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Jim: Off Paxil, Do We Start a Replacement Drug?


Jim

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Hi. We are new.

 

My wife faces the dilemma of whether or not to start a new drug (effexor) to help with anxiety. This has been recommended by Dr.

We are searching for advice and guidence. Does anyone know of knowledgable professionals in Oregon? Looking for help.

 

Sounds like this problem is a familar one discussed here by those with experience. Whether it is better to wait out the wd effects or treat a condition with a new drug.

 

My wife has been off paxil and trazodone now 17 days. Some significant improvement of wd symptoms, but continuing akathisia. Taking clonazepam for akathisia. The paxil was bad because of muscle/joint stiffness which prevented improvement of a shoulder injury. Now off paxil and shoulder pain much improved. Afraid effexor would create same muscle/joint stiffness and rigidity, which would mean intolerable pain.

 

Anxiety and depression are bad for her. But is it withdrawal or a big underlying problem needing treatment? Will it get better without adding a new drug? A year of shoulder injury pain seems to have brought on the anxiety and depression. However, the last 5 years have been filled with a lot of stress, worry, and grief. Cummulative trauma we think. It's a deep hole. How to come back? We are working on starting therapy. But the akathisia seems to be debilitating and impossible to tolerate at times.

 

Thanks in advance for any help.

Wife's History - neck/shoulder muscle pain

started 20mg paxil for anxiety 93 days

10mg 22 days

alternate 5/10mg 20 days w tremors

5mg/4.5mg 18 days w akathisia

0 now for 17 days, add 1.5mg clonazapam for akathisia

also stopped c/t long-term use trazodone 150, same time 17 days ago

started cogentine for akathisia

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  • Administrator

Jim, thanks for posting on behalf of your wife.

 

Akathisia is definitely a severe withdrawal symptom. If someone suffers severe withdrawal, what more knowledgeable doctors would do is put her back on the original drug, perhaps a lower dose, and taper more slowly off it.

 

Some doctors might try a switch to Prozac, and taper her off that. You would need to find a doctor who is knowledgeable about this.

 

Will Hall http://willhall.net/, a psychiatry activist, may know of a doctor in Oregon who may be able to help you. (If you get the names of any doctors, please post them here -- we are trying to develop a roster of knowledgeable doctors.)

 

Generally, tapers that are too fast cause withdrawal symptoms. Slower tapers reduce the chance of withdrawal symptoms. The rate of withdrawal varies from individual to individual. Some people need many months to taper off with tolerable withdrawal symptoms.

 

Paxil may be the worst drug for withdrawal, followed closely by Effexor, but any psych drug can cause withdrawal.

 

Did she go off Paxil because of an adverse reaction? If not, I would try a half-dose of her customary dose of Paxil immediately to see if that helps the symptoms. It is possible she would need to go back to a whole dose.

 

Paxil comes in a liquid form for gradual dosing.

 

What dose of Paxil was she taking? What was the tapering method?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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My wife was only on paxil for 5 months. Three months at 20mg, then 3 weeks at 10mg. Then 3 weeks between 5mg and 10mg. This is when tremors/akathisia started. At first we upped dosage if tremors appeared and they would stop. (Dr's advice). Eventually, they would not stop with an increase, so we felt the need to push on and get it over with. 10 days at 5mg, and then 8 days liquid paxil at 4.5mg to slow taper until akathisia become too much and went to ER. Pyschiatrist there advised 0. Our desire was slow taper, but no professional seemed to see any problem with faster given the time on paxil and the dosage. (short half-life, everyone says).

 

My wife's need to get our paxil asap, was that it gave her muscle rigidity. Her neck and shoulder muscles were very tight and it was impeding any progress in aleviating the pain there. She has had severe neck and shoulder pain for a year up to this point. (That's enough cause for anxiety & depression itself). Finally, with the paxil gone, her shoulder pain is much much less, just in the last week. The muscles are not tight anymore. This is why it was imperative to remove the paxil. Going back is not an option.

 

Dr. did suggest switching to prozac. But, we figured another SSRI, same muscle rigidity problem.

Wife's History - neck/shoulder muscle pain

started 20mg paxil for anxiety 93 days

10mg 22 days

alternate 5/10mg 20 days w tremors

5mg/4.5mg 18 days w akathisia

0 now for 17 days, add 1.5mg clonazapam for akathisia

also stopped c/t long-term use trazodone 150, same time 17 days ago

started cogentine for akathisia

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  • Administrator

My wife was only on paxil for 5 months. Three months at 20mg, then 3 weeks at 10mg. Then 3 weeks between 5mg and 10mg. This is when tremors/akathisia started. At first we upped dosage if tremors appeared and they would stop. (Dr's advice). Eventually, they would not stop with an increase, so we felt the need to push on and get it over with. 10 days at 5mg, and then 8 days liquid paxil at 4.5mg to slow taper until akathisia become too much and went to ER. Pyschiatrist there advised 0. Our desire was slow taper, but no professional seemed to see any problem with faster given the time on paxil and the dosage. (short half-life, everyone says).

 

....

Dr. did suggest switching to prozac. But, we figured another SSRI, same muscle rigidity problem.

 

For three weeks, did she alternate dosages between 5mg and 10mg? 5mg one day, 10mg the next?

 

Akathisia is usually a side effect of some psych drugs, but it can be an SSRI withdrawal symptom.

 

Although your wife was on Paxil for only 5 months, it sounds like she was unusually sensitive to it. The muscle pain was an adverse reaction. I can see why she would want to get off it quickly.

 

It sounds like she is in one of those d*mned if you do, d*mned if you don't situations. To reduce withdrawal symptoms, one would usually go back on the med and taper slower. But she has adverse effects on meds, too.

 

My guess is you're right, with her sensitivity, any SSRI might cause an adverse reaction.

 

Please contact Will Hall and ask him for a referral to a doctor who might know something about adverse reactions and withdrawal. None of the doctors you've talked to get it.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Moderator Emeritus

I'm out in The Dalles and have a supportive doctor--not specifically especially knowledgeable about drug withdrawal issues but supportive of my extremely slow taper, and into alternative therapies (she's also a fully qualified Ayurvedic practitioner). I'm sorry, that's not much help--I know TD is the boonies! I just drove to Portland and back last night so this morning I'm pretty aware of how far that is.

 

Everything Alto has said is pretty much all I know about it. I would add that SSRI's can have different effects and be quite different chemicals, despite all being SSRIs, so they don't necessarily all have the same side effects, if the side effects are from some other part of the chemical besides its interaction with serotonin.

 

If you're going to switch to a new med, though, I'd stay away from Effexor, which I've heard is one of the harder ones to taper off of.

 

Personally, from what I've heard from other sufferers, I think a low dose of Prozac or maybe Celexa would be your best bet to try. I think both of those are available in liquid form, so you could try something like 5 mg and see if that gives her some relief. (A switch to Celexa did help me with Paxil withdrawal symptoms, but I wasn't having the muscle tension stuff, just extreme suicidality, which also sucks.)

 

If you do reinstate to a low dose, she may not feel 100% better but just experience enough improvement to make it easier to get through withdrawal. Certainly, if you do reinstate, you need to take some time to stabilize before restarting the taper.

 

Please take a look at my posts on brain remodeling to help understand why even a short time on Paxil, and its half life et cetera, are not really relevant to the withdrawal process. This is information that most doctors (whose training in pharmaceuticals is funded by the pharmaceutical industry) don't have, or don't understand.

 

I also highly recommend, if you have time, reading Robert Whitaker's Anatomy of an Epidemic. And I think Alto's posted a link to a paper or two by Giovanni Fava, also worth taking a look at.

 

Oh, and: what she's experiencing now is DEFINITELY withdrawal. I don't think you can diagnose a condition as "not withdrawal but some original problem" until someone has been completely off psychiatric drugs and feeling good for at least two years, and even then personally I think it's iffy, especially with antidepressants (see Fava and Whitaker).

 

But in this case there's no question. Sadly, when it comes to psychiatric medications, you can almost assume that your doctors don't know what they're talking about. Even the textbooks they studied from in medical school were written by psychiatrists in the pay of the pharmaceutical companies, and they all learned the same lies. And medicine has its own weird culture which makes it oddly impermeable to new information, so doctors' knowledge of actual neuroscience is outdated by about two very important decades.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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Jim, I am also thinking your wife's best bet might be either a reinstatement of Paxil, maybe 1mg, or, as Rhi said, a little Celexa or Prozac.

 

Definitely NOT Effexor, it's a noradrenergic, that would have a higher risk of increasing agitation.

 

Jumping off 4.5mg Paxil to zero was a risky move. For some people, that might initiate terrible withdrawal symptoms. The nervous system is dynamic. It is possible at this point hers has "realized" it's missing Paxil and a little Paxil might calm it a bit.

 

On the other hand, if she alternated dosages earlier, that might have triggered the akathisia and reinstating won't help. Alternating dosages is second only to cold turkey in eliciting severe withdrawal symptoms.

 

I'm not a doctor (neither is Rhi) and this is not medical advice, we're just making our best guesses based on our experiences and those of others we've seen.

 

On the plus side, while hellish, withdrawal akathisia is not considered life-threatening, and people do recover from it over time.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Yes, she did alternate between 5 and 10mg of paxil. I read latter that's not a good idea. But, her Dr. also specifically suggested alternating.

 

She tried one 37.5mg dose of Effexor and had a hellish night. So, that's out. Adverse reaction.

 

And yes, we to have learned some of the limitations of modern medicine. We started with a therapist today who "gets it".

 

Thank you for the ideas and kind thoughts.

Wife's History - neck/shoulder muscle pain

started 20mg paxil for anxiety 93 days

10mg 22 days

alternate 5/10mg 20 days w tremors

5mg/4.5mg 18 days w akathisia

0 now for 17 days, add 1.5mg clonazapam for akathisia

also stopped c/t long-term use trazodone 150, same time 17 days ago

started cogentine for akathisia

Link to post
  • Administrator

Jim, there's no going back and doing over, but I believe her severe withdrawal symptoms are because of alternating dosages, doctor's advice or not. It seems incredible, but few doctors know the meaning of the word "taper."

 

Personally, I would try a small amount of Paxil again. But first, let her system settle down a bit from the Effexor.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

Link to post
  • Moderator Emeritus

But, her Dr. also specifically suggested alternating.

 

She tried one 37.5mg dose of Effexor and had a hellish night. So, that's out. Adverse reaction.

 

 

Most doctors are clueless about getting off psych meds.

 

Alto knows more about AD withdrawal than any doctor I've ever encountered or heard about, except for maybe one or two (out of many dozen). I think new folks here have no idea what a privilege it is to have access to her as a resource. Those of us who've been around this festival of fun a little longer have learned.

 

Me, I'm more knowledgeable about the benzos.

 

I too had a hellish 27 hours or so after I took one dose of Effexor. Nasty stuff.

 

Thanks for your courteous attitude. I'm not sure everyone who posts here realizes that a lot of us are suffering ourselves, and we're not getting paid to be here. So a little gentleness goes a long way.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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  • Administrator

Jim, this doctor may be able to help:

 

Dr. James R. Phelps, MD

Samaritan Mental Health

3509 North West Samaritan Drive

Corvallis, OR 97330

Phone:

(541) 768-5235

 

also see http://survivingantidepressants.org/index.php?/topic/988-recommended-doctors-therapists-or-clinics/page__view__findpost__p__11058

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 5 weeks later...

Hospital now for one week. For about 3-4 weeks off paxil, muscle pain got noticably better. Then gradually started getting worse. Anxiety bad. Pain is intolerable now. Clonazepam has been held at 1.5 mg now for 8 weeks. I think my wife is experiencing benzo tolerance withdrawal from the clonazepam and the bad muscle pain is a benzo withdrawal side effect. Doctors don't agree. Say stick with same dose for now and try other things. Buspar, gabapentin. Not sure what's next. My wife is ready to refuse all drugs.

 

Am I wrong to think the clonazepam is the problem? Are they saying no because that would be difficult problem to solve?

Wife's History - neck/shoulder muscle pain

started 20mg paxil for anxiety 93 days

10mg 22 days

alternate 5/10mg 20 days w tremors

5mg/4.5mg 18 days w akathisia

0 now for 17 days, add 1.5mg clonazapam for akathisia

also stopped c/t long-term use trazodone 150, same time 17 days ago

started cogentine for akathisia

Link to post
  • Administrator

Jim, very, very few doctors understand what's going on with withdrawal syndromes.

 

I'm worried that the treatment your wife is getting at the hospital is making her worse. Did you contact Dr. Phelps?

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I started having symptoms with Paxil after only 5 months too. Jerking and brain zaps mostly. I'm having severe withdrawals and cut my taper to slower. I might end up having to spend more time withdrawing than the length of time I was on Paxil.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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I just wanted to commend you on being such a supportive husband. You are sincerely trying to help and take her symptoms seriously. Nobody can know how hard hard it actually is and it's good you're supporting her like this. I also experienced akathisia a while back while in the hospital as I couldn't take my Cymbalta through an IV. The w/d from Cymbalta made my hospital stay an indescribable nightmore. Akathisia is horrible. For that reason alone, that dependancy on medicine, made me really think how I don't want to be on drugs. There are good natural remedies. I always had success in the past with Gelsemium, St. John's Wort and Valerian for my anxiety and depression. But I don't recommend St. John's Wort while tapering off a/d because you can get Serotonin Syndrome.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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Jim;

 

I am so sorry for the hell your wife and you are both going through right now. I do think that Alto is giving you a very careful and good advice and I hope you will be able to contact the Dr. she located.

 

I am weaning from Effexor and nearly choked when I read their recommendation of that drug.

 

Please know that I think your wife is very lucky to have you in there advocating for her and trying to figure out how to get her health back. My money is on you both to survive this thing and emerge the better from it.

 

Crocus

xxxx

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