comes to start tapering. Right now I am unemployed and I don’t think it’s the right time for me to start the tapering journey. Being also in Greece, means that I don’t have access to healthcare professionals “properly educated” about tapering antidepressants, compounding pharmacies and other related resources (at least of what I know of). Even my doctor, who prescribed me with Seroxat, keeps telling me about the chemical imbalance - serotonin deficiency stories and when we decide to discontinue the pill, it’s going to be a 2 months process . Having read about the hyperbolic nature of SSRIs, I don’t trust his process at all. So…

 

1st question: Should I search for a new doctor or try and “educate” my current one? Last time I tried, it didn't go pretty well.

 

2. My doctor told me that Seroxat pills are not meant to be cut, crushed or diluted and as far as I know the liquid version of Paxil/Seroxat has been discontinued. What is the safest and most accurate way to taper the 20mg pill? 

 

2a. I have read here that scales like Gemini have a +/- discrepancy in mgs. Is it “ok” to go with that in mind till the “End game Taper”? (if I remember correctly that’s 0.004mg) or start from the get go with a diluted pill?

 

2b. Does anyone know if the seroxat pills are consistent in the amount of paroxetine contained? I mean if I measure a 20mg pill as ‘x’ mg on a scale will this be the same mg in the next pill? 

 

2c. Should I search for a compound pharmacy in Greece instead? Don’t they also use scales though? How will I be certain that the active ingredient is the correct one based on a 10% reduction?

 

I have read in the paper “Tapering of SSRI treatment to mitigate withdrawal symptoms, Personal View”, by Mark Abie Horowitz, David Taylor, published Online, Lancet Psychiatry 2019 and i quote: “ We suggest that a personalised rate for withdrawal could be established by an initial trial reduction of SSRI dose, equivalent to a reduction of 10% serotonin transporter occupancy (or 5% if being cautious), with subsequent monitoring of the severity and duration of withdrawal symptoms. An initial 10% reduction in serotonin transporter occupancy is suggested because this would result in approximately halving the dose from the therapeutic minimum dose (eg, from 20 mg to 10 mg of citalopram), which is tolerated well by most patients. If the patient’s Discontinuation-Emergent Signs and Symptom score were to have returned to baseline 1 month after the initial reduction, then a rate equivalent to 10% reduction of serotonin transporter occupancy per month could be prescribed…”

Does this mean that someone can go from 20mg to 10mg at once and then start reducing 10% from the previous dose or I got it all wrong?

 

3. I read about the BrassMonkey method and it really resonates with me. I am bad at math though and I got confused at how we calculate the end game doses. Is there any video available of how we crush pills and measure small dosages for micro tapering?

 

4. I have been a smoker for over 20 years and a casual drinker. Is there any correlation between smoking/drinking while trying to taper? 

 

5. Does anyone know if there is a healthcare provider, doctor or pharmacy well informed about safely tapering SSRIs in Greece?

 

6. Finally, this whole thing kind of makes me obsessive thinking. I mean questions like "do I have sufficient information? will it go right this time? Should I do this or that? is this the right time? etc" Is this normal?  

 

Pfeww I think this was it! Not as short as I intended it to be . Still really anxious while writing this because I reminisce about the tough WD period and about getting prepared for another go. Reading others stories and their WD symptoms also makes me really nervous, but their perseverance and their success stories gives me courage.

Also this is the first time I write to a forum of any kind.

 

Again thank you very much for taking the time to read my post and a huge respect from my side for everyone in here. The work you do is beyond words!

 

Thanks,
 

[Catwoman73]

Hi @cousteau, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes.  

 

Thank you for completing your drug signature!

 

It sounds like you have done a fine job of informing yourself about hyperbolic tapering, and why it is so important.  And you've also tapped into many of the resources we recommend around here, like Claire Weekes, Mark Horowitz, and outro.  

 

You are not alone in dealing with doctors who are completely ignorant about these drugs, and how to taper them properly.  My own doctor's solution was making large cuts and/or dosing every other day.  As you know, these are not good options, and have gotten me into a world of trouble many times in the past.  This time, I am doing a brassmonkey slide taper with a 5% drop every six weeks (1.25% per week for four weeks, then a two week hold).  So far, so good, though my doctor thinks I've lost the plot lol!  

 

I'm going to do my best to answer your specific questions below, and also pass along a few other pearls of wisdom to help you along!

 

1/5.  Doctors tend to not like to be educated by their patients.  Personally, I have fired mine when it comes to my antidepressants, and I am paying a very well informed NP who used to be part of the outro program in Canada to manage my taper.  You may not have very many options- finding a withdrawal informed doctor is like trying to locate a needle in a haystack.  There is a large number of people here who don't tell their doctors anything about their tapering plans.  The just keep getting their prescription refilled without discussing it with their doctors, and tapering independently.  So how you choose to proceed is up to you.  I will link our thread on good clinics/providers for you- I'm not sure there are any in Greece, but you could have a look through the thread and see what you can find.

 

Recommended Doctors, Therapists, and Clinics

 

2/3.  There are a variety of ways to approach tapering seroxat.  I will link our thread on tapering paroxetine below.  Many here do use shaving the pills and using a Gemini scale quite effectively.  You can also make your own liquid if you prefer.  Have a read through the thread below, and when you make a decision about how you want to proceed, we can absolutely help you out with anything you need!

 

Tips for Tapering off Paxil/ Paroxetine

 

When weighing pills, you are best to weigh 5-10 pills, write down their weights, and take the average weight when making your calculations.  There will be a slight variation between pills.  You can't let yourself worry about that- as long as your methods are consistent, you should be just fine.  Personally, I prefer making my own liquid over shaving the pills, but some people don't tolerate liquid formulations very well.  It really is all a big experiment.

 

As for dropping from 20 to 10mg quickly due to SERT occupancy- yes, this does make sense in some situations.  Personally, I wouldn't do it in your situation, only because you have been off and on these medications previously, and you reinstated at a high dose, requiring a very long time to stabilize.  This can lead you to becoming hypersensitive to even small changes.  I would recommend starting out with a 10% drop (or 5% if you want to be cautious), or starting a brassmonkey slide right away. 

 

I'm not sure that there is a video on the endgame taper, but we do have a good thread on those final doses.  You may find this helpful.

 

Managing the Endgame Taper

 

4.  We recommend avoiding all neurologically active substances while tapering.  This includes alcohol, nicotine, caffeine and recreational drugs.  These things can be extremely destabilizing while tapering.  Of course, it's up to you what you want to do, but there have been members here who have chosen to get themselves off of the alcohol and cigarettes before proceeding with tapering.  We also recommend avoiding taking other psychiatric medications to deal with your withdrawal symptoms (so, no benzos, etc) for the same reason- you may become further destabilized when adding new meds.  Furthermore, all you really do by adding other meds is create a situation where you have to taper another med, thereby prolonging your withdrawal/tapering journey. 

 

5.  It is absolutely normal to have some nervousness, or reluctance around tapering, particularly for those of us that have been through hell in the past!  It sounds like you are quite well informed, and as a member here, you also have us to help answer any questions that arise as you proceed.  I'm going to give you a few little pieces of advice that might help you along your journey below.

 

You can help facilitate the healing of your nervous system by taking really good care of yourself.  Eat a balanced, whole foods diet, stay adequately hydrated, get gentle exercise, get enough rest/sleep.  Avoid the substances I discussed above.  All of these things create the best possible environment for the body to heal from anything, including psychiatric drug injury.  That being said, you will experience some withdrawal symptoms more than likely, no matter how slowly you go.  It's important to find non-drug methods of coping with any symptoms that pop up.  We have a whole bunch of threads on coping with symptoms- I will link some of them below.  Personally, mindfulness and meditation have kept me very level headed throughout my journey (so far) this time.  You may find some of your own methods of coping as well- I find swimming to be very calming, along with engaging in artistic things (I'm not very artistic lol- I do paint by numbers!). 

 

Apathy, anhedonia, emotional numbness, emotional anesthesia 

 Derealization or Depersonalization

 Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals 

Shame, guilt, regret, and self-criticism

 

It is a really good idea to start keeping a symptom journal as you begin your taper.  Below is a list of typical withdrawal symptoms that you can use as a template if you wish.  The reason this is important is because, as you proceed, you will have days/weeks where you feel better, and days/weeks where you feel worse.  We refer to this as the windows and waves pattern of stabilization.  It is an excellent sign of healing.  The only thing is, the days can blend together sometimes, and it can be difficult to identify those windows and waves- a journal can help with that.  It can also serve as an excellent reminder that all waves do end, as most of us do tend to feel like the bad feelings will never go away when in the middle of a wave.  I'll link our thread on windows and waves here, too!

 

The Windows and Waves Pattern of Stabilization

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Here at SA, we only recommend two supplements- magnesium and omega-3 fatty acids.  Links to these below.  A word of caution though- it is very common to become hypersensitive to all sorts of things while in withdrawal, including other medications, supplements, or even foods.  If you start any new supplements, including the ones we recommend, start with a very low dose, and increase slowly over time if you tolerate them.  I am a prime example of this hypersensitivity- I can't take magnesium at all- it causes brain zaps and insomnia for me!  Your journal can be helpful in identifying things you have become sensitive to- I track all of my food, activities, etc in my journal for this reason.  I also can't drink chamomile tea, of all things lol.  It's supposed to be relaxing, but causes me to become itchy and agitated!

 

In summary, I would consider giving up the alcohol and cigarettes prior to tapering, but it's entirely up to you!  I would recommend starting to find some non-drug methods of coping with your withdrawal symptoms right away, even if you don't experience withdrawal symptoms right away.  It can take time to build these new habits, and it is much easier to build them when you are not already in the depths of withdrawal.  When you do start to taper, there are a few methods you can use, as described above, and we're happy to help you with any questions you might have. 

 

Most of all, I want you to know that you can do this!  I know it feels a bit scary and daunting, give what you went through last time you stopped, but I can assure you that it's a very different experience with hyperbolic tapering.  This is my fourth time coming off of these meds, first time doing hyperbolic tapering,  And it is a MUCH easier experience.  So just keep believing- your body will heal.  That's what we are designed to do- humans have to fight pretty hard not to heal! ❤️‍🩹

 

This is your introduction topic- each member gets one intro topic.  Please post any questions, concerns or updates here, on this thread.  Do feel free to explore the rest of the forum though- as you know, there is lots of good info here.  And, if you feel up to it, don't hesitate to engage with other members by reading their intro threads, and dropping a word of support in the comments.  This journey can be a lonely one, but it is made easier when you create a community of people that understand what you are experiencing! 

 

I look forward to following your journey!

[cousteau]

Wow @Catwoman73 I can't thank you enough for your thorough answers to my questions and for welcoming me in SA. I truly appreciate it 

I will say it again, you people in here do an amazing job.

One more question regarding weighing the pills. If I understand correctly, I will have to measure each pill individually (out of 10 let's say) and then I will come up with average weight. If let's say the average weight is 24mg then I will start calculating my doses based on that weight?

Also, will I have to do this (measure the average) every time I get a new pack of seroxat?

Finally, I read somewhere in here, that thankfully, the active ingredient is evenly distributed in every pill, os that true? I use GSK branded Seroxat.

Thank you very much again and I wish you all the best! 

 

[Catwoman73]

Active ingredients are evenly distributed throughout the pills.  

 

My apologies on this, but there's no need to average pill weights with seroxat.  If you wan to make a 10% cut, you would just weigh the pill, and shave off 10%.  So in your example above, if you weighed a single pill and it weighed 24mg, you would shave off 2.4mg from the pill, and would take the remaining 21.6mg.  You would have to do this daily, with each pill.  Some people do a bunch in advance, but I don't recommend that, because if you make a drop and don't tolerate it, and decide to updose a bit, you've wasted a lot of time cutting down pills.  You're better off doing one each day.

 

Averaging is necessary with capsules with beads/powder.  I apologize for that- my brain is struggling a bit these days.

 

Please let me know if you have any further questions or concerns!

[cousteau]

No worries @Catwoman73, no need to apologize. Feel better soon!

Again, thank you very much for the detailed answers, much appreciated!

Have a great day ahead