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ByTheBeach: Paroxetine 30mg for 2O years - 4 years tapering - Have I crashed?


ByTheBeach

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Began taper in November 2020 following the Brass Monkey Slide method.

 

Switched to liquid October 2022.

 

Current dose: 0.9ml

 

On September 11th 2024 on waking I could not lift my head off the pillow - approx 2 hours duration. Severe shaking, dizziness and nausea.

 

Admitted to hospital via ambulance. All the medical tests came back as normal. Discharged the same day.

 

Have had approx 10 episodes since although not as severe but unable to drive/go out.

 

Have had a blocked ear for 2 years and this was checked out by ENT consultant AFTER the first episode (above) and no dysfunction of my ears was found.

 

Depression and irrational thoughts have increased in the last year.

 

Is it possible that my CNS has become unstable?

 

If so, what can I do to help myself?

 

 

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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  • KenA changed the title to ByTheBeach: Paroxetine 30mg for 2O years - 4 years tapering - Have I crashed?
  • Moderator

Hi @ByTheBeach, 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.  And I want to congratulate you on your progress so far- Paroxetine is a beast to get off of, so you've done well to get as far as you have!  I am sorry to hear about your current state though- it's no fun!

 

Since you describe increasing depression and irrational thoughts increasing over the last year, I suspect your nervous system has been destabilizing for a while, and you just hit a critical point this last month.  As I'm sure you've already read here (if you discovered the Brassmonkey Slide, I imagine you've been lurking for a while), things get a lot more difficult as your dose gets lower and lower.  Many people have to slow down and/or make smaller cuts at the lower end of the dosage range.  If you have maintained your rate of decreases, despite increasing symptoms, it's not terribly shocking that you've crashed. 

 

Just to make certain- you have been doing the two week holds with the Brassmonkey slide?  Skipping those is a surefire way to have it all catch up to you eventually.  The holds are what makes it work!

 

The question is, what to do now?  From where I stand, you have two options.  First, you can hold.  Likely a very long hold- think many months, a year- perhaps longer.  Once destabilized, it can take a while to get your nervous system to settle down- our nervous system is a notoriously slow healer.  But the good news is that you will heal.  It's just going to take time and patience. 

 

Your other option is to try a small updose, and see how you feel.  Maybe up to 1.0ml to start.  Hold for at least a week, preferably two.  If that increase makes you feel activated/hypersensitive (more on that in the links to follow), drop back down to 0.9, and that will have to be your holding spot.  If you feel better, or about the same, you can try another small increase.  Rinse and repeat until you feel you've gotten enough symptom relief that you can tolerate it for a longer hold, giving your nervous system time to stabilize.  Then you could start tapering again, maybe with smaller cuts, and/or a slower pace.  More on updosing here:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 How long does it take to stabilize after reinstating or updosing?

 Hypersensitivity and kindling

 

Regardless of which route you choose to go, it's going to take time to stabilize again.  There are a few things you can do to help your nervous system heal- most are quite intuitive.  Eat a balanced, whole foods diet, stay well hydrated, engage in gentle exercise/movement, and get adequate rest/sleep.  Avoid all neurologically active substances, such as alcohol, caffeine, nicotine and recreational drugs- these are like pouring gasoline on a fire for your symptoms!  And don't add any other psychiatric meds into the mix- while in withdrawal, the effects of these meds are not predictable, and could make you worse rather than better.  We recommend two supplements here- magnesium and omega-3 fatty acids.  Do be mindful though- it is quite common for those of us in withdrawal to become hypersensitive to all sorts of things- medications, supplements, and even foods!  So if you decide to try a supplement, even those we recommend, start with a very low dose to see how you fare.  If you tolerate it well, you can increase the dose slowly over time. 

 

You may have already read about the windows and waves pattern of stabilization here.  This is a phenomenon where, as we heal, we have periods of time where we feel better, and periods where you feel worse.  If this is happening, it's actually a good sign, so don't be alarmed by it.  More on windows and waves here:

 

Windows and waves pattern of stabilization

 

You may benefit from keeping a symptom journal at this time.  Track each of the symptoms you are experiencing, rating them for severity each day on a scale of 1-10.  This can help you identify your windows and waves, and show you how you've progressed over a prolonged hold.  If you choose to track your food and activities as well, you may identify a handful of things that can trigger waves for you, and then you can avoid those things, making the journey a bit less bumpy.  By journaling, I have identified that I am extremely sensitive to coffee (even decaf), chamomile, more than tiny amounts of refined sugar, intense exercise, and magnesium (it's supposed to relax you- for me, it causes brain zaps and insomnia).  So journaling is a very helpful tool. 

 

In terms of coping with your emotional and cognitive symptoms, we have many, many threads here on that topic.  I'll link some below.  I have found that practicing mindfulness every single day to be very helpful.  Guided meditations/yoga Nidra and recorded nature sounds are also helpful in calming the nervous system.  Breathing deeply does help- I know it sounds like a small thing, but it does work.  And I've worked hard to challenge and replace the negative thoughts behind the negative emotions.  And when all else fails, good old-fashioned distraction is my method of choice.  I love to swim (I feel great in the water!), cook, dance, and engage in artistic projects.  Do anything that has brought you joy in the past to retrain your brain to react to things differently. 

 

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

Getting Started with Mindfulness

Symptoms and self-care

 

In summary, you can either choose to hold where you are, or try a small updose to see how it affects you, with the hope that updosing gives you some symptom relief.  In either case, now is the time to take really good care of yourself, mentally and physically, in order to support your body and brain's healing.  You will get through this!!!❤️‍🩹

 

This is your introduction topic.  Each member gets one intro topic.  Please post updates or questions here, on this thread.  But do explore the rest of the forum- as you know, there's lots of good info here!  Feel free to read and comment on the intro threads of other active members here as well.  This will help to create a sense of community for you, and this journey is a lot easier when you don't feel so alone!

 

Sending hugs- I look forward to following your journey, and helping out in any way I can! :)

 

 

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN, July 22 8.2mg esc. 2.0mg LDN. July 29 8.1mg esc. 2.0mg LDN. Aug. 24- 8.0mg Esc. 2.0mg LDN.  Aug. 30 7.9mg esc.  Sept. 6 7.8mg esc.  Sept. 13 7.7mg esc. Sept 21 2.5mg LDN. Oct. 4 7.6mg esc. Oct. 11 7.5mg esc. Oct. 18 7.4mg esc. Oct. 25- 7.3mg esc.  Nov. 1- 3.0mg LDN.

 

Supplements/other meds: Vitamin D, B12, Claritin, HRT

 

PLEASE DO NOT PM ME!  PLEASE ONLY TAG ME FOR URGENT QUESTIONS!  Thank you!

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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Thank you so much for all the information and advice.

 

As I have been following SA for 4 years, I am already doing everything that I can to help myself based on the information here on SA.

 

I have increased my dose to 1.0ml  - should that be for 4 weeks and then hold for 2 weeks as I have been doing throughout the taper?

 

I omitted Quetiapine 12.5mg from my sig but have added it now. It helps me get some sleep. 

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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  • Moderator

Updosing is a little bit different.  It's not typically done like a reverse Brassmonkey taper.  You can increase by a small amount every one to two weeks until you get to a dose where you feel you can tolerate your symptoms. Pay very close attention to how you are feeling as you do your hold after each increase- if you notice that you start feeling activated by taking your dose (as described in the hypersensitivity and kindling like I provided), you'll need to drop back down to your previously tolerated dose.  I can't emphasize the importance of moving very slowly enough here.  Big jumps or moving too fast can set your nervous system on fire, and leave you in a world of hurt, far worse than what you are currently experiencing.  Personally, I prefer to two week hold between increases for this reason.  Some people make the mistake of thinking that more is better when updosing- this is absolutely not the case here.  Slow is the way!

 

When did you make the increase?  Any change in your symptoms since you did that?

 

Definitely don't change your quetiapine dose right now- keep that nice and stable until you are completely off of the quetiapine.  

1995- 2007- On and off multiple antidepressants (Prozac, Paxil, Effexor, Wellbutrin, escitalopram). Memory poor- can’t remember dates. Always tapered fast or CT.  2007- tapered Wellbutrin, zopiclone and escitalopram over one month to get pregnant.  Withdrawal hell for many years.

2009- Daughter born 🥰 Post partum depression/psychosis- no meds taken.

2016- Back on escitalopram due to job change/anxiety

2022- Severe covid infection- Diagnosed with long covid 08/22.

2023- 01/23- Long term disability approved for long covid.  Started taper under MD advice from 20mg: 11/23- 15mg. 2024- March-10mg. Started low dose naltrexone for long covid-5mg- terrible reaction, reduced to 0.5mg.  April- 10mg escitalopram, 1.0mg LDN. May 1- 9.0mg escitalopram, 1.0mg LDN. May 15- 9.0mg escitalopram, 1.5mg LDN.  June 12- 8.5mg escitalopram, 1.5mg LDN.  July 8- Brassmonkey micro taper started.  8.4mg escitalopram, 1.5mg LDN.  July 15- 8.3mg esc, 1.5mg LDN.  July 18 8.3mg esc, 2.0mg LDN, July 22 8.2mg esc. 2.0mg LDN. July 29 8.1mg esc. 2.0mg LDN. Aug. 24- 8.0mg Esc. 2.0mg LDN.  Aug. 30 7.9mg esc.  Sept. 6 7.8mg esc.  Sept. 13 7.7mg esc. Sept 21 2.5mg LDN. Oct. 4 7.6mg esc. Oct. 11 7.5mg esc. Oct. 18 7.4mg esc. Oct. 25- 7.3mg esc.  Nov. 1- 3.0mg LDN.

 

Supplements/other meds: Vitamin D, B12, Claritin, HRT

 

PLEASE DO NOT PM ME!  PLEASE ONLY TAG ME FOR URGENT QUESTIONS!  Thank you!

 

I am not a doctor.  I don't even play one on TV.  This is not medical advice, but based on personal experience.  Please consult a medical professional.

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Hello,

 

I made the increase yesterday from 0.9ml to 1.0 ml. No change in symptoms as yet.

 

Is that too bigger jump for a reverse Brass Monkey taper? :unsure:

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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  • Moderator

How exactly have you been doing your Brassmonkey Slide? Please give full details on how you have been dosing and holding.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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Hello,

 

Thank you for responding.

 

2020 November

Began shaving 30 mg tablets by the same reduction for 4 weeks and holding for 2 weeks.

 

2021 October

Switched to 20mg tablets  - holding.

 

2021 December

Switched to liquid  - reducing 10% every 4 weeks and holding for 2 weeks.

 

 

2022 June

Glaxo Smith Klein withdrew the liquid from the UK market.

Back on tablets for a few months.

 

2022 November

Prescribed liquid off licence via Hospital pharmacy. 10mg/5ml.

I reduced at 10% every 4 weeks and held for 2 weeks.

 

2024 June

Changed reduction to 2.5% every 4 weeks and holding for 2 weeks.

The first 2 years of tapering were not precise due to other health problems - requiring surgery twice.

 

 

 

 

 

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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  • 2 weeks later...
  • Moderator

I'm not seeing anything to be concerned about with your Brassmonkey Slide. The symptoms you described are not consistent with the low end of a Paroxetine taper. They are, however, consistent with an adverse reaction to the Quetiapine. Adverse reactions don't always hit immediately. Sometimes they can take a while to build up and then peak intermittently, as you are seeing. You need to see your doctor about getting off of this medication. He may wish to switch you to something else or take you off of it completely. I would never recommend a CT, but a fast taper may be required. Either way, switching or fast tapering is going to be challenging.

20 years on Paxil starting at 20mg and working up to 40mg. Sept 2011 started 10% every 6 weeks taper (2.5% every week for 4 weeks then hold for 2 additional weeks), currently at 7.9mg. Oct 2011 CTed 15oz vodka a night, to only drinking 2 beers most nights, totally sober Feb 2013.

Since I wrote this I have continued to decrease my dose by 10% every 6 weeks (2.5% every week for 4 weeks and then hold for an additional 2 weeks). I added in an extra 6 week hold when I hit 10mg to let things settle out even more. When I hit 3mgpw it became hard to split the drop into 4 parts so I switched to dropping 1mgpw (pill weight) every week for 3 weeks and then holding for another 3 weeks.  The 3 + 3 schedule turned out to be too harsh so I cut back to dropping 1mgpw every 4 weeks which is working better.

Final Dose 0.016mg.     Current dose 0.000mg 04-15-2017

 

"It's also important not to become angry, no matter how difficult life is, because you can loose all hope if you can't laugh at yourself and at life in general."  Stephen Hawking

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Thank you for responding.

 

I have taken 12.5mg at night for 5 months - cutting a 25mg tablet in half.

 

The tablets are very small.

 

Can you advise me on how to manage the taper?

 

 

 

 

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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Brass is right. Quetiapine and paxil are interacting and ramping up dopamine levels. Any psychotropic drug is likely to interact with paxil withdrawal. Covering up paxil wd symptoms like insomnia with such drugs is no good strategy. Guess you found out the hard way yourself.

 

https://www.drugs.com/drug-interactions/paxil-with-seroquel-1800-1156-1979-1274.html#:~:text=Interactions between your drugs&text=Using PARoxetine together with QUEtiapine,%2C judgment%2C and motor coordination.

 

I would prefer (fast) taper above a switch cause then a 3rd source is added where 2 is already causing difficulties.

 

Please read link below for taper instructions but preferably do not switch to manufacturer liquid, keep using same pill. Either using a pill cutter (25/4) or making homemade liquid.

 

Using a pill cutter you could go from 12.5 to 6.25 then hold for a short time to stabilise and evaluate. This will be the (short)way to less interacting but you will still experience wd symptoms from seroquel.

⬇️

Bye Sebas

  • 46 years old male
  • job in spatial planning
  • into sports, animals and nature
  • Started using 20 mg Paroxetine (Paxil) in 2004 for stressrelated anxiety/depression
  • Attempted several times to stop, starting a few years after 2004
  • Found out in 2015 about paxil withdrawal symptoms and the 5-10% taper guideline
  • Started using liquid paxil in 2015/2016
  • 2018 --> 11.2 mg of paxil
  • 2019-2023 developed severe food- and other sensitivities (anti imflammatory, anti oxidant, food colourings, oils, herbs, chemicals etc.)
  • 12/2023 Had been building up for 4 years to Poop-out/tolerance, introducing brassmonkey slide method 0.1mg/week
  • 26/1/2024 10 mg (journey halfway).
  • 14/7/2024 8.4 mg
  • No supplements, strict diet
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Hello,

 

Thank you for your detailed response, it is very helpful.

 

When I begin to reduce below 6.25mg it will be difficult for me to manage as the tablets are so small.

 

I have looked up how to make a liquid but due to brain fog/anxiety I am unable to work out how to do it precisely.

 

Can you advise me on the correct way to do this based on reducing from 6.25mg please?   :(

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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8 hours ago, ByTheBeach said:

Hello,

 

Thank you for your detailed response, it is very helpful.

 

When I begin to reduce below 6.25mg it will be difficult for me to manage as the tablets are so small.

 

I have looked up how to make a liquid but due to brain fog/anxiety I am unable to work out how to do it precisely.

 

Can you advise me on the correct way to do this based on reducing from 6.25mg please?   :(

 

If you thoroughly mix up 6.25mg with 12.5 ml of (lukewarm, for solubility) water, then every 2 ml liquid you withdraw will contain approximately 1 mg of the drug.

You will need to make new mix on daily basis by using a dosing syringe (available from the pharmacy on request) and a small amber jar. First give it some time to fully dissolve, stirr to help the process.

Not sure if this jar should be contained in or out fridge cause it says room temperature in the link. Mine (paxil) is stored in fridge.

You can add some orange juice and then drink solution. 

 

Generally when two drugs are interacting then tapering (in this case quetiapine) should provide some relief. But at the same time it will create wd from (too fast) taper itself. Slower taper will however not solve the interacting.

Choices are few but keep focus on midterm goals.

 

People on this website have survived from terrible challenging situations so whatever comes our way we will eventually conquer.

Keep that in mind.

 

Bye Sebas.

 

 

  • 46 years old male
  • job in spatial planning
  • into sports, animals and nature
  • Started using 20 mg Paroxetine (Paxil) in 2004 for stressrelated anxiety/depression
  • Attempted several times to stop, starting a few years after 2004
  • Found out in 2015 about paxil withdrawal symptoms and the 5-10% taper guideline
  • Started using liquid paxil in 2015/2016
  • 2018 --> 11.2 mg of paxil
  • 2019-2023 developed severe food- and other sensitivities (anti imflammatory, anti oxidant, food colourings, oils, herbs, chemicals etc.)
  • 12/2023 Had been building up for 4 years to Poop-out/tolerance, introducing brassmonkey slide method 0.1mg/week
  • 26/1/2024 10 mg (journey halfway).
  • 14/7/2024 8.4 mg
  • No supplements, strict diet
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Thank you so much for explaining how to prepare the liquid. 

 

Yes, it is challenging and thanks to SA I know that whatever comes my way, with patience I will be healed eventually.

 

2001- 2024 Paroxetine 

2020 - Slow taper from 30mg using Brass Monkey Slide Method

2022 - Switched to liquid

2024 - Current dose = 1.0ml

2024 - Quetiapine = 12.5mg - Since June

 

Magnesium Glycinate 100mg = twice each day since 2022

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