Tamamamma: wanting to taper Paxil

[Tamamamma]

I’m new here and am very happy to have found this resource.  I have been on 20mg Paxil for 16 years.  I failed at tapering about 8 years ago....did it the way my doctor suggested and crashed three months out.  I am scared to stay on it forever, that it will poop out and I will be in a bad spot.  So I got the liquid form and started, what I thought was, a slow taper.  Also of note, is that the liquid is name brand and I always took generic.  I made the mistake of cutting my dose by 25%...so a full dose would be 10ml, I took 7.5.  I did this for a month and felt fine.  Then I cut by another ml.  A week after that, WD hit.  I quickly upsized to 9 ml (a 10% cut of my original dose. Mostly nausea for the first 2 1/2 weeks, which was very distressing to me.  Thankfully, that faded.  Thst’s when the anxiety hit.  It is worst in the mornings but sometimes persists in the evenings too.  I’m 6 weeks out from the upside right now.  I have waves and windows.  I’m currently in a wave.  Trying to accept where I’m at and what I feel.  I worry that even a slow taper will be too hard for me. And I worry that I won’t stabilize at this dose.  Thank you for any wisdom you can share with me.

[Gridley]

Hello, Tamamamma, and welcome to SA.  I'm sorry you're having these unpleasant symptoms, which are typical of a too-fast taper.  You will be able to taper off Paxil--as long as you take it very slowly.  I'll give you some guidelines.  You might want to read Brassmonkey's thread.  He's a moderator here who successfully tapered from 40mg Paxil while in poop-out and is now doing very well 2 years Paxil free.

 

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We recommend tapering by no more than 10% of current dose every four weeks.  Some need to go more slowly and I'll give you some information on alternate tapers that may be suitable to you if you're afraid of going too fast.   Though you felt fine after the 25% cut, often withdrawal symptoms are delayed, and this was likely compounded by the following 1ml cut.  I suggest you hold where you are until you stabilize--until your symptoms are relatively stable without wide swings.  This may take several months.  Then you can begin your taper.  Here is the standard 10% taper which suits a broad number of people.

Why taper by 10% of my dosage? 

 

A micro-taper going forward is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. This is how Brassmonkey, who I mentioned earlier, tapered off Paxil and also is the method I'm using with Lexapro.

 

The Brassmonkey Slide Method of Micro-tapering

 

This link is specifically about tapering Paxil.

 

Tips for tapering off Paxil (paroxetine)

 

Here is some information about the withdrawal symptoms you're experiencing.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system.  Magnesium glycinate is a good form of magnesium.  Epsom salt baths are also a good way to absorb magnesium.

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Please research all supplements first and only add in one at a time and at a low dose in case you do experience problems.

 

Please continue to use this thread to document your taper and to ask questions. 

 

 

 

 

 

 

 

 

 

 

 

 

[Tamamamma]

Thank you for your response.  In your experience, does what I’m going through indicate that I may need to go super slow? I’m considering a brass monkey type taper with only two 2.5% drops per round.  So 5% every 6 weeks.  On my good days, I tell myself that getting through this first taper experience that was too fast, I have been strengthening my coping skills and a slow taper will be totally tolerable.  Other days, like today, I really struggle w the “what-ifs”.

[Gridley]

29 minutes ago, Tamamamma said:

 In your experience, does what I’m going through indicate that I may need to go super slow?

 

What you're going through is not uncommon.  It's not time for you to taper yet, so you don't have to make a decision now.  When the time comes, the taper rates you suggested sound very good and could be a good point to start.  But don't rush the taper.  You need to stabilize first.

 

It's great that you're strengthening your coping skills.  We all have what-ifs.  The trick is to not get caught up in them and, instead, to move on.  You sound like you've got a good handle on the road ahead.

[ChessieCat]

Hi Tamamamma and welcome from me too.

 

Q:  Are you taking any other drugs, regular OTC or supplements?  If yes, please add these to your drug signature.  Thank you.

 

Experiencing withdrawal symptoms from tapering too quickly and/or not holding for long enough can make us think that we will need to taper slower than 10% every 4 weeks and can cause us to be scared to try a 10% reduction.

 

You can see how large your reductions were below, much larger than the suggested 10% monthly:

 

2003-March 2019: 20mg Paxil

25% reduction and only held for 1 month

march 1,  2019-April 1, 2019: 15mg Paxil

13.33% reduction

April 1, 2019-April 8, 2019: 13mg Paxil

April 8-current: 18mg Paxil

 

My suggestion would be to hold at your current dose of 18mg for several months to allow your system to stabilise.  This might take anything from 3 to 4 months.  It is better to hold for longer than to try and reduce too soon.  Stabilising is not linear.  See:  Windows and Waves Pattern of Stabilization.  And also WDnormal (withdrawal normal).  Please also be aware that you may notice differences throughout your menstrual cycle if this is applicable, or menopause can affect things too and unfortunately can make it a bit harder to differentiate things.

 

When you make your first reduction after stabilising, you could try a 5% reduction and see how you feel.  If you find that your withdrawal symptoms are negligible you could try a 10% for the next reduction, which would be at least 3 weeks after the 5% reduction.  When doing a 10% reduction it is best to hold for 4 weeks afterwards.

 

Please note that the reduction is calculated on the current dose, not the original dose.

 

I'll post some more things in the next two posts.

 

 

[ChessieCat]

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

 

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]

We strongly encourage members to learn and use non drug coping techniques to help get through tough times.

 

Understanding what is happening helps us to not get caught up with the second fear, or fear of the fear.  This happens when we experience sensations in our body and because we don't understand them we are scared of them and then start to panic.

 

This document has a diagram of the body explaining what happens in the body when we become anxious:

 

https://www.getselfhelp.co.uk/docs/AnxietySelfHelp.pdf

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio FEMALE VOICE:  First Aid for Panic (4 minutes)

 

Audio MALE VOICE:  First Aid for Panic (4 minutes)

 

Non-drug techniques to cope

 

dealing-with-emotional-spirals

 

Dr Claire Weekes suffered from anxiety and learned and taught ways of coping.  There are videos available on YouTube.

 

Claire Weekes' Method of Recovering from a Sensitized Nervous System

 

Audio:  How to Recover from Anxiety - Dr Claire Weekes

 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy

 

Resources:  Centre for Clinical Interventions (PDF modules that you can work through, eg:  Depression, Distress Intolerance, Health Anxiety, Low Self-Esteem, Panic Attacks, Perfectionism, Procrastination, Social Anxiety, Worrying)

 

On 4/28/2017 at 4:03 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

[Tamamamma]

Thank you to both of you, ChessieCat and Gridley.  I have been a big fan of Claire Weekes for a long time. I’m sure I will be coming back to these posts often and will go over all of the links you provided.  I believe I have put almost everything in my signature.  I will update that with more details about my supplements tonight.

[Tamamamma]

I thought I had saved the supplements in my signature....I have fixed that.  About a year and a half ago, I had a hormone imbalance which felt very unpleasant.  Very high estrogen and nearly non-existent progesterone.  Low thyroid.  We got that remedied and I felt great until I tapered incorrectly.  I still work with s doctor to keep an eye on the hormone side of things.

[Tamamamma]

Today has been a bit tough...I’ve been in a wave most of the week.  Today I am feeling a bit of the tummy upset that was so bad after my too-big cut.  I am wondering if it is the magnesium or not.  I took two mag glycinate yesterday and again today.  Anyway,  I have turned to meditation and Claire Weekes’ audio books for comfort. My favorite quote from today’s listening: “The good days bring us hope, rest, and peace.  The bad days bring us knowledge.” She made the point that, if we never had bad days, we would not have the chance to practice our coping skills.

[Tamamamma]

This wave I’m in has been tough.  Especially the icky tummy, which I thought had gone for good.  It’s been 6 weeks since I tapered too fast (25%) and increased back to 90% of my original dose.  I have had people tell me that it may take a few months to level out, but when I’m in a wave, the “what if’s” plague me.  I’ve even considered upping my dose a tiny bit, but that’s scary, too.  I wonder if I was right to take on the challenge of weaning when the drug always worked well for me.  I just felt like, after 16 years, I either needed to try to come off or resign myself to being addicted forever.

[Gridley]

14 minutes ago, Tamamamma said:

I’ve even considered upping my dose a tiny bit,

 

Since you've made three changes in the last couple of months you might want to just hold where you are and stabilize there.

[Tamamamma]

One more question....I will be traveling from the US to Germany in a couple of weeks.  It just occurred to me that the time change will affect my dosing.  I usually take it at bedtime.  Would you still take it at bedtime?  Or adjust and take it when it WOULD have been my bedtime if I was still in the US?  Germany is 8 hours ahead of my time. Thank you SO much for the support.  I appreciate it very much.

[brassmonkey]

It all depends on how sensitive you are. I did a lot of international travel during the last years of my taper and stuck to my regiment of taking my meds when I got up.  It lead for a very scrambled schedule time wise but I didn't have any problems.  Granted I was on a very small dose and quite stable at the time.  If you have the lease sensitivity to you meds the I would recommend taking them on your "at home" schedule adjusted for the time change.  This will avoid any shocks to your system. Cellphone alarms are very helpful.  Also remember that on travel days it is very hard to keep track of anything, so multiple daily doses or staggered doses can take a lot of concentration.  If possible, preset your meds in one or two of those daily carrier thingies it takes a lot of worry out of it, and makes things easier to keep track of.  Be sure to keep them in your carry-on and not in your checked luggage. Lost bags do happen and you don't want your meds to go with them. Been there, done that, no fun.  Hope you have a great time, summer in Germany should be beautiful.

[Tamamamma]

Thank you, brass monkey.  I am still in the midst of waves and windows, although I can see that the waves are less severe than before.  I should probably err on the side of caution as far as my dosing goes.  One thing I was not aware of, at the start of this, was that switching from generic to name-brand, and tablet to liquid, can cause issues.  Unfortunately, I’ve done both.  Hopefully things will level out soon and I can spend the summer being relatively stable before attempting a slow taper.

[Tamamamma]

I wish these waves would stop!  It’s been two months of waves and windows now.  Last week I felt almost normal.  Now I feel like crap again.  I have a fabulous vacation coming up next week and it is actually causing me more worry than joy in my present state.  I hate this.  Trying to stay positive, but I am struggling.

[Tamamamma]

Any feedback would be appreciated.  Sorry to be a broken record...but this wave and the nausea that has come back w it have really got me down.  I kinda thought my waves would gradually get less severe, but this one feels pretty bad.  I feel stuck....like I just continue to not make any changes and stick it out.  It’s been 2 months since this awful WD started (granted, last week I had days where I felt great).  You have said it may take 3-4 months to stabilize, so I’m trying to believe my day will come. Was I wrong to switch from generic to liquid Paxil when I first tapered?  Could it be causing some of the problem? Could that be why I’m not pulling out of this?  Should I have updosed more than I did when I realized I had gone too low, too fast?  I had tapered 25% for a month, another 10% for a week, went back to 90% of my original dose 18mg out of 20mg (9ml liquid).  I’m just so sick of this crap even though I know others have suffered more than me.

[ChessieCat]

On 5/29/2019 at 1:38 AM, Tamamamma said:

Last week I felt almost normal.  Now I feel like crap again.  I have a fabulous vacation coming up next week and it is actually causing me more worry than joy in my present state.

 

It is highly likely that the stress of the upcoming holiday has caused the wave.  This is not unusual.  Other members who are stable and tapering who go on holidays sometimes find that after their holiday their symptoms increase.  Any additional stressors, whether bad or good, can tip the scales.  I had a helicopter flying lesson for my 60th birthday and even though I was stable and I wasn't scared to do it, my symptoms increased for several weeks afterwards.  Some more examples:  seasonal holidays periods, changing jobs, moving house, arguments, health issues.

 

Q:  Do you drink coffee, caffeine drinks or alcohol?  Or are you taking vitamins (some members find B vitamins activating, especially B6)?

 

The fact that you felt almost normal last week is a good sign.

[Tamamamma]

Thank you for your insight.  I was actually nervous about this trip (although it is a great thing to get to do) even before I got into WD.  I’m sure that it is making my WD worse.  I don’t drink caffeine or alcohol.  I also don’t have sugar, it hasn’t appealed to me at all since WD began.  I quit taking the Truehope supplements I listed in my sig just in case they were irritating my tummy. I hope I don’t feel too awful when I get back, but I can see how that could happen.  

I plan to try to keep up my meditation practice while in the trip...hopefully to help my CNS stay as calm as possible.

Wow! Helicopter lessons at 60!  You sound like an awesome lady!

 

is Dramamine ok to take for the flight?

[Tamamamma]

Does this community feel that Paxil is the worst AD to quit?  It has such a bad reputation.  Things have been going really well this summer after updosing back to 9ml and holding.  It will soon be time for me to start tapering (I am starting with 6%), which I am nervous about.  I make it worse by reading other people’s posts, which are often scary.  Even though I realize that this site and FB groups are naturally going to get most of their action from those that are struggling vs those that are doing fine.  I really want off this drug, but I am fearful of throwing myself back into WD, which sucked.  I’ve been around different internet groups and as much as i’d like to feel inspired by the recovery stories of people who have successfully tapered other drugs, I wonder if their drug was as bad as Paxil. On a more positive note, I have found a psychiatrist and a counselor who both support my efforts to taper.

[Gridley]

23 minutes ago, Tamamamma said:

I wonder if their drug was as bad as Paxil.

 

I suggest you take a look at Brassmonkey's thread (one of our moderators).  He was on Paxil for twenty years, did a long, slow, successful taper, and is now over one year Paxil-free and doing very well.

 

Google "SurvivingAntidepressants.org Paxil success stories."  It's wise to monitor what you read.

[Tamamamma]

Yes, Brassmonkey’s story is very inspiring to me.  It just seemed that there were a lot more success stories for other meds than for Paxil, and I wish there were more Paxil ones (I’m speaking of popular FB groups too, not just here).  Hopefully it’s happening more often and those people just aren’t hanging around these sites.  I guess it doesn’t matter, I’m gonna give it a go anyway.  I just need to stop worrying about it and take it as it comes. An important lesson for me to learn anyway, as I am trying to develop skills to Be a less anxious person with or without meds.

[brassmonkey]

Hi Tama-- Paxil has a reputation for being one of the hardest to taper off of, and although we have seen our share of people struggling with it there are always extenuating circumstances.  Too fast a taper, too big of reductions, tapering when not stable, That sort of thing.  If done with care it is quite possible to do it in a fairly painless manner.

 

It is a good thing that you are only dealing with the one drug, it makes things a lot "easier". Plus a positive attitude, which you seem to have.  I strongly suggest not going with a straight 6% reduction, but rather opt for a 10% Brassmonkey Slide.  We have been having very good success with this method and it does a good job of minimizing the WD symptoms.  If this sounds interesting just say so and we will help get you started. BTW Gridley is one of our shining examples of how it works.

[ChessieCat]

20 minutes ago, brassmonkey said:

BTW Gridley is one of our shining examples of how it works.

 

As is BrassMonkey who devised the method.

[Tamamamma]

Thank you all for your input.  I am definitely going to use the brass monkey slide.  I was thinking 3% one week, 3% the next, w a four week hold.  But I am reconsidering now that I have your feedback. My only concern w the slide as described in your article, is if the hold after the last drop will be long enough.  Eight years ago, when I followed my doctors tapering protocol, WD hit a full three months after quitting the drug.  With my most recent experience, detailed in my sig, it took a month for WD symptoms to hit.  Would I need to hold longer after the last drop in the brass monkey slide method? I’d love to hear your opinions, since you are familiar with people’s experiences.

[brassmonkey]

From what we have seen with most people the two week hold is sufficient, but if a person wishes to hold longer there is not problem. We have some members who are holding four and some six weeks. This is where "listening to your body" comes into play.

 

The reason many people crash after three months (three months is a very common time frame) using the typical doctor suggested taper is because it is just too fast and has no hold periods.  This causes the unresolved symptoms that are in the background to build up until the body can't take the pressure and the crash happens.  The doctors often refer to it a "the return of the original symptoms", which we know is totally false. Most people who have used the doctor recommended taper schedule are very worried about starting a new taper, and I totally understand.

 

By doing a slow, controlled taper, like the Brassmonkey Slide, the changes are more gradual which allows the body to adapt and heal.  Because of the small changes and build in hold times the body is allowed to catch up with it's healing and avoids the buildup of symptoms in the background, which in turn keeps the crash from happening.  If you wanted to do a 6% taper I would suggest doing 1.5% a week for four weeks and then a 2 week hold.  This will spread out the symptom spike from one big one (6% all at once) or two medium size ones (3% weeks 1 and 2) to four small ones (1.5% a week for four weeks).  This makes it a lot easier for your body to adjust and heal and makes the symptoms much more manageable.

[Tamamamma]

Thank you for your advice.  I will do exactly what you suggested.  I am planning to start at the end of the month.

[Tamamamma]

Feeling discouraged today. I’ve been tapering since September.  6-7% every six weeks and I have been dividing that percentage into four smaller drops.  It seemed extremely cautious, which is what I wanted.  My last drop has me at 7.3 ml.  However, the past two days I am feeling my classic withdrawal feeling.....nausea, lack of motivation, icky emotionally.  What the hell?? This stuff sucks!  My plan is to ride it out and not drop again until I feel better.  And then drop by even less next time. Thoughts?

[brassmonkey]

Are you taking a small hold period every four of the small reductions?  It is very important to have a couple of weeks hold every four reductions to let the background symptoms settle out.  Otherwise they can build up and cause break through problems.

[Tamamamma]

Yes.  I drop 6-7% by breaking that down into four smaller drops, taken in four consecutive weeks, followed by a two week hold.  I was really hoping that by being so conservative, I could feel well throughout my taper.  

[brassmonkey]

You probably already know it but the proper name for what you are doing is the Brassmonkey Slide Method.  It is one of the most successful ways to taper and have a minimum of symptoms during the process.  We have a large number of members using some variation of this method with good success.  It does not guarantee that your taper will be symptom free, but it will reduce the severity of the symptoms with each drop in dose and the symptoms should resolve more quickly between reductions. 

[Tamamamma]

Yes, I have been following your advice w the brass monkey slide.  Would you recommend updosing then waiting it out or waiting it out without updosing?  Is it probable that I need to taper slower that 6-7% each 6 weeks? Thank you so much for your time.

[brassmonkey]

An updose would restart the stabilization clock.  Unless the symptoms are to the point you can't function it's not a good idea to updose.

 

Many people find that a 5% Brasmonkey Slide works quite well.

[Tamamamma]

Thank you for always taking time to answer me.  I really love what you said in another post today about how there are always good things going on inside and around us.  I try to live my life noticing those things, but the reminders are nice!
 

When I began the taper, I chose to believe that, if I went slow and carefully enough, I could get through it without feeling WD symptoms.  It helped me be brave enough to start. I guess that may have been foolish.  Right now it is queasiness most of the day for the past four days. It took me by surprise and I wonder if I am just too sensitive to keep tapering.  I’m sure some of that doubt is brought on by the way I feel at present.

[Tamamamma]

Is it unusual that I started getting WD at 7.3ml (14.6 mg) after tapering Paxil slowly (6-7% every 6 weeks)?  I started at 10ml (20mg).  I’m handling the symptoms well, although they’re not fun.  I worry that feeling the WD early on means I might not be able to finish the taper.  When I’m feeling good, I am proud to have come 1/4 of the way off.  When I feel worse, it seems like such a tiny step in the right direction.  If I could keep the symptoms at the level they have been with this drop, I think I could do it.  But I know it gets harder the lower you go.  I’m currently holding until my tummy issues are gone before I continue.  Probably 4% every 6 weeks for now.  Or should I push on through the tummy issues?

[Tamamamma]

I would love some feedback on this. I Slowed down my taper a lot because of the WD I was feeling in early January (7.3ml at that point). Once it passed, I wanted to be stable for an anniversary, so I held.  I dropped from 7.3 to 7.1 brass monkey style in March. Then the pandemic started and I didn’t want to feel any more anxious than necessary. After holding for a couple of months, I dropped from 7.1 to 7ml two weeks ago.  About a week later, I started to feel WD symptoms again.  I am feeling very discouraged by my sensitivity to these drops.  My psychiatrist has suggested a Prozac bridge, which I am beginning to consider.  It seems like the next best option next to giving up.  Although, if I do give up, I want to at least make it to 5ml so I could switch to a tablet.  I wonder if I can do it! I read through the Prozac bridge thread and saw that Alto suggests dropping the Paxil very quickly after beginning Prozac, yet that seems really scary to me after trying to taper ever so slowly and still having problems.