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Jan1974

Jan1974: Paxil / paroxetine & ulcerative colitis

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Jan1974

Hello, new here. Male, 44 years old, from Brussels, Belgium.

 

I tapered down paroxetine (paxil) too fast (i did it unsupervised, over 1 month time. i was fed up with the side effects and generally fed up with doctors - i've been an ulcerative colitis patient for 20 years. been on paroxetine 13 years).

 

i had all the withdrawal symptoms immediately (brain zaps, tingling, increased anxiety, diarrhea) and 3 weeks after tapering down fully (1 month) it hit me incredibly hard. panic and anxiety. crying with sheer panic. was hospitalized in psychiatric institution.

 

They re-started the paroxetine (30mg) and added sleeping pills so i could get some sleep (trazolan + etumine + dominal). we are now 1 month later. i recently got out of psych hospital, not because i'm doing so good, but to get my ulcerative colitis treated in a different hospital.


anxiety/panic are still high, it seems they are permanently high.

 

The doctor agreed that there is a possibility that the paroxetine no longer works the way it used to. She said she could try to "boost" it with another antidepressant. So far no move has been made. Am now back on the 30mg paroxetine + the sleeping pills above .+ ulcerative colitis medication.

 

I don't know what to do next.

 

What can help?

 

walking outdoors helps a tiny bit, but only while i'm doing it. when i get back inside, the anxiety/panic is right back.

 

i am now aware i tapered down much too fast, however much i want to i can't go back and change that.

 

Thank you for your feedback. Reading others' related posts & feedback now.

 

 

Edited by ChessieCat
changed some to lower case

paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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Shep

Hi, Jan.

 

Welcome to Surviving Antidepressants.

 

You are on quite a cocktail of drugs. I'm not familiar with some of them and some of them aren't showing as being listed in the Drug Interaction Checker we commonly use here on the forum. So I would suggest that you research them on an online drug interaction checker in Belgium and see if there are any interactions. Please let us know what you find. 

 

trazolan - I looked this up and it's what we call Trazodone here. Please note that it does have a common adverse reaction with the mCPP metabolite:

 

Tips for tapering off trazodone (Desyrel)

 

etumine - I looked this up and it's an atypical antipsychotic. More information here - Clotiapine (Entumine).

 

dominal I looked this up and it's a "anxiolytic, antiemetic, and antihistamine" (Prothipendyl (brand names Dominal, Timovan, Tolnate)

 

You've been on the above three drugs for a month, so you may or may not be dependent on them.

 

When did you stop sleeping? 

 

It's possible that your reinstatement of Paxil at 30 mg was too high a dose within the context of a very destabilized nervous system after having done a rapid taper. Please see this thread for information on reinstatements:

 

About reinstating and stabilizing to reduce withdrawal symptoms 

 

And some threads on tapering:

 

Tips for tapering off Paxil (paroxetine)

 

Why taper by 10% of my dosage?

 

The Windows and Waves Pattern of Stabilization

 

Questions / requests: 

  • When did you first start experiencing insomnia?
  • Are you taking any supplements? If so, please add them to your signature
  • Are you taking any drugs not listed for your ulcerative colitis or any other health problems? If so, please add them to your signature. 
  • Please add the doses of all your drugs in your signature. 

 

I'm not as familiar with Paxil as some of the other people on staff, so I'll ask the moderators who are familiar with Paxil to take a look at your thread and respond. 

 

It will help to have a drug and symptoms journal, as listed below. As you let us know more about your drugs and symptoms, we can better assist you. It's possible you'll want to come off one or more of the recent drugs before you develop a dependency. The drug and symptoms journal will guide is in helping you set up a game plan for coming off. 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs, we need to see your symptom pattern throughout the day: Are symptoms worse at any particular times of day?

 

The time of day, dosage, and severity of symptoms are essential information. Include:

- Time and dosage for drugs taken in morning, with time and description of any symptoms in the morning
 
- Time and dosage for drugs taken in afternoon, with time and description of any symptoms in the afternoon
 
- Time and dosage for drugs taken in evening, with time and description of any symptoms in the evening
 
- Time and dosage for drugs taken in middle of the night, with time and description of any symptoms in the middle of the night (such as waking)
 
And so forth. A diary, in chronological order, looking something like this:
 
6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

 

 

Please continue to use this thread to document your symptoms and to ask plenty of questions. 

 

 

 


Drug free May 22, 2015 after 30 years of neuroleptics, benzos, z-drugs, so-called "anti"-depressants, and amphetamines 

 

My Success Story:  Shep's Success: "Leaving Plato's Cave"

 

And what is good, Phaedrus, and what is not good — need we ask anyone to tell us these things? ~ Zen and the Art of Motorcycle Maintenance


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

 

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Altostrata

Welcome, Jan.

 

We need to see your daily drug schedule and symptom pattern to see if any of those drugs, or a combination, is causing an adverse reaction. This is not uncommon when you're taking more than one psychiatric drug.

 

Please use the chemical name of the drug, such as clotiapine, instead of the brand name of the drug, such as Etumine, in your posts as some of those drugs are not available in some countries and we may need to research them.

 

Also, please Google for a drug interactions checker, put all your drugs in the online tool, and copy and paste the report in English in this topic. When you're taking more than one psychiatric drug, quite frequently, they interact in bad ways.

 

The link I have, https://www.drugs.com/drug_interactions.php is for the US version and I don't know if it will have your drugs in its database, but you might find a European version.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Jan1974

thanks guys. i just returned to the psyc hospital, i couldnt handle it alone at home. anxiety&panic permanently too high.

right now suffering from constipation (ulcerative colitis is normally a disease which has diarrhea as a key symptom due to inflammation in the intestine, so i dont understand whats going on)

very worried that the constipation is so severe that i wont get it out and they'll need to operate.

 

the psychiatrist assured me that those 3 sleeping aids she prescribed (on them 1 month now) are not dependency-forming.

 

Questions / requests: 

 

When did you first start experiencing insomnia?

 

after tapering off Paxil (1 month taper, 13 years of use), three weeks later insomnia and panic hit me full blast. during the taper i thought the anxiety and insomnia was minimal (so i continued)

 

Are you taking any supplements? If so, please add them to your signature

 

none at the moment anymore, i became too scared of possible interactions

 

Are you taking any drugs not listed for your ulcerative colitis or any other health problems? If so, please add them to your signature. 

 

Added

 

Please add the doses of all your drugs in your signature. 

 

Added now.

 

Edited by ChessieCat
unbolded responses and added spacing

paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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Jan1974

i'm back up at the original 30mg paroxetine again (since DEC 20) after my much-too-fast taper.

Not sure what I should do with that (or ask the psychiatrist what to do with that since I'm in a psyc hospital now. she is aware that i very much want to get rid of it)

 

and now i'm also on trazodone, clotiapine & prothipendyl (she prescribed those 3 since i wasnt sleeping anymore at all due to severe anxiety/panic/insomnia after the taper) first she only did trazodone, added clotiapine after a few nights because no help, then added prothipendyl later because still not sleeping. now i'm sleeping a couple hours per night. it seems my nervous system is super-agitated ever since the taper and nothing is settling it.

 

reading your comments on trazodone makes me worried the trazodone may be adding to my anxiety rather than helping it.

will ask the psychiatrist to drop it (on a low dose anyway, 25mg)


paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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Altostrata
2 hours ago, Jan1974 said:

the psychiatrist assured me that those 3 sleeping aids she prescribed (on them 1 month now) are not dependency-forming.

 

58 minutes ago, Jan1974 said:

and now i'm also on trazodone, clotiapine & prothipendyl

 

The risk we want you to address is not dependency -- though the psychiatrist is incorrect, these drugs do incur dependency -- it is drug-drug interactions.

 

When you take too many drugs to press the nervous system down, the nervous system can react with increase activity, such as panic, anxiety, and sleeplessness. This is called a paradoxical reaction, because the batch of drugs is supposed to be calming but is causing the opposite effect.

 

They can also be interacting with the Paxil. Taking more drugs or increasing dosing will cause additional paradoxical reactions.

 

However, as you're in the hospital, you may not have much control over the drugs you're given. If I were you, I would firmly request investigation into potential drug-drug interactions, paradoxical reactions, and adverse effects such as constipation or gastroparesis.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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SDOE

I just wanted to address constipation.  Have you asked anyone at the hospital about using a fleet enema or something similar?


-2005 -2016 60mg Cymbalta

11/2016 abrupt drop to 30mg. Insomnia started (about 2x a week.)

6/29/2017 started aggressive taper. Dosage:6/29 25mg,7/7 20mg,7/10 15mg,7/1713mg,7/18 10 mg,7/22 8mg,7/31 7.5mg,8/1 6.25mg. At 6.25mg insomnia every night (waking 2-4am.) 

8/2017 began up dosing 8/9 7.5mg,8/16 10mg.

Late 2017 new taper from 25mg. Approx 10% reduction per mos (mini-tablets.) 10mg sleep would not stabilize. Cont'd taper meds running out.

Jan 2019 stopped taper at 2.5mg. Using only supplements. Morning 500mg tyrosine, 100mg L-theanine, 600mg NAC. After breakfast 1000mg fish oil, 5mg iron, 2000IU D3, B complex, 500mg ginseng, 50mg ginkgo, probiotics & 50mg zinc. Bedtime 1000mg tryptophan, 500mg gaba, 3mg time released melatonin, 325mg magnesium powder, & 100mg progesterone.

Feb 2019 brain zaps gone. Still have chronic insomnia & anxiety at times.

March 2019-Purchased Alpha Stim

May 2019-sleep still inconsistent.

 October 2019- (Morning) L-Tyrosine, Super B complex, 5mg ferritin,fish oil, vit c, (Evening)200mg progesterone, 1mg Natrol Time Release Melatonin, 325mg Calm magnesium, glycine powder. Alpha Stim only seems to help with anxiety not insomnia. Usually wake up nightly average of 2 hours. *Using 25mg Benadryl or 12.5mg Doxylamine Succinate occasionally

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Jan1974

they did a "big" enema (1.5litres of water) earlier.

recently they gave me a high dose of movicol (macrogol) 6 packs in 750ml water to drink.

i was finally able to go to the bathroom half a day later.

now its the question what the future will bring .. will it go back to constipation or not.

they will be giving me 2 packs of movicol daily from now on.


paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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SDOE

Glad they offered you the enema because constipation isn't good when your colon is inflamed or has a tendency to get inflamed.  Meds can cause constipation even if you have UC. If the meds are causing constipation, I wonder if changing your diet by adding high fiber foods would help. I know with UC you probably try to normally avoid fiber but if you are getting constipated perhaps you can handle some types now. Or maybe some magnesium supplements?  Hopefully, they are offering you yogurt or some type of probiotic too.


-2005 -2016 60mg Cymbalta

11/2016 abrupt drop to 30mg. Insomnia started (about 2x a week.)

6/29/2017 started aggressive taper. Dosage:6/29 25mg,7/7 20mg,7/10 15mg,7/1713mg,7/18 10 mg,7/22 8mg,7/31 7.5mg,8/1 6.25mg. At 6.25mg insomnia every night (waking 2-4am.) 

8/2017 began up dosing 8/9 7.5mg,8/16 10mg.

Late 2017 new taper from 25mg. Approx 10% reduction per mos (mini-tablets.) 10mg sleep would not stabilize. Cont'd taper meds running out.

Jan 2019 stopped taper at 2.5mg. Using only supplements. Morning 500mg tyrosine, 100mg L-theanine, 600mg NAC. After breakfast 1000mg fish oil, 5mg iron, 2000IU D3, B complex, 500mg ginseng, 50mg ginkgo, probiotics & 50mg zinc. Bedtime 1000mg tryptophan, 500mg gaba, 3mg time released melatonin, 325mg magnesium powder, & 100mg progesterone.

Feb 2019 brain zaps gone. Still have chronic insomnia & anxiety at times.

March 2019-Purchased Alpha Stim

May 2019-sleep still inconsistent.

 October 2019- (Morning) L-Tyrosine, Super B complex, 5mg ferritin,fish oil, vit c, (Evening)200mg progesterone, 1mg Natrol Time Release Melatonin, 325mg Calm magnesium, glycine powder. Alpha Stim only seems to help with anxiety not insomnia. Usually wake up nightly average of 2 hours. *Using 25mg Benadryl or 12.5mg Doxylamine Succinate occasionally

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Jan1974

Topic title:  a good alternative to Paxil for tapering off

 

Hi all,

 

I'm currently on 30mg Paxil, which is notorious for being one of the most difficult antidepressants to get rid of.

 

I was wondering : can I switch to another antidepressant, one which is known to be easier to "get rid of", and then taper off that product instead of having to go through Paxil withdrawal ?

 

I'm thinking about other drugs in Paxil's group, the SSRI group.

Any experiences / suggestions / feedback ?

 

 

Edited by ChessieCat
added topic title, spacing before merging to intro

paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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ChessieCat

MOD NOTE:  Member's later response:

 

9 hours ago, Jan1974 said:

I am currently not taking any supplements.

 

--------------------------------------------------

 

 

Simplified list of supplements:

 

Morning immediately

tyrosine   500mg 

L-theanine,   100mg

NAC   600mg

 

After breakfast

fish oil   1000mg 

iron   5mg

D3   2000IU

B complex

ginseng   500mg

ginkgo   50mg

probiotics

zinc   50mg

 

Late Afternoon

NAC   600mg

 

Bedtime

tryptophan*   1000mg

gaba   500mg

melatonin   3mg time released

magnesium powder   325mg

progesterone   100mg

women's anti-stress formula   167mg

 

Will take 25mg benadryl about 2 nights a week to ensure a couple of good nights sleep during the week. Bad night wake up after 4 straight hours may/may not fall back asleep after 2-3 hours.  A good night now is a little over 6 straight.  On average have more bad nights than good nights.

 

*As a side note mixing tryptophan with AD can cause serotonin syndrome

 

Edited by ChessieCat
added mod note

Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Altostrata

MOD NOTE:  Member's later response:

 

9 hours ago, Jan1974 said:

I am currently not taking any supplements.

 

--------------------------------------------------

 

Jan, what symptoms are you trying to correct with those supplements? Some of them have side effects.

 

Are you still in the hospital? What other drugs are you taking?

 

Many doctors would cross-taper you to Prozac in order to go off Paxil, but there is a risk of Paxil withdrawal even if you switch to Prozac. See The Prozac switch or "bridging" with Prozac

 

Edited by ChessieCat
added mod note

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Jan1974

Altostrata, please note I didnt write that list of supplements

 

And yes, I am still in the hospital. All drugs they're giving me are listed in my signature.

They have recently addded remergon (mirtazapine) (i believe 30mg) + lorazepam (temesta) 2mg because I still wasnt sleeping despite the existing drugs.

I am finally sleeping at night now. Still having anxiety all through the day. I am in utter hell.

My eyesight seems to be deteriorating rapidly, I have an appointment at the eye specialist on monday.

 


paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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ChessieCat
7 hours ago, Jan1974 said:

please note I didnt write that list of supplements 

 

I thought that list of supplements was listed in your drug signature.

 

Have you changed your drug signature?  What supplements are you taking?

 

Or have I accidentally used another member's drug signature?


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Jan1974

I am currently not taking any supplements.


paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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ChessieCat

Okay, sorry, my mistake.


Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Jan1974

Hello again, I just noticed my last post was from Feb 2019.

Sad to report that I am still in the midst of withdrawal (near-constant panic state, crippling insomnia, crying endlessly) and in a psyc hospital 3 days/week.

I came across the posts discussing Lamotrigine as a possible help with withdrawal symptoms. However these posts are from years back and I didnt spot any current posts of people trying Lamotrigine to aid with these symptoms. Is this still considered a good option ? My current psychiatrist may be open to it.

 


paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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ChessieCat

Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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Jan1974

Okay Chessiecat, thank you very much for those


paxil 30mg since 01/2005

paxil taper 30mg to zero, 1 month's time, OCT 2018

paxil re-start 30mg, DEC 20 2018  -  upon entry in psych hospital (crisis)

 

+ current meds :

paxil 15mg (lowered gradually since dec 2018)

trazodone 100mg

lorazepam 1mg

lyrica (pregabalin) 25mg

 

+ ulcerative colitis medication : asacol (mesalazine) 2x500mg per day, since 1999

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ChessieCat

Your post has been moved to an existing topic.    There are many topics already being discussed on SA.  Before creating a new topic please search to see if one already exists.  SA likes to keep similar discussion in one topic so that it is easier for members to find.  Because the site search function does not seem to work very well I prefer to use an internet search engine and add site: survivingantidepressants.org to my search term. 

 

fasting

 

 

Edited by ChessieCat

Being very patient.  I'll get there - slowly.  ETA mid 2021

ADs:  25 years - 1 unknown, Prozac (caused muscle weakness), Zoloft/sertraline; citalopram (pooped out) CTed (very sick for 2.5 wks a few months after)

Pristiq:  50mg 2012, 100mg beg 2013 (mild Serotonin Toxicity)

Began tapering Oct 2015  Current from 17 Oct 2020:  Pristiq 0.56 mg (compounded + liquid)

My tapering program

My Intro (goes to my tapering graph)

My website - includes my brief history + links to videos & information on the web

PLEASE NOTE:  I am not a medical professional.  I provide information and make suggestions.

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