Lesliehome: Currently cross-tapering from Paroxetine to Sertraline

[Lesliehome]

Hi Everyone!

I am new here and have been taking Paroxetine since 2000 at increasing doses over the years.  I think it "pooped out" on me years ago, but I was afraid to stop taking it.  Terrible uptick in anxiety, intrusive thoughts, depression, and panic about two years ago after a life-changing event.  Psychiatrist initially had me go up to the maximum dose of 60 mg of Paroxetine about a year ago, which didn't help.  She then suggested adding Buspar 15 mg daily, which also didn't help.  We are now trying to cross-taper off of the 60 mg Paxil onto 200 mg Sertraline.  She gave me a four week tapering schedule.  I went from 60 to 50mg of Paroxetine and began 50 mg of Sertraline in October for one week.  Went from 50 to 40 mg of Paroxetine and from 50 to 100mg of Sertraline week two.  Went from 40 mg to 30 mg of Paroxetine and from 100 to 150 mg of Sertraline week three.  Went from 30 mg to 20 mg of Paroxetine and from 150 to 200 mg Sertraline week four.  She wanted me to go from 20 mg of Paroxetine to 0 and hold steady at 200mg of the Sertraline.  I decided to go from 20 mg of Paroxetine to 10 mg while holding steady at 200 mg of Sertraline in week five.  I am now in week six and have gone from 10 mg of Paroxetine to 5 mg and still at the 200 mg of Sertraline.

 

I have honestly been suffering from what sounds like withdrawal from the Paroxetine for about two years off and on, before the cross-taper.  It has been unremitting anxiety, depression, panic, crying spells, suicidal ideation, intrusive thoughts, but I have been able to sleep and usually calmed down by evening.  I was really afraid to go off the Paroxetine but I have been desperate to feel better.  Every day is a struggle.  The cross-taper has been going pretty well with the exception of feeling totally jittery and anxious and having panic attacks at first.  The Sertraline seems to have helped with the worst of the depression and intrusive thoughts, but now that I am down to 5mg of Paroxetine, I have started having physical symptoms like 24/7 restless legs, tingling sensations, headaches, sweating, and insomnia.  I am afraid that I have gone too quickly and have done irreversible damage.  I asked my psychiatrist about it and she said the worst of the symptoms should resolve in a few days.  I don't want to go down anymore and think I should go back up to 10  mg of the Paroxetine to help stabilize some of these new symptoms.  Please give me some advice.  Thanks so much!

[Jane318]

Greetings @Lesliehome, 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 signature.  I would ask you to please edit your signature to reflect the specifics of your taper - the specific date, drugs, and doses for each week you changed something.  (Statements like "past five weeks" are not meaningful later.)  Also, please list all drugs you are taking currently currently on the last line.  This helps the moderators quickly see what is going on and where you are now.  

On 11/22/2024 at 12:27 PM, Lesliehome said:

have been taking Paroxetine since 2000 at increasing doses over the years.  I think it "pooped out" on me years ago, but I was afraid to stop taking it.

SSRIs "poop out" for many of us after long use.  Still, our brains have adapted to the drug's presence and cannot usually just be abruptly stopped.

 

On 11/22/2024 at 12:27 PM, Lesliehome said:

She then suggested adding Buspar 15 mg daily, which also didn't help. 

If Buspar is not helping, have you thought about discontinuing it, since you haven't been on it long?

 

On 11/22/2024 at 12:27 PM, Lesliehome said:

We are now trying to cross-taper off of the 60 mg Paxil onto 200 mg Sertraline.  She gave me a four week tapering schedule.

This is a very fast taper off paroxetine.  I agree with your observation that you are likely suffering withdrawal from the Paxil/paroxetine.  Here at SA, we recommend a slow, hyperbolic taper, which you can read about here:  Why taper by 10% of my dosage?

 

While both Paroxetine and Sertraline are SSRI anti-depressants, they affect the brain in slightly different ways - it is not a one-for-one replacement in the brain.   Further, your psychiatrist has you on very high dosages of both drugs.  The SERT occupancy chart for Sertraline essentially flatlines at 100 mg.  That is, there is no benefit above 100 mg.  You might ask about that.

 

SA doesn't endorse cross-tapering from one drug to another - we've seen many cases like yours, where it creates more problems.  Further, we exist to help people get off psychotropic drugs altogether.

 

On 11/22/2024 at 12:27 PM, Lesliehome said:

I am afraid that I have gone too quickly and have done irreversible damage.  I asked my psychiatrist about it and she said the worst of the symptoms should resolve in a few days. 

You will heal, but it will take time.  That your psychiatrist said the worst symptoms should resolve in a few days...  I hope this is true, but for most of us who have done tapers too quickly, it's taken a long longer.  Unfortunately, most doctors remain woefully ignorant of how difficult it is to get off these powerful drugs.

 

On 11/22/2024 at 12:27 PM, Lesliehome said:

I don't want to go down anymore and think I should go back up to 10  mg of the Paroxetine to help stabilize some of these new symptoms.

Since you have been at 5mg paroxetine for only a couple days, Yes I would go back up to your previous dose, 10 mg, if I were you.  If you do and if you see improvement (and do not experience kindling), I would stay at 10 mg for as long as it takes you to stabilize.  If you do not see improvement at 10 mg, you may need to go back up a bit more.  It may take weeks or months to stabilize.  Then you can begin a slow taper to 0.

 

You may want to read more about reinstatement here:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

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

Hypersensitivity and kindling

 

In protracted withdrawal, it is very normal to have periods where you feel better, and periods where you feel terrible.  This is what we call the windows and waves pattern of stabilization.  This is actually a good sign of healing!  Read more about windows and waves here:

 The Windows and Waves Pattern of Stabilization

 

 

It’s important to keep tabs on your symptoms.  You can use the following list of typical withdrawal symptoms to track the severity of your symptoms over time:  Daily Checklist of Antidepressant Withdrawal Symptoms (PDF).  This will help you track improvement over time.  

 

You may choose to also track your foods and activities to identify things that trigger symptoms as well.  We do encourage people who are tapering to avoid caffeine, alcohol, and recreational drugs.  Many prescription and OTC drugs can cause problems too and should be avoided as much as possible. 

 

There are a few things you can do to help your nervous system stabilize / heal.   Eat a balanced, whole foods diet, stay well hydrated, engage in gentle exercise, and get adequate rest/sleep.  Avoid all neurologically active substances, like caffeine, alcohol, nicotine and recreational drugs- these are like pouring gasoline on a fire for your symptoms.  Avoid adding any other psychiatric medications to deal with your withdrawal from psych meds- the effects of these meds on a destabilized nervous system is unpredictable, and taking something else could make you worse.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium (glycinate is a good form) and omega 3 (fish oil). Many people find these to be calming to the nervous system.

Magnesium, nature's calcium channel blocker 

Omega-3 fatty acids (fish oil) 

So if you decide to try a supplement, even those we recommend here, Add in one at a time and at a low dose in case you do experience problems.  If you tolerate it well, you can increase the dosage slowly over time.  

 

We have many threads on how to cope with symptoms – I encourage you to check out the various forums / links on the SA.org home page.

 

This is your introduction topic.  Each member gets one intro topic- please post updates and questions here, in this thread.

 

Please let us know what you decide and how you are doing.  Best wishes.

 

 

[Cheeky]

Hey there @Lesliehome, 

Unfortunately, I am a another survivor of Paxil and have gone through a lot trying to come off . Please follow the advice here , they know more than most doctors . Hang in there it will get better 🌸