Whyclef: Cross Taper Nortriptyline to SSRI Paxil

[whyclef]

I have been experiencing severe anxiety and anxiety attacks after tapering from a high dose of Prednisone to treat Crohn's Disease.  Symptoms have become debilitating and resulted in agoraphobia other than work which has even resulted in some days being missed.  DR has prescribed 20mg Paxil and wants me to reduce Nortriptyline dose to 10mg when I begin Paxil which is imminent.  I have been on Nortriptyline for 4+ years off label to help with Crohn's pain.  I have to reduce Nortriptyline dose due to Paxil interfering with metabolizaiton of Nortriptyline.  So...

 

1.  If I reduce Nortriptyline by 10mg, but start 20mg Paxil should I still expect to experience withdrawal side effects?

 

2.  Would it be ok to follow the 10% taper method with Nortriptyline while taking the Paxil since the 20mg dose of Nortriptyline is a lower dose?

[scallywag]

Whyclef -- Welcome to Surviving Antidepressants (SA)
 
I hope you'll find the information in the SA forums helpful for your situation. I'm sorry that you are in the position that you need the information, but am glad that you found us.

A request: Would you summarize your history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-18 months particularly?

• Any drugs prior to that can just be listed with start and stop years.
• You don't need to include symptoms or diagnoses other than the initial condition that led to prescribing the first drug.
• We ask for this information in your signature so that we can see it at a glance. A list is easier to understand than one or multiple paragraphs.
• You can find instructions in this topic: Please put your withdrawal history in signature

Your questions:
 
If I reduce Nortriptyline by 10mg, but start 20mg Paxil should I still expect to experience withdrawal side effects?

It is possible that you will have withdrawal symptoms. Nortryiptyline is a tricyclic antidepressant (AD) and Paxil is an SSRI. People can have withdrawal symptoms when switching to another drug of the same type.  I would think that a switch from one class of AD to another increases the risk of symptoms.
 

Would it be ok to follow the 10% taper method with Nortriptyline while taking the Paxil since the 20mg dose of Nortriptyline is a lower dose?

 

In a word, no. 10 mg Nortriptyline is a maintenance dose, as is 20 mg Paxil.  Cross-overs usually have fast-taper (25% or 50% per week) the first drug while increasing dose of the new one to avoid serotonin toxicity/serotonin syndrome.

 

The most common is cross-over is to Prozac.  Although it refers to Prozac, you may find it informative to read about different switch/cross-over/bridge timeframes and tactics in this topic:
 

Prozac switch or bridge

 

Word to the wise:

 

If you think you might want to taper off Paxil in the future, please ask your doctor about prescribing a medication other than Paxil (generic name paroxetine). Paxil is can be an absolute BEAR to taper; Lexapro (escitalopram) seems to be the same.

 

Please ask questions, if any, here in your introduction topic. Let us know how you are doing.

[nz11]

Whyclef any update?