Jaybab: 24 years of Paxil, now 6 months free and experiencing difficulties

[jaybab]

I started taking Paxil at age 24, in 1995, for severe depression and anxiety. I had had a depressive streak for many years but it became overwhelming in early 1995 and talk therapy alone wasn't helping. I was jobless, losing weight, suffering anhedonia, and couldn't sleep. Racing mind, suicidal ideation, etc. I went on Paxil at 2Omg, continued talk therapy, and eventually got a job which I somehow managed to keep. I attributed the positive shift in my life circumstances to the Paxil, and, given that I didn't seem to be experiencing any significant side effects, happy to stay on it for the time being.

 

In the following decades, each time my life circumstances changed, I thought perhaps I did not need to be on Paxil anymore. In 1998, 2004 and 2013, using different tapering protocols (none of which was for more than a few weeks), I went off Paxil, and each time, within 6-8 weeks after getting to zero, I encountered a massive, overwhelming downward spiral that, symptom-wise, recalled where I was at physically and psychologically in 1995 when I was first prescribed Paxil. (I also got the brain zaps in withdrawal that everybody seems to get.)

 

In 2018, at 40mg of Paxil, I was finding myself increasingly unhappy, irritable and depressed. I had flashes of temper; causeless anxiety would surface; and I became more and more passive  and lethargic in my worklife (which was worrying, as my wife and I own and operate our own business). These things had been going on for years but I had just thought that living like this was the best I could hope for. I was also increasingly worried about what the long-term physical side effects of Paxil use might be. After reading the book The Body Keeps the Score, I became intrigued by the idea that the depression and anxiety I experienced could be the result of trauma (two preadolescent concussions, and an instance of abuse from parents), which might be effectively addressed by neurofeedback. In May 2018, I started neurofeedback therapy (specifically: Clarity Direct Neurofeedback), combined with talk therapy, and after a few months of feeling ever better, with many psychological breakthroughs, I decided to go off Paxil.

 

I tapered off 40mg of Paxil over 3 months, under supervision, getting to zero on Oct. 24, 2018. I suffered no obvious withdrawal symptoms during this period, not even the brain zaps. I attributed the ease of withdrawal to the neurofeedback and talk therapy I was continuing to undergo on a weekly basis.

 

For a couple of months I felt great. I had a surge of energy available to me; I realized how lethargic I had become on Paxil. From my point of view, the higher level of energy allowed me to more easily handle things that had previously been intolerable (and thus, irritating). Causeless anxiety did not arise. Nightmares, which has been routine in the Paxil years, ceased. There was no depression. And there was a revived enthusiasm for work and non-work projects.

 

By late January 2019, though, things changed. I started experiencing causeless anxiety. There was a persistent ache in the lower abdomen, which resembled the ache I would occasionally encounter in the '00s during times of work-related stress. Then there was insomnia, which I had never experienced before in this way. Night terrors. Racing mind, palpitating heart, shortness of breath, frequent urge to urinate (sometimes hourly), mind looping through horrible scenarios without cease. I guess it was a panic attack.

 

This scared me into seeking out advice from others. What I heard back was: you must exercise everyday, get the heart rate up for at least 20 minutes. With a single exception when I did yoga for a couple of years in the mid-2000s, I had neglected exercise for most of my adult life. So, I started running. This seemed to help, but it wasn't enough. Insomnia returned once a week, then twice a week, then more. The belly ache persisted all day, everyday. A visit to my GP on April 2 confirmed that there were no medical issues — I was just experiencing anxiety.

 

As the insomnia got worse and my nighttime sleep fell to 2 hours a night, I finally ordered a nutritional supplement (Kavinace Ultra PM) that had been recommended to me. I tried vodka to help sleep, that worked one night. A friend said try Benadryl, and that kind of worked for one night. But I was getting desperate. I went to see a nurse practitioner at the psychiatric clinic, and explained where I was at. She prescribed a non-addicting med Hydroxyzine (common brand name: Atarax) for insomnia/anxiety, and said I could take it and the Kavinace at the same time if I wanted. We discussed other options if this did not work for me. We agreed that I would never go back on Paxil, that if necessary, I would be prescribed something else, possibly Zoloft. She was intrigued by the neurofeedback therapy, but didn't have an opinion about it.

 

The hydroxyzine helped with insomnia. Then the Kavinace finally arrived in the mail, and I started taking that every night. I've been getting a full night's sleep, and the belly ache has for the most part disappeared. There is some grogginess. I have ordered some 5-HTP that I hope to substitute for the Kavinace.

 

But with anxiety diminished... depression is now appearing regularly. I am having real difficulty keeping away from excessive rumination, which I know is bad for me — like many people who are depressed, I find my mind wandering toward comparing myself to others, comparing myself now to the self I was in what seem to have been better points in the past, and basically building up scenarios for the future that are all negative and hopeless. I'm running, doing yoga, visiting as much as possible with friends, doing volunteer work here and there, taking a short break from my vipassana meditation practice (which has been frustrating me), and, with a significant (and untimely) downsizing imminent in the business my wife and I run, I've started to look for suitable odd jobs or part-time employment. Unfortunately for me, I find myself living in a small town where the skills I once was able to make a humble living from — writing, editing, proofreading, etc. — are in low demand. (In my current state of mind, I'm not even sure I could *do* that work.) I don't have a lot of confidence that I can find work. So: fear and anxiety about what's to come, shame and guilt over finding myself into this position, at age 48.

 

Mostly, I am confused as to what is going on internally, and this is the principal reason I'm posting here. I sure could use some guidance. It seems to me there are 3 explanations for the depression I am experiencing:

 

1) Six months after going to zero, I am still in some form of withdrawal from 24 years' use of Paxil. The brain and body are trying to adapt to the new Paxil-less situation, trying to help, trying to grow new neural pathways, etc etc. This takes time. So: be patient, wait it out.

 

2) I am experiencing a full-blown midlife crisis. I have no clear career path, employment prospects and future income are uncertain. This would give anyone stress. Depression comes with the territory. I am having to face this without Paxil, and am only just learning many good life habits and techniques that most normal people figure out in their 20s. So: be patient, wait it out.

 

3) I have returned to some kind of baseline condition — a disorder of severe depression and anxiety, that is best treated by psychiatric medication. There does seem to be evidence of a genetic predisposition (on both sides of my family) for this. The neurofeedback can't get at it, the talk therapy can't get at it, all the good practices for mental health can't get at it. So: go back to meds, but don't take Paxil.

 

My wife says from her point of view, #2 is what I'm experiencing, BUT she says, look, we are secure enough financially for me to have some time to get through this. I see her point, intellectually, but my body/mind keeps tending toward depressive thoughts and states of mind if it is not fully occupied by something. There are many times a day lately when I become so overwhelmed, when every possible outcome from my present situation seems so awful, that I wish I were dead. I am not having suicidal ideation. But I am having long periods of despair.

 

 

[Altostrata]

Welcome, jaybab.

 

Exactly what are you taking now, at what times of day, and what dosages? Do your symptoms follow any daily pattern? What is your sleep schedule?

 

Kavinace contains phenibut, a gray-market psychotropic that is related to benzodiazepines. Those types of drugs can cause depression as a side effect. Tapering it may help, but before you do that, please answer the above questions.

 

[jaybab]

Thank you Altostrata, this is very helpful information.

I've been taking 1 Kavinace Ultra PM at night for the last 10 nights or so. 

My symptoms do not seem to follow a daily pattern.

I think I will stop taking the Kavinace immediately and just take the hydoxyzine at night instead.

[jaybab]

Alostrata — A bit more info. The Kavinace Ultra PM supplement I am (update: was) taking is in capsule form. It's made up of 3mg of melatonin and 650mg of a "proprietary blend" of 4-amino-3-phenylbutyric acid HCI (I assume that's the phenibut you mentioned) and 5-hydroxytryptophan. So, I'm not sure how much phenibut I was getting.

 

I have purchased some 5-HTP 200mg supplements but I have not taken any. Would you have any advice there...?

[Altostrata]

Please taper off the Kavinace. You can do this by pouring out a bit of the capsule each day and taking the rest.

 

It sounds like you have withdrawal insomnia. What is your sleep schedule? See

 

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

 

What is the sleep cycle?

 

Melatonin for sleep: Many people find it helpful

 

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

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

 

A lot of people find fish oil and magnesium supplements helpful, see
https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Try a little bit of one at a time to see how it affects you. Taken in small doses throughout the day, magnesium can be relaxing.

 

[jaybab]

Thanks Altostrata. On yr advice, I am tapering off the Kavinance, which I'd taken for maybe 9-10 nights in a row. Took zero Monday night. Took half a capsule last night (Tues) at bedtime, circa 930pm.

 

I took 25mg Atarax (hydroxyzine) upon waking circa 1-2am and unable to return to sleep. Was able to get sleep after that, waking 530am.

 

I'm wondering if other folks in w/d have had good fortune with Atarax for insomnia and/or arising daytime anxiety?

 

 

 

 

[jaybab]

The passive suicidal ideation that I've had for the last few years has really ramped up. I've made an appointment to see my psychiatric caregiver tomorrow to figure out what to do.

[JB1234]

On 4/24/2019 at 4:18 PM, jaybab said:

The passive suicidal ideation that I've had for the last few years has really ramped up. I've made an appointment to see my psychiatric caregiver tomorrow to figure out what to do.

Hi Jaybab,  I’ve been on An SSRI for over 20 years as well and am looking to do neurofeedback. Did you try it?  If so did you find it helpful. I have been on the board for a short period of time and I identify with a lot of what you wrote. I hope you are feeling some comfort in this online community 

[jaybab]

JB1234 — Thanks for the kind wishes.

I'm sorry I can't be more helpful than offering the following. I didn't keep complete records, but my memory is that I did weekly neurofeedback therapy sessions for at least 12 weeks before starting the taper off Paxil. At that point, I felt that the neurofeedback was having a positive effect. It seemed like perhaps neurofeedback could be better for me than Paxil; and I liked the idea that most people only need 15-25 sessions to get what they're gonna get from it (I was going to need more — at least 35 — as someone who'd suffered two concussions as a child). So I went off the Paxil over 8 weeks (I think?), on my prescribing psychiatrist's schedule, while continuing the neurofeedback. I've been doing neurofeedback in the six months since, with a 4-week interruption in January and some weeks off since then, but as you can see from the above, it wasn't enough — for me. For others, though, maybe it's part of the way forward....

 

Edited April 28, 2019 by jaybab
grammar errors