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DeterminedAnna

DeterminedAnna: long time Seroxat / Paxil / paroxetine user

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Longroadhome

Thank you for the reply Anna 

i don’t know why I started to get dry eyes from poop out but when I asked about it on this site apparently it’s a common side effect . I also have inflamed irritated eyes at the moment I think worse than usual due to pollen count. Again never had this before . What do you take for it and what helps alleviate it ?

im doing ok just about keeping my head above water so to speak. lots of symptoms with some new ones creeping in . I have started to get painful achy muscles the pain moves around my body in different muscles groups and painful joints  too . 

Last month I started to get really bad headaches but these have diminished somewhat over the last week. 

Anxiety not too bad better than it was (this week anyway) and depression very up and down . Sometimes very  bad but good thing is when it’s really bad it wears off after a week or two and goes back to bearable  . Like you I think I have Akathisia. 

How are you Anna how’s the symptoms?

It sound like you have  a lot of support from the family  which is really good. 

Theres a few of us at the moment coming off seroxat on this site.  some withdrawing from higher doses than us and not doing well and another that tapered too quick and is getting lots of symptoms and has remained at 10mg for the time being .

This drug is wretched.

 

 

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DeterminedAnna

Hi @Longroadhome Thank you once again.

 

There's every chance pollen is playing a role with your eyes. I would not take any pharma medications for it. Those would likely be antihistamines and as Paxil/Seroxat/paroxetine is an antihistamine and withdrawal from it is likely affecting our histamine systems,  taking an antihistamine could upset the balance.

 

Case in point, as you can see I took diphenhydramine a few weeks back to help me sleep and within a few days the sedating effect stopped working, and soon after I got what felt like a bad cold and depression symptoms. But my partner didn't get a cold even though I sneezed near him, which makes me think it was rebound effects of diphenhydramine – the symptoms came on when I stopped taking it. I was really congested with a runny nose and postnasal drip which in turn caused a sore throat and coughing. So in my mind, I'm not going to try diphenhydramine again as the risks outweigh the benefits.

 

What could help with your sore eyes is a cold compress – I wrap ice cubes in several tea towels and hold it over my eyes for ages. It really brings the swelling and irritation down. Also, I wear sunglasses a lot when outside to reduce the irritation of pollen and sunlight. And I keep the windows closed in the house – or at least in the rooms I'm in at that time. But best thing, hands down, is the cold compress. And there's absolutely no medication risks with doing that.

 

Hope that helps x 

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DeterminedAnna

Hello @ChessieCat and @Shep

 

I'm sorry to be a pest but as you've been active on my intro thread before, I wonder if you or other mods could offer any guidance about the Prozac switch that's been recommended to me by a psychiatrist. I've not made any changes and am still holding at 7mg Seroxat, as I have been since end of February when I updosed from 5.96mg.

 

Since that time, there's been a lessening of the extreme symptoms I had in January and February (in hindsight I think I had akathisia), but it hasn't been brilliant. On average, I have probably one reasonable day a week. The rest of the time I have depression and anxiety, and the physical symptoms that go with those things. With the exception of a period around 13 April where I had a cold and Shep gave me great advice, I am regularly practising non-drug techniques of coping.

 

My notes about the Prozac switch – sorry they're long – are on page 2 of my intro thread. I'm in a dilemma. For three days last week I had a distinct window (it really was if a light came on suddenly and unexpectedly), and now I'm back in a wave (real panic symptoms on waking today) which have been brought on / exacerbated by the fear of switching to Prozac. Any words of wisdom would be hugely appreciated. Big thank you.

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Shep
2 hours ago, DeterminedAnna said:

My notes about the Prozac switch – sorry they're long – are on page 2 of my intro thread. I'm in a dilemma. For three days last week I had a distinct window (it really was if a light came on suddenly and unexpectedly), and now I'm back in a wave (real panic symptoms on waking today) which have been brought on / exacerbated by the fear of switching to Prozac. Any words of wisdom would be hugely appreciated. Big thank you.

 

I would hesitate making any major changes such as a Prozac Bridge when you are seeing such improvements. A three day window is a great sign that your nervous system is stabilizing. 

 

And if the fear of the switch is what caused the window to end, I'm not sure I would go with a bridge at this time. 

 

Please post your thoughts on this. 

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Longroadhome
6 hours ago, DeterminedAnna said:

Hi @Longroadhome Thank you once again.

 

There's every chance pollen is playing a role with your eyes. I would not take any pharma medications for it. Those would likely be antihistamines and as Paxil/Seroxat/paroxetine is an antihistamine and withdrawal from it is likely affecting our histamine systems,  taking an antihistamine could upset the balance.

 

Case in point, as you can see I took diphenhydramine a few weeks back to help me sleep and within a few days the sedating effect stopped working, and soon after I got what felt like a bad cold and depression symptoms. But my partner didn't get a cold even though I sneezed near him, which makes me think it was rebound effects of diphenhydramine – the symptoms came on when I stopped taking it. I was really congested with a runny nose and postnasal drip which in turn caused a sore throat and coughing. So in my mind, I'm not going to try diphenhydramine again as the risks outweigh the benefits.

 

What could help with your sore eyes is a cold compress – I wrap ice cubes in several tea towels and hold it over my eyes for ages. It really brings the swelling and irritation down. Also, I wear sunglasses a lot when outside to reduce the irritation of pollen and sunlight. And I keep the windows closed in the house – or at least in the rooms I'm in at that time. But best thing, hands down, is the cold compress. And there's absolutely no medication risks with doing that.

 

Hope that helps x 

Thank you Anna I’ll try ! As you say no risk. 

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Longroadhome

For what it’s worth and I’m no moderator but your doing so well and a three day window shows your moving forward. 

We seem to be st the same stage of recovery as I am also experiencing the odd positive day where symptoms are there but in the background and they don’t overwhelm me. 

If you feel like this why not wait it out a while longer?

Also I’m sure there is s thread somewhere on this site about others that have bridged with another SSRI. Might be worth you reading but can’t remember where i read it . 

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Sassenach

I agree with Shep and LRH.

I only have my own experience but once the improvements started they gradually became more and more frequent.

Now 7 weeks in and beginning to look forward to the day ahead.

There were occasions in the early weeks when it seemed so slow I was tempted to try change but I am now glad I stuck to it.

Unfortunately it seems the medical professionals in the UK are constantly demonstrating they do not do not have the answers to WD, if they even acknowledge it exists.

The mods on here know their stuff stick with their advise.

I am really glad I did.

 

Sassenach

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Gridley
6 hours ago, Shep said:

I would hesitate making any major changes such as a Prozac Bridge when you are seeing such improvements. A three day window is a great sign that your nervous system is stabilizing. 

 

 

I would definitely agree with Shep.

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DeterminedAnna

Hello @Shep (and @Longroadhome and @Sassenach and @Gridley)

 

Thank you for your all of replies. They're of such huge comfort.

 

I think I've been lulled into a sense of security because the local NHS mental health team I've seen recently have all acknowledged how difficult Seroxat is to stop taking, which is a marked difference in attitude compared to my experience of mental health professionals when I was tapering and crashed badly in 2013. Consequently, when the psychiatrist has suggested a switch to Prozac, I felt more willing to consider this. I've also seen some positive stories on the Prozac bridge thread here.

 

Shep – you asked for my thoughts. Here they are:

 

Why I'm considering the Prozac switch:

 

- This is my third attempt at getting off Seroxat. This latest taper has followed the 10% rule, making the reductions every four weeks. I made a mistaken excess drop in late December which totally knocked me off balance, leading to hell throughout January and February and the 1mg updose at the end of February. I am terrified of going through the symptoms I had in those months again and fear that when I resume my taper I will have to go through all that again.

 

- If I resume my Seroxat taper, with 7mg as my starting point, and go for the gentler Brassmonkey slide to try to avoid the January and February experiences, it would take me until August 2022 to get down to 0.37mg if it all goes to plan – not even to zero. That would make me 42 years old, and my chances of starting a family even more reduced. I have calculated my taper in this Google Sheet. I know and agree with the guidance on this site about slow and steady, but I have the 'complication' of wanting to start a family. I knew this when I met my partner in 2010, and by 2013 I attempted to taper (without knowing the 10% method) when I was 33 because we wanted to start a family. The thought of missing my time and not being able to do this is breaking my heart. My partner and I do not want to adopt.

 

- I have my concerns about what Seroxat is doing to my liver. For the first time in my life, my liver enzymes are elevated and my GP is concerned enough to be putting me through various tests and referrals. I understand that Seroxat inhibits its own metabolism, so when down to lower doses, that process starts to ease up and the medication gets processed more quickly, perhaps making Seroxat's shorter half-life even more of an issue. My liver enzymes showed problems in February. And I was found for the first time ever to have low platelets. I'm am concerned that withdrawing from Seroxat and specifically Seroxat is taking its toll on my body in ways I didn't anticipate and ways that are above and beyond the horrendous stuff we all know.

 

- Having looked through all my notes, I can only see that for the months of January to April, I have only had one three-day window (the one last week) and occasional blocks of a few hours where symptoms have lifted. When they do lift, it genuinely is like a storm has passed and there is no residual rain, not even a 'memory' of the symptoms, almost like they were never there. If I look at my daily notes, I see generally my symptoms fluctuate from bad to worse, with no logic that could be attributed to what I've eaten, what I've done or not done. So I don't feel like I am making much progress at all. The updose at the end of February seemed to help me sleep better, but overall, there are far more bad days than good. I'm waiting for a solid block of stabilisation that would give me the confidence to resume my taper, but I'm still waiting. I want to resume my taper as soon as possible for the reasons of starting a family, but I realise it would be risky to restart my taper before seeing some real stability.

 

- My diarrhoea has not stopped since December and in hindsight my toilet habits became increasingly runny throughout the 2018 part of my taper. I suspect this is due to a reduction in anticholinergic activity that Seroxat has. When on higher doses of Seroxat, I am more constipated. I feel having constant diarrhoea is not helping anything at all. I am not taking anything (e.g. Imodium – loperamide) for this because I'm wary of drugs. I'm sure changing my diet could help, but my partner does all the food shopping and cooking and to ask him to adjust our routines on top of everything else he is already doing for me just feels too much.

 

- Along with everything else associated with lower doses, I suspect Seroxat's short half-life and the fact it is now being processed more quickly is playing a part in my fluctuations. I don't buy into the 'low serotonin = depression' BS, but I do think unstable, fluctuating neurotransmitters play a role in withdrawal. I wonder if interdose withdrawal happens with Seroxat at lower doses – I appreciate that taking Seroxat every day at the same time means after about four days the level is pretty constant, but having a 21-24 hour half life means there must be a dip of some kind. And with a sensitive nervous system, any dip could be felt. I'm therefore wondering if switching to Prozac, with a longer half-life might offer more stability.

 

- Perhaps because I'm desperate for a way to stop taking Seroxat that's more bearable, I can't help but look to articles like this which suggest Seroxat is much harder to stop taking than other SSRIs. If there's a chance that switching to Prozac could make the next few years of tapering more bearable then I'm considering that chance. Also, my partner is desperate to move house and to do that I need to earn more money than I'm currently earning – my self-employed income has taken a big hit in the past few months because of being so unwell. I need to be able to function and work.

 

I believe in the advice on this website far more than I do the medical establishment. As above, I have the Prozac liquid and tablets in the house but I'm just so unsure, and terrified of changing. And that changing over might do more harm than good. I'm seeing my GP next Wednesday (8 May) and will complain that the urgent mental health team I've been seeing recently have effectively told me to switch to Prozac (which potentially amounts to the most significant change in my medication in 17 years) and abandoned me. Having said that, I don't know why I'm surprised. As I said above, I felt some relief and validation by their acknowledgement of Seroxat problems (I think that sense of relief contributed to my window last week), but casually saying 'just switch to Prozac' demonstrates that the acknowledgement of Seroxat problems is probably just about placating me.

 

Thank you for reading all this. I'm sorry I write loads. It helps.

And thank you too for any thoughts on the above, especially my theories about the science. x 

 

 

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Longroadhome

Just a quick reply from

me Anna as I’m st work , 

i don’t  think anyone is going to be able to give you the clear answer you are looking for as in a Yes do the switch or No as we are all unique and what works for one may not work for another as is clearly seen time and again on this site. 

You are going to have to make the decision.  

what I  would probably do is draw up a list of For and Against and make a decision from there and stick to it. 

Though I would love this over and done with quickly (wd) I have resigned myself to holding and tapering slowly but my circumstances are different to yours and I can understand why you are considering the bridge. 

Good luck and please let us know your decision either way x 

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Longroadhome

Anna I’ve just read on the bridge forum that you highlighted that Bridging while in withdrawal from one SSRI to another does not work . Because you are already in withdrawal. 

Check it out. 

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Sassenach

Hi Anna

 

Really tough decision but as I said yesterday once the windows started for me they improved considerably within the space of a month.

I tnink I read somewhere on here that Prozac was one of the hardest to get off despite the half life theory, unfortunately I cannot remember where.

Might be worth asking the mods, don't rely on my memory.

I know this sound simplistic but if you have enough Seroxat why not give it one month as you have finally seen some improvement, put it on your calendar so you review without fail and not let it drift.

You obviously keep a diary so accurate entries for this month are essential.

I have started percentage scoring the days to measure improvement, not scientific but it helps me.

I know you say time is an issue but one month is really not going to make a difference, better than out of the frying pan.

Did the psychiatrist give detailed information as to why the change would help, why do you feel they have abandoned you?

I know you are conflicted but bad decisions are usually made when we are under pressure or feeling low.

For what it is worth I have had liver problems and low platelets ( they often go together ) for 17 years but good care means apart from W/D I am fine.

 

Sassenach

 

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Sarahbarah

Hi Anna,

 

As I read your last post, particularly the part about half life, a thought occurred to me. What do you think about splitting your dose into two doses every twelve hours?

 

Thinking of you,

Sarah

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Shep

Anna, I've asked the other mods who are more familiar with the bridge for their opinions. 

 

Please continue holding and let us know if you've had any more windows and how you are feeling now. 

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DeterminedAnna

Hello @Shep

 

Thank you for your reply and I really appreciate your referral onto your colleagues. I'm still holding at 7mg and my current signature is still accurate.

 

Not had any more windows since last week and still have very similar symptoms.

 

This is a mix of continual anxiety and agitation, suicidal anhedonic depression and overwhelming sense of hopelessness, intense unpredictable crying spells. When I say 'suicidal' I mean that graphic images just keep flashing in my head without any 'conscious' thinking that way. Like when driving yesterday, the scene of me crashing my car into an oncoming lorry just appeared in great detail, even though I was consciously humming along to a cheerful tune on the radio. I'm trying to practise the advice on this site but the techniques aren't scratching the surface – the symptoms follow no rhyme or reason and keep knocking me for six. I wouldn't put my partner and family through attempting suicide, but they are the only reason I have to stay alive.

 

I sleep generally between 5 and 7 hours a night, which is hugely better than January and February... but I'm having lots of what I can only describe as 'lucid nightmares' where I'm awake and hearing the outside world while having nightmare imagery and racing, disconnected thoughts and my body is trembling (and if my partner happens to brush against me I jolt in terror, often shouting at him to get off me). Still having diarrhoea every day, usually within minutes of waking up.

 

In the past two days I have had shooting pain down the left side of my neck, left shoulder, upper left arm and upper left back (I've been using a heat pad and have taken paracetamol twice). I've also got an itchy rash on the nape of my neck. It's hot, red, dry, scaly skin with tiny blisters, but not eczema or psorasis. I last had this same rash at the end of December when I made my mistaken excess drop. The rash I suspect is WD related, but the neck pain I suspect has come about indirectly from tension and sleeping in an awkward position.

 

I think I had akathisia in January and February as the sense to jump out of my skin and escape was extremely strong, and was only sleeping about two hours a night because my mind was racing so much – it was a feeling and set of symptoms quite different to how I am now. During this time I was often unknowingly doing a gurning face and grimacing noises that my partner and family noticed. Perhaps I am misdiagnosing myself as I didn't have the urge to move which I understand is part of akathisia, but I had an agitation that was beyond regular anxiety. I'm describing this because I'm not sure if this is akathisia, but I'd like a record of it here in case I have the same symptoms again in the future.

So some things (primarily sleep) have improved following my updose at the end of February, but not to the point where I'm functioning.

 

I keep repeating myself. Sorry.

Thank you and the SA team so much for your help.

 

PS. One question – from something that @Longroadhome said above. If a person goes through a taper and symptoms are minimal, are they NOT in withdrawal? Is withdrawal only applicable if symptoms emerge?

 

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DeterminedAnna
10 hours ago, Sarahbarah said:

Hi Anna,

 

As I read your last post, particularly the part about half life, a thought occurred to me. What do you think about splitting your dose into two doses every twelve hours?

 

Thinking of you,

Sarah

Hi Sarah,

 

Thank you so much for your thoughts. I've considered splitting my doses too and I appreciate your suggestion, but right now, as per my latest reply to Shep, I'm trying to keep things as routine as possible. I'll keep you posted. Thank you again XXX

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DeterminedAnna
On 5/1/2019 at 5:21 PM, Sassenach said:

Hi Anna

 

Really tough decision but as I said yesterday once the windows started for me they improved considerably within the space of a month.

I tnink I read somewhere on here that Prozac was one of the hardest to get off despite the half life theory, unfortunately I cannot remember where.

Might be worth asking the mods, don't rely on my memory.

I know this sound simplistic but if you have enough Seroxat why not give it one month as you have finally seen some improvement, put it on your calendar so you review without fail and not let it drift.

You obviously keep a diary so accurate entries for this month are essential.

I have started percentage scoring the days to measure improvement, not scientific but it helps me.

I know you say time is an issue but one month is really not going to make a difference, better than out of the frying pan.

Did the psychiatrist give detailed information as to why the change would help, why do you feel they have abandoned you?

I know you are conflicted but bad decisions are usually made when we are under pressure or feeling low.

For what it is worth I have had liver problems and low platelets ( they often go together ) for 17 years but good care means apart from W/D I am fine.

 

Sassenach

 

Hi Sassenach,

Thank you for your thoughts and advice. I'm under no illusions about Prozac. If it was a reliable, easier shortcut to getting off Seroxat I'm sure we'd all be trying it. 

 

I'm in dialogue with Shep and other mods will hopefully be sharing their opinions on the Prozac switch. I'm so grateful for this site. Support elsewhere is pitifully inadequate.
 

Your suggestion doesn't sound simplistic – and even if it does, simple is often better. I have Seroxat on repeat prescription so can effectively get it indefinitely. And I have a couple of spare bottles of it because on two occasions my GP issued me two bottles when I only needed one. I've kept them as backup. Not that I like the concept of a poison being a backup.

Yes, I keep a diary, so I'm going to take your lead and rate my symptoms every day. And you're right, one month isn't anything.

 

The psychiatrist didn't give much info about the Prozac switch. In fact, she kept asking me why I was using liquid Seroxat, thinking I couldn't swallow tablets, even though at the start of the session when giving her an overview of where I am I told her clearly that 'I'm using the liquid Seroxat to measure precise doses'. So her repeated questions on why I'm using liquid Seroxat, and why I'm only taking 7mg, made me think she wasn't really listening to me.

 

It was only when I got very firm with her, albeit crying, and said I am taking Seroxat not to help underlying depression and anxiety, but to prevent withdrawal effects, that she made the Prozac suggestion. She was insistent that 7mg Seroxat was having 'no therapeutic effect' so I got out the SERT occupancy graphs that I'd seen on this site (https://www.survivingantidepressants.org/topic/6036-why-taper-sert-transporter-occupancy-studies-show-importance-of-gradual-change-in-plasma-concentration/ She sort of sneered at this and said 'we can only go on the guidelines'.

 

 

The part of the discussion about medication happened to be five minutes before my time was up.

 

The reason why I feel she / her team abandoned me was because I'd been referred to an 'urgent care' team by my GP.  Nobody explained the remit of this team at the outset so I had no understanding of their limited role and quota of appointments. First I had four appointments over four days with mental health nurses who all agreed with me about Seroxat withdrawal. But they swiftly changed the conversation to standard depression / anxiety discussion. The psychiatrist was only able to see me on the fifth occasion, and it was like her nurse team had reported to her I had health anxiety, because the psychiatrist, although saying 'Seroxat is a nightmare to come off' kept talking to me like I was imagining the symptoms, or causing them by faulty thinking. She also latched onto an innocent comment by me that 'my 70-year-old mum is really healthy – she swims for an hour and walks for half an hour every day', before steering the conversation towards my supposed feelings of inadequacy in light of my mum's impressive energy.

The sixth meeting with the urgent care team was again with a mental health nurse, who arrived with Prozac tablets and an instruction to take them and stop the Seroxat over a week. I rejected this, saying I asked the psychiatrist for liquid Prozac to measure more precise and smaller doses. Nurse seemed put out but said she would speak to the psychiatrist I'd seen. After the meeting, I ignored that nurse's request not to email the team, and put it in writing my views about the experience of the urgent care team along with the only way I'd consider switching to Prozac – a cross taper. I reiterated that my symptoms were due to Seroxat withdrawal, not any kind of underlying depression or anxiety.

 

Had a seventh meeting with a different nurse, who brought with her liquid Prozac and discharged me. And this is why I feel abandoned. From the urgent care team's perspective, they'd given me (new drugs) and that was problem solved. In my eyes, they had effectively instructed me to make the most significant change to my medication in 17 years, but without any professional support overseeing. This is why I feel abandoned.

I shouldn't feel surprised by this. It's par for the course – decent professional help for antidepressant withdrawal is extremely rare. I guess I had my hopes raised when my GP said 'we're going to get you some urgent help'. All my life I've been a big supporter of the NHS and to come to the realisation that there isn't any real professional help available is... well... soul-destroying. On the whole, we're raised to trust the professionals – having that illusion shattered is not a nice feeling.

I think it's fair to say I can't handle any ups or downs at the moment. When I heard the mental health nurses saying how bad Seroxat was to stop taking, I felt some sense of validation. In fact, I cried huge tears of relief to the first nurse I saw (who was young, and probably fresh from training) when he said 'your brain chemistry is going up and down due to withdrawal' making a wavy line hand gesture.

 

Argghhh another long rambling reply from me. Writing has always been my outlet. Only thing I seem to be able to write about at the moment is withdrawal.

Thank you for the comment about your liver and platelets. That is of genuine comfort, thank you.

How are you? How are things at 5mg escitalopram?

 

Thank you again Sassenach.
 

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DeterminedAnna
On 5/1/2019 at 5:20 PM, Longroadhome said:

Anna I’ve just read on the bridge forum that you highlighted that Bridging while in withdrawal from one SSRI to another does not work . Because you are already in withdrawal. 

Check it out. 

Hey LRH,

 

Thank you for your replies. Always. They really do make a difference.

I've done quite a few replies today and rather long ones at that. I'm not going to change anything right now.

 

My partner has just come home from work so I want to show him some attention! (Was not in a good way when he left this morning).


I'll reply properly very soon, but just want to say thank you. And genuinely thinking of you XXX

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Sassenach

Hi Anna

 

Like you I will reply properly shortly but one thing.

Your description of crashing your car is virtually identical to an experience I had.

That was down to a med I was on, will try and remember which.

Are you on any med that could cause this? I do understand thet it is frighteningly real.

Get back to you tomorrow.

Have a good evening.

Sassenach

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Altostrata
4 hours ago, DeterminedAnna said:

If a person goes through a taper and symptoms are minimal, are they NOT in withdrawal? Is withdrawal only applicable if symptoms emerge?

 

That is correct, that would be a successful taper.

 

Anna, you're doing brilliantly educating your doctors when you can. I'm very sorry that you're going through a rather Kafkaesque round of the typical clinical mismanagement of adverse drug reactions.

 

Did you see your liver enzyme results? How bad are they?

 

Digestive problems, etc. can be symptoms of an unhappy liver. Are you taking any other drugs now? They could be fighting in your liver. 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.

 

Not sure if Prozac would be the best bridge. If paroxetine has irritated your liver, it could be that you're a poor metabolizer via liver enzyme cyp 2D6. Prozac would also overload this liver enzyme. Citalopram might be better, see  https://www.uspharmacist.com/article/overview-of-drugdrug-interactions-with-ssris

 

Would you be able to see Dr. David Healy in Wales?

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Oliver1974

Ann

 

I realize you’re feeling desperate. The whole idea of changing anything until your nervous system calms down sounds like a bad idea. Apart from medications, are you doing anything else to lower your stress? You seem to have quite a few plates spinning at the moment. Pressure to start a family, making more money etc. Are you taking anything to help lower your anxiety, say diazepam for example? I mention this because diazepam has helped me get through some insanely hard times with withdrawals.

 

Regards

Stefan

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Songbird
4 hours ago, Oliver1974 said:

Are you taking anything to help lower your anxiety, say diazepam for example? I mention this because diazepam has helped me get through some insanely hard times with withdrawals.

 

We generally do not recommend adding in new drugs - please do not make drug recommendations here.

See: What will get you warned or banned.

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Oliver1974

Sorry songbird. The aim here was to share of what worked for me.

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Sassenach

Hi. Anna

 

Do you take paracetamol, if so how often and what dose?

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DeterminedAnna
16 hours ago, Altostrata said:

 

That is correct, that would be a successful taper.

 

Anna, you're doing brilliantly educating your doctors when you can. I'm very sorry that you're going through a rather Kafkaesque round of the typical clinical mismanagement of adverse drug reactions.

 

Did you see your liver enzyme results? How bad are they?

 

Digestive problems, etc. can be symptoms of an unhappy liver. Are you taking any other drugs now? They could be fighting in your liver. 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.

 

Not sure if Prozac would be the best bridge. If paroxetine has irritated your liver, it could be that you're a poor metabolizer via liver enzyme cyp 2D6. Prozac would also overload this liver enzyme. Citalopram might be better, see  https://www.uspharmacist.com/article/overview-of-drugdrug-interactions-with-ssris

 

Would you be able to see Dr. David Healy in Wales?

 

Thank you so much Alto.

Sounds silly, but I thought withdrawal was an inevitable part of tapering. And that tapering and withdrawal are interchangeable terms. But I'm wrong. And this means I there's potential for me to resume my taper WITHOUT withdrawal symptoms?

 

Yes, local mental health team has ultimately proved nightmarish. Raised my hopes with reassurance, then essentially said 'here, have a different drug but make the switch without our help or supervision'. Why would they literally provide new medication (the Prozac) on the same day that they've decided to discharge me? Even the official guidelines say switching antidepressants should be done under the close supervision of a medical professional.

My GP won't give me the numbers for my liver enzyme tests, saying it won't mean anything to me. I'll ask again at the next appointment but I sense she's thinking I've got obsessive health anxiety. Nonetheless, I've got a liver ultrasound in a few weeks.

I'm not taking any other drugs outside of those in my signature. So the 7mg Seroxat every day and that's it. I stopped taking aspirin for cortisol awakening response a few weeks ago (I'll update my signature) – conscious it might not be helping my low platelets and it wasn't really making a difference to morning panic symptoms. I'm still taking 200mg magnesium citrate and 2000 IU vitamin D every day.

 

My theory (it's probably baloney) is that I'm processing the Seroxat more quickly now that I'm at a lower dose, and that this is causing daily fluctuations that my nervous system can't handle (even if the chemical fluctuations are tiny, . This is one of the reasons why I thought Prozac, with its much longer half life, might be more bearable to taper at lower doses. 

 

Another reason that I've considered Prozac – not mentioned above – is that my older sister has taken Seroxat and Prozac at different stages in her life (but only for periods of months, not 17 years like me). She said Prozac was the easier of the two for her to stop. And since she's genetically similar to me, I thought that might be a good indicator of my response.

 

I now understand that the Prozac switch doesn't work in withdrawal. And that I'm clearly in withdrawal. (All along I've been thinking my symptoms are just par for the course in tapering).

 

I would be able to see Dr Healy and would very much like to. I think he is in North Wales, which is a three-hour drive from me. I contacted him (via david.healy@rxisk.org) in 2013 when I crashed even more badly than this taper. He said at that time there was little he could do and from a distance. Are you in touch with him? Could you help me get to see him?

 

I realise the work you do for everyone on this site is enormous (and I only know the tip of the iceberg). So THANK YOU Alto. 

 

PS. There's a High Court case going on here in the UK about Seroxat and the problems of stopping it. Annoyingly, the mainstream media doesn't appear to have picked it up, but it's being talked about on Twitter. Bob Fiddaman has blogged about it: https://fiddaman.blogspot.com/2019/05/uk-seroxat-litigation-adjourned-blame.html#.XM18qpNKgWo 

 

 

 

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DeterminedAnna
5 hours ago, Sassenach said:

Hi. Anna

 

Do you take paracetamol, if so how often and what dose?


Hi Sassenach,

 

I only took paracetamol (2x 500mg) twice over the past few days, for neck pain, which has pretty much gone now. Don't take it regularly – fast becoming wary of all meds!

Sometimes take for period pain, but only once every 35-ish days. And only if a hot water bottle hasn't helped first.

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DeterminedAnna
15 hours ago, Oliver1974 said:

Ann

 

I realize you’re feeling desperate. The whole idea of changing anything until your nervous system calms down sounds like a bad idea. Apart from medications, are you doing anything else to lower your stress? You seem to have quite a few plates spinning at the moment. Pressure to start a family, making more money etc. Are you taking anything to help lower your anxiety, say diazepam for example? I mention this because diazepam has helped me get through some insanely hard times with withdrawals.

 

Regards

Stefan

Hi Stefan,

Thank you for your concern and suggestions. I'm with Songbird and this site – I don't want to take diazepam or benzos because they are addictive and mess with the brain and nervous system. Taking a psychiatric drug is what led me to these problems in the first place.

You're right about having plates spinning and thank you for recognising this.

The thing is, the pressure to start a family is from within – it's one of the many reasons I want to stop taking Seroxat. So I don't really know how I can ignore that pressure. Likewise, the need to earn more money is unavoidable. It's now not just a case of earning more money to move house – I need to earn enough money to pay regular bills! My partner and I are willing to put the house move on the back burner, but not being able to pay my share of the mortgage and other household bills ultimately comes down to being able to work. I've not been able to do that properly for months, and the longer I stay unwell, the more financial trouble I am going to get into. 

To calm myself, I do deep breathing, progressive muscle relaxation, calming music, gentle walks, and Michael Sealey tracks on YouTube: https://www.youtube.com/channel/UC9GoqHypa-SDrGPMyeBkjKw. Also, I drink camomile tea a few times a week, and take magnesium every day. I'm sharing these tips as they might help you.

Thank you again or your thoughts. Please think long and hard about continuing to use the diazepam. A quick fix is never a real fix.

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Oliver1974

Anna,

 

Addiction runs rampant in my family. I am extremely judicious with any and all medications. I realize there are no quick fixes with any of this process. Diazepam has allowed my central nervous system to calm down sufficiently for me to withdraw successfully from Trazadone. I will be using it to aid with my Zoloft titration next.

 

I’m sorry to have suggested this to you. I’m glad you’re working with songbird. Just being able to share in your experience is helping your system co-regulate!

 

warmest regards

Stefan

 

 

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Sassenach

Hi Anna

 

Looks like you are having a Eureka time.

The realisation that tapering without major withdrawal symptoms should give new impetus and I for one am sorry that I did not pick up on this in all that you wrote.

However it is in the past cannot be changed and the challenge ahead is more important and you now see the importance of stabiliisation.

It is the platform to moving forward and will give the chance to decide what to do and when.

You seem to think you are not improving but I sense a new confidence in your writing. You listened to them and not only made your own decisions but told them too.

It does not matter if you cried, in fact it shows how stronger you are now because you still stayed in control, so maybe they did help!

Would you have done this a couple of months ago?

I suggest you now do the same with your GP. She cannot withhold test results and to say you would not understand is insulting.

It is time doctors got the message we pay their wages, mine have finally accepted it.

More important is the ongoing diarrhoea. If you have had this for months you must also have experienced some level of dehydration.

Your liver and kidneys are responsible for excreting the majority of toxins from the body. I know from personal experience that the liver certainly is not optimum with the above two conditions. I have been through hepatic toxicity and it can make you feel dreadful, I would certainly not want it as well withdrawal symptoms.

The tests and the scan together should give the GP all she needs to move forward, make sure she does.

Finally ( hurrah ), you have put the house and maybe baby on the backburner for now.

I understand  the need to make money.

So primary objective stabilisation, then you will be able to work and all the rest ie. house and baby will follow and as a bonus😂 you and your partner will be happier.

Simples as the meerkat said.

Things are falling into place, stay strong and go for it girl!

 

Sassench

 

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Altostrata
15 hours ago, Oliver1974 said:

Sorry songbird. The aim here was to share of what worked for me.

 

Oliver, thanks for your concern. We avoid recommending new drugs as we do not prescribe. If someone has the drug on hand, though.....

 

9 hours ago, DeterminedAnna said:

My theory (it's probably baloney) is that I'm processing the Seroxat more quickly now that I'm at a lower dose, and that this is causing daily fluctuations that my nervous system can't handle (even if the chemical fluctuations are tiny, . This is one of the reasons why I thought Prozac, with its much longer half life, might be more bearable to taper at lower doses. 

 

Your theory is not unlikely, DA, we've seen it before. What times of day do you take your drugs, at what dosages? What is your daily symptom pattern? Do you get worse symptoms at any particular time of day? That would indicate they have something to do with the drug.

 

Paroxetine is a bear to quit. Many doctors crossover to Prozac because their patients find the withdrawal symptoms unbearable.

 

In the US, we have a right to see the results of our medical tests. Why did your doctor schedule an ultrasound?

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DeterminedAnna
12 hours ago, Altostrata said:

 

Oliver, thanks for your concern. We avoid recommending new drugs as we do not prescribe. If someone has the drug on hand, though.....

 

 

Your theory is not unlikely, DA, we've seen it before. What times of day do you take your drugs, at what dosages? What is your daily symptom pattern? Do you get worse symptoms at any particular time of day? That would indicate they have something to do with the drug.

 

Paroxetine is a bear to quit. Many doctors crossover to Prozac because their patients find the withdrawal symptoms unbearable.

 

In the US, we have a right to see the results of our medical tests. Why did your doctor schedule an ultrasound?

 

Hello Altostrata,

I take my Seroxat at about 11am every day. I was taking it about 8.30am but I had a few appointments in a row and so it switched to 11am.

My most routine symptom, of late, is the 'lucid nightmares' I described above. So in the last few hours of sleep (between 5am and 8am), I'm half awake hearing the outside world but also having jittery, panicky, random, nightmarish images flash through my mind at 100mph. If my partner happens to touch me during this time – including kiss me goodbye as he goes to work – I jerk at him in response and shout. When I wake properly and get up, this horrible experience taints the whole day. I don't want to wake up and go through the same cycle again and again. Life feels pointless.

I have diarrhoea throughout the morning into early afternoon. Most days it stops by evening.

 

Other than those cycles, everything else fluctuates from bad to worse, with random crying spells. Feelings of dread, despair and hopelessness are constant. I am exhausted, but my mind is racing and ruminating.

I cannot stop thinking about Seroxat withdrawal. I keep reading online about it. I keep reliving the occasion when I first started it. I now recall being given it when I was 17 (in 1997), taking it for only a week and not being able to keep still – in that week attempting suicide by paracetamol overdose. Though I can't be sure on the dates. Perhaps I was given Seroxat after the suicide attempt. The suicide attempt was definitely around the same time as the Seroxat. But I never took it for more than a week then. I now wonder if that first use of Seroxat caused lifelong damage.

 

I keep thinking about the time I first started taking Seroxat long-term – as a 22 year old, the date that is in my signature. Again, I think within a few days of starting it I took an overdose of diclofenac that I had at home for whiplash after a major car accident (it was a car accident, two house moves and escaping a violent relationship all in the space of a year that caused me to have a breakdown and led me to Seroxat).

I keep revisiting my past tapers. I have no hope. It's the only theme to my thoughts – no other, more positive, topic gets any airtime in my mind and when I try to change the channel I can't concentrate. It's the first thing that comes into my mind when I wake, and last thing at night. It's become a compulsion and obsession. I never had OCD prior to taking Seroxat. Is this compulsive thought pattern a withdrawal symptom?  I feel locked into this, unable to break free from it. My mind ignores the success stories, telling me with a believable logic that my brain is permanently damaged and that I won't heal.

 

Everything I do gets turned back in my mind to withdrawal. I watched a TV show set in the late 1990s – made me think of my pre-Seroxat life. I see somebody happy on TV – feel jealous. My partner tells me a funny story – I can't laugh with him and feel guilty.

It's really taking its toll on my relationship. My partner says he is not depressed but he is far from happy. We haven't been intimate for at least six months. He is suffering. I am dragging him into my hole. Our plans to move and start a family seem impossible. I asked him if he would like me to go back on a greater dose of Seroxat. He said 'would that make you happy?' I said no, but being in the numbed Seroxat state might help me function.

It's been five months since my miscalculated drop destabilised me and spiralled into this extreme wave. I have kept a diary and in those five months I have only had one discernible, distinct window. The things that improved following my updose at the end of February is the quantity of sleep I'm getting, my appetite and a reduction in akathisia symptoms. But the anxiety and depression still persist and are overwhelming.
 

I am practising deep breathing, listening to mindfulness tracks and soothing music. I am taking gentle walks. I have good sleep hygiene. But these things aren't scratching the surface.

 

Having seen my partner crying about this yesterday – the first time he has cried in years – I don't feel like holding at this dose for the possibility of improvements is an option any more.

 

I can't go on like this. I need to do something more drastic. I won't take my life because of what it would do to my partner and family. But this is not living.

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DeterminedAnna
13 hours ago, Altostrata said:

 

Oliver, thanks for your concern. We avoid recommending new drugs as we do not prescribe. If someone has the drug on hand, though.....

 

 

Your theory is not unlikely, DA, we've seen it before. What times of day do you take your drugs, at what dosages? What is your daily symptom pattern? Do you get worse symptoms at any particular time of day? That would indicate they have something to do with the drug.

 

Paroxetine is a bear to quit. Many doctors crossover to Prozac because their patients find the withdrawal symptoms unbearable.

 

In the US, we have a right to see the results of our medical tests. Why did your doctor schedule an ultrasound?

PS. I'm sure the same rule about medical tests applies here. I will firmly ask for a printout of my blood test results at my next GP appointment. Perhaps she didn't want to feed what appears to her to be my health anxiety.

My GP has scheduled a liver ultrasound, presumably in relation to my liver function.

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Longroadhome
3 hours ago, DeterminedAnna said:

 

Hello Altostrata,

I take my Seroxat at about 11am every day. I was taking it about 8.30am but I had a few appointments in a row and so it switched to 11am.

My most routine symptom, of late, is the 'lucid nightmares' I described above. So in the last few hours of sleep (between 5am and 8am), I'm half awake hearing the outside world but also having jittery, panicky, random, nightmarish images flash through my mind at 100mph. If my partner happens to touch me during this time – including kiss me goodbye as he goes to work – I jerk at him in response and shout. When I wake properly and get up, this horrible experience taints the whole day. I don't want to wake up and go through the same cycle again and again. Life feels pointless.

I have diarrhoea throughout the morning into early afternoon. Most days it stops by evening.

 

Other than those cycles, everything else fluctuates from bad to worse, with random crying spells. Feelings of dread, despair and hopelessness are constant. I am exhausted, but my mind is racing and ruminating.

I cannot stop thinking about Seroxat withdrawal. I keep reading online about it. I keep reliving the occasion when I first started it. I now recall being given it when I was 17 (in 1997), taking it for only a week and not being able to keep still – in that week attempting suicide by paracetamol overdose. Though I can't be sure on the dates. Perhaps I was given Seroxat after the suicide attempt. The suicide attempt was definitely around the same time as the Seroxat. But I never took it for more than a week then. I now wonder if that first use of Seroxat caused lifelong damage.

 

I keep thinking about the time I first started taking Seroxat long-term – as a 22 year old, the date that is in my signature. Again, I think within a few days of starting it I took an overdose of diclofenac that I had at home for whiplash after a major car accident (it was a car accident, two house moves and escaping a violent relationship all in the space of a year that caused me to have a breakdown and led me to Seroxat).

I keep revisiting my past tapers. I have no hope. It's the only theme to my thoughts – no other, more positive, topic gets any airtime in my mind and when I try to change the channel I can't concentrate. It's the first thing that comes into my mind when I wake, and last thing at night. It's become a compulsion and obsession. I never had OCD prior to taking Seroxat. Is this compulsive thought pattern a withdrawal symptom?  I feel locked into this, unable to break free from it. My mind ignores the success stories, telling me with a believable logic that my brain is permanently damaged and that I won't heal.

 

Everything I do gets turned back in my mind to withdrawal. I watched a TV show set in the late 1990s – made me think of my pre-Seroxat life. I see somebody happy on TV – feel jealous. My partner tells me a funny story – I can't laugh with him and feel guilty.

It's really taking its toll on my relationship. My partner says he is not depressed but he is far from happy. We haven't been intimate for at least six months. He is suffering. I am dragging him into my hole. Our plans to move and start a family seem impossible. I asked him if he would like me to go back on a greater dose of Seroxat. He said 'would that make you happy?' I said no, but being in the numbed Seroxat state might help me function.

It's been five months since my miscalculated drop destabilised me and spiralled into this extreme wave. I have kept a diary and in those five months I have only had one discernible, distinct window. The things that improved following my updose at the end of February is the quantity of sleep I'm getting, my appetite and a reduction in akathisia symptoms. But the anxiety and depression still persist and are overwhelming.
 

I am practising deep breathing, listening to mindfulness tracks and soothing music. I am taking gentle walks. I have good sleep hygiene. But these things aren't scratching the surface.

 

Having seen my partner crying about this yesterday – the first time he has cried in years – I don't feel like holding at this dose for the possibility of improvements is an option any more.

 

I can't go on like this. I need to do something more drastic. I won't take my life because of what it would do to my partner and family. But this is not living.

Hi Anna as you said we dont live far from each other would you like to meet up and talk ? 

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Altostrata
8 hours ago, DeterminedAnna said:

I take my Seroxat at about 11am every day. I was taking it about 8.30am but I had a few appointments in a row and so it switched to 11am.

 

When did you change this? With paroxetine and your sensitized state, simply changing the schedule might cause symptoms. How does that coincide with your recent symptom pattern?

 

8 hours ago, DeterminedAnna said:

My most routine symptom, of late, is the 'lucid nightmares' I described above. So in the last few hours of sleep (between 5am and 8am), I'm half awake hearing the outside world but also having jittery, panicky, random, nightmarish images flash through my mind at 100mph. If my partner happens to touch me during this time – including kiss me goodbye as he goes to work – I jerk at him in response and shout. When I wake properly and get up, this horrible experience taints the whole day. I don't want to wake up and go through the same cycle again and again. Life feels pointless.

I have diarrhoea throughout the morning into early afternoon. Most days it stops by evening. 

 

The morning symptoms are from the normal cortisol peak, which is triggered by early morning light. You might be able to soften them by wearing a sleep mask. See

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

Easing your way into meditation for a stressed-out nervous system

 

When did the diarrhea start? (In the US, we economize on vowels and put them in our retirement accounts.)

 

I would think the liver ultrasound would be an escalation from abnormal liver results. They want to rule out diagnosable diseases, which is a good idea. But seeing what those abnormal test results are would be helpful.

 

If they can't come up with anything but still see liver damage, it's probably from the drug or drugs. Paroxetine is a powerful inhibitor of a particular liver enzyme, cyp 2D6. If you take paroxetine and another drug requiring this liver enzyme for its metabolization, you can get a traffic jam in the liver with a buildup of paroxetine, the other drug, or both. This can cause liver damage (abnormal liver function tests).

 

If you happen to be a poor metabolizer via cyp 2D6, liver damage from cyp 2D6 drug combinations is even more of a hazard. I got liver damage myself from taking paroxetine with an antifungal -- and I have normal cyp 2D6. (This very predictable drug-drug interaction was utterly and totally mismanaged by my GP.)

 

The good news about iatrogenic liver damage is that the liver has an amazing ability for regeneration. It took about 6 months, but my liver healed itself and has been fine ever since.

 

When is the ultrasound scheduled? Real medical conditions need to be ruled out before you take another drug that might affect your liver. Can you ask for a liver enzyme test to see if you're a poor metabolizer of paroxetine? If you're a poor metabolizer via cyp 2D6 (a normal condition, btw), you'll want to know to avoid future drug damage. Your doctor should have thought of this.

 

What exactly did that psychiatrist say about the Prozac switch? A psychiatrist should be aware of liver enzyme conflicts. If you are a poor cyp 2d6 metabolizer, a good bridge off paroxetine for you might be citalopram, which does not rely upon cyp 2D6. https://www.ncbi.nlm.nih.gov/pubmed/21192344

 

 

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Longroadhome

Anna how do I ‘nudge’ a moderator to ask a question ?

 

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DeterminedAnna
Posted (edited)
14 hours ago, Altostrata said:

 

When did you change this? With paroxetine and your sensitized state, simply changing the schedule might cause symptoms. How does that coincide with your recent symptom pattern?

 

 

The morning symptoms are from the normal cortisol peak, which is triggered by early morning light. You might be able to soften them by wearing a sleep mask. See

 

Tips to help sleep -- so many of us have that awful withdrawal insomnia

 

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

 

Easing your way into meditation for a stressed-out nervous system

 

When did the diarrhea start? (In the US, we economize on vowels and put them in our retirement accounts.)

 

I would think the liver ultrasound would be an escalation from abnormal liver results. They want to rule out diagnosable diseases, which is a good idea. But seeing what those abnormal test results are would be helpful.

 

If they can't come up with anything but still see liver damage, it's probably from the drug or drugs. Paroxetine is a powerful inhibitor of a particular liver enzyme, cyp 2D6. If you take paroxetine and another drug requiring this liver enzyme for its metabolization, you can get a traffic jam in the liver with a buildup of paroxetine, the other drug, or both. This can cause liver damage (abnormal liver function tests).

 

If you happen to be a poor metabolizer via cyp 2D6, liver damage from cyp 2D6 drug combinations is even more of a hazard. I got liver damage myself from taking paroxetine with an antifungal -- and I have normal cyp 2D6. (This very predictable drug-drug interaction was utterly and totally mismanaged by my GP.)

 

The good news about iatrogenic liver damage is that the liver has an amazing ability for regeneration. It took about 6 months, but my liver healed itself and has been fine ever since.

 

When is the ultrasound scheduled? Real medical conditions need to be ruled out before you take another drug that might affect your liver. Can you ask for a liver enzyme test to see if you're a poor metabolizer of paroxetine? If you're a poor metabolizer via cyp 2D6 (a normal condition, btw), you'll want to know to avoid future drug damage. Your doctor should have thought of this.

 

What exactly did that psychiatrist say about the Prozac switch? A psychiatrist should be aware of liver enzyme conflicts. If you are a poor cyp 2d6 metabolizer, a good bridge off paroxetine for you might be citalopram, which does not rely upon cyp 2D6. https://www.ncbi.nlm.nih.gov/pubmed/21192344

 

 

Hi Alto,

 

Thank you for all your help and tips. I wear an eye mask, have blackout curtains, and keep my bedroom cool. And I'm good about pre-sleep routines (no blue light, don't drink caffeine etc). But still those awful morning surges happen. Perhaps I should start taking the baby aspirin before bed again?

 

I was taking Seroxat at 8.30am until 7 April. Then on 8 April I switched to 11am. My symptoms were not markedly different before or after changing the timing of my dose. However, I realise a more objective way to track this would be rating my symptoms every day and comparing – but I fear this would only add to my obsession with Seroxat withdrawal. I want to get away from this dominating every moment of every day.

 

If I was sensitive to a timing change by just a few hours, how am I ever going to get off Seroxat?


The diarrhoea (I like your comment about vowels, let's call it a bowels and vowels point) has been especially noticeable since end of December. But I wasn't tracking my symptoms throughout 2018 (and in many ways that allowed me to keep Seroxat withdrawal at a comfortable distance, not running my life as it is now). I do recall though that throughout all of my latest taper – which started in February 2018 – that things have got increasingly runny.

 

My GP appointment is this Wednesday (8 May). I will insist on getting numbers for the liver test results and will ask about cyp 2D6 testing. The ultrasound is the following Tuesday (14 May). 
 

I saw two people in the psychiatrist's appointment. I took extensive notes throughout the session. I am not sure if the first woman was a doctor (she didn't tell me her job title), but when giving her the overview of where I am, I told her about my main reason for wanting to stop Seroxat – to start a family – and the liver issues.

The first woman introduced the Prozac option to me saying that she wanted me to start it right away and then after I'd got stable with the Prozac, wean me off the Seroxat.

 

Towards the end of the appointment another woman joined and she was introduced as a more senior doctor, a consultant psychiatrist. The first woman said it was this senior doctor that would review/approve the Prozac plan.

 

When the more senior doctor arrived, about halfway through the 1h20m session, I again explained my tapering schedule since last February, clearly saying "My first reduced dose was 20 minus 10%, so 18mg, then my next reduce dose, a month later, was 18mg minus 10%, so 16.2mg..." The psychiatrist then asked me how I actually do this and I told her I use liquid Seroxat and oral syringes. The fact she asked this makes me think she is clueless about tapering and didn't even realise Seroxat is available as a liquid.

Anyway, it was the last 15 minutes of the session that Prozac and medications got 'properly' discussed. And the senior psychiatrist kept talking about "minimum therapeutic doses" which I know is baloney. She said she wanted to start me straight away on 20mg Prozac daily and only then once I felt better should I wean off the Seroxat. I rejected the 20mg dose suggestion as too high a dose and she asked if I'd consider 10mg, which I showed uncertainty about.

 

She then said got a bit frustrated and said something like "if you ask me what I would do and the guidelines say, I would stop the paroxetine today, and give a week washout period, then start you on the fluoxetine... that would be the preference". She then said "if you stop the antidepressant then depression will relapse, that is another way of saying withdrawal – so I feel like 10mg fluoxetine should at least be there when you come off paroxetine".

She then said fluoxetine is good for anxiety and agitation (but she was again talking like this was about treating an underlying problem, not withdrawal), and that she could give me something to "take the edge off while we do the switch", mentioning promethazine. She then said something about mirtazapine but backtracked saying "no, that's not good in pregnancy", then said something about rTMS, "which has less side effects, but we'd like you to try at least two medications first" (my later research found that my local NHS trust is a big advocate of rTMS). She then said "It's a pity that you've been on paroxetine all these years... that your GP kept coming back to paroxetine... because by the time patients come to us they've been on three, four antidepressants".

 

Once she'd given me this talk, I said I found her suggestion of just stopping Seroxat really belittling of my experience and I pointed out about therapeutic doses, showing her the SERT occupancy graphs. I said "you cannot just stop this [Seroxat] cold turkey". To which she said "I can sense the anxiety around this". And I replied "It's very easy for it to be put down to anxiety, but 20, 30 years ago it was believed that drugs like diazapam could just be stopped, but now that's not the case".

 

She said ok, we can work with you... "Then the option here is to introduce fluoxetine 10 then come slowly off paroxetine. Then you have another one, in the background, and the withdrawals will not be as intense". I made a 'hmmmmm I'm not convinced sound' and she then said "You don't have to decide today, and then there is promethazine..."

As the conversation was going round in circles with her suggesting things and me either responding with uncertainty or out-and-out rejection, it came to an end.

The next time I was seen by the same doctor's team was two days later, when a mental health nurse arrived with 7x 10mg generic fluoxetine tablets. And it was after that meeting with the mental health nurse that I sent an email to the doctor's team saying that I'd only consider a quick cross taper (by this time I'd already read your description of making the switch quickly like changing a tyre, so I wasn't enamoured with a drawn-out changover), involving liquid fluoxetine. A further three days letter I met another mental health nurse who provided liquid Prozac in response to my email. That was my last meeting with the team. So a case of 'here's your new meds, do it yourself without our supervision' kindof attitude.

It was around the time of the psychiatrist appointment that I raised the Prozac bridge in my intro topic.  I still have the liquid and tablet fluoxetine in the house, but I've not done anything with it.

 

I hope this helps give you all the context you need. I'm always meticulous with taking notes. I have journalism training to thank for that. And I'm sorry I write loads. I have to document all this.

Thank you again Alto. Your site has given me more help and shown more wisdom in five months than I have had in a lifetime. Thank you.

Edited by DeterminedAnna
Clarity

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