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Bee5: reinstated paroxetine, dose too high?

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Bee5

Hi,

I was initially put on 37.5 mg paroxetine during a postpartum depressive episode in June 2016. My pdoc suspected the dose to be too high and reduced to 25 mg. I held on 25 mg for almost a year, and then my pdoc and I decided to try a dose reduction to 12.5 mg. I had a few brain zaps, but nothing serious, so I held there for a few months. My pdoc and I decided to drop to 0 mg in October 2017 (by taking 12.5 mg alternate days then zero). Again, only brain zaps were experienced. Four months later, at the beginning of March 2018, severe protracted withdrawal kicked in. I had not discovered this forum, so I immediately jumped to 12.5 mg at the recommendation of a doctor friend, and several days later jumped to 25 mg at the recommendation of my pdoc. When I experienced what I now know is a wave, I thought the paroxetine dose was not high enough, and my pdoc increased it to 37.5 mg. I have been on this dose for May and June, but now I have developed really loud tinnitus, and I suspect that the 37.5 mg dose might be too high. My pdoc supports my reducing to 25 mg. However, I don't want to destabilise my system. I have tried to work out the pharmacokinetics of the controlled release tablets, to see how to 'spread' my reduced dose over 24 hours, but have not found much on the internet. My intuition would be to take my 25 mg controlled release in the morning, along with 5 mg immediate release, so that I would have a peak and then a gradual dose over 24 hours. This would reduce my dose from 37.5 mg over 24 hours to 30 mg over 24 hours. Since I strongly believe that my system is flooded with serotonin, I think that this step won't destabilise me as there is an accumulated 'stash' of serotonin floating around my system.

Any advice from the seasoned taperers out there? 

Thanks for hearing my story,

Bee5

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Altostrata

Welcome, Bee.

 

Skipping doses is a terrible way to taper, many people here got awful withdrawal symptoms from that. Brain zaps are a bad sign, not a trivial one. If you can, please tell your psychiatrist to stop recommending that, it's a high-risk way to go off paroxetine.

 

Your doctor friend was correct to suggest reinstatement, your psychiatrist was not in recommending an increase in dosage before finding out how 12.5mg worked for you.

 

Did you experience the "wave" shortly after jumping to 25mg?

 

Anyone on a drug for more than a month is at risk for withdrawal symptoms. We recommend 10% decreases per month. As you are on 37.5mg paroxetine, you might reduce 3.75mg and see what happens. You will need the prescription liquid or you can make your own.

 

See Why taper by 10% of my dosage?

 

Tips for tapering off Paxil (paroxetine)

 

Immediate-release paroxetine has a half-life of about 23 hours. You're going to have to add it in somehow, the liquid is immediate-release. The best way to convert to immediate-release is to take part of your dosage in Paxil CR and part in immediate-release Paxil. You had the right idea.

 

(Forget about the serotonin aspect, that whole theory area is invalid.)

 

What is lamotrigine supposed to be doing for you? Lamotrigine can also cause tinnitus as a side effect.

 

Are you currently taking any other drugs? What is your daily symptom pattern? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.

 

Please let us know how you are doing.

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Bee5

Thanks for your insight Alto. I forgot to mention that I am also on 300 mg quetiapine, and have subsequently updated my signature. My pdoc's rationale is that the paroxetine treats my 'high baseline anxiety' which I now know is protracted withdrawal. His rationale for the lamotrigine is that it augments the anti-anxiety properties of paroxetine. His rationale for the quetiapine was to quickly get me back onto homeostasis after my 'relapse', which I now now is protracted withdrawal.

 

My pdoc and I have walked a long path together since my postpartum depression, and he effectively saved my life by forcing me off benzos, and forcing me through withdrawal from benzos. This was back when I was married. I am now divorced, and I have a young child, so there is no way I could allow myself to go through withdrawal again, because I need to keep working, full day, and I cannot be incapacitated as one becomes in severe withdrawal. Financially I have no other option other than to work.

 

The medicine combination that I am currently taking has successfully brought me back to the brink of full functionality, apart from the fact that I have waves and windows. The waves were initially so bad that I needed to take a day or two off work, but now the waves simply mean a few days being distracted at work and a few nights of poor sleep (so far the waves have been approximately a week long each time). 

 

My tinnitus has increased steadily after reinstating, to the point where it has led me to believe that the paroxetine dose is too high. My strategy is to reduce paroxetine to 25 mg and then hold indefinitely. While holding on paroxetine, I would like to reduce the quetiapine to 0 mg, and I know that this will take several months following the 10% taper rule I followed previously. I would then like to taper of lamotrigine.

 

I know that reducing from 37.5 mg to 30 mg seems high, but previously I was able to reduce from 37.5 mg to 25 mg with no major upsets. Luckily my system seems to be behaving the same way it did previously. If I get withdrawal symptoms, I will increase paroxetine by 2.5 mg, but for now I would like to see if the tinnitus improves while I hold at 30 mg (the 30 mg is 5 mg IR and 25 mg CR).

 

Alto, I wanted to ask you, do you still get waves and windows, or does it eventually stop?

 

I also wanted to comment on pdocs; in general, there is no point in trying to convince them of anything, because they default to their interpretation of 'relapse' or 'underlying anxiety surfaced' or 'high baseline anxiety'. It is my opinion that the only pdocs that could possibly understand what we on these forums are going through, are those that have personally experienced withdrawal. Hopefully these pdocs will lobby to get withdrawal to be taught to all pdocs at university level. I am so grateful to forums like SA and benzobuddies, because without them, we would feel like the withdrawal would never stop.

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Altostrata

Unfortunately, we don't know which drug is helping stabilize you, as your psychiatrist added them all at once, instead of following the best practice of adding one at a time and seeing what happens. As he doesn't understand withdrawal syndrome, his reasoning about baseline anxiety yadda yadda is incorrect. You do not have layers of anxiety to be treated by different drugs. You only have one nervous system, and to be safe, he clobbered it with a big cocktail.

 

In any case, my guess is that you do not need that high a dose of paroxetine. In fact, reinstating 10mg paroxetine back in March, without the quetiapine, probably would have been enough. But since you've been on at least 25mg paroxetine since March, you may get withdrawal symptoms from reductions.

 

How do you feel now that you've reduced 37.5mg to 30mg paroxetine?

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Bee5

I only reduced two days ago, so I think it's too soon to say, but I will definitely post my progress on the forum. 

Do you still get waves Alto? If not, how long after stopping paroxetine did they stop? 

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Altostrata

I went off paroxetine in 2004. It took 11 years for all withdrawal symptoms to go away.

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Wwaterboy

Altostrata,

 

Did you CT in 2004? I will read your intro topic. Sorry.

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Bee5

Hi Alto,

I struggled to sleep last night, so the 7.5 mg drop is probably too much. I have updosed to 32.5 mg, which is much closer to a 10% reduction. I will try to hold on this dose for a month.

Bee 5

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Bee5

I am holding on 32.5 mg but the tinnitus persists, and I have started to get some intense night sweats. My pdoc is back in the office on Monday, and I have sent him an email asking him to review his notes from my 2016 tapers of paroxetine and quetiapine - I know I reduced from 37.5 mg to 25 mg paroxetine, and from 300 mg to 0 mg quetiapine, but I can't remember which tapering he initiated first. I remember both the tinnitus and the night sweats, but can't remember when they went away. Am in a bit of a wave at the moment, but a much smaller wave than before, so I think I will be ok in a few days. I have reduced any activities that I deem to be stimulating.

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Bee5

Still holding on 32.5 mg paroxetine and was going to reduce the quetiapine from 300 mg to 275 mg, but am in a bit of a wave, so I am not going to reduce just yet. The night sweats have me waking up freezing, and then I have to aim the fan heater at myself in order to fall back asleep. As soon as sleep stabilises I will adjust the quetiapine. Tinnitus persists, but is marginally better.

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Carmie
On 7/24/2018 at 5:59 PM, Bee5 said:

Still holding on 32.5 mg paroxetine and was going to reduce the quetiapine from 300 mg to 275 mg, but am in a bit of a wave, so I am not going to reduce just yet. The night sweats have me waking up freezing, and then I have to aim the fan heater at myself in order to fall back asleep. As soon as sleep stabilises I will adjust the quetiapine. Tinnitus persists, but is marginally better.

 

Hi Paroxene, 

 

Sorry to hear that you’re in a bit of a wave. Yes, best not to taper again until you stabilise. 

 

Im tapering off Seroquel too. I started at 300mg. I’m down to 6.5mg now but it’s still going to take many years to get off that. Slow and steady wins the race. 

 

All the best with your tapering💚

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Bee5

Thanks Carmie, it is so frustrating having windows and waves, because I am so happy and hopeful during windows, and so terrified during waves 😥.

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Bee5

Have reduced my quetiapine to 275 mg, and as expected, I had a bit of anxiety on the second night on the lower dose. It is less than a 10% drop though, so hopefully it will pass in a few days. Going to hold for a month. 

I also took 5 g of L-glutamine, for the first time for my digestive issues, but soon after that I realised that L-glutamine is actually involved in the glutamate system. Since excess glutamate leads to anxiety, I immediately stopped the L-glutamine. So it could be the L-glutamine that contributed to my anxiety last night. Did L-glutamine affect anyone on this forum?

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Carmie
On 7/26/2018 at 8:42 PM, Bee5 said:

Thanks Carmie, it is so frustrating having windows and waves, because I am so happy and hopeful during windows, and so terrified during waves 😥.

 

 

Hi Bee, 

 

Yep, The ups n downs make it difficult to decide what one can do each day in advance. I just take each moment as it comes, there’s not much more one can really do. When I’m in windows I make happy memories to look back on. When I’m in waves I find all sorts of distractions to keep me sane. I do a lot of crocheting, watch DVDs, Netflix n YouTube videos. I also love arts n crafts n try n get out in nature as much as I can. 

 

 

On 7/30/2018 at 4:31 PM, Bee5 said:

Have reduced my quetiapine to 275 mg, and as expected, I had a bit of anxiety on the second night on the lower dose. It is less than a 10% drop though, so hopefully it will pass in a few days. Going to hold for a month. 

I also took 5 g of L-glutamine, for the first time for my digestive issues, but soon after that I realised that L-glutamine is actually involved in the glutamate system. Since excess glutamate leads to anxiety, I immediately stopped the L-glutamine. So it could be the L-glutamine that contributed to my anxiety last night. Did L-glutamine affect anyone on this forum?

 

I hope all goes well with the taper. I’m tapering the quetiapine at the end of this month again. 

 

As regards supplements, I would be careful using any of them during withdrawals. The only ones recommended on this site are fish oil and magnesium. Starting with one at a time n slowly updosing. 

 

Sending hugs🤗

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Bee5

Thanks for the support Carmie. I did a tapering spreadsheet, and it will take me at least two years to reduce everything to my 'target' of 12.5 mg paroxetine and no other meds. I guess I had better get comfortable accepting waves and windows, and enjoy the journey because it's going to be a looooong one.

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Carmie
1 hour ago, Bee5 said:

Thanks for the support Carmie. I did a tapering spreadsheet, and it will take me at least two years to reduce everything to my 'target' of 12.5 mg paroxetine and no other meds. I guess I had better get comfortable accepting waves and windows, and enjoy the journey because it's going to be a looooong one.

 

Hi again Bee, 

 

The way I’m going it might take me ten years to get off these dreaded meds but I’m not going to ,et that stress me. I’m just taking each moment as it comes. That’s all we can do. 

 

Like you said, we have to get comfortable in windows n waves, there’s no way out of it. We just have to float through the symptoms like Claire Weeke’s says. 

 

Mine is a loooooong journey too😃.

 

Sending hugs🤗

 

 

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Bee5

Thanks Carmie. Who is Claire Weeke?

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Carmie
On 8/10/2018 at 5:19 PM, Bee5 said:

Thanks Carmie. Who is Claire Weeke?

Hi Bee, 

 

Hope you’re doing ok. She was a doctor that wrote about how to cope with anxiety, and a lot of people on this site use her methods to help get through withdrawals. 

 

Just google survivingantidepressants and Claire Weekes n you’ll come across information. She’s written books, there are also YouTube videos you can check out. Have a look at what she calls floating. 

 

How are you doing with your tapering?💚

 

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Bee5

Hi Carmie,

 

I will definitely look up Claire Weekes. I am approaching my next paroxetine drop. It is disheartening that I am going to be on meds for so long, but if I think back to my akathisia (which of course my pdoc did not believe), I see no alternative. I am so frustrated that my nervous system is so sensitive.

 

I have developed slight sexual dysfunction, but at least I am still able to orgasm (sorry if this is oversharing). I have also developed a fear of going to bed because I am scared of having a "toxic"/"adrenaline" wake-up, ESPECIALLY after a dosage drop.

 

Thanks for checking in.

 

Bee

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Carmie

Hi again @Bee5

 

Im sorry you have so many symptoms. Yes, best to go slowly. I did the calculations today with brassmonkey’s calculator n it will take me at least ten years to get off 7.5mg of quetiapine as I can only taper by 5% . I definitely don’t want to go through severe akathisia again. That is the worse symptom ever. Slow n steady like a turtle is the way to go. 

 

A lot of people on this site have morning fear when in waves, myself included sometimes. There was a stage where I woke up in severe tremors every morning for months n I didn’t want to go to bed. They have subsided somewhat now. I’m not sure why, maybe because my dose is smaller, who knows. This process is not linear. It’s all over the place. 

 

Sorry to hear about bout your sexual dysfunction. That’s another thing that a lot of people on this site talk about too. 

 

There are millions of symptoms, some you wouldn’t even relate to withdrawals but they are related. It’s a day at a to me n just trying to still live your life as best as one can, even with limitations. I have been really ill for over twenty years, so way before these withdrawals so I’m kind of used to living within my boundaries. There are always things one can still do despite whatever circumstances we are in. 

 

When I’ve been in severe waves though my focus is on distracting myself n trying to get to the end of each day as best I can. When I’m in windows I make lots of happy memories. I’ve just been on a beach holiday with friends. 

 

Take care💚

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Bee5

Thanks so much for your support Carmie. I had an appointment with my pdoc yest, and we agreed that I drop to 30 mg paroxetine, but then hold paroxetine until I am completely off my quetiapine. Holding thumbs for minimal symptoms. I got off quetiapine relatively easily last time, but of course I know this is not an indication of how tapering will go this time around. 

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Carmie
5 minutes ago, Bee5 said:

Thanks so much for your support Carmie. I had an appointment with my pdoc yest, and we agreed that I drop to 30 mg paroxetine, but then hold paroxetine until I am completely off my quetiapine. Holding thumbs for minimal symptoms. I got off quetiapine relatively easily last time, but of course I know this is not an indication of how tapering will go this time around. 

 

Hope all goes well with your latest taper Bee, 

 

It’s quite a juggling act for you when you have three meds to come off. I’m glad though you got off the seroquel easily last time. I hope this time will be the same for you. 

 

Keep us all updated with how your tapering goes.

 

Take care💚

 

 

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Bee5

Hi,

 

I have always been on Aropax CR, and now that I am tapering off, my pdoc suggested I switch to Paxil, since those tablets are easier to cut up.

In an effort not to shock my system, I have been taking 25 mg Aropax CR (paroxetine hydrochloride, controlled release), and 5 mg Paxil (paroxetine hydrochloride, instant release), to get my system used to Paxil. There is a currently a supply shortage of Paxil in my country, and my pdoc said I could use Serrapress (paroxetine hydrochloride. instant release, generic) instead. I am afraid that my system isn't even used to Paxil yet, let alone a third type of paroxetine hydrochloride. I am scared to shock my system into instability. I have managed to source a box of Paxil from a smaller pharmacy, so my thinking is this:

  1. Use this box of Paxil to jump to Paxil only (September). 30 mg Paxil.
  2. Source another box of Paxil, and a box or Serrapress, and use them half-half for two months (October and November). 15 mg Paxil and 15 mg Serrapress.
  3. Serrapress only. 30 mg Serrapress.

Any guidance would be appreciated.

 

Thanks,

Bee

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Bee5

Hi,

I recently read about a phenomenon called flu brain, which states that neurotransmitter production changes while your body is infected with the flu virus. My question is - has anyone on this forum experienced this? I personally felt more anxious and depressed in my recent bout of flu.

Secondly, I stumbled across a doctors' forum where some doctors were discussing why some people get brain zaps when they have the flu and/or a fever, and one of the doctors postulated that the fever/temperature regulation system in the body is responsible for the brain zaps. My second question is - since it is well-known that some SSRIs (like paroxetine) influence temperature regulation, do you think that brain zaps when discontinuing SSRIs are related to temperature disregulation?

 

Thanks for your thoughts,

Bee

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manymoretodays

Hi Bee5,

I think your body is plenty used to Paxil.......unfortunately........that's part of the problem.

 

On 8/21/2018 at 5:19 AM, Bee5 said:

Thanks so much for your support Carmie. I had an appointment with my pdoc yest, and we agreed that I drop to 30 mg paroxetine, but then hold paroxetine until I am completely off my quetiapine. Holding thumbs for minimal symptoms. I got off quetiapine relatively easily last time, but of course I know this is not an indication of how tapering will go this time around. 

 

I'd be just holding for now with the quetiapine, if I were you.  We recommend a taper off your more activating drugs first.  Tapering multiple psych drugs, which first?  

 

Have you completed the switch over from your Paxil CR to the immediate release?  You might continue to do this with the new generic paroxetine.   And then just HOLD tight for at least 4-6 weeks.  The 3 K's.....keep it simple, slow, and stable   You've done a fair amount of changing things recently.   Up, down, up......different drugs, etc.

 

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.  The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

 

In the Tips for tapering off Paxil there's some information about manufacturers that may come in handy for you to share with your prescriber, so you can get what you need to taper.  It does sound like being on the immediate release formulation is the way to go, to get started tapering.  I personally have not tapered Paxil.  Where you are on a high dosage now......you might be able to tolerate this kind of cross over okay.  I'll check with the other moderators on this though.

 

 Why taper by 10% might be helpful to you to read once again, even if you already have.

 

Love, peace, healing, and growth,

mmt 

 

Edited by manymoretodays
bold, removed white space

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Bee5

Thank you MMT. I phoned both Aspen and GSK today to try and understand the Paxil supply problem (in South Africa, Aspen sells and distributes Paxil, even though it's a GSK product, GSK verified this for me over the phone today). The Paxil should be back at the end of September, and I was able to source a box of Paxil at a small pharmacy, so I should have enough Paxil until stock is replenished. 

I am not comfortable instantly switching from a CR tablet to an instant release, so here is my proposed plan for September: take a 12.5 mg Aropax CR and a 20 mg Paxil until my remaining CR tablets are finished (I have about 2 weeks' worth). Then I intend to move over to 30 mg Paxil. 

I read the tapering Paxil thread, and most people seem to be ok with switching from CR to instant release, but I know my body, it is very sensitive to any change in psychotropic medication. Therefore I will rather transition to instant release slowly, then hold indefinitely until I am off the quetiapine. 

Thanks for your input and assistance. 

Regards, 

Bee

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Altostrata
1 hour ago, Bee5 said:

12.5 mg Aropax CR and a 20 mg Paxil

 

Hi, Bee. Why not continue to take 12.5mg Aropax CR with Paxil for as long as you can, then substitute the Serrapress or whatever generic for the Paxil when you have to?

 

Is there any foreseeable problem in obtaining 12.5mg Aropax CR?

 

Is paroxetine liquid available in your country? That would be immediate-release, but if you could keep the manufacturer consistent, it would eliminate some of the drug variability and give you more flexibility in tapering.

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Bee5

Hi Alto,

The reason for wanting to move onto the Paxil is that it's time for me to reduce to 30 mg, and the 12.5 CR + 20 mg Paxil is 32.5 mg. I will take the CR and Paxil for the next two weeks then move over to 30 mg Paxil (I have managed to source a box, and have secured another box for October, and then the stock levels should be back up in the country).

I definitely intend to investigate liquid Paxil for when I get down to the lower levels, but to be honest, I don't think I am going to go less than 12.5 mg. My pdoc thinks even 12.5 mg is too low, because he thinks it's sub-therapeutic, but I will work on him over the next two years (I am going to go off quetiapine first, then start reducing paroxetine below 30 mg).

Thanks for your advice as always,

Bee

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Altostrata

I'm not following your reasoning for switching your entire dose to Paxil. If you taper by 10%, very soon you're going to have to do something more precise than combine existing dosages or cutting tablets. Using a liquid is usually the easiest way to titrate.

 

If you're tapering quetiapine first, why don't you continue to take

On 8/27/2018 at 4:56 AM, Bee5 said:

25 mg Aropax CR (paroxetine hydrochloride, controlled release), and 5 mg Paxil (paroxetine hydrochloride, instant release)

 

When you can't get Paxil anymore, you can take 5mg of whatever generic is available.

 

Why are you changing your paroxetine dosing at all? This brings a potentially confounding variable into your tapering.

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Bee5

My initial strategy was to taper 10% paroxetine and 10% quetiapine alternating months, but my pdoc said I should taper the quetiapine first. 

The Paxil will be back in stock by the end of the month, so I should be able to remain on the Paxil indefinitely. I just asked the pdoc for an alternative before I knew that countrywide stock will be replenished. I am not going to go below the 30 mg of paroxetine until I am completely off the quetiapine. 

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Altostrata

What effect does quetiapine have on you?

 

Yes, quetiapine is a dangerous drug, and you have been taking a high dosage. I would not praise your psychiatrist for that. Have lab tests come back showing something in your metabolism is off? Why is your psychiatrist changing your drugs now?

 

Paxil can be very difficult to go off.

 

I would not alternate reducing Paxil and quetiapine, the risk of withdrawal symptoms from either is high and you won't know which is causing them, should you get them.

 

What times of day do you take your drugs, and their dosages? As you change dosages, please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

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Bee5

When I had severe postpartum depression, the pdoc put me on paroxetine for depression and anxiety, quetiapine at the dosage where it's registered as an antidepressant, and lamotrigine to 'augment' the anxiolytic effects of the paroxetine. 

The regime worked for me before, and I successfully weaned off the quetiapine. But all hell broke loose 4 months after weaning off paroxetine. This is why this time around, I am going to take years to come off the quetiapine and lamotrigine, but I don't plan to come completely off the paroxetine, ever (target is to get to 12.5 mg). 

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Altostrata

That's all mythology about the drugs. My question is: What effect does quetiapine have on you now?

 

Please answer my other questions in

 

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Bee5

Hi Alto,

 

To be honest, I have no idea to tell how quetiapine affects me, because I am taking three types of medication, so I don't know which medication is causing which effects. I have not had any metabolic tests, but I there does not appear to be anything off with my metabolism (other than weight gain, but I would say that is because of my raging appetite, rather than a metabolic deficiency). My main symptoms/side effects are sexual dysfunction, tinnitus, night sweats, weight gain, intermittent anxiety, intermittent depressed mood. 

My psychiatrist is not changing my meds, but is assisting me in tapering, I have been on paroxetine, quetiapine and lamotrigine since March, after experiencing protracted withdrawal. His reasoning is that the quetiapine is the one causing most of the side effects, so he wants me to taper off the quetiapine first, before tackling the others.

I intend to hold on the paroxetine until I have come off the quetiapine.

I take paroxetine in the morning, and quetiapine and lamotrigine at night.

Since my recent drop in quetiapine, I have had one anxious night awakening. Hopefully there will be not other withdrawal effects.

 

Thanks,

Bee

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Bee5

Hi fellow SA peeps,

 

Does anyone find fish oil activating? I don't know if it was the fish oil, or the fact that I decreased quetiapine from 275 mg to 250 mg, but I was really anxious last night, raging adrenaline and a fast heartbeat. Can anyone weigh in if it's quetiapine withdrawal, or if it's the fish oil? I decreased my quetiapine dose on the 25th of August.

 

Regards,

Bee

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