Bee5: reinstated paroxetine, dose too high?

[manymoretodays]

Hi Bee5,

 

I have wondered about the fish oil being activating too.  I read somewhere that if too high of the EPA/DHA ratio......it could be more activating.  So I go with a 360/240 ratio on that.  Barlean's is the brand that I've been using for quite some time......fresh catch and ultrapurified(hopefully good enough).   

 

I think it might have been Dr. Andrew Weil's site where I read that.  High EPA activating and then DHA more neutral.  I think that the EPA converts to DHA eventually though.  I'd have to do a review of topic to confirm.  Omega 3's, King of supplements  I think that it's discussed a bit there.

And then I just stick to a lower total dose overall with my Omega 3's.......about 1200 mg total per day.   I've got another bottle of capsules in my freezer which are much higher ratio EPA/DHA and it did seem to be too much at one time.  I should probably just toss them.

 

Then again.....it may be the reduction in the quetiapine........or perhaps a little of both??  It can be hard to know exactly.

 

Hope that helps.

Love, peace, healing, and growth,

mmt

 

 

[Bee5]

Thank you so much for this. I will look up the ratio. But for now, I am going to steer clear just in case. 

Having your heart pound and race and having an adrenaline rush is no fun. 

I never used to be sensitive to dose changes, but now the slightest change causes hectic symptoms. 

[Carmie]

Hi Bee, 

 

Im sorry your last dose change affected you so much. I tapered down my Seroquel too. I started at 300mg n I’m now down to 7.5mg. I haven’t kept records but in the beginning when the doses were high I just kept going down by 25mgs. I knew nothing about tapering though at the time. I also had severe withdrawals doing that. 

 

For the last last couple of years I’ve been tapering around four to five percent as I can’t tolerate ten percent. It’s way too high for me. 

 

Im not sure about the fish oil as I haven’t used it as yet but I do know doing the drops you’re doing really affected me. 

 

Wishing you all the best in your tapering 💚

[Altostrata]

On 8/28/2018 at 12:11 PM, Bee5 said:

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). 

 

I would do it a little differently. I'd taper the paroxetine after quetiapine, keeping lamotrigine for last. Lamotrigine can help keep your nervous system stable through withdrawal -- as long as you don't have adverse effects from the lamotrigine.

 

On 8/28/2018 at 11:20 PM, Bee5 said:

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

 

The raging appetite and weight gain is a common side effect of quetiapine. Paxil could be involved, too.

 

When did the tinnitus start?

 

What times of day do you take each drug, and their dosages? Are your symptoms worse at any particular time of day? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time on the left and notations on the right.

 

On 8/31/2018 at 3:18 AM, Bee5 said:

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

 

Since you made the quetiapine change at the same time, it was probably the quetiapine. Did you stop taking fish oil? You could try it again and observe to see its effect. Very occasionally people find fish oil activating.

 

Since you decreased quetiapine 5 days ago, how are you feeling now?

[Bee5]

On 9/2/2018 at 5:34 AM, Carmie said:

Im sorry your last dose change affected you so much. I tapered down my Seroquel too. I started at 300mg n I’m now down to 7.5mg. I haven’t kept records but in the beginning when the doses were high I just kept going down by 25mgs. I knew nothing about tapering though at the time. I also had severe withdrawals doing that. 

 

Last time the 25 mg jumps weren't bad; this time they are terrible! I think my nervous system has become more sensitive over time. I think I will have to do the same as you Carmie, and taper by less eventually. How many years have you been tapering?

 

On 9/2/2018 at 6:26 AM, Altostrata said:

I would do it a little differently. I'd taper the paroxetine after quetiapine, keeping lamotrigine for last. Lamotrigine can help keep your nervous system stable through withdrawal -- as long as you don't have adverse effects from the lamotrigine.

 

This is what we tried last time, came off quetiapine, then paroxetine, stayed on lamotrigine, but got protracted withdrawal 4 months in, despite being on lamotrigine. I now know I tapered too fast. My plan this time around is to go off quetiapine, and only then decide the next steps, I don't want to think too far in advance.

On 9/2/2018 at 6:26 AM, Altostrata said:

When did the tinnitus start?

 

It started roughly around the time that the paroxetine really kicked in, about 6 weeks into the 37.5 mg paroxetine. It has definitely gotten better, now that I am on 32.5 mg, so I suspect that it is the paroxetine.

 

On 9/2/2018 at 6:26 AM, Altostrata said:

What times of day do you take each drug, and their dosages? Are your symptoms worse at any particular time of day?

 

I take 32.5 mg paroxetine in the morning. I take the 250 mg quetiapine and 150 mg lamotrigine at night. Every time I do a dose drop, the symptoms usually manifest as night-time anxiety (before bed) and once night awakening (sometimes anxious sometimes not). 

My overall mood does drop though, until my body adjusts to the new dose. I will set up an electronic diary to track symptoms.

 

On 9/2/2018 at 6:26 AM, Altostrata said:

Did you stop taking fish oil?

 

Yes, and I feel much better.

 

On 9/2/2018 at 6:26 AM, Altostrata said:

Since you decreased quetiapine 5 days ago, how are you feeling now?

 

Still experiencing a bit of night-time anxiety, had an anxious awakening last night. Hopefully these symptoms go away in the next week or so (they usually do).

 

Thanks for checking in on me.

Bee

[Altostrata]

12 hours ago, Bee5 said:

It started roughly around the time that the paroxetine really kicked in, about 6 weeks into the 37.5 mg paroxetine. It has definitely gotten better, now that I am on 32.5 mg, so I suspect that it is the paroxetine.

 

If I were you, I might reduce the paroxetine a bit next, after the quetiapine reduction settles down, to address the tinnitus. Then, after a month, go back to reducing quetiapine.

[Bee5]

Thanks Alto, I will see how the tinnitus feels toward the end of the month.

[Carmie]

Hi Bee, 

 

Yes, it’s better to taper slower. I can’t remember how long I’ve been tapering but it’s been many, many years n doing the brassmonkey slide it might take me another ten. I can’t taper too quickly as the akathisia comes unbearable. I don’t really focus on how long it will take. 

 

I’ve been doing water titration for years now. I can’t go down by ten percent anymore, though I did in the past. My body will only let me go down by around five percent now. 

 

There is nothing linear about withdrawals. One day you can tolerate something n the next day you can’t. 

 

Wishng you all the best with your continued tapering💚

[Bee5]

Hi Carmie,

 

Thanks for the encouragement, I see you have also bee encouraging the new member @Lilabella, she is really struggling with quetiapine withdrawal, perhaps you could reach out to her and let her know more about your symptoms?

Out of interest, how long after a dose drop does the akathisia hit you? And what other symptoms do you get?

 

Thanks,

Bee

[Carmie]

On 9/5/2018 at 3:04 PM, Bee5 said:

Hi Carmie,

 

Thanks for the encouragement, I see you have also bee encouraging the new member @Lilabella, she is really struggling with quetiapine withdrawal, perhaps you could reach out to her and let her know more about your symptoms?

Out of interest, how long after a dose drop does the akathisia hit you? And what other symptoms do you get?

 

Thanks,

Bee

 

Hi Bee, 

 

How are you doing today? Yes, I’ll contact Lilabella again. As regards symptoms though, they change so much n it really doesn’t matter what medication someone is coming off. From what I’ve read the same symptoms are playing havoc with people on all the different meds, they all down regulate the brain receptors. 

 

I get everything from tingling, shaking, I get hot n then cold etc etc. I’ve had sore teeth, burning mouth, earaches, itchy ears, itchy skin, sore throats etc 

 

Akathisia is the very worst symptom, but there’s degrees of it. I’ve had it so bad in the past where I thought my body was going to explode n I felt like I was being electrocuted. When it’s not so intense I can cope with it okay, I just use lots of distractions. Going to quick with tapering is was makes it bad n the doctors had cold turkeyed me off meds in the past before I knew about withdrawals. It was horrific!

 

I have cognitive n memory problems but I had them already because of chronic fatigue syndrome. I also have severe brain fog, but I’ve had that for 24 years as well due to my illness, so the depersonalisation thing was already there for me, everything around me always feels surreal. I also feel like I’m looking through Vaseline. 

 

As regards the akathisia, the times it happens after tapering is different too. It’s not linear either, just like all other symptoms. Sometimes it comes on straight away, sometimes it takes four or so days, sometimes a week, sometimes a fortnight. If I taper slowly it doesn’t become too severe n I have days without it.

 

All I can say is, when it comes to tapering, withdrawals are all over the place. Slow n steady does it. 

 

Take care, sending hugs🤗

 

 

[Bee5]

Hi Carmie,

 

Settling into the new dose of quetiapine, my night-time anxiety is slowly lessening. But to a large extent I think the anxiety is made worse by the fact that I am so scared that I won't be able to sleep, that I make the anxiety worse, despite evidence to the contrary (most nights I fall asleep within 15 minutes). I have taken up reading (a book, not an electronic device) before bed, and it helps me to get sleepy.

 

Never in my life do I want to get the akathisia again, as it makes me instantly suicidal. I will go of as slowly as I need to, for as long as it takes. I estimate I will come off the quetiapine in about 1.5 years. 

 

Thanks for checking in.

 

Bee

 

 

[Bee5]

Hi!

A general question to SA members: does anyone have days where they find exercise activating? I am a jogger, but I am cautious with my jogging after dosage drops, because it has been activating for me in the past. Any thoughts on this?

Bee

[Baxter]

I had experiences similar to yours when decreasing cymbalta years ago. Just - listen to your body...maybe you could try walking on a nice route after decreases? I found that  being outdoors, in natural light was nice during the bumpy ride down - most of the time. Don't give up on exercise!!! it is so good for - everything. 

 

 

[Bee5]

Thanks Baxter, I am learning to listen to my body, but I don't always get it right. If I start to feel anxious as I set off on a jog, I take a significantly shorter route, so I am trying to match the route to the mood: anxious = 3 km, non anxious = 6 km.

One thing that I do know, is that when I am stable on a dose, I enjoy running much more, and feel the benefits more, and this drives me to run more; this is the cruel paradox of withdrawal, that the very thing that helps you when you're well makes you worse when you are not well.

[Gridley]

"But to a large extent I think the anxiety is made worse by the fact that I am so scared that I won't be able to sleep, that I make the anxiety worse, despite evidence to the contrary "

 

Bee,

 

This is what Dr. Claire Weekes, who did pioneering work in dealing with anxiety, called "secondary fear" or "fear of the fear."  She gives some tips in dealing with this in this link.  There are also several Youtube videos that I found helpful in handling anxiety.

 

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

 

 

 

[ChessieCat]

8 hours ago, Bee5 said:

Hi!

A general question to SA members: does anyone have days where they find exercise activating? I am a jogger, but I am cautious with my jogging after dosage drops, because it has been activating for me in the past. Any thoughts on this?

Bee

 

exercise-do-more-do-less-do-nothing-what-worked-for-you 

 

On 7/29/2011 at 11:06 AM, Altostrata said:

Just wanted to note about exercise:

 

Exercise can increase the release of cortisol, the stress and alerting hormone. Exertion may well make you feel lousy.

 

Walking is the form of exercise that least causes increases in cortisol. But if you do it strenuously and in the evening, you may well wake yourself up with some alerting hormone.

 

So don't overdo it, especially in the evening.

 

 

[Gridley]

Bee, I find exercise activating and so I take it very easy.

[Carmie]

10 hours ago, Bee5 said:

Hi Carmie,

 

Settling into the new dose of quetiapine, my night-time anxiety is slowly lessening. But to a large extent I think the anxiety is made worse by the fact that I am so scared that I won't be able to sleep, that I make the anxiety worse, despite evidence to the contrary (most nights I fall asleep within 15 minutes). I have taken up reading (a book, not an electronic device) before bed, and it helps me to get sleepy.

 

Never in my life do I want to get the akathisia again, as it makes me instantly suicidal. I will go of as slowly as I need to, for as long as it takes. I estimate I will come off the quetiapine in about 1.5 years. 

 

Thanks for checking in.

 

Bee

 

 

 

Hi Bee, 

 

I’m glad your anxiety is lessening. Yes, we can ramp it up ourselves, you’re right there. I see Gridley gave you a link to Claire Weekes. Her method is very good, I hope it helps you.

 

Reading a book before bed is a great idea. I find reading novels really helps me to zone out, though I haven’t read one in a while. I’ve been reading other things. I must get back into reading novels when brain fog isn’t too severe. 

 

Yes, when akathisia is acute it certainly makes one feel suicidal. I don’t think there’s anything worse. 

 

Did you see Lillabella has stabilised somewhat at the moment, that made me smile. It always makes me so happy when I read of people being in windows n stabilising. 

 

As regards exercise it’s better not to push it as it can ramp up symptoms. Take it easy. 

 

All the best💚

 

 

 

 

[Bee5]

Thanks so much @ChessieCat, @Carmie and @Gridley for your support.

 I will certainly not push myself on the exercise front.

And I will read the Dr Claire Weekes resource Gridley sent.

Yes, it seems Lilabella is better.

[Bee5]

On 9/9/2018 at 1:57 PM, Carmie said:

As regards the akathisia, the times it happens after tapering is different too. It’s not linear either, just like all other symptoms. Sometimes it comes on straight away, sometimes it takes four or so days, sometimes a week, sometimes a fortnight. If I taper slowly it doesn’t become too severe n I have days without it.

 

Hi Carmie,

 

So last night, just over a fortnight after my quetiapine reduction, I had three "adrenaline/cortisol" spike awakenings, that terrified me. Do you think they could be related to the dose drop, even though it has been 17 days since my drop? Also, from your experience, how many days do these symptoms last before settling into stability on the new dose?

 

Thanks,

Bee

[ChessieCat]

These topics might help:

 

waking-with-panic-or-anxiety-managing-cortisol-spikes

 

Windows and Waves Pattern of Stabilization

 

Stabilising After a Reduction - What Does That Mean?

Withdrawal Normal Description

 

Edited September 11, 2018 by ChessieCat

[Bee5]

Thanks @ChessieCat, the commitment of the mods on this site is inspiring.

 

Two items that are not clear for me:

1. The "waking-with-panic" thread addresses morning panic for the vast majority of the posts. After dose drops, my panic-wakings happen at night, either as I am trying to fall asleep, or they wake me sometime between 01:00 and 02:00. Does anyone have advice for how to soften/prevent this?
2. The 'time to stabilise' seems very individualistic, so I am hoping @Carmie could maybe provide some insight into how long it took for her drops to stabilise?

[Carmie]

13 hours ago, Bee5 said:

 

Hi Carmie,

 

So last night, just over a fortnight after my quetiapine reduction, I had three "adrenaline/cortisol" spike awakenings, that terrified me. Do you think they could be related to the dose drop, even though it has been 17 days since my drop? Also, from your experience, how many days do these symptoms last before settling into stability on the new dose?

 

Thanks,

Bee

 

Hi Bee, 

 

Yes, different symptoms can happen at any time. As I mentioned the process is not linear. We goes through windows n waves n they can happen all in the one day too. It always takes a different amount of time to stabilise after each taper. 

 

Once when I didn’t hold long enough, before I was on this site, I got such severe akathisia about two or three months after the taper. I think it lasted a week or so. I was holding for months after that reduction.

 

There is no rhyme or rhythm to this journey. You can get symptoms at any time n you can get new symptoms at any time and old symptoms can come back too. 

 

Your cortisol spikes were probably from withdrawals n if you get any other weird symptoms they are usually withdrawals. I remember getting toothaches n earaches thought I had infections, but no, they were withdrawals.

 

Take care💚

 

 

[Bee5]

Thanks for always providing insight Carmie. Last night was better than the previous one, so let's hope the awakenings are over.

[Carmie]

On 9/12/2018 at 4:08 PM, Bee5 said:

Thanks for always providing insight Carmie. Last night was better than the previous one, so let's hope the awakenings are over.

 

Im glad you had a better night Bee, 

 

All we can do is take each moment as it comes. I’ve been in a windows n waves situation today but I’m doing okay. Just taking a moment at a time is the only way to go. 

 

Ive been overthinking too much lately because of certain things and I’ve had to keep reigning myself in n say take a moment at a time. Sometimes things we think will happen don’t actually happen. Worrying doesn’t solve anything.

 

Sending you sunshine☀️☀️☀️

[Bee5]

Sorry about the overthinking Carmie, I seem to do a lot of that when in a wave.

 

So today a new (but familiar) symptom appeared: brain zaps. I have only made a change in quetiapine, but I have read that brain zaps can occur when withdrawing from quetiapine too. The most recent hypotheses I have heard about brain zaps are:

• They are caused by changes in levels of dopamine, serotonin and GABA
• They are minor, localised seizures
• They are related to central temperature regulation, and that is why some people get them when they have the flu or a fever

Have fellow SA members experienced brain zaps when coming off quetiapine? In the past, I only noticed them when dropping paroxetine dosage. I did a 10% drop in quetiapine, so I don't think I dropped by too much. Is there a way to avoid withdrawal symptoms completely (e.g. if I were to try the @brassmonkey slide method), or will there always be symptoms experienced after a dosage drop, even if the dosage drop is 10%?

 

The only other change I made in the recent past is to decrease the proportion on controlled-release paroxetine in my daily dose (used to be CR only, but now 20 mg is instant-release and 12.5 mg is CR). Could this be causing brain zaps?

 

Thanks for listening as always,

Bee

[brassmonkey]

Hi Bee-- Brain zaps can be associated with just about all psych meds. and in WD are often a sign that the last reductions have been too fast or too large.  An occasional one is no problem, but if they happen a lot it indicates that a person should slow down.

 

A 10% drop is the largest that we recommend.  Some people have trouble even at this reduction and have to go even smaller.  Symptoms are going to be a part of the tapering experience no matter what.  We just try to reduce them as much a possible so they are more tolerable.  I would highly recommend trying a Brassmonkey Slide as it is specifically designed to reduce the amount and severity of the symptoms caused by each drop. Many people find a 10% Brassmonkey Slide to be quite tolerable.

 

Brassmonkey

[Gridley]

I've been doing the Brassmonkey Slide taper of Lexapro for 1 1/2 years and recommend it.

[Bee5]

Thanks @brassmonkey. Just a question, since you did your final step off to 0 mg, have you experienced any withdrawal symptoms?

 

Thanks @Gridley. I am just so surprised that it is affecting me at these high dosages, I would think that withdrawal only really starts to become troublesome at lower doses. I will need to do a sort of slide next drop.

[Carmie]

Hi Bee, 

 

Just wanted to say that withdrawals affected me at high doses too. I started off at 300mg. I’ve never had brain zaps though. 

In this journey though we can never say never as we all keep getting new symptoms all the time.

 

All the best with your continued tapering 💚

 

 

 

 

[India]

Good luck with this. I have just reinstated at 1mg after 10 weeks of withdrawal hell . During my withdrawal I too was awoken by nocturnal panic attacks. For me, I feel there is a clear link with my citalopram withdrawal. I've found fish oil/magnesium to be very beneficial as well as trytophan but everyone is different.  I now accept I tapered too fast this time around hoping I would not get a protracted withdrawal. I have .  I've only just managed to obtain liquid from the Doctor. Quetiapine I don't know about.

[Bee5]

Thanks @India, looking at your signature, you may have tapered too quickly. I weaned off Paroxetine in 5 months and had protracted withdrawal 4 months later - horrific akathisia/suicidal ideation/panic. This time I am prepared to take years to come off paroxetine, and am starting weaning off quetiapine first. Thanks for sharing on the nocturnal panic awakenings, it is a horrific side effect. There is a whole thread on here that @ChessieCat recommended, where @Altostrata and others shared their experiences and mitigation measures, but that thread focused heavily on the cortisol spike that happens early in the mornings, but my awakenings are during the night, and are a sudden surge of what literally feels like adrenaline (or noradrenaline, not sure what that feels like). I would love to get input on whether other SA members experience the 'panic awakenings' as adrenaline/noradrenaline (epinephrine/norepinephrine in the USA) rushes as opposed to a cortisol spike. Has anyone experienced both, and would they be able to explain the difference?

[Altostrata]

Those nighttime wakings are like the jolts some people get when they are falling asleep. It is a paradoxical reaction; the nervous system, which is confused, is struggling against the deep relaxation of sleep.

 

Playing soft music all night may help, it can be soothing.

[brassmonkey]

Hi Bee5-- it's surprising just how powerful these drugs are and how little it takes to have some affect.  After a five and a half year taper my symptoms were very minor by the time I jumped to "0".  but there were still some.  those have cleared greatly over the past year and a quarter.  The most pronounced would have been the strong waves of anxiety that happened at 8 and 12 months off.  The lasted a couple of weeks each. In general I could feel the symptoms growing weaker each few days.  Having been on the drug for about 23 years I think there is going to be a fairly long period of recovery.  As far as acute symptoms go there aren't any.  I do have a lot of body aches and pains but I attribute that more to a "life well lived" and work around them.

 

Brassmonkey

[ChessieCat]

Here is the topic: inner-compass-and-the-withdrawal-project

 

I've moved your post there.

 

Edited September 14, 2018 by ChessieCat

[Bee5]

On 9/14/2018 at 6:57 PM, Altostrata said:

Those nighttime wakings are like the jolts some people get when they are falling asleep.

 

Since I have had a wide range of withdrawal symptoms, I am able to differentiate between my night-time panic awakenings, and jolts. The jolts are hypnic jerks, and happen while I am drifting off to sleep. The 'adrenaline rush' awakenings don't cause any physical jolting, just a burning panic throughout the torso and a feeling of fear/panic. These are not limited to the mornings. I have read some members describing it as 'toxic sleep'. I would like to know if other members differentiate between the three phenomena?