Centime: Paxil withdrawal

[Centime]

Hi Everyone,

I’m glad to find this forum, which I joined because I’m about to try to get off Paxil, which I’ve been taking for 25 years. I’ve tried twice before and the withdrawal was so severe that I ended up in the ER both times. This was before SmithKlineBeecham admitted there was a problem with withdrawal, and no one, including the doctors I saw, knew anything about it. Of course I tried to taper way too fast. I went back on it because the withdrawal was intolerable and because it did work on my depression, from which I’ve suffered all of my life. Now it has quite suddenly stopped working. I’m taking 60 mgs of Paxil and 300 of Wellbutrin (time-release version). Other drugs I’ve tried over the years include Elavil, Triavil, Pamelor, Valium, Effexor, Celexa, Zoloft, Desyrel, Prozac, Remeron, Brintellix, Viibryd, Lexapro, plus (at various times) Klonopin, Ambien, Trazadone. For about six months I also took antipsychotics because a doc thought I might be bipolar 2. It was a disaster—never have I been so terrified of mental illness. Those drugs included Seroquel, Lamictal, Cymbalta, Quillivant, and Latuda, which caused akithesia (sp?). My poor brain has been under the influence of these substances for a total of 32 years now. I’m deeply anxious about discontinuing all meds, but determined to do it. I want to know the truth about what my mind is like without them. I wish I knew of a specialist in my area (upstate NY) I could consult. My doc is great, but I don’t think he knows more than the average shrink about the withdrawal syndrome. I plan to start the taper on May 1st, and lessen the dose once a month by 5% of the previous month’s dose, a schedule that seems to be generally recommended. I’m scared! And that’s my situation. 

 

On a more personal note, I’m a writer and teacher. Hobbies are sewing and gardening.I look forward to exchanging info. With others here.

[Gridley]

Hello, Centime and welcome to SA.  When an AD like Paxil stops working, it's called "poop-out" or "tolerance" and is not uncommon.  Once you've reached tolerance, increasing the dose won't work, and you are wise to begin your taper.  We do not recommend tapering more than one drug at a time, so we suggest you stay on the Wellbutrin while you taper the Paxil.  This link is about tapering multiple psychiatric drugs.  

 

Taking multiple psych drugs? Which drug to taper first?

 

While Paxil is a less activating drug than Wellbutrin, the fact that you have reached tolerance points to tapering the Paxil first.  One of our moderators, Brassmonkey, reached tolerance on a high dose of Paxil and did a slow taper to get off.  You might find reading his thread helpful.

 

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.

 

Please include the dates of your taper, the rate at which you tapered, and whether you did every-other-day dosing.  Please keep your signature as simple and easy to read as possible.

 

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 psychiatric drugs.  Some people may have to taper at a more conservative rate as they are sensitive to even the smallest drops.  The 5% taper you mention is prudent.
  

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

 

Brain Remodelling

 

Tips for tapering off Paxil (paroxetine)

 

Here is some information on withdrawal, the severity of which the slow taper is designed to minimize.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

Youtube video, 4 minutes: Healing from antidepressants

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

Many members have found the techniques in the following two links helpful.

 

The Dr. Claire Weekes Method of Recovering from a Sensitized Nervous System

 

Non-drug techniques to cope with emotional symptoms.

 

Most psychiatrists are clueless about withdrawal and tapering.  I hope your specialist is a rare exception.  Here are some tip on talking with your doctor.

 

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.

 

 

 

 

 

 

 

 

  

Edited April 28, 2018 by Gridley

[Centime]

Thank you, Gridley. In the past I’ve quit Wellbutrin cold turkey without a problem. Paxil has been  a very different story. I was thinking of stopping the Wellbutrin first for that reason. I’m seeing my doc in a few days and will tell him what you said. I really appreciate your input.

[brassmonkey]

Hi Centime-- Welcome to SA, I'm so glad you've found us.  Making the decision to reduce ADs  can be very stressful, but as Gridley has shown you we have a lot of information on the subject.  60mgai of paxil is a very heavy dose and it would probably be good for you to reduce at least part of that before you worked on the Wellbutrin.  We can talk more about that later. If you're not overloaded with information ATM I would suggest that you take a look at this thread:

 

The Brassmonkey Slide Method of Micro-tapering

 

Brassmonkey

[Centime]

I see windows and waves mentioned in the forums. What are they? Thanks!

[Kristine]

Hi Centime, Welcome to Sa  I noticed you asked about windows and waves elsewhere...I find the following is the the best explanation. Much Love K xo

 

[Centime]

Thank you, Kristine. Great explanation.

[Rabe]

Thank you Kristine...I cried watching it!  Says it all very well....

[Songbird]

Your taper plan looks sensible.  It's also good to be a little flexible, by listening to your body and adjusting your taper as needed.  Sometimes it can be good to hold at a dose for longer or do smaller drops, depending on what's happening for you.  Be aware that even slow tapering does not mean there will be no withdrawal symptoms, but generally they will be much milder and tolerable (when compared with fast tapering).   I don't know much about Welbutrin, but 60mg is a hefty dose of paroxetine.  You mind find you actually begin to feel better as your dose comes down.

[SkyBlue]

On 4/28/2018 at 9:54 PM, Centime said:

I see windows and waves mentioned in the forums. What are they? Thanks!

 

Hi Centime, 

I've moved your question back to this thread, your introduction thread. Please keep all of your questions here; we ask each member to have only one thread.

 

Good question -- windows and waves is the cyclical pattern of healing that we see. It is discussed here: http://survivingantidepressants.org/topic/82-the-windows-and-waves-pattern-of-stabilization/

[Centime]

I saw my doc again. Because I've had no trouble stopping Wellbutrin in the past, he suggested that I taper it first so I can concentrate on the Paxil with nothing else complicating the picture. As of today, I'm off it, feeling lightheaded and tired, but otherwise OK. After another week or two I'll begin a very slow Paxil taper, assuming no new problems develop.

 

Is this where I should be reporting my progress? Thank you all for being here.

[brassmonkey]

Don't tell me that you just CTed 300mgai Wellbutrin!!!

 

Tips for tapering off Wellbutrin, SR, XR, XL (buproprion)

[Centime]

Hi Brassmonkey,

I went down to 150 for 2 weeks, and just today stopped the other 150. I talked to my doc at length about it and he thought it would be OK, and it has been, except for some lightheadedness and tiredness. In the past I’ve discontinued Wellbutrin twice CT with no problem (not knowing any better). I’m planning to wait until I’m sure I’m ok before starting to taper the Paxil, using your method since I went through two seriously bad withdrawals in the past. I really appreciate your advice, and actually trust this site more than I do my doctor. He’s very kind and open-minded, but doesn't seem to know much about withdrawal problems. The same is true of every doc I’ve ever seen in 30 years!

[Centime]

I’m finishing my second week at 50 mg.s of Paxil (60 to 55 to 50). I have mild withdrawal: lightheadedness, slight nausea,  nothing serious. Is it OK to continue tapering 10% if the symptoms are tolerable? In the past these symptoms went on for months and months, not worsening until I got down to about 5 mg.s. I’m thinking that so long as I’m functional, I should proceed by cutting the dose 10% every month or so even if I have mild withdrawal. I’m afraid that if I wait until I feel “normal,” I’ll never get off it! Advice is much appreciated. Thank you, Centime. 

[MiguelFreeman]

@Centime

Stop tapering and let the brain stabilize only taper grain when the symptoms stop 

here in SA we recommend to taper slowly and whit the minimal or if possible no
 WD symptoms, hold and let the brain stabilize I have felt the consequences of not listing to the minor symptoms and then getting a huge wave of hard symptoms  so plus relax on the taper, I have seen that in your  WD list  the drugs you came off were hard Ones and if you didn't have Wed from them this one will give you all of the WD of the previous ones the last drug  to taper sometimes if WD 2 fast might trigger the WD of pass drugs since the brain made the changes and then tapering from the last drug might cause a butterfly effect so be cheerful and listen to your body .

[Centime]

Thanks, Miguel. I was wondering about that—if Paxil withdrawal would somehow involve the other drugs. What a complicated mess! I'll stop at this dose until all the WD effects go away. I think it's going to take me a century. Thanks for answering! Centime

[Altostrata]

Merged with Centime's Intro topic. Please put questions about your particular situation and status reports in this topic.

 

17 hours ago, Centime said:

I’m finishing my second week at 50 mg.s of Paxil (60 to 55 to 50). I have mild withdrawal: lightheadedness, slight nausea,  nothing serious. Is it OK to continue tapering 10% if the symptoms are tolerable? In the past these symptoms went on for months and months, not worsening until I got down to about 5 mg.s. I’m thinking that so long as I’m functional, I should proceed by cutting the dose 10% every month or so even if I have mild withdrawal. I’m afraid that if I wait until I feel “normal,” I’ll never get off it! Advice is much appreciated. Thank you, Centime. 

 

Miguel is correct -- thank you, Miguel -- when you get withdrawal symptoms, stop tapering! Mild withdrawal symptoms are a sign your nervous system is already unhappy with the changes you've made. When you're in a hole, stop digging.

 

Centime, it looks like you want to go fast. Please consider whether you want to risk symptoms that are much more severe. Going on and off drugs and making lots of dosage changes over the years is wearing on your nervous system. If you want this exit from Paxil to stick, I strongly recommend you make the taper slow and gradual.

 

When Humpty Dumpty falls off the wall, neither we or your doctors can promise to immediately set him right.

[Centime]

Thank you, Altostrata. You’re right—I can hardly wait to put Paxil in the past! But I’ll follow your advice and stay on the current dose until all WD symptoms go away. I’m really grateful to have found this site—it’s a huge help and a great support system.

[Centime]

Does anyone know what causes “fuzzy brain,” neurologically speaking? I know it’s a common result of SSRI withdrawal, but am wondering about the neurology. Does it come and go, or is it something that goes away gradually? I seem to have a mild case of it.

 

I’m also wondering about mental vs. physical symptoms of withdrawal. I clearly have physical stuff going on, but other than a little anxiety, my spirits are fine. I’m not depressed (so far). Is this unusual? I’m surprised.

[Gridley]

Symptoms come and go, both physical and emotional, and everybody is different.  It's great you're not depressed and your spirits are fine.  Your pattern is not unusual.  I think you'll find every combination possible of symptoms among those in WD.  This link shows how varied they can be.

 

Glenmullen’s withdrawal symptom list.

 

 My symptoms are mostly emotional.  That could change.  Just be ready to go with the flow if there's a change.  I remember one of our mods writing that he had checked off just about every one on the Glenmullen link above.

[Centime]

Would it be a mistake to switch to the generic Paxil while tapering? It didn’t work as well as the real drug in the past, but it’s a lot cheaper. Advice? Thank you!

[ChessieCat]

Here is SA's discussion:  generic-vs-brand-versions-of-antidepressants

 

It is really up to you whether you choose to change from brand to generic.  For me, I made the decision to stick with brand, however I am on a pension so cost is not a factor.

 

If you do decide to change to generic, I suggest that you ensure that you always get the same generic.  It's also a good idea to do a cross over which is gentler on your CNS.  You could take 3/4 brand + 1/4 generic for several days, then 1/2 and 1/2, then 1/4 brand and 3/4 generic.  You could make the the change over a longer period and/or make smaller cross over amounts, eg 7/8 and 1/8 etc.

 

[Centime]

Thank you both for these answers. I’m sticking with the real drug, and am resigned to going very slowly. I’ve found great comfort on this site, and have told a lot of people about it. 

 

Current WD symptoms: brain fog, memory glitches, tiredness. But at least I’m functional (sort of)!

[Centime]

Hi Everyone,

 

I’m tapering off Paxil, which I’ve been taking for almost 30 years. I’m now down to 42.5 mgs from 50, starting the first of May and am doing OK except I’m beginning to feel the way I did before I ever took an AD: tired all the time, can’t concentrate, blue. It’s not an emergency situation, as it was then, but the same flu-like malaise. My mood is darkening slowly as I cut the dose by tiny degrees. 

 

How do you tell what is depressive illness and what is withdrawal? I’m worried about sending myself into another depression and mistaking it for withdrawal. Not sure how to tell them apart! Many of the withdrawal symptoms people describe are the same things as the reason I started taking ADs in the first place. It’s very confusing!

 

Thanks for being here. Centime

[ChessieCat]

I merged the new Intro topic you created with your original Intro topic.  Each member has only 1 Intro topic where they can ask questions about their own situation and journal their progress.  Please do not create any more Intro topics.  Thank you.

 

These may help:

 

Is it withdrawal or relapse?  Or something else?

How do I know it's withdrawal and not relapse?

 

[Centime]

Sorry for posting in the wrong place. It’s a little confusing, because the forums have a “Start new topic” option at the top.

 

I appreciate the links—thank you!

[Centime]

Hi Everyone,

I’ve been tapering off Paxil since May, and am now using Brassmonkey’s scale, going down 2.5% of previous dose a week for 4 weeks, then holding for two weeks. I’m depressed. No energy, no appetite, no interest in anything, just want to sleep all the time. This is pretty much why I started taking ADs to begin with! I’m wondering if what I’m feeling is a form of withdrawal, or if it’s just the depression emerging again? How do you tell? I’m willing to tough it out if there’s hope that this will go away, but I’m discouraged. Any advice? 

[ChessieCat]

On 6/25/2018 at 12:03 PM, Centime said:

Sorry for posting in the wrong place. It’s a little confusing, because the forums have a “Start new topic” option at the top.

 

To post in your Intro you go to the bottom of the page and type in the box which has a grey text:  Reply to this topic ...

[ChessieCat]

44 minutes ago, Centime said:

How do you tell?

 

Is it withdrawal or relapse?  Or something else?

How do I know it's withdrawal and not relapse?

[Centime]

Hi All,

 

I’m pretty sure that what I’m experiencing now is about 90% depression and 10% withdrawal. The WD symptoms are mostly mild dizziness/faintness. I’m tapering off Paxil very slowly, now down to about 35 mg from a high of 60.

 

The depression is very familiar: no energy, no appetite, no interest in anything. All I want to do is sleep. Very low mood. The world seems a hopeless mess. The reason I think this is depression is that it has increased in direct proportion to my tapering. Each week I go down 2.5% of the previous dose, and after a few days the depression deepens a little. I’ve been on a steady slow decline.

 

Do you think it’s possible that this is a manifestation of withdrawal? I REALLY don’t want to give up trying to get off Paxil—I’ve come so far—but at a certain point it starts to seem like I’m inflicting depression on myself. Any thoughts on this would be much appreciated.

[brassmonkey]

Are you throwing in a couple of week hold every four tapers?  It is very important to have the hold periods to let things stabilize.  The ever increasing symptoms in an indication that you're progressing too fast and are letting the background symptoms build up.  If they are not allowed to stabilize eventually they will break out in a major crash.

[Centime]

Thank you for this response, Brassmonkey. Yes, I hold for two weeks after each four, for a total of 10% of the previous dose every six weeks.

 

I’ve read that withdrawal feels unlike depression. I’ve been through too-fast Paxil withdrawal twice, and it was very different from depression. This feels like my original depression, the reason I started taking the drug (and it worked). How can I tell which is the illness and which is withdrawal? I know that Dr. Glenmullen lists depression, flu-like symptoms etc. as signs of withdrawal, but the illness itself causes that too. I’m afraid of losing more years of my life to it.

 

Do you believe that everyone can live without these drugs? For me, depression was life-threatening. I want to know what my brain is like without Paxil, but what if my depression is permanent? If it is, and it goes untreated, it’ll kill me. I had a traumatic childhood and have done years and years of therapy, so I know what I’m dealing with in terms of probable causes. More talk therapy is not going to fix what’s broken.

 

I guess my question boils down to this: how long do I have to taper in order to figure out whether I need the drug or not? I see no point in inflicting a recurrence of the illness on myself. But if what I’m feeling IS withdrawal, I’m willing to tough it out. But how does one tell? Thank you for listening.

[Centime]

Update: the last few days I’ve felt suddenly better (a window?). More energy, less depressed, Yay! It surprised me. I was about to give up, thinking I was just permanently depressed and needed the drugs. What I notice in hindsight is that my orthostatic hypotension is much worse. If I stand up fast I have to put my head down or I’ll pass out. I feel sure this is caused by withdrawal. I’m going to stop reducing the dose to see if it will resolve.

 

Anyone with orthostatic hypotension, what has your experience been?

[brassmonkey]

I would get periods of orthostatic hypotension through out my taper. Very disconcerting. I would hold onto something for balance and flex my stomach muscles then be careful moving for a minute or two. I'd get it in waves that would last a few days and then settle down for a couple of months. Hasn't bothered me since I reached "0".

[Centime]

Very reassuring—thanks!

[Centime]

I’ve now been slowly  tapering off Paxil since January, and am down to about 32 mg. I’m depressed, and am wondering how to tell whether it’s the illness reasserting itself or whether it could possibly be a symptom of withdrawal. I’m not desperate (yet) but wonder if anyone’s had the experience of depression as part of withdrawal, and had it go away?