Albert: preparing to get off Paxil / paroxetine for good

[Albert]

On 11/30/2021 at 1:41 AM, Colonial said:

 

Sure!

It's a reference to the type of drug he was taking.

While tapering, as long as there is some left in the system, the brain-body does not really evacuate the trace amounts out.

 

Day 9 begins the process of evacuating the drug in earnest from the brain.

I had a decent article on that somewhere but I haven't been able to relocate.

 

Brain fog, as He is describing tends to roll in then and this link shows test results on cognitive functioning to day 16:

Cognitive function during early abstinence from opioid dependence: a comparison to age, gender, and verbal intelligence matched controls | BMC Psychiatry | Full Text (biomedcentral.com)

 

Ad the brain begins to remodel itself, it is not unusual for people to notice a worsening in their physical symptoms that had begun to resolve, if even temporarily.

 

There was a Ted Talk once where the gentlemen said His hardest week of withdrawal was day 23-30, and then He began to improve significantly.  So, for someone also dealing with AD WD, It's not surprising He is having some difficulty with any or all symptoms from either drug..

 

 

This seems like exactly what I may be dealing with.   I may be super sensitive considering all of the different AD's and the Paroxetine still being in the mix.  Thanks Colonial .

 

[ChessieCat]

Q:  What drugs and doses are you currently taking?

 

Please state the time you take them.

 

Thank you.

[Albert]

I am currently taking 20 mg of Paroxetine.  That is the only drug that I am taking.   It is split into two doses.  I take a 10mg tablet at 7:00 AM and I take a 10mg tablet at 7:00 pm for a total of 20mg daily.   That is the only medication that I am left on.  

[ChessieCat]

Q:  How is your sleep?

[Albert]

I sleep pretty good from 10:00 PM to about 4:30 or 5:00 am.  Then I wake and toss and turn.  Every once in awhile I will have a rougher night and wake at 2:30 or 3:00.    My other symptoms are as follows.  

>  Mild to moderate twitching at random times during the day 

>  Ice cold feet and hands that will come and go 

>  Body temp will often get really cold or really hot and sweat. 

>  Pretty SEVERE brain fog

>  Generalized weakness - I can take walks and do slow stuff but pretty limited after that 

>  Periods where I will get Dizzy

>  Blurry vision off and on 

>  Quick bouts of nausea that will come and go. 

>  VERY tight muscles in the back of my neck and backs of my legs 

>  Mild burning sensations up and down my legs and in center of my arms.  

>>> I had a good moth or longer where these really settled down but they have all fired back up.  They are still not quite as intense as they once were back when my bridge failed.  

 

[ChessieCat]

I have no knowledge or experience with tapering off an opoid so I do not know how long it takes to recover after stopping the drug.

 

However, just like tapering off any drug, you will need to wait until your withdrawal symptoms resolve.  I suggest that you keep notes for yourself.

 

When you do decide to start tapering it might be a good idea to make a test reduction of a small amount.

[Albert]

So basically wait until all symptoms have resolved before deciding to taper Paroxetine.  Then when I do go to taper, just start with a very tiny amount 1st.   Correct?   Anything that can help me balance out in the meantime? 

[ChessieCat]

21 minutes ago, Albert said:

Anything that can help me balance out in the meantime? 

 

Being as stress free as possible and time.

[Albert]

Thanks for the tips!!!  I will try to keep stress in check.   

[Albert]

I have been working through all of this while trying to get better.  My job is pretty routine, but does have its stressful times.  Is the stress something that can just slow the stabilization and cause symptoms, or is it something that can actually keep stabilization from happening?   Thanks

[ChessieCat]

The way I see it is that stress diverts the brain away from working on balancing things out, regaining homeostasis, which it is always trying to do.

 

As an example, when we experience a shock or are put in a frightening situation the body reacts by slowing digestion because it is busy trying to keep us safe.

 

You might find it helpful to do some relaxation during every day, and I mean small amount 5- 6 times or more a day.  It doesn't take long.  And after a couple of weeks of doing this it becomes more second nature.  When you start to feel a bit stressed or anxious you are more likely to notice it and can then take that minute or two to bring the stress on your body down and it can stop it from building up to too high a level.  I also use self talk and words like "relax" or "chill" or "you're okay".

[Albert]

I will start trying to add that into my day.   Thanks again!!

[Albert]

Past two days have been slightly improved.   Still waking at about 4:30 AM and then broken sleep till about 6:00 am.  Twitching, Ice cold feet, still moderate cognitive problems, moving very slowly and balance slightly off.  Inner anxiety has been less and that has let me enjoy the weekend.

At what point would one consider Paroxetine poop out.  Is that the same as withdraw?   Can one wait out Paxil poop out?  

[ChessieCat]

I think that at this time it would be difficult to work out if you are experiencing poop out because you have only recently got off the Hydrocodone.  And you've noticed some improvement which is a good sign that you are stabilising.  You will possibly still notice windows and waves as you gradually improve.

 

Once you have stabilised:

 

Stability

 

WDnormal

 

Moderator brassmonkey has written more about WDnormal in his Success Story:

 

tao-of-the-brassmonkey

 

then you could consider poop out:

 

Poop out happens when the drug has stopped working.  This is called by several names:  tachyphylaxis, poop out and reaching tolerance.  The general medical professional response to this is the increase the drug, add a new drug or switch drugs.  If the drug is increased due to poop out, there will most likely come a time when the drug reaches tolerance again, and then the process is repeated, increase, add or switch.

 

What can happen when tapering out of poop out is that after a reduction you start to feel a bit of improvement, and then gradually the symptoms start to worsen.  Tapering when not in poop out can be different in that after making a reduction you might get mild withdrawal symptoms and then those symptoms resolve over a few weeks.  You can read more about it here:

 

Tachyphylaxis, Reaching Tolerance or as It's Lovingly Known “Poop-Out”

 

tolerance-or-poop-out-or-tachyphylaxis

 

I think I have already suggested that you start with a small test reduction (perhaps try a 0.5% or 1% reduction) and see what happens when you do that.  If things don't get worse, or even improve a bit (which could possibly be a confirmation of poop out), then you will know that it is okay to recommence tapering.

 

And then you will need to observe the pattern of your symptoms according to what I have described above.

[Albert]

Thank You very much.   I will try my best to stay put here for awhile longer and just see how I am doing and then see how I react.  If I do decide to make a very tiny reduction of .5 or 1 percent, is that OK to do by just taking sand paper and sanding the pill down, or would it be better to start a compounding pharmacy ? 

 

[ChessieCat]

2 hours ago, Albert said:

is that OK to do by just taking sand paper and sanding the pill down

 

The more accurate you can get your dose the better.

 

See Post #1 of this topic:

 

tips-for-tapering-off-paxil-paroxetine

 

Whilst you are waiting to stabilise I suggest that you research ways to get the dose you need.  You might be able to get prescription liquid.  According to the above you can also make your own liquid.  Some members has posted about doing this in this topic:

 

how-to-make-a-liquid-from-tablets-or-capsules

 

If you do decide to use liquid see:

 

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

 

Brassmonkey did his taper off Paxil using a Gemini 20 scale and weighing.  I am going to ask him why he chose to weigh instead of making his own liquid.

 

There are many posts by him about how to do this in this topic:

 

using-a-scale-to-weigh-and-measure-doses

 

Brassmonkey's Intro:

 

brassmonkey-talking-about-myself

 

Brassmonkey's Success Story:

 

tao-of-the-brassmonkey

[Albert]

Thank you for checking with Brass Monkey around cutting the pill vs liquid.   I do have a Gemini scale but I would want to make sure that I get the dose as close as I could.   We also have a compound pharmacy in our area and it was only $50 per month if I am thinking right.  Might be a little  more now.  I think that they use the pure Paroxetine powder, but if using the scale and cutting the pill I am not opposed to trying that. 

Today I was able to go to work and navigate through the day.  Still have these periods where I really struggle with brain fog.  I had some periods today where I also really struggled with balance and my legs.  Then it would like clear up and return maybe an hour later.  Same with the brain fog.  It is there for like 30 minutes where I can hardly function and then it will start to clear up a bit.  Is this normal for the symptoms to go in and out like that during the day ?   Is that a good sign? 

 

[ChessieCat]

I checked with Brassmonkey and he said that making a liquid from your Paxil tablets is okay to do.

 

The reason he weighed his was because when he started tapering getting non standard doses of antidepressants was in the very early stages.  People taking benzos were making liquids from their tablets, but at that time it wasn't really known if it could be done with antidepressants.

[ChessieCat]

And tapering using liquid is more accurate than weighing powdered tablets.

 

Brassmonkey also told me that in his work he did a lot of weighing so he was felt comfortable doing it that way.

[Albert]

Thanks for the info!!!  I appreciate that. 

[Albert]

I had a much improved day yesterday.  I was up moving around, doing some things in the garage and around the house.  I also did a 2 mile walk.  I also slept till 6:00 AM.    Still having some brain fog and minor twitching but I did have an improved day.  

[Albert]

While I have been improving ,I am still struggling with cognitive impairment.  Is this something that can still improve while I am trying to stabilize on my current dose of paroxetine, or will I have to start tapering the Paroxetine in order to start seeing this improve?  Is there some point that I would want to start tapering if I do not see much cognitive improvement to avoid permanent damage?  Just checking 

[ChessieCat]

For me personally, I found that as my dose got lower that my memory improved.  I can remember times when I would be trying to play Candy Crush on I had trouble trying to find the 3 in a row.  There was also a very long time when I had difficulty doing jigsaw puzzles, something that I have always loved doing (the real thing, not on the screen).  I wasn't able to mentally turn a piece around.

 

I also found that when doing a task I had to fully focus on it and not get distracted.

 

However, please note that improving your cognitive abilities is not a good reason to start tapering IF you still have withdrawal symptoms.

 

brain-fog-blank-mind-comprehension-concentration-cognitive-and-memory-problems

 

[Albert]

Thanks for reply ChessieCat.  I read through that link and if I understand this correctly.  It is not advised to start tapering when you are still experiencing WD symptoms and not fully stable.  By what I read, the Brain Fog will eventually diminish as I develop consistency and stabilize at my current dose.  Then start planning to taper.  Am I correct?  Thanks

[ChessieCat]

The brain fog might be something that you have even if your other symptoms ease.  You will need to listen to your body/symptoms.  Everyone of us is an experiment where N=1 so it is impossible to say that what works for one person will/will not work for another.

 

If you find that all the other symptoms ease and the only thing remaining is the brain fog, then you could try doing a test reduction of a small percentage, for example a 1% reduction as see how that affects you.

 

There are no hard and fast rules.  If there was it would definitely make this whole getting off drug/s thing a lot easier.  You have to find what works for you.

[Sebas]

Yes wait until WD symptoms such as cognitive issues are fully stable, then at least another 2 weeks for your CMS to settle down. Theres no such thing as 'permanent damage', allthough wd symptoms sometimes lead us to think so.

Tapering down to soon may lead to difficulties due to CNS (which wasnt fully stable at the time) becoming disturbed/destabilised again. If we tend to rush things then most of the time we loose time in stead of winning time. Forget about time and focus on reducing wd and feeling as stable as possible given the circumstances.

[Albert]

Thanks for the advice, I will stay put for awhile as I am still experiencing multiple withdrawal symptoms.  Even though I am getting better, I still have a lot of my symptoms that come and go, they are just a little less intense. 

[ChessieCat]

After reading Sebas's reply I just want to clarify something.

 

I notice that I used the term "brain fog" in my post, when I should have said "cognitive impairment".

 

I have experienced both.  When I reduced from 100g Pristiq to 50mg I experienced extreme brain fog.  It felt like I had a head full of mud and was struggling to process thoughts.  An extreme form of what I have your head feeling like it is stuffed with cotton wool.  I get this feeling sometimes when I experience hayfever.  When I updosed (and no that is not a suggestion I am making to you), the cog fog cleared very quickly.

 

Cognitive impairment is different.  Examples:  you cannot think of the right word/s; you find that you are not as quick at doing something as you had been (like my Candy Crush and jigsaw puzzles).

 

So from my experience brain fog seems to be a withdrawal symptom whereas cognitive impairment is just the brain learning to get things back to normal.  When I write that it almost seems like they are both withdrawal symptoms, but I think in some/most instances the cognitive impairment is just part of the process of getting off the drug.

 

Either way, as I said, you need to listen to your own body/symptoms.

 

But when you think you are ready to taper, there is nothing wrong with trying a test reduction first.  It is better to do that, instead of making too large of a reduction and having to updose.

[Albert]

Need some advice please.  I am currently not tapering and have just been trying to stabilize now for 2 months.  I have developed a severe sinus infection.  Broke down after 3 days and had to go to Dr.   They are wanting to put me on an antibiotic / steroid combination to attack and get ahead of the infection.  Can someone please remind me of the antibiotics that we want to try and stay clear of if possible?  She mentioned just regular penicillin but rather than take something that meh throw me back into acute WD, I will take my chances with this infection 

[ChessieCat]

If you have a proven infection it is better to treat it.  If you do not treat it at the start then you could end up having to take a second course of antibiotics and/or stronger one and/or other drug.  For me, personally, I would not take the steroid to start with, but would request a suitable antibiotic.

 

You can search for topics on SA but using the site search function or using an internet search engine and adding site:survivingantidepressants.org to the search term.

 

cipro-levaquin-azithromycin-z-pack-and-other-antibiotics

 

[Albert]

They mixed the antibiotics and steroid.  I had to start taking it as I was just getting worse and worse.  I am gonna call in on Monday and see if they will change it over to antibiotics only as I don’t want the steroid to really mess me up.  Thanks for the advice!!! I really appreciate it.   

[Albert]

Well, I am day three on the antibiotics/ steroid combination.  I do seem to be having some increased symptoms and a little trouble sleeping but nothing chronic as of yet.  I only have 4 more days.  Will go ahead and see how it works out and hope for the best. 

[Albert]

I have noticed an increase in burning skin, muscle twitching, ice cold feet and shins.  

[Albert]

I have officially been Diognosed with COVID.  I was already having severe Brain fog, but now it has reached new heights!!!  I have also noticed another symptom that has came back that I had not had for for a long time / until

here lately ( Frozen Feet ). I just  feel like I am going backwards.  

[Albert]

Starting to recover from COVID, still having pretty severe brain fog as well as tight muscles and other mental symptoms as well.  Hoping that since I am starting to recover from Covid that my other symptoms will hopefully settle down.  I was really hoping that once Paroxetine was the only drug left in my system that I would be able to stabilize 

[Albert]

Looking for some advice and updating my board.   I feel like I am still improving, even though sometimes I don't want to admit it.  My cognitive impairment is still there but has started to decrease.  I still have periods of ice cold legs and body temp deregulation, itching, blurry vision, very mild prickling, and morning cortisol spikes ( wrestles by 5:00 AM ).  I also still experience all of my other symptoms but they are slowly decreasing in intensity and I have been able to function.  I have been working and I have been doing very light exercise.  I would like to think about starting to taper again here in about 3 months if all of my symptoms have settled down.  I do have a Dr that will support a slow taper and there is also a local compounding pharmacy.  The compounding is fairly reasonable at $100 per month for one pill.  However, I am currently taking 10mg Paroxetine twice per day ( total 20mg daily).  I started this about 6-8 months ago ( approximately ) as it helped me when I was in a very chronic state.  Over the course of the next three months or so, should I consider trying to slowly close the gap back to taking the Paroxetine once per day, or could I put myself at risk of experiencing a major set back by doing that.   I have not ruled out compounding myself or making it into liquid, but I thought the compounding pharmacy may be more spot on.   Thanks AJ