Johnb: 20+ years on Paxil now tapering

[Johnb]

Hello and big hugs to all of you fighters. I have been reading this forum for the last years but newer written anything before. I will not write my full life story but my background is that I developed social phobia in my late teens  and where put on ssri 1995, first year I do not remember which make but where prescribed Paxil shortly after and have been on them since 1996. They worked but not completly so after a move back to my home town after University a new doctor also gave me Xanax which of course helped more but led to an addiction. 2004 after several years I got help and managed to quit Xanax where put on Mirtazapine for troubble sleeping and managed to quit them quite easily after 6 months or so.

 

This is where I made the huge misstake of beliving that if I could quit Xanax although tough and Mirtazapine I could do the same with Paxil so in 2015 I did a 1 month taper from 20 mg to zero. I battled withdrawal for roughly 3 month thinking it would ease of but keept getting worse so I reinstated to full 20 mg. This is where i began reading this forum and understood that I need to stabilize before making a new attempt. So in May 2016 i started taper from 20 mg to 17,5, 15, 12,5 and where down to 10mg in spring 2017 when I belived a combination of for me to fast taper and trobble at work led to an depression.

 

I hold on 10 mg until depression had ended and even more humble I continued taper when i felt stable in November 2017 but now at a much slower pace around 3-4% every second week.

 

During this time I also have been going to CBT therapy for my social phobia and I have managed to keep it under controll. I haven't written all drops in my signature but I started to feel frustrated about the very long time I could see myself tapering from 4mg to zero so in december 22 I tried making a bigger 10% drop from 3,6 to 3,2 and that hit me bad. It triggered a lot of negative thoughts and feelings of shame and made my mood very low. My sypmtoms when making the smaller drops usualy concentrates around day 4-6 and are anxiety and tiredness. I stayed there for two months and since the have been making two smaller drops leading up to 3 mg where I have been since first of March.

 

What has happened is that I have gotten back the full social fobia and extreme feelings of shame in social contexts to the degree that it is beginnig to be unbearable.

 

I know that during tapering underlying issues will increase but I feel so sad that it came from nowhere and I have been functioning as well as one can from 10 mg and down, could it be that I hit my wall at somewhere  around + 3mg? I am in the position of thinking of updosing to around 4mg where i know I didn't have the severe anxiety. Any input or adive would be very appreciated.

 

 

Edited March 18, 2019 by ChessieCat
reformatted

[ChessieCat]

Hi Johnb and welcome to SA,

 

I'm really pleased to see that you have been tapering your paroxetine.  Thank you for creating your drug signature.  From what you have written it appears that you have not included all the reductions you have made since Aug 2018.  Please include all reductions.  Also please add the dates or early/mid/late for the 2018/2019 information.

 

So that we know that you have the information I'll provide what we give to new members.

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  Why taper by 10% of my dosage?

 

When reducing we might experience mild withdrawal symptoms.  However if the drug is taken away too quickly the withdrawal symptoms may be more than mild:  Dr Joseph Glenmullen's Withdrawal Symptoms

 

This topic explains how to get the dose you need:   Tips for tapering off Paxil (paroxetine)

 

Many members find that the lower their dose gets the slower they need to go, reducing less and/or holding for longer:  Why taper paper: dose-occupancy curves

 

There also seems to be doses which members reach during their taper that they seem to have more difficulty getting past.

 

12 minutes ago, Johnb said:

I am in the position of thinking of updosing to around 4mg

 

During the time you have been at a lower dose your brain will have already made some adaptations.  Going back to 4mg might be too much and make things worse.  At SA, we think in terms of lowest effective dose and suggest that when increasing that it is done by small amounts.  You might find that increasing by 0.1mg or 0.2mg might be enough to reduce the withdrawal symptoms.

 

Please read Post #1 of this topic which is also relevant to updosing:  About reinstating and stabilizing to reduce withdrawal symptoms

 

This is your own introductions topic where your can ask questions about your own situation and journal your progress.

 

 

[ChessieCat]

Here's some additional information which might help you to understand what is happening:

 

Recovery isn't linear it happens in a Windows and Waves Pattern

 

Withdrawal Normal Description

When we take a psychiatric drug, we are adding chemical/s to the brain.  The brain then has to change to adapt to getting the chemical/s.  It might have to change something to do with A and then once that change has been made it affects B so another change has to be made and so on down the line.  It is a chain reaction, a domino effect.

 

The same thing happens when we take the drug away.  That's why it's possible to experience such a vast array of withdrawal symptoms, and they can change, and be of different intensity.

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

These explain it really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

 

On 12/4/2015 at 2:41 AM, apace41 said:

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

[ChessieCat]

You might also consider this method of tapering:  the-brassmonkey-slide-method-of-micro-tapering

 

[Johnb]

Thank you ChessieCat for your reply I tried to update my signature but ran out of rows, will try again tomorrow. I am very proud of batteling it down to 3 mg and only we on this site knows the effort, pain and patience it takes. I have been reading the brassmonkey tread and found it very inspiering but having problems weighting 2,5% on my scale since i am using 10mg pills and a file. 

[ChessieCat]

Might be time to change over the liquid.  We suggest do a cross over without making a dose change, the following combinations 3/4 + 1/4, 1/2 + 1/2, 1/4 + 3/4 for 3-7 days.

 

On 5/27/2011 at 10:52 AM, Altostrata said:

 

Use Paxil liquid to taper
This is the easiest and most accurate way to taper Paxil.
......

Make your own liquid
You can make your own liquid with water. See How to make a liquid from tablets or capsules

 

The way to get the information in.  You only need to add the year for the first instance:

 

Paroxetine:  date, dose; date dose; date dose; etc

[Johnb]

Hello, I have now updated my signature with the dose cuts from 5mg to current 3 mg. I forgott to write that the last two months I have had at least three occations when I had to use all my effort to steer away panic attacks and that scared me since I havn't had any for 25 years before I went on medication. 

One thing struck me and that is that from time to time to help sleep and take the edge of the worst anxiety I have taken Atarax (Hydroxyzine) and last week daily, but not the last couple of days and could it be that this has lowered my mood even further?

 

Edited March 19, 2019 by ChessieCat
added drug brand name

[ChessieCat]

 

22 Aug  5 mg

53 days                 4%

4 Oct 4,8 mg

8 days                   6.25%

12 Oct 4,5 mg

7 days                   4.44%

19 Oct 4,3 mg    

20 days                 4.65%

9 Nov 4,1 mg

12 days                 4.87%   

21 Nov 3,9 mg

7 days                   2.56%

28 Nov 3,8 mg

17 days                 5.26%   

15 Dec 3,6 mg

7 days                   8.33%

22 Dec 3,3 mg

55 days                 6.06%

15 Feb 3,1 mg

24 days                 3.22%

1 Mar 3,0 mg

 

The above are the reductions you have made, the days in between reductions and the % of the reductions.

 

17 days                 5.26%   

15 Dec 3,6 mg

7 days                   8.33%

22 Dec 3,3 mg

 

On 15 December you made a 5.26% reduction and 7 days later you made an 8.33% reduction which is a total of 13.59%.

 

Even though you did hold for 55 days after this large reduction, you may still be feeling the effects.  Many members find that the lower their dose gets the slower they need to go, reducing less and/or holding for longer:  Why taper paper: dose-occupancy curves

 

You might also consider this method of tapering:  the-brassmonkey-slide-method-of-micro-tapering   You can make the reduction less than the 10% month.  One benefit of doing the BM Slide is that if you feel withdrawal symptoms you can hold for a bit longer before making the next reduction.

 

It's important to listen to your body and your symptoms and use these as a guide for when to reduce.

 

When to end the taper and jump to zero?

 

1 hour ago, Johnb said:

One thing struck me and that is that from time to time to help sleep and take the edge of the worst anxiety I have taken Atarax (Hydroxyzine) and last week daily, but not the last couple of days and could it be that this has lowered my mood even further?

 

antihistamines-for-withdrawal-insomnia-diphenhydramine-doxylamine-hydroxyzine

 

And note:

 

On 6/3/2012 at 3:38 AM, Altostrata said:

The problem with is diphenhydramine is its beneficial sleep effect can wear off and it can go paradoxical -- it will keep you awake instead. So use it sparingly if you can.

 

You might find  Magnesium helpful.  I find that it takes the edge off my anxiety.  There have been several times I have stopped taking it and then restarted it and I have noticed the difference each times.

 

It's best taken throughout the day.  Remember to only make one change at a time and when trying something new try a small amount first.

[Johnb]

Thank you so much for taking the time and effort with the calculations, I clearly see that I made too big cuts during december and that this have triggered the though time. I will try to stabilize from here on and hopefully it will go away. I take Magnesium every night and also omega 3 in the mornings. That is the only suplements I take and do not know if it helps since I have been taking them for the duration of my taper but it feels safe taking them and see that they are recommended.

Hugs John

 

 

 

 

[ChessieCat]

You're welcome.  When I don't have brain fog I enjoy challenging my brain, more so since not working (paid) but only doing, usually boring, volunteer work.

 

Magnesium works better take throughout the day, not just in one dose.  I take mine twice a day, but if I am feeling more on edge than normal then I will take extra in the middle of the day.

[Johnb]

Hello, I have some questions. I have realized that I will not continue tapering any more and I acctually reinstated to 3,3 mg to see if the worst anxiety will dissapear. My tapering was manageble to somwhere below 4 mg but the last three months have been real pain and too an extent that I having trouble working. So my plan is to se if holding at 3.3 mg will give any release.

I saw my doctor today for a receipt renewal and he said that the low 3,3 mg is not having any effect especially since I have been taking Paxil for 25 years.

He suggest that I start taking 5 mg Escitalopram and said that after two weeks I could quit the Paxil completly with minor troubble which I find hard to belive.

I however like the idea of switching medicin and when time comes hopefully have an easier ride tapering Escitalopram than Paxil, I wounder what you think of that?

 

So the idea would be to hold at 3.3 mg Paxil for couple of weeks, then start Escitalopram 5 mg and stabilize  for a couple of weeks and then either ct or fast taper the Paxil.

 

Hugs

 

John 

[Carmie]

Hi JohnB,

 

Please don’t make any changes as yet, jumping off the Paxil after being on if for over 20 years, and changing to Escitalopram may cause more problems. People on here have also had a terrible time getting off Escitalopram as well. 

 

You are already so low in your Paxil. Why add other things that can destabilise your brain even more? It would be best to stabilise on the Paxil, and then taper down slowly. I’m tapering my medication by just over 3% myself now. 

 

Cold turkeying or tapering off the Paxil too quickly will no doubt ramp up withdrawals as well. Please stay safe. 

 

Sending hugs🤗

[Gracee]

Hi Johnb.  Carmie is right.   Stick with the devil you know and avoid shocking your brain and body by addition of other drugs.  Hold at 3.3 mg Paxil for several  more weeks, then continue tapering in small cuts.      Take your  time tapering at these small doses.  This is not a race.

G. 

[Johnb]

Thank you for the input, I understand that starting a new medication is not a god solution. I guess after some rough months with anxiety an nearly panik attacks I was hoping for a quick fix and the doctor promised a smooth switch. 

I will hold at 3,3 mg and see what happens.

Hugs

John

[Gracee]

14 hours ago, Johnb said:

Thank you for the input, I understand that starting a new medication is not a god solution. I guess after some rough months with anxiety an nearly panik attacks I was hoping for a quick fix and the doctor promised a smooth switch. 

I will hold at 3,3 mg and see what happens.

Hugs

John

 

Glad to hear you will hold.  There is no quick fix and no magic pill, but there is recovery if you are willing to taper small, slow and steady.

Best wishes and hugs,

G

[Carmie]

Hi John, 

 

I’m happy too that you’re going to stabilise on Paxil. Changing to the Escitalopram could make things a lot worse. There really is no magic pill or quick fix in this journey.

 

Windows and waves is how our brains heal themselves. I’m afraid we have to go through this to become medication free. I’m tapering by just over 3% and I still go through waves. Don’t get disheartened, we will get there in the end. You have done so well getting down to 3.3mg. 

 

Keep us updated as to how you’re going. 

 

Sending hugs🤗

[Johnb]

Hello, a week after updosing things felt better for acouple of days with less than usual neuro emotions ,but the last week it is back to the same as before, high anxiety, neuro emotions and depressed. This is again getting me to doubt if this really is withdrawal or relapse back to normal state which to be honest I really do not remember how it wassince I started at age 23 and now I am 46.

I do not think I have tapered to fast exept last december when I lowered to much but that is nearly 4 months ago.

I really do not know what to do except for hanging in a little longer att current dose of 3,3 mg. But I do not at all felling like continuing tapering and instead thinking of getting a new ssri at low dose and have it as a base when contiuing tapering the Paxil.

[Johnb]

Hello, a late update but thought I could share my experience if it could help anyone. I am finaly free of ssri as of 2021-03-11. Last time I wrote I was in a bad spot with near panic attacks and extreme anxiety. In May 2019 I was down to 3mg paroxetine and made a switch to 5 mg escitalopram and went fast to zero on the paroxetine. After that I took a well deserved rest from any tapering and held to 5 mg until August 2020. From August 2020 to March 2021 I tapered the 5 mg escitlopram to zero. 

I started slow but could increase the pace since synmptoms where no near of what I experienced with the paroxetine. It actually felt very easy and I was able to do both 30% and 50% cuts in the end, whilts dealing with paroxetin 5% was a real struggle with clear symtoms.

 

This could be down to that with paroxetine I had been on over 20 years but with escitalopram only 15 months or just that my brain had much less trouble with escitalopram than with paroxetine.

 

If I had known this I would have made the swith earlier perhaps at 10 mg and it would probaly have saved me a lot of troubble. It is still to early to write a sucess story and will get back when I have a full year on zero but I fell pretty ok today.

 

Hugs and love

 

John