johnjohn82: Lamictal Withdrawal - Kindled- Really need some help

[johnjohn82]

Hello to you all,

I found this website while googling my issues and decided to sign up to ask for some feedback from people who seem to have been or are going through dificulties with their ssri medications.

I was taking prozac 20 mg for 6 months and had been to many other ssris over the last 15 years. THe reason I started taking it was to get rid off paxil as I knew how hard it was to taper off of it. I saw a psichiatrist who had really helped a friend of mine who became a fat zombie after some others doctors kept throwing pills at him. This doctor helped him ditch all the meds except the antidepressant and he improved a lot. I went to see him and he asked me to take a lot of tests and siad I was a typical Adhd who would get help from a stimulant medication and also said The ssri wasn't really helping my case. So I asked to change to prozac, a easier drug to quit. I did it and managed to quit paxil. I ended up staying on prozac for 5 months and was postponing quitting it as I was back to college and didn't want to take any risks.

1 month ago I mentioned to him I was feeling quite anxious and he suggested me to try lexapro. Being brief, I did and I hated it. Felt really tired and aphatetic. Even the stimulant medication I'm on didn't touch it. After 3 weeks and decreased my dose to 5 mg to see if the fatigue improved and it didn't. I then started taking 2.5 mg and even skiped some days. The days I didn't take I felt better than ever. I had an appt and told my psychiatrist how crappy I felt and I went back to prozac, 10 mg this time. The problem is: It didn't work. I felt the withdrawal effects and I was feeling scared. Migraines, nightmares, you know the ordeal. I then talked to him and he prescibed lexapro liquid to me, to take the dose I felt confortable with. I am taking now 3 mg lexapro AND 10 mg prozac, which I am supposed to quit but feel insecure as I don't like the lexapro at all and I want to taper off of it.

I really messed it up here. Lexapro was the worst drug I ever took, it was making me feel depressed and after only 4 weeks only I couldn't stop it. For the last month I can't think of anything else, I am stressed out and afraid. DOn't really know what to do. I would apreciate any help and feedback.

Thank you

 

Edit: What makes me more anxious is that even though at 3 mg I am not feeling the withdrawal, I don't like the way I feel on it. I would much rather be tapering a drug that I could be stable on.

[johnjohn82]

I didn't quit Prozac , I was still hoping it would build up and I would be able to quit lexapro without the withdrawal effects. It didn't help and I am not feeling well. I traveled to get to meet my nephews and I felt depersonalized during the whole time, it was scary. Today at my therapy group I felt like I wasnt there, I cant concentrate on my classes. The last two days I took 20 mg of Prozac as I was desperate to get better and no lexapro. I was hoping prozac would cover the withdrawal effects as I read it should. When I take lexapro I feel terrible, feel out of it, tired, unable to hold a conversation. Tapering it slowly will be hard, I feel crappy on it. I've been taking vyvanse for 4 months and I will stop taking it as I DON't think is helping the situation. I was allways scared of being in this place again as iin 2004 I descontinued paxil and had the worst time of my life.

 

I've been reading some topics here and I believe the best course of action would be to stick to a dose until I stabilize. THAT's what I will do and hope I fimd energy to keep updating here.

 

 

Edit: I feel tingling on my body , I am really scared of this drug.

[clearday]

Welcome -

 

Could you please go to your profile and fill out your signature - it will help others to help you better. My signature below is an example.

 

A moderator should be along to give suggestions.

 

Sounds like all these years on SSRIs is catching up with you. Sounds like your body just doesn't like these drugs anymore.

 

Jumping from drug to drug is confusing your already overtaxed nervous system.

 

It's nice when these drugs work, but when they don't, it's all hell.

[bubble]

Hello John and welcome to SA,

 

I'm sorry that we somehow missed your post when you first wrote on 6 May. I'm writing from my phone now because I'm travelling so can't see if you added your signature with your drug history: brief mention of the drugs you were on and more details on more recent ones.

 

What I see from what you wrote is that you shouldn't have been put on Lexapro at all. That anxiety you started experiencing 5 months after stopping Paxil was probably withdrawal from Paxil especially if you tapered it too fast. One AD doesn't "take over" from the other especially not seamlessly as doctors claim.

 

Although you were on Lexapro briefly judging by your symptoms, you'll still have to taper it properly. I personally don't think that Prozac will "cover' Lexapro withdrawal although some say it does.

 

It would also be very helpful to put ALL the drugs you are taking in drugs interactions checker. I think you might be surprised by what you read... Post it here please.

 

Also when somebody with a 15 year history of taking psychiatric drugs speaks of adhd I am highly suspicious that what doctors "diagnose" as such are actually symptoms of withdrawal,side effect, interaction or their combination. In other words iatrogenic. Why did you originally start taking drugs?

 

Sorry I can't post any links but I'm sure one of the mods will do so soon.

 

Stopping and starting drugs is very destabilising and I agree with you that a search for stability is your primary aim now. In that process it's very important that you accept your symptoms as something temporary that will pass and don't attack it will more drugs/changing dosages,etc. This will only make it worse. Prepare for some rough ride and ride it out. If necessary take some time off from your obligations.

 

When you give us more details with at least approximate dates of when you started taking and stopping both Prozac and Lexapro and their dosages we'll be able to suggest what could be the best course of action. Please don't forget other drugs you're taking.

Once again welcome.

Bubble

[johnjohn82]

Hey clearday and bubble, thanks for your answers. I already updated my signature.

 

Bubble, I don't think the anxiety I was experiencing was related to quitting paxil. SInce 2000 I 've got this anxiety, sense of urgency and unability to concentrate. On prozac I didn't feel especially more anxious. What happened is that for a long,long time I wasn't doing anything with my life and everytime I tried to go back to college I wasn't able to follow through. This year I started again after 8 years and that sure made me tense. I shouldn't have messed with my meds at this point, I was kind of doing it even with all this anxiety. The switch inserted a variable here that took all my focus away from the things I am doing. BAd call on my part. The month I started taking lexapro I vanished from friends, from the bars I co-own with my friends, people started asking and that didn't help. I felt guilty and anxious about it.

You mention a important point, the fact that SSRI can exarcebate adhd as a side effect. I am sometimes afraid that some of my fears, my inability to concentrate and my anxiety and agitation could be made worse due to them. While I was taking Lexapro 2.5 on alternate days I felt so much better the day after I didnt take any, better than ever.. I don't think that should be a definitive proof of anything but it made me wonder. How can we know what the antidepressants are doing to you if you take it for so long?

 

 

I started Prozac in october or november 2014 and started Lexapro on april this year. I ve been taking xanax XR 0.125 or 0.250 mg daily since 3 weeks ago. THat worries me too.

 

Thanks again for taking your time to reply.

 

Edit: Forgot to answer one of your questions: I started taking antidepressant in 99 due to a deep depression, tiredness and no motivation. Since 2000 though anxiety has been my main issue.

[clearday]

So, you stopped Effexor last year after ten years on it.

 

Effexor withdrawal often lasts a few years, and is difficult. People in protracted, delayed onset effexor WD often complain of difficulty concentrating and finding words to say in conversations..

 

I'm guessing that you're in Effexor withdrawal. The other medications have just agitated things, and created problems of their own as well, perhaps creating WD symptoms of their own on top of Effexor WD.

[Altostrata]

Welcome, johnjohn.

 

In your first post, you mention a stimulant medication. Please put that in your signature as well.

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

 

What makes me more anxious is that even though at 3 mg I am not feeling the withdrawal, I don't like the way I feel on it. I would much rather be tapering a drug that I could be stable on.

 

 

It's difficult to say whether you're having adverse effects from your combination of Lexapro and Prozac, or an adverse reaction to either drug. The symptoms you feel could be from going on and off many drugs and recently skipping doses of Lexapro. Your nervous system has been destabilized from all this activity, not from the drug or drugs.

 

How long have you been taking 3mg Lexapro and 10mg Prozac? Have you been taking this consistently, at the same times each day? Have your symptoms changed while you've been on this combination? When do you take your other drugs? Please keep notes on paper of your daily symptom pattern.

[johnjohn82]

Hey Altostrata,

I haven't had a regular schedule of either drug at all. You're right and I should know better. I panicked and wasn't making any decision, I just ran everywhere. Today I took the 3 mg in the morning and will keep doing it at the same time. I am not taking anymore prozac either, even though I was on it before and didn't have any bad reaction I don't think its helping and im the long run I am just adding an extra variable that makes it even harder to know what' s going on. I'm less panicked now, just slept for 9 hpurs. It's 6 PM and I am getting up!

 

I take 20 mg of vyvanse Altostrata, and I will make sure I write it on my signature. I didn't take any today and I keep it to a minimum. It's still another variable and I think the fact I Didn't know what drug was causing what made me much more anxious. I feeling seNSITIVE right now and a stimulant wouldnt help.

 

Thanks a lot for your reply, I am calmer right now and writing here and reading all the replies helped me come back to reason. I will post the interaction checker later on.

[johnjohn82]

Just checked the drug interactions between the meds I'm taking. I haven't taken any prozac the last two days and I shouldn't anyways. I will be vigilant about any problem even though I took for only two weeks this time. The interaction List: http://www.drugs.com/interactions-check.php?drug_list=1013-565,1115-648,1475-2533,133-52

 

Last two days weren't that bad. I'm taking the 3mg of lexapro in the morning which makes me more tired. I'm still nervous about the drug, thinking too much about a bad reaction I could have on it, thinking I'm stuck on it ,but I am sticking to the plan. Stabilizing on this dose first and taking my time. I'm hoping I won't feel that incapacitating fatigue on this low of a dose. I didn't take any Xanax XR yesterday but today I took half a 0.5mg pill. I feel better on it and started doing some things I was avoiding. I want to feel safe and stable right now without feeling like a zombie. On 5 mg I was feeling like crap, had muscle tensions, felt distant, a litlle depressed, had headaches.

 

Altostrata, what you said about all the skiping doses, adding prozac and changing doses makes a lot of sense. I DIDN't feel good on Lexapro but all this mess made me much worse. I am hopeful things will be better.

[Altostrata]

Please take 3mg Lexapro consistently, at the same time each day, for a week, then let us know how you feel.

 

Vyvanse can cause anxiety and sleeplessness. Why are you taking it?

[johnjohn82]

Hey Altostrata, thank you a lot for your advise. I will do it for a week and see how it goes.

 

I'm taking vyvanse because I was diagnosed with Adhd, after a series of tests. My pshichiatrist thinks its more important I take the stimulant than any ssri. On 30 mgs I felt it was too much and I started taking only 20 mg. these last days I haven't taken any as I am really tense and feeling kind of paralyzed by this tension. Vyvanse makes me more clear minded and on some days I even used it as a sleep aid. I am finding I should focus on my phobias and anxiety first right now , as I mentioned I for a long time withdrew(I am sure that's not the right spelling : ) ) from any commitment and I am starting to slowly commit myself to small things.

 

Thanks for answering, I really appreciate it.

Are there people on the forum taking really small doses of a ssri and find it to be theraupetic and not only a way to avoid withdrawal?

 

Edit: After starting Lexapro I was taking the vyvanse more as a way of not sleeping 20 hours a day.

[johnjohn82]

I'm not feeling very well, When I take Lexapro I feel like I'm under water, slow and it's hard to concentrate. I also have this feeling when I wake up that I didn't get any rest whatsoever. I hope thes effects dissipate with time.

[Altostrata]

Whether a drug is "therapeutic" or not is a subjective judgment. We do see very small doses of a drug can reduce withdrawal syndrome, however.

 

Have your withdrawal symptoms decreased?

 

If 3mg Lexapro makes you tired, perhaps you should gradually move your dose to later in the day.

[johnjohn82]

I'm not 100% sure but I believe the withdrawal simptoms did decrease as I'm starting to feel really similar to the way I was feeling before I tried to quit. For now I will keep taking it on the mornings to avoid imsonia but I will may have to change that later if the tiredness doesen't get better. Thanks for the reply!

[johnjohn82]

Had a good day today even though I woke up feeling pessimistic. I took vyvanse 15 mg and it helped. Didn't need any Xanax today, what a relief!

[johnjohn82]

Feeling bad and scared now. I feel like crap on lexapro. I felt today some regular simptoms or side effects: waking up like I hadnt slept at all, vivid dreams, Dizziness, felt itchy 1 hour after I took my dose, feeling depersonalized and feeling of pressure on my eyes(like they are dilated).

 

Took 1/4 of xanax xr an hour ago.

 

Yesterday I felt much better after taking a litlle vyvanse but it might have made things worse.

 

Still my baseline is really poor now. Don't know if I should be aimimg to updose in a couple days.

I feel like crap on lexapro since 2 weeks after having started it but I wasn't this bad before reducing from 5 mg.

[Altostrata]

Please give reinstatement at least 4 days to take effect. It may take a while for your nervous system to settle down.

 

How often and at what dosages have you taken Vyvanse over the last month?

[johnjohn82]

You are right, I'm more on the side of overstimulation from the drug.

 

During the last 4 months I took vyvanse 20 mg daily, I didn't have a problem with it until I started tapering lexapro.. This week I took 15 mg on Monday and that was it. I'm kind of sensitive right now and the side efects is outweighing the benefits.

Last month I took the usual dosage (20 mg) until last Week.

 

Thanks for your support Alto.

[johnjohn82]

I forgot to mention I'm taking ltheanine, fish oil and a over the counter med for the headaches and head pressure.

I used to take magnesium and I would like to get some but in Brazil is hard to find a good one( Dr best glycinate and the citrate in powder from another brand are the ones I found to be good)

[Altostrata]

I fear you might also be physically dependent on Vyvanse, and when you don't take it, you suffer withdrawal symptoms from that, too. This complicates the Lexapro situation.

 

Google "Vyvanse dependency"

 

How about going back to 10mg Vyvanse per day?

[johnjohn82]

Oh, that's why you were asking.

Yes, Before this whole thing I spent some days without it and I really felt it.

This time I'm so tense about the ssri that I dismissed this.

I'll read the link now, I allways assumed the rebound from vyvanse would only last 2-3 days maximum.

I'm willing to do a slow taper from vyvanse, I'm confortable with it, I know the side effects and it doesen't scare me at all.

I will take 10 mg the rest of the week and see if it gets better.

Thank you a lot.

[ladybug99]

Hi JohnJohn. I just read this thread of yours and noticed you take xanax here and there. Please be careful with this drug. It's a benzodiazapine and the most highly addicting drug. I suffered terribly for 2 years from this drug. It's really bad. I'm wondering if it's contributing o you having rough days. When the drug wears off, you could hog into withdrawal, hence the symptoms. I just wanted to let you know this. If i were you, i wouldn't take it anymore...it's only going to come back and bite you...

 

Tulip

[johnjohn82]

Hey Ladybug,

I was gone for a while, I changed my lexapro dosage 5 days ago beacause 3 mg was clearly too much. I read the thread about the prozac taper and thought that maybe my attempt would be more sucessful If I added a smaller dose of prozac. I've been taking prozac 5 mg and lexapro 1 mg for these 5 days and i'm feeling better this way. I found lexapro, at least at the smaller doses to be too stimulating, I was feeling too anxious. I also bought some magnesium and I've been taking it since yesterday.

 

That wasn't my plan but having a little prozac is conforting as I've been on it before and I never adapted to lexapro. One thing I notice is that I'm much less agitated now than when I was taking prozac 20 mg and all my 10 years on effexor. I allways thought I had a bad case of anxiety and my meds weren't covering it but I believe they were the ones to blame.

 

I'm really scared of xanax xr, I've been taking 0.125 every night for the last 8 weeks I believe. I read enough of terror stories about it and I'm not confortable with it and afraid I might have developed an addiction by now. I will look into ways of tapering this dose, thank you for your advise.Do you believe I could be having withdrawals bettwen doses even on the xr version and this low dose?

 

Edit: I noticed everytime I take lexapro My eyelids start to twitch 10 minutes later. I aslo found that even on a dose this low I can't sleep if I take it at night. Taking it during the day makes me tired, I didn't get along with this drug at all.

[ladybug99]

Hi John John. How are you feeling? It sounds like you made a right decision about lowering the lexapro and upping the prozac. Guess our bodies will certainly dictate what it wants. I'm so glad you're doing better.

 

If you take a look at my thread, you will see i haven't been doing well. Bad anxiety. Alto suggested i stay at my dosages for 4 days, which i did, but nothing has changed. I'm waiting to hear back from her as to what to do. I'm wondering if I'm having an adverse reaction to prozac and need to get off this sooner, rather than later.

 

How long did it take you to start feeling a bit better?

[johnjohn82]

It's been 2 weeks without Lexapro. I've been taking 5 mg prozac only.

I'm not feeling any of the acute withdrawal symptoms which is good but I've been feeling really afraid. I'm nervous the symptoms will appear and I've never been in such a low antidepressant dose since I started on them 15 years ago. I'm feeling much less agitated, all this time I could never pay attention to the moment I was allways feeling the need to move, like I had an itch inside. I didn't give a damm about anything including myself. I'm afraid of what is to come, wander if i will do fine on this dose if I will hit bottom in a while.

Tomorrow I will have an appt with my pshyciatrist and he is open minded, I hope We have a good talk.

[johnjohn82]

Just came back from my appointment. Last night I didn't take any drug whatsoever as I was out of them and I felt so clear minded today. I would be very excited about that except that I know I can't quit cold turkey right now. My pshichiatrist said Antidepressants are not for me and Said I should quit. He believes Vyvanse is the answer and on that I disagree with him. I'm rejecting every drug, I feel terrible on any of them. I should have tapered when I wasn't having so many reactions from the Antidepressants, I had many chances to do that. I believe lexapro was the last drop on a nervous sistem already sensitized. I hate this drug. When I was in hell after withdrawing from paxil they gave me a bunch of drugs , antypshicotics, mood stabilizers(not paxil though) but the one that made me suicidal was citalopram. I OD on it and spent a week on the hospital for that. 5 years ago I was perscribed Lexapro and after 1 week asked to be hospitalized due to adverse reactions. I just visited the hospital and quit the drug. I should've learned to stay away from citalopram/escitalopram.

These last days I met myself again, I 've been dead for so long. So many times I visited this website before thinking about tapering but never had the drive to. I came here really confused this time and had a hard time sticking to any plan. The temptation to just ditch the drug is here but I can't do it after reading other threads of people trying to reinstate after months. I guess I will try a smaller dose and hope its bearable.

This week I scheduled a session of breathing training , an acupunturist and scheduled a session with my psychologist.

[Altostrata]

jj, did you stop taking the Prozac?

 

Please don't do that. Take the 5mg regularly, at the same time each day.

 

Vyvanse is an amphetamine analog that incurs dependency. It sounds like you need a new doctor.

 

It also sounds like you are adding to your problems by worrying about something that hasn't happened and may never happen. Clearly, you had adverse effects from the Effexor you were taking for years, as well as the more recent Lexapro. You are feeling better on 5mg Prozac. Isn't that enough?

 

What makes you think you need an antidepressant at all? You need to look closely at your assumptions that you need psychiatric treatment.

 

Yes, you are probably at least physiologically dependent on the xanax xr. Do not skip doses of this or any other psychiatric drug.

[johnjohn82]

Hi Alto, I've never stopped taking it except for one night.

I'm feeling so much better than all the last 10 years, I'm not agitated and anxious all the time. I'm starting to believe this can work out after all.

 

I'm now taking:

- 5 mg prozac every night

- 1/6 of a 0,5 mg xanax xr pill every other night.

- 5 mg Vyvanse every other day

- omega 3, magnesium chelated from dr best every day

 

I'm also going to a phisioterapist specialized on posture and breathing exercises and it's helping a lot.

[Altostrata]

If you're happy with your current drug combination and don't want to go off it, there's not much more we can do for you.

 

I see you are taking Vyvanse every other day. I presume you like the effect?

[ladybug99]

John John, How are you doing? Was thinking of you and wondering how you are. I hope you're well on your way to wellness!

[Iamfine]

I've been on most of them and if I can get better ANYONE can. I wouldn't worry about the Xanax so much you are on a teenie dose and you haven't been on it that long. You have a good attitude, I predict you will be fine.

[johnjohn82]

Hey alto and hey ladybug : )

 

I've been having a tough time, a lot happened the last few weeks on my personal life.

Alto, I had doubts about the vyvanse before but I've been off of it for 2 weeks , I decided to quit altogether after some days taking 5 mg.

 

I was going to post in here the good news that I though I had stabilized on the prozac 5 mg. I had somedays at school that I could stay seated, no inner restlessness and I was very emotional about it. I might have lived more than 10 years with akastasia caused by different SSRIs and though it was my personality.

 

However I had a feeling that even a tiny dose of xanax was making me feel worse, I was taking around 1/6th of a 0.5 mg pill. I quit it and after 2 days of some symptoms I thought I was over it, however yesterday I started to feel too anxious, some depersonalization and took one of the pieces I had. That made me much worse really, since then The fevers, cramps and anxiety returned. I'm just too sensitive to the benzo effects now and I'm in doubt if I should just try to endure some days of difficulties instead of reinstating or ask my pshichiatrist for Klonopin or valium and taper from a very tiny dose(I was taking around 0,1 mg) .

 

I've been really tense with this situation as I don't want to extend my time on benzos.

 

Hey Imfine, Thank you for your encouragement, I might be worrying too much on this process and that is not helping. I had the worst of times when I quit paxil 10 years ago and any changes I make on the meds I start to remember those times and can't concentrate on anything else. Thanks a lot.

 

Ladybug , I want to hear from you, I'm heading to your topic now: )

[johnjohn82]

Alto,

I want to quit them all if possible. My goal now is to get rid of xanax and I already quit vyvanse.

Last time I went to the physiotherapist with whom I do some breathing exercises she mentioned I looked much healthier and I told her I was reducing my meds. I'm afraid to get my expectations too high, It was hard to get back on my feet after I crashed when I quit paxil.

 

This forum has been my strongest source of support and I thank you a lot for that.

[ladybug99]

Hi John John. I'm so sorry to hear you had some problems in life lately. Unfortunately, life has its stresses, and when you are trying to climb through the ravages of psyche drug hell the 'normal' life stresses seem insurmountable. Just keep reminding yourself that this 'hell' is temporary...and thank God for that!

 

John John, i don't know much about Vyvanse, so it's hard for me to give you advice on that, but i do know about benzo hell. I've been there! This August i will be 2 years out. Did you ever look at Benzo Buddies.org? It's very much like this site. It will give you find of info on benzos, plus people and moderators will come in to help give you advice.

 

I can't help but wonder if you are having zanax tolerance withdrawal. Zanax is VERY short acting, hence easier to go into withdrawal between your doses. If i we you, I'd write an intro in the benzo site and ask a moderator for suggestions. They just might advice you to switch to super small dose of valium (longer acting) and slowly wean off. If your body is dependant on a benzo, then taking it, then not for couple days, Will throw your nervous system out of wack.

 

I hate to read all this suffering going on from all these friggin drugs. It upsets me so much. My heart was breaking when i read that you were back to struggling. I truly hope your nervous system is stabilizing as i write this. Just know that you will stabilize...and that you will heal from all this. Just know that your life will be grand again, my friend.

 

Let me know how you're doing. ????????

[Altostrata]

johnjohn, good to hear reinstatement of Prozac seems to be working.

 

Please go to http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/to discuss the benzo situation.
 

[johnjohn82]

I've been feeling really anxious and tense, I've been overthinking and over analyzing everything. I wanted to get rid of xanax as I didnt want my use to go on any longer and I tapered it taking smaller pieces everyday. After 3 days off I was feeling kind of weird, disconected and that was making me anxious. I decided then to updose the prozac to 10 mg attempting to make it better. It didnt make any sense, I did it because I was scared. My body temperature got really high, the restlessness was terrible. That night I went to a Pshichiatric clinic and talked to the doctor in there. I was anxious, scared and agitated. I talked to him for 1 hour and I found it really helpful. In the end of our talk he mentioned he would suggest me to take a benzo to calm down but he didnt think I would need it as I was looking much better. I felt confortable there and it was relieving to act on my scared thoughts as I usually let them pile up and never ask for help. I noticed how much my isolation and obsessing are damaging to me. My ex girlfriend took me there and I mentioned to her I felt it was a good thing to go there and that I only asked for help(from her and from the doctor there) because I 'm reducing my meds. On my meds I would never do that. I tried to see as a good thing as sign that I can relate better to people. I've been taking antidepressants for 15 years and honestly I've never done well on them. I feel my sleep is better, I'm much less agitated and I'm going to see a new psychologist next week as I experienced how great it is to share my fears with someone else. I'm really afraid even though I 'm starting to see the benefits I'm having with less meds. I keep seeing signs my depression is going to come back and see myself going into the deep depression I was when I quit paxil 10 years ago.