PerAsperaAdAstra: getting off of Paxil properly

[Momiki]

Hi PerAsperaAdAstra,

 

As promised, here is the link to the document of the NHG on tapering antidepressants:

https://www.nhg.org/sites/default/files/content/nhg_org/uploads/201809_multidisciplinair_document_afbouwen_ssris_en_snris.pdf

 

They don't employ the 10% rule of lowering dosages, so definitely at the end of the taper the jumps are too big, but at least they acknowledge that getting off antidepressants can be hard. (Although I now see you planned on talking to your GP in August, so perhaps this document is no longer necessary?)

Edit: Hm, they apparently do use a 10% rule, but based on receptor occupancy rate, not on percentage of current dosage:
"Afbouwdoseringen zijn berekende doseringen en benaderen een daling van 10% in de serotoninetransporterbezettingsgraad per stap [Klein 2007, Meyer 2004, Suhara 2003, Takano 2006]"

Ah, well. In the end, our bodies tell us whether we're going too fast or not, so it's best to listen to that.

 

[PerAsperaAdAstra]

Thanks for the message Jolene! 

 

Thanks for mentioning the NHG PDF. Haven't seen that one.
Although I'm quite positively surprised by the fact that the NHG document states some good stuff (not downplaying the withdrawal symptoms of those in withdrawal, use of the serotonin occupancy curve), but in regard to the schedule no harm reduction approach seems to have been used. I almost get withdrawal symptoms only thinking of the fact it suggest getting people off antidepressants in a mere 20 weeks or so. That has the potential for a world of hurt, withdrawal wise. 

 

Recently I saw a leaflet from the NHS. I'm not sure if this had to do with the Mark Horowitz scientific research about withdrawal. Don't know where to find it, but that resource seemed like an even better artefact to show my GP. It stated all the things that the people on this forum know, like the existence of protracted withdrawal and the fact that some tapers might take several years. The contents made me rather happy!
But I've been procrastinating on the visiting my GP part and telling him. So he doesn't know that I'm nearing 10 mgai. ;-).

 

And you're definitely right on the "listen to your body paradigm". Oh so right! Had I honed that skill earlier on then I might have tapered off much slower much earlier on. Would sure have saved me from hurt. 

[PerAsperaAdAstra]

I'm getting close to getting to 10 mgai. So far all is going pretty well. Winter in general isn't my best of seasons so perhaps next year I will hold to keep myself in the best condition when the seasonal slump hits in.

 

Thing I'm noticing is that this veil that's numbing many feelings and thoughts is sometimes less prevalent. Definitely feel my mind racing more often. Also my feelings (both the good and the lesser good ones) are more pronounced.

[Gridley]

On 3/6/2021 at 6:28 AM, PerAsperaAdAstra said:

I'm getting close to getting to 10 mgai.

Please keep in mind that the lower you go, it's generally best to go slower.  Listen to your body.  The last 10mg are the most potent.

[Gridley]

On 1/24/2021 at 1:18 PM, PerAsperaAdAstra said:

'm not sure if this had to do with the Mark Horowitz scientific research about withdrawal. Don't know where to find it, but that resource seemed like an even better artefact to show my GP.

 

This may be what you're looking for.  I think Horowitz is great and coming from a psychiatrist background he may carry more weight with your doctor.  

Another amazing interview with Dr Mark Horowitz - In the ...

 

 

[PerAsperaAdAstra]

You are totally right! Two weeks ago all of a sudden I felt neuro-anxiety. Somehow I could feel my nervous system was having a hard time dealing with something. Because of that I've decided to hold the current dosage for a month to let things settle. 

 

Based on what I've heard people have to be vigilant when going below 10mgai. I'll definitely heed your advice.

 

Thanks for the link by the way you provided @Gridley, much appreciated!

 

 

[PerAsperaAdAstra]

Made my way below 10 mgai! The decreases are slowly getting more difficult. Also starting to become aware of more thoughts and emotions. Some of these thoughts and emotions are draining, but I guess it's a good thing to start feeling both the good and the bad. 🙂

 

The pharmacist handed me a new brand of Paroxetine so I've decided to take a little bit of a hold for a while longer. Don't know whether my nervous system fully agrees to this new brand.

[Gridley]

11 minutes ago, PerAsperaAdAstra said:

 

The pharmacist handed me a new brand of Paroxetine so I've decided to take a little bit of a hold for a while longer. Don't know whether my nervous system fully agrees to this new brand.

I don't know if you have any of your old brand Paroxetine left.  If you do, when switching brands we advise a gradual crossover (I can give you details if you have any of the old brand left).  If you don't, it would definitely be a good idea to hold while your system acclimates itself to the new brand.

[PerAsperaAdAstra]

2 minutes ago, Gridley said:

I don't know if you have any of your old brand Paroxetine left.  If you do, when switching brands we advise a gradual crossover (I can give you details if you have any of the old brand left).  If you don't, it would definitely be a good idea to hold while your system acclimates itself to the new brand.

 

Thanks for your message @Gridley! The pharmacist gave me Sandoz which is new. I still have some from Aurobindo left. 

The stupid thing is that I sort of went from Aurobindo to Sandoz in one go. Apparently that wasn't the best decision. Tapering is still progressing quite alright, no big problems, but I might have made it more difficult for myself than strictly necessary.

 

Would it still make sense to gradually transition? If so I'd love to hear your tips in this regard.

[Gridley]

27 minutes ago, PerAsperaAdAstra said:

 

Would it still make sense to gradually transition? If so I'd love to hear your tips in this regard.

How long have you been taking the new brand?  And how are you doing on it?

Edited June 30, 2021 by Gridley

[PerAsperaAdAstra]

11 minutes ago, Gridley said:

How long have you been taking the new brand?  And how are you doing on it?

 

I started with the Sandoz brand on 4 June 2021. In those 26 days I did a single 2,5% decrease. After that I was in the 2-week hold period which I've decided to extend.

 

The most dominant thing I notice is increased cognitive fog, increased lethargy and a depressed mood. But I find it hard to deduce whether this may have to do with me dipping below 10 mgai or the actual change in Paroxetine brand. But the brand change should be the likely culprit.

[Gridley]

14 minutes ago, PerAsperaAdAstra said:

 

I started with the Sandoz brand on 4 June 2021. In those 26 days I did a single 2,5% decrease. After that I was in the 2-week hold period which I've decided to extend.

At this point 26 days in, I wouldn't reintroduce the old brand.  You want to make as few changes as possible.  I have dealt with several brand changes to Escitalopram and Lorazepam during my taper.  Generally, the brand switch occurred without warning (as it almost always does) and without my having enough of the old brand to do a gradual crossover.  Sometime I've experienced a slight ramp up of symptoms, sometimes not.  Right now, I doing a crossover in Valium brands and, like you, can't tell whether my symptoms are due to the new brand or the taper.

 

Bottom line, I've found that any ramped up symptoms that occurred during the crossover period calmed down reasonably quickly and weren't a cause for concern.  

 

As I said earlier, a hold (perhaps a month) at this point would be a good idea.

 

For future reference, here's the crossover schedule we recommend.  This would be applicable to a change in brand and also to a switch in mode of delivery, as from tablet to liquid.

 

3/4 dose old, 1/4 dose new for 3 to 7 days

1/2, 1/2 for 3 to 7 days 

1/4 dose old, 3/4 dose new for 3 to 7 days

all new thereafter

 

 

 

 

[PerAsperaAdAstra]

Thanks @Gridley! Awesome! Thanks for your feedback, much appreciated. I'll hold at least 2 weeks more.

 

And should I get a new brand again then I know what to do now 🙂

[Sebas]

15 hours ago, PerAsperaAdAstra said:

Made my way below 10 mgai! The decreases are slowly getting more difficult. Also starting to become aware of more thoughts and emotions. Some of these thoughts and emotions are draining, but I guess it's a good thing to start feeling both the good and the bad. 🙂

 

The pharmacist handed me a new brand of Paroxetine so I've decided to take a little bit of a hold for a while longer. Don't know whether my nervous system fully agrees to this new brand.

Congrats 👍 for reaching this point. Are you using the fluid suspension, taperingstrips or ...?

(Waar staat trouwens dat mgai voor, is dat hetzelfde als miligram/mg?) Zit nu met een longer hold op 11.2 mg.

Succes en ciao ciao

[PerAsperaAdAstra]

7 hours ago, Sebas said:

Congrats 👍 for reaching this point. Are you using the fluid suspension, taperingstrips or ...?

(Waar staat trouwens dat mgai voor, is dat hetzelfde als miligram/mg?) Zit nu met een longer hold op 11.2 mg.

Succes en ciao ciao

 

Hi Sebas thanks for your message! Slowly we're getting somewhere 😄

I'm using a scale similar to the Gemini-20 which is often recommended here. I do the cutting with a small cutter and a file. It isn't the most accurate way of doing it but it gets the job done until now. In time I want to transition to filling my own capsules using powder.

This method allows me to introduce longer holds without being dependent on a provider of tapering strips.

 

MGAI staat trouwens voor milligram active ingredient. Ik heb ervoor gekozen dezelfde terminologie te hanteren die Brassmonkey gebruikt in zijn omschrijving van de slide method. 

[Momiki]

Slow but steady does the trick! Congratulations on reaching this point.

[PerAsperaAdAstra]

Got my second Moderna jab yesterday. First jab didn't do that much. This time I can definitely feel my immune system is throwing a temper tantrum. Very manageable still. Painful jaw and joints, slight fever. It hasn't ramped up anxiety though or other sxs so I'm happy about that.

 

It appeared the pharmacist gave me Aurobindo again instead of the Sandoz. Now I have to transition back.

And although I saw the recommendation to gradually add in a larger percentage of the new brand of antidepressants it seemed too complex to me. For one I would have to do the math for percentage*mgpw_sandoz combined with percentage*mgpw_aurobindo and then I would also have to make sure to properly cut and weigh exactly the right doses. That prospect just seemed too much. 

Luckily I'm starting with the fourth week of the current slide so I can hold for another while and have my system stabilize. 

 

Other than that I felt really really tired the last few weeks if not months. Sometimes having to do 2 naps each day. I've started experimenting with not starting the day with coffee and letting the cortisol do its magic without any stimulants. It seems that I'm having more energy (knock wood) so I will keep this going!

[Momiki]

Good to hear from you again! I'm glad the vaccine isn't giving you too much trouble. I'll be knocking along that wood for a continuation of more energy!

[PerAsperaAdAstra]

1 minute ago, Jolene said:

Good to hear from you again! I'm glad the vaccine isn't giving you too much trouble. I'll be knocking along that wood for a continuation of more energy!

 

Thanks @Jolene :-D. I hope you will regain your stamina soon so you can start doing the things again you love doing. 

[PerAsperaAdAstra]

First time that I have hit a significant bump in tapering Paxil. Probably has to do with me going from one manufacturer to another in combination with a 2,5% decrease in dosage. Also some  changes in my work situation cause stress in the background which likely exacerbates it. Good reason for me to hold here and become mindful again that tapering is serious business that I should not take lightly.

 

I seem to have gravitated through some of it already. But it took some intense panic, agitation, crying, neuro emotions, feelings of hopelessness and other symptoms from the Glenmullen list. Let's hope this was a warning. 

[PerAsperaAdAstra]

Today was way better. Cortisol spike in the morning accompanied with panic and dread. Accepted it as best as possible and went to work. Was able to confide in some co-workers in regard to the stress I had been feeling which helped too. After that the wave or whatever it was sorta subsided.

 

I think the fact that I haven't been taking the antidepressants at more or less the same time of day hasn't helped either. So a good reminder to pay a bit more respect to my nervous system and hold for a little while.

[Momiki]

Hey PerAspera, how's it going?

[PerAsperaAdAstra]

Thanks for your message @Jolene 🙂
Sorry that a reply took a while, haven't looked here for a while.

 

I'm doing pretty well in the withdrawal department. Currently I'm at 7,6256 MGAI *yay*.

 

I wonder whether I will hold at this point. Not so much because of withdrawal symptoms or that my body is giving hints of it being out of whack. It's just this time of year in which I tend to feel really gloomy. Seasonal Affective Disorder never ceases to hit me in October/November and then in the winter again. My life state will probably take a bigger hit if I also continuing tapering. Therefore it might be better to hold until when we're nearing spring again. 

 

Curious what other people with SAD do in this time of year though.  

[ChessieCat]

3 hours ago, PerAsperaAdAstra said:

It's just this time of year in which I tend to feel really gloomy. Seasonal Affective Disorder never ceases to hit me in October/November and then in the winter again. My life state will probably take a bigger hit if I also continuing tapering. Therefore it might be better to hold until when we're nearing spring again.

 

I think holding is a good idea.  I am very close to stopping my Pristiq but I have had other non-ADWD/tapering issues happening (including recently starting a low carb low sugar diet) and have ended up staying on for longer than planned (was supposed to be off on 23 October last month) simply so that I keep the variables to a minimum.

 

3 hours ago, PerAsperaAdAstra said:

Curious what other people with SAD do in this time of year though.

 

There is discussion within the Light Therapy topic on SAD / seasonal affective disorder.

 

light-boxes-light-therapy-for-depression-and-sleep-disorders

 

sad-seasonal-affective-disorder-or-might-we-be-fighting-nature

 

[Momiki]

On 11/7/2021 at 7:34 PM, PerAsperaAdAstra said:

Thanks for your message @Jolene 🙂
Sorry that a reply took a while, haven't looked here for a while.

 

I'm doing pretty well in the withdrawal department. Currently I'm at 7,6256 MGAI *yay*.

 

I wonder whether I will hold at this point. Not so much because of withdrawal symptoms or that my body is giving hints of it being out of whack. It's just this time of year in which I tend to feel really gloomy. Seasonal Affective Disorder never ceases to hit me in October/November and then in the winter again. My life state will probably take a bigger hit if I also continuing tapering. Therefore it might be better to hold until when we're nearing spring again. 

 

Curious what other people with SAD do in this time of year though.  

 

No problem at all! I don't expect quick replies on this forum, doesn't suit its nature. Great to hear you're doing well with tapering!

 

I don't have SAD, so I can't say much in that department. I do find this time of year the least attractive, with the cold, gloomy, wet weather and few fun activities. Personally I'd rather taper during this time, since I feel 'meh' anyway, and hold during summer, so I can undertake activities at that time without withdrawal symptoms. If you feel holding will be good now, though, then I'd say: do it! There is no harm in holding, it gives your nervous system extra time to recover. 

[PerAsperaAdAstra]

Update! Held for a few weeks and felt relatively OK afterwards. Made me decide to continue the taper. Thus far it has progressed without much problems.

 

I just have to use my light boxes for SAD and radically accept that I'm just feeling a bit less well than I would during summer. Taking more naps because of the increased tiredness.

 

But still I'm very lucky that I'm not facing many of the problems of other members on this forum. Some minor emotional blunting. Occasional anxiety that leaves rather quickly. If that will be all for the remainder of the taper I can consider myself rather lucky. 🙂

[PerAsperaAdAstra]

I’ve been “celebrating” my 2nd year of tapering Paxil now. Started in March 2 years ago already. Things have been going fairly well. Made it to a little above 6 MGAI or something and now temporarily holding.

 

Beginning this month my dad has been admitted to the hospital. This caused an uptick in symptoms and breakthrough anxiety since some of the care came solely on my shoulders to bear. So a good reason for holding and a breather. 
 

With these lower doses I can definitely feel emotions more intensely. I wonder how much more intense my feelings will get the more I near 0 MGAI. 
 

Although challenging from time to time, all is still manageable. And I get to practice coping skills. And I’m getting in contact with layers that I perhaps should have wanted to explore earlier on.

[ChessieCat]

It's good that you recognise the reason why you are feeling the emotions more.  I had the same thing happen to me as my dose got lower.  And yes, using the non drug coping skills is very helpful and I have found that they are a good to have in the tool kit once I got off and I am dealing with general life issues without the drug/s.

[Momiki]

Happy anniversary, PerAsperaAdAstra. I'm glad to hear you are doing okay. And 'beterschap' for your father, I hope he is doing well.

[PerAsperaAdAstra]

Last week (August 14, 2022) I decided I had to updose to around 0,1 MGPW (should be around 10 MGAI).

The mental and physical symptoms (OCD like thoughts, anxiety, panic attacks) kept further spiralling out of control until the point I couldn't take it anymore. It didn't allow me to care for my dad and do all the other stuff like work expected of me. In the end I couldn't stabilize although I held my dosage for several months.

 

I have been cutting my dosages by using only a scale and nail file mostly. Now I think I've come to experience this just doesn't work when coming to the lower dosages on Paxil because of these mini weight differences that start to take their toll.

When I decide to decrease my dose again I will need to start crushing pills and using capsules I guess.

Edited August 21, 2022 by PerAsperaAdAstra
error in mgpw

[ChessieCat]

You can make a liquid from Paxil tablets.

 

cross-over-changing-form-eg-tablet-to-liquid-of-drug-or-changing-brand-of-same-drug

 

[PerAsperaAdAstra]

Thanks ChessieCat! That's also something I can consider. I always find the math for making the liquid a bit daunting but enough time to become familiar with it I guess. 😄 

[ChessieCat]

10mg tablet in 10mL water, each 1mL of liquid contains 1mg dose

 

10mg tablet in 20mL water, each 1mL of liquid contains 0.5mg dose

 

10mg tablet in 50mL water, each 1mL of liquid contains 0.2mg dose

 

10mg tablet in 100mL water, each 1mL of liquid contains 0.1mg dose

 

To calculate the dose in 1mL you divide the 10mg by the amount of water

 

[Sebas]

@PerAsperaAdAstra

Also check this out: 

https://www.cebancompounding.com/Default.asp

 

This dutch compounding pharmacy (Breda) is currently producing my capsules on behalve of the local pharmacie. They can produce up to 0.1 mg. 

[PerAsperaAdAstra]

Thanks @Sebas, also a good option! 👍🏼

[GiantsWSC]

@PerAsperaAdAstraHi, my journey was similar to yours since Paxil was pretty much the only med I took for an extended period. Not sure how many mgs you are on now but rest assured you'll get to zero and it will be one of the greatest feelings in your life. The tapering process outlined by BrassMonkey is a lifesaver.

 

There will be times you'll have to hold the taper longer and not drop the dose level but I'm sure your body will give you hints. Took me about 5 years of tapering to finally rid it all. Good luck on your journey!