Bee5: reinstated paroxetine, dose too high?

[India]

On 9/14/2018 at 1:12 PM, Bee5 said:

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?

Bee, thank you for your feedback. I agree that I reduced too fast! I gambled with the fact that I might have had a better 3rd month. I reinstated but too high ( 3 drops =3x2mg=6mg). Had an adverse reaction yesterday ( really disturbed thoughts and anxiety). I think that I will start on 1mg. Last time I went back on 10mg and was ok.

As for the panic-- mine was absolutely nocturnal and not morning and feel exactly as you describe. Woken by my heart racing ten fold. Panic awakenings are a perfect term. It is so validating to      

be able to confirm symptoms!!!! You need it for your sanity! I sincerely hope you heal from all this. 

[Bee5]

Thanks @brassmonkey for giving me hope that it is possible to come off eventually. Thanks @ChessieCat for moving my link to the topic on the Withdrawal Project.

 

20 hours ago, India said:

Had an adverse reaction yesterday ( really disturbed thoughts and anxiety). I think that I will start on 1mg. Last time I went back on 10mg and was ok.

 

As you said, everyone is different. I reinstated my full dose of paroxetine - this sent me into huge windows and huge waves for a few months, where the waves felt like withdrawal waves, and the windows were 'too good'. I have stabilised over the past six months. My pdoc has a good analogy, he says that when you reinstate, it is like throwing a stone into a pond, the immediate ripples around the stone are large, but they get smaller as they move away from the stone. What I am trying to say is that maybe you haven't reinstated to high, but that you are experiencing these ripples or windows and waves, as your system tries to enter homeostasis.

 

Sending light your way through this difficult time.

[Bee5]

On 8/31/2018 at 4:20 PM, manymoretodays said:

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.

 

Hi @manymoretodays,

 

I'm back on the Omega topic. I just checked, and my Solal Omega All has the same 3:2 ratio of EPA:DHA as the Barlean's one you mentioned. I will try it again to see if it is activating. The reason I want to try it is because I am getting a few brain zaps (one or two a day) and I suspect that it is related to switching from controlled-release paroxetine to immediate-release paroxetine. I read @brassmonkey's "Are We There Yet?" thread, and he pointed out something that I think may be very relevant to my case: "no holds for changing manufacturer, no holds for changing from tablet to liquid, no holds for stabilizing after illness or vacations". So is changing formulation (but not dose) the likely cause of my brain zaps? Has anyone else experienced brain zaps after a formulation change? And did Omega 3 help?

(I did also step down the quetiapine, but I have never had brain zaps related to quetiapine before).

Thanks for listening,

Bee 

 

 

[manymoretodays]

That sounds great Bee5.  Just start low, keep records, and slowly increase the dose.  With the fish oil/omega 3's.

I think it will help with brain zaps.  It's stabilizing. 

I wouldn't over analyze the cause of the zaps too much........it's hard to know exactly what medication change caused them.  It's a common W/D symptom.

 

I'm going to try increasing my dose a bit myself.  I presently take a low dose of 1200 mg Omega 3's.  I split the dose into 2.  I also keep the capsules in the freezer, which does seem to eliminate any GI(gastrointestinal) problems.  Fish farts.    It was only when I was on more than 3000 mg, that I seemed to bruise easily.     So hopefully I can tolerate getting on up to 2400 mg day.......gradually.

I just get occasional brain whooshes, as I call them.   My moods are stable enough........actually much better overall....... post zero medications/drugs.  

 

So there is that.  

 

Generally with change in manufacturer or formulation, or situational stuff.......we recommend holding at your present dose.  Or just staying put, without further reductions. 

Is that what you mean when you state "no hold"?  We treat those situations that you mentioned above as "dose change events".

 

I hope that helps.

L, P, H, and growth,

mmt

[Bee5]

Yes, that was what I meant. From @brassmonkey's thread, it would imply that one should hold if they change formulation/manufacturer. So I think I should hold for a while before doing my next quetiapine down-dose. It is just so frustrating that no-one yet knows what brain zaps are (physiologically). It seems that my Solal Omega 3 is a waaaaaaaay lower dose than yours  @manymoretodays, because as per the pic below one capsule only contains 1000 mg of Omega 3 (consisting of 75 mg EPA and 50 mg DHA), and daily dosage is 2 capsules. Are your stated dosages referring to Omega 3, or to EPA and DHA? 

 

Regards,

Bee

[manymoretodays]

Mine are EPA/DHA 360/240 mg per 2 capsules/softgels plus other omega fatty acids 80mg.

So.......680 mg total per 2 capsules.

I take 2 capsules twice a day.

 

I think you could try what you have.  Just start with one each day.   And then go up from there. 

I really recommend keeping them in the freezer too.

[Bee5]

Thanks @manymoretodays, but luckily I don't get fish burps or fish farts, so room temp is ok for me 😊

[manymoretodays]

Hi Bee5,

Just go with the total EPA and DHA to adjust your dose of omega 3's.

Yes......yours are fairly low.......compared to mine.  You might be able to find something else that won't have you swallowing so many capsules, if you tolerate a bit.

Best,

L, P, H, and G,

mmt

[Bee5]

Hi SA members,

Just an update, I have decided to continue holding quetiapine at 250 mg (I was supposed to drop to 225 mg this month); because the drop from 275 to 250 mg quetiapine, combined with the simultaneous change from controlled-release paroxetine to immediate-release paroxetine have given me quite a few withdrawal symptoms, which are not over yet. As much as I want to drop, I have to heed the sage advice of other forum members that say that you shouldn't drop dosage until you are stable on your current dosage.

 

Has anyone else experienced that withdrawal symptoms intensify if you have a difficult day at work? I had a long, stressful day yesterday, and it caused me some anxiety, and one adrenaline-rush wake-up last night.

 

Hoping for stability soon.

Bee

 

[Carmie]

Hi Bee, 

 

Good for you for holding. Yes, please don’t taper again until you stabilise. If you taper too soon you won’t get further ahead any quicker because the withdrawals will get even more severe n you will have to hold even longer. 

 

Yes, any kind of stress can ramp up withdrawals, whether it’s physical or emotional. It overstimulates the CNS. 

 

Hope it doesnt take too long for you to stabilise but if it does just continue holding until you’ve reached your baseline again. 

 

Take care n all the best💚

[Bee5]

Thanks for always being so supportive @Carmie, you are an example to us. This flip-flopping between symptoms is both scary and tiring. 

[Carmie]

On 9/27/2018 at 1:08 AM, Bee5 said:

Thanks for always being so supportive @Carmie, you are an example to us. This flip-flopping between symptoms is both scary and tiring. 

 

Hi Bee, 

 

Your term flip flopping certainly sounds like what we are doing. Our symptoms keeps changing all over the place. They come n go, you get new ones n old ones return.

 

Hope you manage to find some blessings in your day. If you can, try n spend some time in nature. I think it’s really important to get out in nature. 

 

Take care💚

[Rose9975]

Hi Bee5, I am sorry to read about your tapering symptoms. Do you have many children? All antidepressants have such side effects.

[Bee5]

@Rose9975 I have one child.

 

SA community: I am still experiencing brain zaps on the change-over from controlled-release paroxetine to immediate release. It has been 5 weeks since the change. @Altostrata you mentioned that brain zaps are a serious symptom. Do you know of anyone on SA who had brain zaps when merely changing formulations of the same medication? 

[ChessieCat]

Hi Bee5,

 

Q:  What time do you take your dose?

 

Q:  When do the brain zaps occur?

 

Q:  Do you seem to get them at the same time every day and they go completely or lessen several hours after taking your dose?

 

I've asked the other mods for their thoughts about splitting your dose and taking it twice a day.  My thinking behind this is you may be a fast metaboliser and/or the half life of immediate release may not be covering you for the full 24 hours period which may be causing interdose withdrawal, and hence the brain zaps.  Your answer to my questions above may shed more light on this.

[Bee5]

Hi Chessie,

 

Ok, answers to your questions:

A1: I take my dose at approximately 06:30 each morning.

A2: Usually in the afternoon

A3: I seem to get them in the afternoons mainly. Never in the first few hours after taking my dose.

 

My intuition tells me that it is related to the formulation change, but that I will get used to the new formulation. I would like to avoid changing anything at this stage, but if they don't improve by week 8, then I will split my dose into the CR tablet and the IR tablet morning and night.

 

My question was more curiosity to see if anyone else experienced brain zaps when switching formulation. It always helps me to feel better knowing there are others that experience my symptom.

 

Regards,

Bee

[Altostrata]

It's possible, Bee. Are the zaps getting worse or better?

[Bee5]

Hi @Altostrata,

They have been almost consistent since they started (at about Week 4 post change from a mostly CR to a mostly IR paroxetine dose). My zaps are exclusively triggered by eye movement, and since I am in an office-based job I pretty much just look at the screen all day. It is when I am leaving work and turn my head to reverse the car, or when I go for a jog where I have to look left and right to cross the road, that the zaps happen. I have been experimenting with the fish oil, but I don't take it regularly, I wait until I feel a zap, then take it.  It seems to help.

Thanks,

Bee

[Altostrata]

The liquid might be not quite as strong as your tablet. You might want to updose slightly, to 32.75mg paroxetine. Let us know if that helps.

[Bee5]

Thanks  @Altostrata, I am not on a liquid. I am on a 20 mg immediate release tablet and a 12.5 mg controlled release tablet. I will give it the full 8 weeks before making a call on dose change. Like you say, keep it simple and slow. It will be 6 weeks on the 6th of Oct.

[India]

On 9/14/2018 at 5:57 PM, Altostrata said:

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.

This is exactly how it feels. Also, similar paradoxical reactions in the day, calmness invoking a stress response.

 

I identify with much of this thread. I hope you stabilise soon @Bee5 . Agree with flip-flopping and holding/ going slow. Sorry you are experiencing the brain zaps. The dose splitting sounds like an interesting idea. I'd be interested if you do choose to go that route. Wishing you continued healing.

[Bee5]

Thanks @India, I continue to have brain zaps, which were predominantly in the afternoon, but today they occurred at about midday. I am keeping symptom notes as recommended by the mods. I tried to add protein and lecithin to my diet, but it may be having a paradoxical reaction, so I will remove the lecithin for now. I don't eat enough protein so I will keep on with the protein at least. I also take Omega 3 when I have zaps, but low doses, otherwise it makes me anxious.

Good luck to you too, thanks for checking in.

[Bee5]

Just checking in. The past two days have been better. Had midday brain zaps yesterday, but none today, so I am really puzzled, but as @Carmie says, none of this stuff is linear, and in my opinion non-linear doesn't even describe it. I would call it random non-linear symptoms. Concentration has improved a bit, but still not 100% back. Holding current regime for 6 weeks now, will hold until 'baseline' resumes.

[India]

1 hour ago, Bee5 said:

The past two days have been better. 

Something to celebrate perhaps ?? Non-linear is exactly the way to describe it. Really hope the 6 weeks go well!

[Carmie]

9 hours ago, Bee5 said:

Just checking in. The past two days have been better. Had midday brain zaps yesterday, but none today, so I am really puzzled, but as @Carmie says, none of this stuff is linear, and in my opinion non-linear doesn't even describe it. I would call it random non-linear symptoms. Concentration has improved a bit, but still not 100% back. Holding current regime for 6 weeks now, will hold until 'baseline' resumes.

 

Hi Bee, 

 

I’m so glad to hear that you’ve had a couple of good days. Yay! As you mentioned we’ve both been holding our last change for the same amount of time. Here’s to slowly getting back to our baseline. We will eventually get there. One thing I know for sure is that windows have always come after each of my tapers, the only thing is you never know when.

 

Hang in there💚

[Bee5]

16 hours ago, India said:

Something to celebrate perhaps ??

 

Yes, it is amazing that we as the prescribed harm community celebrate when we have a normal baseline day.  Some calm celebrations are in order.

 

8 hours ago, Carmie said:

the only thing is you never know when

 

Yes, and the terrible thing is - you feel like you have your life back in the windows, only for the waves to show you who's boss when you do your next dose change. I feel like we have become slaves to our medications.

Hugs to you!

[Steve61]

On 10/9/2018 at 2:35 PM, Bee5 said:

 

@Steve61 this seems to be common. Some people find music activating and others find it soothing. I have set up a playlist of calming music (ballads mostly, with a slow tempo), that I listen to at a low volume, and only in that way can I enjoy music if I am in a wave. But often, in the car, I have to switch off completely, because the noise of traffic and people and the car prove to be a bit too much. But don't write music off completely, just see if you can find a way to enjoy its soothing properties.

Hi Bee, I just wanted to thank you for your advice. I am replying here because I don’t want to hijack Carmies thread . I am finding the music and noise in general difficult. Then again I am so sensitive to anything at the moment that it’s not really surprising.  Anyway wishing you well in this withdrawal journey . Hoping that you get plenty of windows

Steve

[Bee5]

Thanks Steve. I hate that feeling of sensory over-stimulation, and often have to switch off the music playing in my car. Hope you get through this wave and stabilise.

[Bee5]

Just an update. Brain zaps seem to have gotten better. I have been taking my monthly iron supplement (I supplement over my monthly menstruation), and I am wondering if it helped. I have done some reading which suggests iron is essential for optimal functioning of the brain, so maybe the iron sorts out my CNS (one can only hope). I have been anaemic in the past, so I will keep my iron levels up, and if it helps the nervous system then great, win-win.

 

Sending everyone light.

[Carmie]

17 hours ago, Bee5 said:

Just an update. Brain zaps seem to have gotten better. I have been taking my monthly iron supplement (I supplement over my monthly menstruation), and I am wondering if it helped. I have done some reading which suggests iron is essential for optimal functioning of the brain, so maybe the iron sorts out my CNS (one can only hope). I have been anaemic in the past, so I will keep my iron levels up, and if it helps the nervous system then great, win-win.

 

Sending everyone light.

 

Hi Bee, 

 

So glad to hear your brain zaps have gotten better. Yay!💚

[Bee5]

Just journalling an update. I am still having the occasional 'adrenaline rush' at night, but it is certainly not every night. The brain zaps come sporadically, usually between midday and the afternoon. I hope that this means that I am stabilising, because I am hoping to drop 25 mg of quetiapine at the end of the month. Have been holding my paroxetine formulation change since 25 August.

[Altostrata]

The iron supplement is probably not the cause, it's your system getting used to the new paroxetine dosing.

 

If I were you, I'd take a good amount of fish oil regularly, such as 2 capsules 3 times a day, see http://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/

 

You might also take magnesium, see http://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

On 9/16/2018 at 3:10 AM, Bee5 said:

 

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? 

 

You've done an excellent job differentiating between those sensations. Yes, the jolts are hypnic jerks. The "adrenaline rush" is an over-reaction by your nervous system to the relaxation of sleep, it's waking you up to make sure you're still alive. You might play soft music, such as meditation music or trance music, all night long to reassure it.

 

Another thing you might do is take some magnesium and glycine when you wake up, that can help you get back to sleep.

 

On 10/4/2018 at 2:56 AM, Bee5 said:

Thanks  @Altostrata, I am not on a liquid. I am on a 20 mg immediate release tablet and a 12.5 mg controlled release tablet. I will give it the full 8 weeks before making a call on dose change. Like you say, keep it simple and slow. It will be 6 weeks on the 6th of Oct.

 

It sounds like the brain zaps are from your nervous system finding there's not enough paroxetine in your system by the afternoon. You might take the immediate-release tablet in the morning and the 12.5mg controlled-release tablet at noon. Gradually move the 12.5mg controlled-release tablet by an hour later every day. This will help distribute the paroxetine.

 

If the brain zaps are finally going away, though, you might not have to do this. Your call.

 

I would not change anything while you have brain zaps.

 

What time of day do you take lamotrigine? What has been your experience with this drug?

[Bee5]

Thanks for your replies as always @Altostrata. 

9 hours ago, Altostrata said:

I'd take a good amount of fish oil regularly

 

I am taking several fish oil tablets daily, and I think it is helping. It is so strange that the zaps come at different times. For instance, today, the zaps are happening in the morning. So I am starting to think it is not related to the time I take the paroxetine, but rather how it is taking time to 're-shape' the brain.

 

9 hours ago, Altostrata said:

You might also take magnesium

 

I also take magnesium, but not every day, but lately it has been almost every day. I find it helps with muscle twitches/jerks.

 

9 hours ago, Altostrata said:

You might play soft music

 

I find music at night activating, but sometimes I play a few calm ballads leading up to bedtime. If I wake up at night, I might read to calm me down, or I meditate, which also calms me down.

 

9 hours ago, Altostrata said:

Another thing you might do is take some magnesium and glycine when you wake up

 

I will definitely try this if it happens again.

 

9 hours ago, Altostrata said:

I would not change anything while you have brain zaps.

 

Agreed. I am not going to make any more changes until I am at baseline (which includes no brain zaps).

 

9 hours ago, Altostrata said:

What time of day do you take lamotrigine? What has been your experience with this drug?

 

I take it at night with my quetiapine. Last year when I weaned off quetiapine and then paroxetine, my psychiatrist kept me on 150 mg lamotrigine. Sadly it did not prevent me from crashing when late onset/protracted withdrawal hit 4 months after stopping paroxetine. So I am unable to answer your question, because I do not see what benefit it has. But once I get off the quetiapine, and down to about 20 mg of paroxetine, I am going to see if I can taper the lamotrigine instead, and then leave paroxetine for last.

 

[Altostrata]

Brain zaps are a withdrawal symptom, they are erroneous electrical signals in the brain.

 

It sounds like you are managing your current state well.

 

Do you take lamotrigine in a 150mg tablet or 100mg plus 50mg tablet? If you could move part of it earlier in the day, it might be helpful.

[Bee5]

Thanks @Altostrata. It is amazing that a mere formulation change (not a dosage change) can cause withdrawal symptoms. I take a 100 mg tablet combined with a 50 mg tablet. I think the brain zaps are almost over, but if they don't abate, splitting the lamotrigine dose might be the way to go. 

[Altostrata]

Lamotrigine is more helpful in divided doses. After the paroxetine dosing settles down, you may wish to move your 50mg tablet an hour later each day, until you are taking it at night.