MasonSmith: Paroxetine, Fear and Seeking Support

[MasonSmith]

Hello everyone, Mason here, and this will be my first post. Not necessarily glad that I'm in this situation and have to be here, but I sure am glad that this place exists for those of us struggling.

I've been on various ADs over the past 3 years. First escitalopram 10mg, then fluoxetine 20mg, then paroxetine 20mg, and very recently (last week) back on fluoxetine 10mg currently, 20mg after? To make things short escitalopram and fluoxetine worked, and then didn't, in addition to a host of digestive issues. Went on paroxetine at the end of 2023 and it worked wonders. Besides some mild diarrhea occasionally, it worked wonders for my mental health, relationships, overall mood, etc. Then over the past few months I was getting sick of the GI issues and didn't want to be on these things for my whole life. I did an experiment (albeit a very dumb one) and went off paroxetine for a few days to see if the GI issues would clear up, and they did. Then the withdrawl symptoms started (sweating at night, hand tremors, tingling in the hands and feet) and I got scared, went back on paroxetine and the withdrawl stopped. Talked to my GP about stopping ADs and he suggested going back on fluoxetine and tapering (using the very incorrect method of 2 - 4 weeks) and check-in at the 3 week mark. Tapered paroxetine to 10mg over two weeks, and then started fluoxetine 10mg this past week. Over the past 2 weeks or so I've been having vivid dreams, some mood swings, burning/tingling in the hands and feet (especially at night when laying in bed), and a minor amount of difficulty in getting to sleep (but still having a good 6 - 8 hours of sleep each night). The following week I'm supposed to up the dosage of fluoxetine to 20mg (which is still 2 weeks out from my doctor's check-in). I've read almost every main advice thread on here, but I'm hoping to get some personalized advice and/or support on here. The main thing is my fear that the symptoms will get worse, that I'll permanently damage my nervous system, etc. I could really use some reassurance here that I'll be okay (I have read some success stories on here, and that helped a ton).

 

I should also add that I'm male, 29 right now. I'm hoping that I haven't screwed myself for life...

I guess I don't really know what I should be doing now. Do I reinstate paroxetine and risk another flip-flop to maybe resolve some of the withdrawl symptoms? Do I stay on the fluoxetine, go up to the 20mg as instructed, and then have to taper longer? Do I stay on the 10mg fluoxetine since the withdrawl symptoms are manageable, and risk longer lasting withdrawl effects?

I'm a bit at a loss right now, and I'm getting too in-my-head about it, which is my main reason for joining here. I'm here for advice, for sure, but the main thing I need is a group of people who understand my concerns and want to actively help me through it. Which I know you all are, and again, I'm so glad this community exists.

 

Hope the rest of you are managing alright. Will try to keep my hopes high.

[Emonda]

Welcome @MasonSmith

 

7 hours ago, MasonSmith said:

I'm hoping that I haven't screwed myself for life...

 

No, you haven't done that. It will take time to settle and taper off, but it's not permanent.

 

7 hours ago, MasonSmith said:

First escitalopram 10mg, then fluoxetine 20mg, then paroxetine 20mg, and very recently (last week) back on fluoxetine 10mg currently, 20mg after?

 

These changes will be challenging for your body to adjust to. Swapping from one AD to another is not a simple process. They work on different receptors. You will have WD symptoms based on what you have CTd.

 

Can you please confirm the date you last took Paroxetine? It was exactly two weeks ago? And you've been taking Fluoxetine for two weeks? Your signature needs to be a little more specific with these dates.

 

7 hours ago, MasonSmith said:

Then the withdrawl symptoms started (sweating at night, hand tremors, tingling in the hands and feet) and I got scared, went back on paroxetine and the withdrawl stopped.

 

Classic WD symptoms. It's good that they settled quickly after reinstating.

 

7 hours ago, MasonSmith said:

Over the past 2 weeks or so I've been having vivid dreams, some mood swings, burning/tingling in the hands and feet (especially at night when laying in bed), and a minor amount of difficulty in getting to sleep (but still having a good 6 - 8 hours of sleep each night).

 

You've effectively CT paroxetine, and this is not advisable. This is not an AD to mess around with. It would have been best to slowly taper off this AD following the maximum of 10% per month approach.

 

7 hours ago, MasonSmith said:

Do I reinstate paroxetine and risk another flip-flop to maybe resolve some of the withdrawl symptoms?

 

I certainly wouldn't be increasing the fluoxetine as planned.

 

I have some ideas but want to hear from the team offline. I believe it would be best to revert to the old AD, if it was just two weeks ago, and slowly taper.

 

The question is, what dose of paroxetine to go back to.

 

When I hear from the team, I'll come back to you.

 

Emonda

[Emonda]

Please post your updates here, as others are waiting to see your reply.

 

I'm off to work, so I can't check/forward PMs easily.

 

Cheers

[MasonSmith]

The last time I took paroxetine was on Aug. 16th 2024, at 10mg instead of the normal 20mg I was on for the months prior. The 10mg was for 1 week, then switched to fluoxetine 10mg the 17th.

[LostInCanada]

8 hours ago, MasonSmith said:

Tapered paroxetine to 10mg over two weeks, and then started fluoxetine 10mg this past week. Over the past 2 weeks

Just to clarify, you are on 10 mg of paroxetine and 10 mg of Prozac correct. 
In my experience, going to 0mg of paroxetine and 20 mg of Prozac will put you in a lot of distress. 
It would be best to stabilize on a consistent dose of paroxetine and stop taking the Prozac. 
Will you be able to cut your pills accurately with a scale? (Gem20 jewelry scale on Amazon) or make your own liquid? 
Just don’t do anything differently till we get an answer on dosage. My rough thought is 15-18mg but we will wait for @brassmonkey
Welcome to SA. Sorry you are dealing with this but glad you found us. 

[MasonSmith]

No... 10mg of paroxetine, then CTd it and switched to 10mg of fluoxetine... which I know now is terrible.

 

My symptoms aren't bad, but I'm scared and anxious. I'm worried I made the wrong decision and I came here too late. My anxiety is spiking and I hope this all can be fixed

[MasonSmith]

I don't have a scale for the paroxetine. I thought it would be easier to switch to fluoxetine and dissolve it in water to taper. But now I don't know what to do

[LotusRising]

46 minutes ago, MasonSmith said:

No... 10mg of paroxetine,

Hi @MasonSmith

 

Welcome to SA.

 

I agree with @LostInCanada. Better to stabilize on paxil. What date did you stop the 10mg of paxil?

[MasonSmith]

The last time I took paxil it was Aug 16th @ 10mg. I was taking the 10mg for one week as a reduced dose before switching, as my doctor instructed.... which I now know was ill-informed on his part and mine...

[LostInCanada]

@MasonSmith how were you feeling on the 10 mg of paroxetine? 

[LostInCanada]

@MasonSmith so August 10-16 was 10 mg of paroxetine

Could you put the start and end day of each drug in your signature please with the exact dosages? Thanks 

[MasonSmith]

About the same as I am now on the 10mg fluoxetine. Minor issues trying to get to sleep, vivid dreams and the tingling in the fingertips. The worst time was the day or two after I switched to fluoxetine. Then things kinda settled to where I am now. Well, I say "settled" even though it's only been a couple of weeks

[MasonSmith]

20 mg paxil felt normal as that's what I was on before all this mess. Then down to 10mg paxil and minor WD, then CT paxil and started fluoxetine 10mg, bad WD for about 2 or 3 days, and for the past week and a half or two weeks now the WD symptoms are similar to when I was on the 10mg paxil

[LostInCanada]

@MasonSmith so would you feel comfortable making liquid paroxetine? It is the same method as fluoxetine. 

@LotusRisingSince he was only on 10 mg for a week and cold turkey 'd off it for almost 3 weeks, he basically ct'd off 20 mg. @Emonda 

[MasonSmith]

Yea I'd be fine with that. It's to dissolve it in the same ml of water and then to drink the required ml per day?

[LostInCanada]

@MasonSmith yes though I have read paroxetine dissolves even better in double the water.

So behind the scenes there has been some discussion. It looks like 10 mg of paroxetine should be the dose moving forward. I will let @Emonda confirm that. He will be about an hour getting back online. 😊

Do you have the 10 mg size of paroxetine? It isn't accurate enough to just cut a 20 mg in half without a scale. 

Also moving forward, stick with the same manufacturer as well. 

Once stable you can transition over to liquid.

[LostInCanada]

Read this link carefully 

 

 

[MasonSmith]

No I have the 20mg ones with the score line. I'll order the scale now.

 

Will so read all of that now.

 

Sorry again for the mess I've made..

[LostInCanada]

3 minutes ago, MasonSmith said:

Sorry again for the mess I've made..

Don’t apologize. This is on the doctors and big pharma.

And you caught it early plus you haven’t been on these drugs long. You will heal thankfully. Just patience and time. 
Look into some CBT and other methods of coping and self care.

No alcohol, no caffeine, no msg, no sodium nitrates, no CBD. Try to eat healthy, practice sleep hygiene and 30-60 minutes of a gentle walk daily in nature are all good goals. 💯🙏

[MasonSmith]

Thank you so much for the support. I don't have the words right now to thank you all enough 🙏

[LostInCanada]

@MasonSmith I just noticed where you live. We used to live in Pembroke. Such a pretty spot. You will soon be enjoying beautiful fall colours. 🍁

 

[Emonda]

4 hours ago, MasonSmith said:

'm scared and anxious. I'm worried I made the wrong decision and I came here too late. My anxiety is spiking and I hope this all can be fixed

 

Deep breaths. It can be sorted. Time and patience are required.

 

Firstly, none of us are doctors. We share our personal experience and learning from others. This is a decision for you to make. We make comments, but it's your decision.

 

Chatting behind the scenes, there is agreement that reverting to Paroxetine is likely the best way forward.

 

It's been just under three weeks since you started taking fluoxetine and stopped taking Paroxetine. Generally, dependency occurs around 4 weeks...but everyone is different. So, hopefully, you are not dependent on fluoxetine. We have no way of predicting this.

 

When reinstating following a CT (not quite a typical CT, as you swapped to another AD...but likely the same outcome), if this occurs within less than 4 weeks, the guide we have looked at suggests reinstating 50% of the last dose. The question becomes: is that 50% of 10mg (you only took this for one week) or 50% of 20mg (you were on that for 9 months)?

 

So, is the right amount to start with 5mg or 10mg?

 

If you reinstate too high, kindling is an issue.

 

If you reinstate too low, worsening WD is an issue.

 

Please read these two link:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

Kindling

 

For the reasons above, Dr. Horowitz cautions people about the "Prozac Bridge," as it can be a "bridge to nowhere". You can end up dependent on two ADs.

 

Please come back to us once you have read those links and we can chat further.

 

Hopefully, another Moderator experienced with this AD chimes in when it's daylight in their time zone.

 

[MasonSmith]

I was reading this: Switching ADs PDF

 

and it says that fluoxetine needs a 7 days washout. Do I need to CT fluoxetine and not start the paroxetine for 7 days, or do I CT fluoxetine and immediately reinstate the paroxetine 10mg.

 

I'm scared that I'll induce serotonin syndrome..

[LostInCanada]

@MasonSmith you would stop the fluoxetine and the next day reintroduce the paroxetine. 
Because we are concerned about kindling, 7.5 mg may be the better option than 10 mg. What manufacturer are you using? The pill will weigh more than 20 mg because of fillers. I suggest getting the average weight of 10 pills and using that as your standard weight moving forward.(My manufacturer is Apotex, the weight for a 20 mg pill is 236.8 mg or 0.237 g on the Gem 20 scale. So 7.5mg for that manufacturer would be 88.8 mg or 0.089 g on the scale) Cut pill in half. (I use a pill cutter) Then use a one sided razor or very sharp knife ie exacto, to slowly shave to the desired weight
Keep a daily journal of symptoms rating them 1-10. 

Please continue to ask questions if anything isn’t clear. 
@LotusRising @Emonda anything to add?

[LostInCanada]

13 hours ago, Emonda said:

been just under three weeks since you started taking fluoxetine and stopped taking Paroxetine. Generally, dependency occurs around 4 weeks..

The sooner you can transition the better. Please let us know when you get your scale and start the paroxetine. Thanks 

[LotusRising]

@MasonSmith

@LostInCanada

 

I agree, 7.5mg sounds the most reasonable.

[brassmonkey]

I think things are getting much too complicated. We have a starting dose of paxil established at 20mgai. That was altered to 10mgai for one week and then CTed. That one week is not long enough to really effect the starting dose. If we are to reinstate at half the dose it would be at 10mgai. Each individual is going to be different, but experience shows that these are the parameters we should observe.

 

The doctor has attempted to have you "bridge" from one drug to another. The second being easier to taper. This works in some cases, but with Paxil the success rate is very low. Leaving the person to suffer through the effects of the initial CT while dealing with tapering the second drug. It is not a pretty sight as several of our members can attest to.

 

The fluoxetine has been used for a long enough time that some tapering would be advised. There is not a magic switch that throws at four weeks making it harder to quit. A fast taper of 25% a week should be fine. This could be done by just visually dividing the tablets into four parts and taking what is required. This would be done concurrently with the reinstatement of the paxil.

 

Once this taper and reinstatement is complete a long hold will be required to stabilize. Given the previous drugs and changes I would hold for a minimum of three months and quite likely longer, before starting to taper. Also because of the different drugs and all the changes the stabilization period is likely to be quite "bumpy". Symptoms will flare up and die out quit quickly and at times be very intense. But things will stabilize, it will just take some patience.

 

Reinstating any AD is a time sensitive matter with a window of just a few weeks. As LostinCanada mentioned, the sooner the better. I would not wait for the scales to arrive, but rather cut your tablets as best as possible and then sort out the more accurate dosing when the equipment arrives.

 

Once stability has been achieved, we can talk about a nice slow controlled taper. Paxil has a reputation as being the hardest AD to taper off of, but it is quite doable. Rest assured that you have not damaged yourself. It may feel like it at times, but healing happens. Even if you went full CT off of everything right, you would eventually get better. It may seem like a rough spot you're in right now, but things will settle out and then with a slow careful taper you will be drug free.

 

 

 

[Emonda]

Thank you Brassmonkey for jumping in.

 

MasonSmith, I would pay very close attention to what Brassmonkey has said.