☼ retexan599 John From Houston, TX

[retexan599]

Hello.  I will be posting my current tapering activity in the Tapering forum, but thought just to introduce myself here.  I am 78 years old, long divorced, fully retired.  I have had a good life overall: great family, productive career, very blessed in those areas.  However, as per my signature, I have fought against depression and anxiety since 1989 with mostly stable periods and some very, very bad periods.  Have been with my current psychiatrist since 2001 and he has helped me greatly; saved my life really.  My reason for tapering is to improve my general alertness and energy level as I have gotten older and towards being elderly.  I will put more detail into my tapering post.  Thanks for having this forum, I have already learned a lot just browsing around it.  

John in Houston

[KarenB]

Hello John and welcome to s/a,

 

This thread can be your journal to record your tapering progress - so this is the best place for you to post those details.  The tapering thread is for more generalised discussion.  You can also ask questions in this thread.  Thank you for filling out a signature - it's very helpful for when your thread gets longer.  

 

Are you still on all those medications (apart from the Quetiapine)?  You certainly have been through a lot - that shows so much strength. 

 

Did you have any symptoms while tapering Quetiapne?  How is the Paroxetine taper going?  We find that most people do best by tapering 10% of their current dose each 4-6 weeks.  This reduces any stress for your Central Nervous System, making it less likely for you to get withdrawal symptoms.

 

You might like to read this also about choosing which drugs to taper first:  http://survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/  and this about tapering Paroxetine http://survivingantidepressants.org/index.php?/topic/405-tips-for-tapering-off-paxil-paroxetine/

 

You can also read in the Symptoms and Self-Care thread to start building up some good practises which will help while tapering.

 

It's good to have you here.

Best wishes,

KarenB

[retexan599]

Thanks for the thoughts KarenB.  Here is some more information. 

 

My psych doctor and I are weaning me from some of my medications.  The purpose of this is to increase my alertness and energy levels as I have aged (currently age 78).  He is working on several premises as I see it:

·         A person’s need for antidepressants is less as they age in the senior citizen category.

·         Recent studies on Paroxetine indicate that it is less efficacious per se than was once thought.

·         I have been on both Mirtazapine (Remeron) and Paroxetine for many years.  Recent studies suggest that prescribing these two medications simultaneously is not indicated. 

 

Quetiapine

We have already (this year 2015) weaned me away from Quetiapine.  I had been taking 75 mg for several years (along with the Paroxetine and Quetiapine).   Starting in March, we went 75mg -> 50mg and in July 50mg -> 25 mg, and at end of August 2015 discontinued altogether.  As far as I can tell I have had no problems with discontinuing the Quetiapine in this manner.  This is kind of amazing to me, as I can recall taking as much as 600mg of Quetiapine (Seroquel) back in 2002.  Over the years we migrated down to the 75mg mentioned above, and now zero. 

 

Paroxetine

As per my signature, I have been taking Mirtazapine 45mg and Paroxetine 30mg for many years.  For reasons above, we are reducing the Paroxetine.  So far:

·         10/6/2015: reduced the Paroxetine in one jump from 30 to 20mg (33%).  No apparent ill effects after 48 days at 20mg.

·         11/24/2015: reduced Paroxetine in another jump from 20 to 15mg. (25%) (I cut the old 30mg tabs in half for this).  No apparent ill effects after 20 days at 15mg.

·         12/14/2015: reduced Paroxetine to 10mg. (33%).   

 

When I visited the doctor on 12/14, I quizzed him at length about the need to taper off more slowly.  I quote some of the material in this forum and showed him the graphs discussed in one of the tapering forum posts.  His basic thought is that the Mirtazapine I am taking concurrently will ‘protect’ the relevant receptors while the Paroxetine is tapering.  I think he plans to move me to doses lower than 10 mg when I see him in in January.  However, from the anecdotal posts here and looking at those graphs, it seems that where people have had the most problem tapering was below 10mg.  But, I have been on Paroxetine for at least 15 years, and I am leery of precipitous reductions below 10mg.  I will continue to research the question, especially with regard to whether the concurrent Mirtazapine will avoid the tapering withdrawal symptoms that others have had.  

 

I am writing this now, because I definitely do not want the kind of withdrawal problems reported in this forum!  I feel no sense of ‘hurry’ about this, so probably will make smaller and smaller percentage decreases below 10mg.

 

I would appreciate comments back from the group about this if anyone has relevant experience.  Particularly withdrawing from Paroxetine in the presence of other antidepressants like Mirtazapine or similar. 

 

Deplin (L-methylfolate)

I want to comment on Deplin.  Dr. R started me on Deplin in mid-2014 in response to my frequent episodes of anxiety (wherein I feel like I need to cry).  Since starting the Deplin, I have had virtually none of these incipient crying episodes.  It has been like magic for me.  Deplin is not listed in various drug formularies, as it is considered to be a food supplement.  Oddly, it is only available by prescription, but is not covered by drug insurance.  Fairly expensive: a month supply of L-methylfolate costs me around $68 with a drug prescription saving card.  But it is well worth the cost to me.  Good stuff!   

 

Thanks for reading.  If I have left out something important, let me know. 

John 

[Fresh]

Hi John , welcome to the site.

I'm not surprised you want to feel more alert . . . I started putting your meds into the interaction checker at

www.drugs.com. These are some of the interactions:

 

 

Major paroxetine  mirtazapine

Applies to: paroxetine, mirtazapine

Using PARoxetine together with mirtazapine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea.

 

Moderate lisinopril  mirtazapine

Applies to: lisinopril, mirtazapine

Lisinopril and mirtazapine may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. 

 

 

You might want to put the rest of your meds into the interaction checker. The quetiapin interacted badly with mirtazapne , paroxetine AND lisinopril.

 

Good on you for using your own judgement with regard to your rate of decrease.  At this stage of the game you may consider slowing down the paxil taper . . . withdrawal symptoms may not appear for 4-6 weeks after a drop.

 

Best wishes ,  Fresh

[nz11]

Fresh you just bet me...ugh! lol

Great minds think alike...deleting a heap out of my post.

Post to follow shortly.

[retexan599]

Appreciating the various feedback I have received and will respond more.  In the meantime....

I left out something important in my description of my journey above.  And that is that I had substantial interaction with ‘talk’ therapists along the way.  The most helpful one I will refer to as Becky.  She worked with me 1989-1993.  I learned that a lot of my issues had roots in my father’s severe alcoholism, the death of my mother at my age 14, and other childhood traumas.  I learned that I was an ‘Adult Child of an Alcoholic’ and consequently had a lot of codependency issues.  At various points I attended CODA meetings which were very helpful, by putting me in contact with others who had leftover childhood issues.  I think that the therapy with Becky & CODA were really helpful in keeping me stable during 1990’s.  Later, I had other therapists who were less helpful, but it was always useful in a healing way to continue such interactions.  I have not been with a therapist per se since around 2003, and my psychiatrist Dr. R has ably filled that role.  I am not sure I can separate the benefit of the psychiatry drugs from the role of therapists over the years; but I think that neither *by themselves* would have improved my life.  Just writing that to be more complete.  

[retexan599]

Replies to some of the good questions you have asked. 

• Did I have symptoms while tapering Quetiapine:  No symptoms that I am aware of. 
• Paroxetine taper results so far: No problems noticed as I went 30>20>15>10.  At 10 mg only for three days. 
• Paroxetine/Mirtazapine interaction: I have been taking both meds (30mg P, 45mg M) since at least 2002.  My condition in those days was severe and perhaps P + M was thought necessary.  I was never aware of the interactions brought up by Fresh; e.g. serotonin syndrome.  I take a lot of heart medications, and at one time took the beta blocker atenolol; I often had confusion and shakiness with that and got my cardiologist to discontinue it.  
• Lisinopril/Mirtazapine: Cardio says the L is a very low dosage; my blood pressure is good and under control.  
• After considering the various info in the forum, I will plan to stay at the 10 mg Paroxetine for some time; will see psych doc in mid-January and will have more discussion about further tapering (e.g. 10% guideline). 
• to nz11: I have been with my pdoc since early 2001; he has been in practice something like 45 years.  I will ask him about study 329, but would be surprised if he did not know about it.  

I'll keep posting my ongoing journey away from the Paroxetine.  Thanks for input!

John 

[nz11]

Welcome retexan

He is working on several premises as I see it:

  Recent studies on Paroxetine indicate that it is less efficacious per se than was once thought.

This suggests to me he is now aware of study 329 and is taking action ...good on him.

[KarenB]

You sound like a really thorough person, John, which seems to be serving you well in this tapering business.  Good idea to stay steady on the Peroxetine for a bit - Christmas can have enough stress going anyway (want to join our 'holding till after Christmas' club?)   'http://survivingantidepressants.org/index.php?/topic/10816-the-hold-till-after-xmas-club-wanna-join/#entry198175

 

It's good you didn't have any issues with your previous tapering.  You've probably already read that sometimes people experience delayed w/d after too-fast tapers, so tapering by 10% from now on is probably quite important. 

 

Best wishes,

KarenB

[retexan599]

Hello. I am doing fine. As noted in my signature, I reduced from 30 to 20 to 15 to 10 mg of Paroxetine in steps starting back in October, 2015.  And keeping the Mirtazapine at 45 mg + 15 mg Deplin all the while.  I had started on 10 mg P starting December 14^th, and no problems arose.  After consultation with my pdoc last week, I have now reduced the Paroxetine to 5 mg, by cutting the 10 mg pills in half; so far no ill effects.  I will continue with 5 mg for a month or six weeks and consult again.  We will probably cease Paroxetine at that time. 

 

Talked at length with pdoc about tapering issues I have become aware from by reading this forum.  Basically, he believes that the 45 mg Mirtazapine is sufficient antidepressant to allow this reduction in Paroxetine.  In addition, the 15 mg Deplin that I take helps facilitate the Mirtazapine action; he described it as the Deplin laying a ‘foundation’ for the Mirtazapine. This has been his advice throughout the overall P reduction process.  So far, it is working out and I am feeling well. 

 

I asked him (theoretically) whether he would be doing anything different if Paroxetine was my only medication.  He said then, we would be definitely talking 10% taper, shaving pills, etc.  But with the Mirtazapine, I don’t need to do that.   As you can tell, I trust my psychiatrist; he has been in practice over 40 years, and I have been his patient since 2001.   No, I don’t take his advice blindly, as I have researched the tapering subject from many web resources, including this one.   Thanks to all who contribute.  Will post back in a few weeks.  

[nz11]

Thanks for taking the time to come in and give an update.

 

I was sometimes wondering how you were doing.

 

John thats a very fast taper. Withdrawal symptoms can be delayed.

 

Did you ask the pdoc how he will deal with the manifestation of delayed paxil wdl symptoms.

 

But with the Mirtazapine, I don’t need to do that.

Well thats an interesting way to look at it.

 

Keep us updated from Houston , over and out.

[retexan599]

Hello, I am doing fine. Update on my Paroxetine discontinuation.  As you can see from my signature, I began a stepwise reduction in October, 2015. Under my psychiatrist's direction I went 30, 20, 15, 10, 5, and then went to zero on February 23rd.  So I have been at zero Paroxetine for about one month.  During this period, I maintained the Mirtazapine at 45 mg and L-methyfolate at 15mg.  I am ok, and do not have significant issues.  After the last step from 5->0, I did feel somewhat unsettled and disgruntled for a short while, but that has settled down.

I have felt more emotional since the discontinuation.  My libido is stronger, although I do not have a partner to share that with.  My sense is that the Paroxetine was suppressing my emotions over the years.  This may have been appropriate during years past when I was fragile, but feels good now without the Paroxetine.  

I will continue to monitor myself as time goes on, as I have noted the experience here of people whose withdrawal problems occurred after a delay period. 

It does seem that the Mirtazapine and l-methylfolate have sustained my CNS through this time.  I plan to continue on both of those meds in the future. 

 

Best wishes to all.  

 

John 

[Fresh]

John , what a positive update.    You're right about being more emotional , but that should settle as your cns strengthens.

 

Are you still on 15mg Deplin too?

[retexan599]

John , what a positive update.    You're right about being more emotional , but that should settle as your cns strengthens.

 

Are you still on 15mg Deplin too?

The generic form of Deplin is L-methylfolate, which I take at 15mg.  

[Hopeinahpwr]

John,

You are an inspiration, I pray for you, please pray for me, I need it in my struggle.

Ben

[retexan599]

Hello.  Update on my Paroxetine discontinuation.  You can see my history in my signature.  I have now been off of Paroxetine for over three months and am doing fine.  As before, I am maintaining the Mirtazapine at 45 mg and L-methyfolate at 15mg.  I am ok, and do not have significant issues.  

I will continue to monitor myself as time goes on, as I have noted the experience here of people whose withdrawal problems occurred after a delay period. 

It does seem that the Mirtazapine and l-methylfolate have sustained my CNS through this time.  I plan to continue on both of those meds in the future. 

 

Best wishes to all.  

 

John 

[cymbaltawithdrawal5600]

From a spreadsheet developed by Nz11 et al. to calculate how fast someone's taper actually was, at a glance:

 

Date started tapering (d/m/yy). 10/6/2015  

Date drug free (d/m/yy). 2/25/2016  

Start dose      30.00  

Jump off dose   5.00  

Define your intervals between drops 4.00  weeks           

Your avg taper speed was  34.40%  OPD 

34.4%   drops  every  4.00  weeks  OPD  (Of Previous Dose).             

You tapered for 21 Weeks.

  

 

I had to use a number for the interval so I chose '4' even though you held a longer interval at one of the doses and shorter at another.  Everything is approximate and I just used the dates in your signature

 

I am sure you will be fine for ? period of time with that precipitous a drop but you did not have the advantage of perusing our document on receptor occupancy rates and going over that with your doc before deciding to taper so rapidly.

 

I couldn't attach the sheet so I just copied the text.

 

I went from a cocktail of 3 drugs, one at very high doses, to zero in the space of, oh, I think it was a week? Memory is hazy. I got through the initial brutal withdrawal somehow and entered a honeymoon period lasting about a month or so. Then a gradual slide into protracted withdrawal at the one year mark. I am just now coming out of another of its stages and I am nearing 4 years off. There's no 'do overs' when you reach the 1 year mark off drugs, nothing to cushion the fall into protracted withdrawal. A he11 I/we wish was reserved only for pharma executives.....

 

I'll never do THAT again.

 

I am sure you'll be luckier but if you are not, we have plenty of help available. And of course, you've got the mirtazapine. Not the same drug as paxil, but maybe it will do the trick. And probably nothing will happen from the rapid taper off seroquel was it? We have just seen too many people develop delayed reactions after a too fast withdrawal off these drugs and end up being convinced by their docs to go back on them when these symptoms arise. Hate to see that keep happening so that is why we urge a slower taper.

[retexan599]

From a spreadsheet developed by Nz11 et al. to calculate how fast someone's taper actually was, at a glance:

 

Date started tapering (d/m/yy). 10/6/2015  

Date drug free (d/m/yy). 2/25/2016  

Start dose      30.00  

Jump off dose   5.00  

Define your intervals between drops 4.00  weeks           

Your avg taper speed was  34.40%  OPD 

34.4%   drops  every  4.00  weeks  OPD  (Of Previous Dose).             

You tapered for 21 Weeks.

  

 

I had to use a number for the interval so I chose '4' even though you held a longer interval at one of the doses and shorter at another.  Everything is approximate and I just used the dates in your signature

 

I am sure you will be fine for ? period of time with that precipitous a drop but you did not have the advantage of perusing our document on receptor occupancy rates and going over that with your doc before deciding to taper so rapidly.

 

I couldn't attach the sheet so I just copied the text.

 

I went from a cocktail of 3 drugs, one at very high doses, to zero in the space of, oh, I think it was a week? Memory is hazy. I got through the initial brutal withdrawal somehow and entered a honeymoon period lasting about a month or so. Then a gradual slide into protracted withdrawal at the one year mark. I am just now coming out of another of its stages and I am nearing 4 years off. There's no 'do overs' when you reach the 1 year mark off drugs, nothing to cushion the fall into protracted withdrawal. A he11 I/we wish was reserved only for pharma executives.....

 

I'll never do THAT again.

 

I am sure you'll be luckier but if you are not, we have plenty of help available. And of course, you've got the mirtazapine. Not the same drug as paxil, but maybe it will do the trick. And probably nothing will happen from the rapid taper off seroquel was it? We have just seen too many people develop delayed reactions after a too fast withdrawal off these drugs and end up being convinced by their docs to go back on them when these symptoms arise. Hate to see that keep happening so that is why we urge a slower taper.

 

 Thanks for taking the time to look that up for me.  I am staying in regular touch with my psychiatrist to milestone my progress.  I actually did have access to the receptor occupancy charts and went over them with him during my taper.  He felt confident that the mirtazapine would be an adequate antidepressant on its own. In addition, he believes (and my experience confirms) that the L-methylfolate provides an additional level of protection. I know that when I started the lmf in 2014 (prior to any tapering) I stopped having the occasional feelings of anxiety and panic that I experienced from time to time.  And, in spite of the expense, I plan to continue the lmf (as well as the mirtazapine) indefinitely.  

 

I think I have a better awareness of possible relapses or bad outcomes, since following this forum, so thanks to all who share. 

[cymbaltawithdrawal5600]

So I am not quite sure why you are here then, if you are following a rate which we know is faster than we recommend and you are seeing a psychiatrist and believe in the 'rightness' his methods instead of the wisdom of ours? We pretty much are of the opinion that the mirtazapine and deplin will to nothing to mitigate the particular wd effects of paroxetine. But those are not likely to be showing up right away anyway. But I wager show up they will. I (and others) see it happen time and time again. Maybe you will be the exception, idk.

 

Did I miss something in your narrative?

 

(PS. Not necessary to quote the previous post to reply, just go to the bottom of the page and start typing in the 'reply' window. Reading the same duplicated stuff all down a page gets tiring and tends to obscure the important stuff.)

[JanCarol]

Hey John,

 

I deeply hope that you are one of the lucky ones.

 

That was a precipitous straight line taper on the heels of a seroquel taper.  We go down in a curve, to prevent these precipitous drops.  But there have been people who tapered like you and walked away.

 

Maybe you are one of those who can "get away with it."  It's just that the risks of how bad it can get - to me - outweigh the benefits of the early "walk away."
 

I agree with CW that your psychiatrist is completely misled that mirtazapine and deplin can cushion a paxil withdrawal.  They are completely different animals, and, at one point Alto called the "deplin" thing a swindle - it's available OTC as "metafolin" and other things:  http://survivingantidepressants.org/index.php?/topic/1328-deplin-the-l-methylfolate-swindle/

 

But you seem to be going fine, more power to you!  If you have any problems in future, it is more difficult to put you back together in 6 months time, than it would be to reinstate a small amount of Paxil (say 1-2 mg) now.

 

If your symptoms increase over the next month, you have about a 2 month window where the chances are better that a reinstatement will help.  Please keep that in mind as you go on your journey.

 

Good luck, and fingers crossed for your success!

[cymbaltawithdrawal5600]

Oh dear I DID miss something when I read your narrative above:

 

Quote: "I plan to continue the lmf (as well as the mirtazapine) indefinitely."

 

So you won't be tapering off any more drugs then? That's part of the purpose of Survivingantidepressants.org: "Peer support for tapering and withdrawal syndrome." It is at the top of every page in this forum.

 

But I have a feeling it will be to your advantage to stick around, that "bit emotional" you were feeling? That is a symptom of withdrawal syndrome coming from dropping your drugs too quickly. Sadly, in my opinion your doctor has no idea what he has encouraged you to do. But he won't be the one feeling the symptoms of this, YOU will. You just might be able to educate him....Be interested to see what he prescribes for you next. Long term on ANY antidepressant is no longer a good idea in light of modern research and the testimonies of the walking wounded who populate this forum.

 

Good luck John in Texas.

[retexan599]

I am still doing fine after discontinuing my Paroxetine in February, 2016.  I have recently (June) noticed a weight loss of about 16 lbs. (207->191).  Not sure when the weight started dropping, but the timing seems to correlate with tapering and discontinuing the Paroxetine.  I have read some threads in this forum about such weight loss and the key thought of: “Paxil shuts down the fat burning enzyme Leptin and after getting off of it, the enzyme awakens from a deep sleep and begins doing its job again.”

 

http://survivingantidepressants.org/index.php?/topic/3552-weight-loss-getting-off-ssris/

 

I will be following my weight a little more closely in the event it turns out to be something other than discontinuing the Paroxetine.  I did have a complete physical recently and no other cause for the weight loss turned up. 

 

I am mainly posting this just to add to the common experience. Best to all. 

[Altostrata]

Very happy to hear you're doing better. I added our cheerful "here comes the sun" symbol

☼

to the title of your Intro topic, to show you're recovering.

Please continue to let us know how you're doing. I hope you will add your story to our Recovery Success Stories eventually!

[nz11]

Retexan nice to hear you are doing ok.

 

Are you still taking 45mg of remeron and 3.75 of the benzo clorazepate?

 

45mg of remeron is the equivalent in dose to 30 mg paxil.

 

You say above that you want to stay on remeron indefinitely ...may i ask why you have decided to do that given it is well documented that long term effects of these drugs are a worsening in all measures.

 

nz11

[retexan599]

nz11 - thanks for your thoughts.  I do plan to stay on Remeron (mirtazapine) indefinitely, although that may not be forever.  My reasoning for not trying to do something with the mirtazapine at this time: 

• my mental health is stable while still taking the mirtazapine and chlorazepate.  
• I made two changes in the last year: discontinued quetiapine and discontinued paroxetine (see signature for details). Those were big changes and I want to let whatever after- effects there may be to pass before making another change.  I am aware from this group that some after-effects may take a long time to emerge.  I am age 79 and do not have an infinite number of years to overcome another unstable period. 
• I started Deplin in mid-2014, so that is another fairly recent change. 
• I have been taking chlorazepate since 1989.  It still helps with anxiety, although in the last couple of years I get better anxiety reduction benefits from the Deplin (l-methylfolate) than anything else.  

Thanks again. 

[retexan599]

Hello.  It has been a year since I first posted in this forum, and a few months since I provided an update, and I have also updated my signature. 

 

I am still doing fine after discontinuing paroxetine earlier this year, and discontinuing Quetiapine in 2015. 

 

In August, I reported a weight loss which I (still) attribute to discontinuing paroxetine (see earilier post re leptin). 

My weight has dropped overall from 207 in 2015 to now leveling out around 185, down from 191 in August. 

 

I still take mirtazapine (45 mg daily), l-methylfolate [generic Deplin] (15 mg daily ), and an occasional 3.75 mg clorazepate. 

 

It has been 10 months now off paroxetine.  It’s unlikely that I will try tapering off my current medication as I am stable and healthy, so do not see need to rock the boat.  I see my pdoc about every two months to stay in touch with him.   He has treated me since 2001. 

 

Thanks to all who contribute here, and wishing everyone a healthy and happy 2017! 

 

John