Katied924: trying to taper off paroxetine after almost 20 years

[katied924]

 

I have been on Paxil since the fall of 1998, when I was 19 years old. I'm now 38. I don't remember the dose I started with but at one point was up to 50 mg per day. Now I'm on 30 mg per day, plus 150 mg of wellbutrin per day.

 

My doctor and I want to stop it. She has reduced me from 30 to 20 mg per day. It's only been 6 days. But I'm experiencing night sweats and shaking, nausea, headaches, dizziness, etc. She wants me to do 20 mg for a month, and then go to 10 mg for a month, and then stop. This seems ... faster than it should be.

 

I am attempting to make an appointment with a psychiatric NP at my therapist's office.

[Gridley]

Hello, katied924, and welcome to SA.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.

• Any drugs prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• Link to Account Settings – Create or Edit a signature

You are absolutely right, and you are wise to be concerned. The drop from 30 to 20mg is over 30%, far too fast a taper, as is the rest of your doctor's plan.   At Surviving Antidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases.  The 10% taper recommendation is a harm reduction approach to going off drugs  Some people may have to taper at a more conservative rate as they are sensitive to even the smallest drops.  

Why taper by 10% of my dosage?

 

The symptoms you are experiencing are typical withdrawal symptoms.

What is Withdrawal Syndrome?
 Glenmullen’s withdrawal symptom list.

 

Reinstatement of a very small dose of the original drug is the only known way to help alleviate withdrawal syndrome.  Please read the first few posts of this topic on reinstatement.

About reinstating and stabilizing to reduce withdrawal symptoms.

 

Since your brain has started to adjust to the lower dosage, I wouldn't reinstate all the way back up to 30mg.  It is better to start lower than reinstate too high. You can always increase. I would reinstate a very low dose, maybe 2mg to start with.  Increase after a week up to 5 mg if it helped but isn't enough.   The following link gives you information on how to make nonstandard doses.

Tips for tapering off Paxil (paroxetine)

 

I hope your psychiatric NP is sympathetic.  Most doctors know little, if anything, about tapering or withdrawal.  These links give tips that should be helpful in talking with your NP.

How do you talk to a doctor about tapering and withdrawal?
What should I expect from my doctor about withdrawal symptoms?

 

This is your introduction topic -- the place for you to ask questions, record symptoms, share your progress, and connect with other members of the SA community. 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 I am glad that you found us.

 

 

[katied924]

Thanks for your thorough and thoughtful reply, Gridley.

 

I thought about calling my doctor about getting Paxil in suspension but you say doctors know nothing about this. Then how do I get the suspension? I can try making it myself but I have a lot of other medical issues and want to make sure my doctors stay in the loop.

 

The Psychiatric NP has training in these meds so I hope she is helpful. I'll let you know!

 

I have added a signature.

[ChessieCat]

From Post #1 in this topic Tips for tapering off Paxil (paroxetine)

 

Make your own liquid
You can make your own liquid with water. See How to make a liquid from tablets or capsules

[katied924]

I saw that! Pretty cool. Still want to run it by a doc. I DO believe that HUGE gaps in knowledge exist among most doctors (they're human beings, after all). But maybe I can try that! It's not like my doctor is watching over me every day.

 

I think I will try the 20mg for a month (depending on any other symptoms that come up) and then try 10% tapers per month via suspension.

[ChessieCat]

These topics are helpful to read before discussing things with a medical professional:

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[brassmonkey]

Hi Katie- welcome to SA, I'm so glad you found us.  Paxil is generally considered one of the hardest ADs to taper off of, but it can be done, safely and with a minimum of pain.  But it has to be done very slowly, carefully and with great patience. Especially when someone has been on it at a high dose for a very long time.  I was on 40mgai for 18 years when I started to taper off.  I've been drug free for over nine months now and life is getting better every day. So I know first hand that it can be done.

 

From what you described above your drop from 30mgai to 20mgai has hit you very hard.  This is to be expected with such a large drop and is not a good thing.  Making such a large drop is the best way to throw the brain and body into chaos and the symptoms that you are experiencing are just the start of what is to come.  These drugs work by making physical changes to the body.  These changes require the presence of a certain amount of the drug to be maintained.  Without that volume of drug the body doesn't know how to function and the results are the symptoms that we feel.  By removing the drug abruptly the body can also be sensitized so any change will cause severe reactions.  Easing the drug out of the body so the body has a chance to adjust to the smaller amounts is the idea behind the tapering process, and it works quite well if things are done slowly.

 

I would suggest that you increase your dose to take the edge off of the symptoms that you are feeling.  Then wait for your body to stabilize.  After which we can start you on a  nice slow taper that will be successful.  Like Gridley mentioned, it would not be a good idea to go back to your full dose, even though it's only been about a week.  Doing so would shock your body even further and cause greater destabilization.  I would try an increase to 22.5mgai for a start and see how that goes.  We might want to try 25mgai but lets see how the other works first.  The thing is, even though an updose can be felt very soon, possibly even the next day, there is a lot of changes going on in the background that need to happen before any other dose changes are made.  This can take several weeks to happen.

 

Waiting at your current level for a month to see what happens is not a good idea.  The further out one gets the harder it is to updose successfully and the more entrenched the symptoms become.  Once the symptoms gain control it is very hard , very painful and takes a very long time to get that control back.  Even with the way you're feeling fight now, you are in a very good position to make a successful taper, and we really want to help you do that.

 

I know you are going to have a lot of questions.  Read through the links the others have given you and then ask away.

 

Brassmonkey

[Rabe]

I just wanted to say that what you wrote was wonderful...Im sure very helpful to her, especially what to do after such a rapid taper, but also to others...I learned a lot from it...and so kind.  Thank you!

Gives me hope with the Clonazepam and Viibryd which I am hoping you will feel can be tapered soon.  Again that gave information and direction which is so needed when feeling so overwhelmed and lost, and was thoughtful, kind, supportive and encouraging...comes from experience. Blessings!

[GiantsWSC]

Hello Katied,

 

I was on Paxil for about the same amount of time as yourself and I totally agree with what Brass mentioned. Your doctor probably has no idea what a fast drop can do to a person psychologically. You can look at my signature and see my progression of dropping, mind you I am coming from a 10 mg taper. Everyone is different in terms of how they are affected during the taper process but just remember this is not a race, you still want to maintain overall well being during this time so it it extremely important to take it slow. You will be able minimize the symptoms and manage your day to day well being much better this way. 

 

 

[ChessieCat]

35 minutes ago, GiantsWSC said:

but just remember this is not a race, you still want to maintain overall well being during this time so it it extremely important to take it slow. You will be able minimize the symptoms and manage your day to day well being much better this way. 

 

Patience is needed to get off these drugs.  We suggest throwing out the calendar and listening to your body and your symptoms.  If after 4 weeks you don't feel stable or life circumstances are a bit more stressful than usual (for example the Christmas period, winter time, or job change) it is better to stay at that dose for a bit longer until things settle down.

 

It is best to make only 1 change at a time.  It is also better not to start taking a complex vitamin because if you experience issues you will not know what exactly is causing it.  B vitamins can be stimulating especially B6.  hypersensitive-to-b-vitamin-or-b-vitamin-complex  If trying anything new, start with a small amount to see how you react and build up to the recommended amount.  The only supplements which SA recommends are Magnesium and Omega-3 Fish Oil.  Try a small amount one at a time to see how you react.

 

Even with a careful and slow taper you will most likely experience times of discomfort.  It is best to learn and use Non-drug techniques to cope

 

As a word of encouragement, I had been on an AD for 25 years and joined SA 2.5 years ago, after experiencing 3 weeks of bad cog fog when I reduced from 100mg Pristiq to 50mg.  I have following SA's tapering protocol and have managed to reduce from 100mg Pristiq to 12mg in that time.  I have only suffered minor withdrawal symptoms.  I am working 3 days per week.

 

There are many existing topics and discussions on this site.  You can use the site search function at the top right, or use a search engine and include survivingantidepressants.org in your search string.

[katied924]

Thank you so much for all the information everyone! Definitely not able to taper slower at this time (not willing to do a suspension without an expert). My doc wants me to stay at 20 mg for two months, not one. I was remembering wrong. I think I’ll stay at 20 mg for two months and then assess the situation. I’ll also talk to my doctor and hopefully the psychiatric NP.

[katied924]

Hey folks - I just discovered this site 3 days ago. I'm 8 days down 10mg of Paxil (from 30 to 20 - no transition time).

 

My family life is pretty chaotic right now - it didn't seem so when I had this idea to taper 8 days ago! I have put in a call to my doctor, and am still waiting to hear from the psychiatric NP.

 

My partner is not at all in favor of the oral suspension and thinks it's a terrible idea. One of the reasons I haven't done it. Plus haven't spoken to a doctor.

 

I'm a step-mom and a germophobe and my 4-year-old step son has hand foot mouth and is touching everything and has open sores on his hand. And I have PMS. Crisis mode.

 

Anyway I need to talk to a doctor about maybe re-upping my dose. Probably not straight back up to 30 mg though.

 

Thanks for reading.

[ChessieCat]

On 02/03/2018 at 4:32 AM, katied924 said:

Thank you so much for all the information everyone! Definitely not able to taper slower at this time (not willing to do a suspension without an expert). My doc wants me to stay at 20 mg for two months, not one. I was remembering wrong. I think I’ll stay at 20 mg for two months and then assess the situation. I’ll also talk to my doctor and hopefully the psychiatric NP.

 

The reason this site exists is because there are very few medical professionals who know about withdrawal and tapering psychiatric drugs.

 

On 01/03/2018 at 11:26 AM, ChessieCat said:

From Post #1 in this topic Tips for tapering off Paxil (paroxetine)

 

Make your own liquid
You can make your own liquid with water. See How to make a liquid from tablets or capsules

 

We have mods/members here who can help you get switched over to making a liquid.

 

36 minutes ago, katied924 said:

I'm 8 days down 10mg of Paxil (from 30 to 20 - no transition time).

 

You may be experiencing withdrawal symptoms which you haven't attributed to reducing too quickly.  Some of the panic you are feeling is quite possibly/most likely due to withdrawal.  Please see this list:  Dr Joseph Glenmullen's WD Symptoms Checklist

 

This is a 33% reduction in your dose.  SA's recommendation is to reduce by no more than 10% of the previous dose followed by a hold of about 4 weeks.  Doing this allows the brain to adapt to note getting as much of the drug.  These drugs are STRONG.  If you do decide to updose it would be better to try a very small increase, eg 1mg.  It may be enough to bring the withdrawal symptoms to a bearable level.  Whatever you decide it would be best to hold on your dose for at least 2-3 months to give your brain a chance to catch up.  This topic is about reinstating but is relevant to updosing.  Please read Post #1:  About reinstating and stabilizing to reduce withdrawal symptoms

 

40 minutes ago, katied924 said:

My partner is not at all in favor of the oral suspension and thinks it's a terrible idea.

 

Is you partner an expert in psychiatric drugs and withdrawal?  If not, I suggest he reads the information we have provided in your topic and other information on this site.

 

42 minutes ago, katied924 said:

I have put in a call to my doctor, and am still waiting to hear from the psychiatric NP.

 

....  Plus haven't spoken to a doctor.

 

Please read these before speaking with them:

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[katied924]

My partner uses they/them pronouns.  no, they are no an expert. I’m reading as much as I can! Thank you. 

[ChessieCat]

A regular doctor can write a prescription.  You don't need to see a psychiatrist.

[Cheeky]

Hey Katie,

Just chiming in to say "Hi",

I've been on theses drugs for the same amount of time and highly recommend these wonderful moderators.

Listen to them as they no more about these drugs then anybody else, Whatever you do don't rush this taper process beouse it will eventually catch up with you, I know this first hand and have stuffed up for the last 6 years trying to get off too quick.

I'm here if you need any support.

 

Cheeky xx

[katied924]

Hi Cheeky - thank you! Yes, the experience of the mods in particular here is very valuable. I appreciate your comments.