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embd: updosing or holding for a bad wave?

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embd

This past week was somewhat improved in the sleep department. My last really bad night (0-2 hours) was last Sunday night, and there were a couple of nights where I actually slept almost through the night. But I've been experiencing very painful muscle cramps in my knees and lower legs for the past few days which have been especially painful at night, so sleep has gone down a bit again over the weekend. I try wearing compression socks or wrapping Ace bandages around my knees to add some pressure, and that helps somewhat but then I get too hot in the middle of the night and have to take them off.

 

On a positive note, my stomach pain has died down, I continue to see an improvement in having more "normal" stool, and my blocked ears aren't constant anymore. My morning anxiety is not every day, and I don't have restlessness or tremors anymore. So I take that as a sign that I'm gradually improving. It's now been over 13 weeks since I last cut and about nine weeks since this bad wave started. Since I work from home, I'm able to crawl in bed with my laptop most days and keep up some semblance of a routine. I've had to increase my daycare hours for my daughter since I'm not able to properly care for her right now, but all in all, I'm managing. My husband and I are relieved every evening to cross one more day off the wave. :)

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embd

@Gridley, have you experienced the sudden, severe twitching of legs in bed at night? I think they're called myoclonic jerks. They just started for me this past week and seem to wake me up out of any sound sleep I'm getting. Is this another thing that resolves on its own, or comes and goes? I hadn't experienced it during my taper prior to this bad wave I'm having. Very painful sensation, and the worst part is how it interferes with sleep. They don't seem to be so bad during the day.

 

Also, I've read that numbing Lidocaine ointment can help relieve nerve pain. I'd like to try applying some of it to my sore leg muscles when I go to sleep at night. Do you think that's a good idea, or have other members tried this and had problems?

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Gridley
50 minutes ago, embd said:

I think they're called myoclonic jerks. They just started for me this past week and seem to wake me up out of any sound sleep I'm getting. Is this another thing that resolves on its own, or comes and goes

 

Here is SA's topic: hypnic-jerks

 

It includes several success stories about the myoclonic (hypnic) jerks stopping.  I haven't experienced this symptom and am sorry you're having to go through it.

 

Regarding the lidocaine, I have read members report not having a problem with lidocaine (generally  in a dental context) and other members whose experience wasn't positive.  Nonpsychotropic drugs can often have a psychiatric effect, especially in withdrawal, and I would be careful using something like lidocaine that blocks nerve sensations.  This would be especially so since you'd likely be using it on a regular basis, unlike those in a dental context.  

 

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embd

What happened to those whose lidocaine experience wasn't positive? I wasn't thinking of using it on a regular basis, just on a really bad night. I try never to use any remedy more than one night in a row. I may try just a bit on one small area tonight to see if it helps or worsens. Do you think that would be a safe trial?

 

Would something like Ben Gay be a better/safer ointment/cream to try? I'm guessing the soreness is likely due more to nerve pain than muscle pain, isn't it?

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Gridley
54 minutes ago, embd said:

What happened to those whose lidocaine experience wasn't positive?

I wasn't able to find the specific post, only the excerpt that showed up on my search under "lidocaine," so I don't know specifically wasn't positive.

 

There's alway a risk but if you wanted to try it on a small area, that would be up to you.

 

Likely you're right--it's nerve rather than muscle pain.

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embd

OK, I held off on the lidocaine for last night and managed to sleep ok. The legs didn't act up as bad. 

 

Is it common for some symptoms to resolve during a wave only to cycle back again later? I'd thought the body shakes and bad diarrhea had gone away, but they're back now.

 

Also, do women find that their monthly cycle really affects the severity of their WD? I didn't notice it making much difference during my normal taper, but during this acute wave, my cycles really seem to affect my symptoms.

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Gridley
56 minutes ago, embd said:

OK, I held off on the lidocaine for last night and managed to sleep ok. The legs didn't act up as bad. 

 

Is it common for some symptoms to resolve during a wave only to cycle back again later? I'd thought the body shakes and bad diarrhea had gone away, but they're back now.

 

Also, do women find that their monthly cycle really affects the severity of their WD? I didn't notice it making much difference during my normal taper, but during this acute wave, my cycles really seem to affect my symptoms.

 

Yes, it is common for symptoms to resolve then cycle back later. 

 

I've read many reports from members that their monthly cycle has a definite effect on the severity of their WD.

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embd

@Gridley, I just wanted to confirm that the type of symptoms/cycling I'm describing just sounds to you like a bad wave from too many cumulative cuts, correct? I wanted to be sure this isn't some kind of protracted withdrawal or an acute reaction to Paxil all of a sudden. Those kinds of problems don't typically hit in the middle of a taper, correct? They would be more toward the end or when first starting or ending a med. 

 

Do you see other members go through this same kind of pattern/severity I'm going through from catch-up symptoms? Having never gone through something like this before, I want to stay on the safe side and be sure it is what I think it is and not something more serious that I should be having monitored (not that doctors would really know what to do). I also don't know if tardive symptoms appear in this kind of wave where they get worse and worse over time instead of better. Symptoms have become a bit more severe again over the last few days, whereas a week ago I was seeing more improvement. Do you believe if I keep holding, this will truly resolve on its own within another month or two most likely? (It's now been a nine-week fairly constant wave.) It surprises me that symptoms can seem to be starting to resolve only to flare up again with almost more intensity than before. It doesn't feel like I'm making any progress in the healing department when that happens. I know you see a lot more members' situations so you would be a better judge than me.

 

Could you look at my taper schedule in my signature below and tell me if my taper was way too hasty up to now, or perhaps just a bit on the fast side as I got to the lower doses? I'm not sure how I stack up against what you would consider a too-fast taper.

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Gridley

 

 

19 minutes ago, embd said:

I wanted to be sure this isn't some kind of protracted withdrawal or an acute reaction to Paxil all of a sudden. Those kinds of problems don't typically hit in the middle of a taper, correct? They would be more toward the end or when first starting or ending a med. 

 

That is correct.  It sounds to me like a regular wave.  It will resolve but unfortunately I can't put a timeline on it.  .

 

Holding is making progress, because you are catching up and healing.  It may not seem that way, but healing is taking place.  There's really not rhyme or reason to the symptoms.  They come and go and cycle back.  I would just keep holding.  That is the safest, smartest and most effective thing to do to regain stability.

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embd

OK, thanks for the reassurance. When you're by yourself, you feel like an island and wonder if this is truly just a wave or something more concerning. Good to know it will resolve given enough time (however long that may be). I wish I could hit the fast forward button a few months. :)  (Have you ever been in a bad wave yourself? If so, how long did it last?)

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embd

Also, does my taper timeline up to now look exceptionally hasty? I thought I was going at a fairly conservative pace, but apparently not.

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Gridley
4 minutes ago, embd said:

Also, does my taper timeline up to now look exceptionally hasty?

 

It looks like a 10% per month taper, not exceptionally hasty but probably too fast for you once you got below 10mg.  Below 10mg is where things start getting tighter.  That's why I think what you're going through is catch-up healing.  

 

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embd

Ugh, I hope it's not an extra month for every month I tapered a bit too quickly! That would be six months of this!!! :(

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Gridley
12 minutes ago, embd said:

I hope it's not an extra month for every month I tapered a bit too quickly! That would be six months of this!!! :(

 

There's no way to calculate, but I wouldn't think it works like that. We really have no understanding of how it works.   I think you're overthinking the situation.  You'll stabilize but we don't know when.  We're in "one day at a time" territory.

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embd

LOL, you sound like my husband. He tells me I'm running a marathon (I'm a sprinter by nature) and I need to pace myself for as long as it takes. As long as I know stabilization is at the end of the road, we'll get there. :)

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embd

Journal entry: Looking back at my notes, I realized most of the uptick in symptoms over the last week or two (increased insomnia and resulting anxiety) were due to the increased pain/nerve/muscle sensitivity in my legs and feet, and increased hot flashes at night. Even if I was able to drift off to sleep easily enough, I was awakened throughout the night by the cramps and hot flashes (which seem at their worst between midnight-5am). 

 

On a whim, we bought a mini freezer last night for the bedroom and put a couple body-size cooling pads (from a local rehab facility) in it by the bed. Throughout the night, when the cramps would wake me up in arching pain, I would take a cooling pad and wrap my lower or upper legs in the pad. The comforting sensation allowed me to fall back to sleep. The bonus was that it cooled my body core enough that the hot flashes didn't bother me much at all. If I woke up an hour or two later in pain again, I'd swap out the pad I was using for a fresh, cool pad and go back to sleep.

 

It could have been a fluke that it worked and I'll have to try this strategy for a few more nights to be sure it's really working, but I may have stumbled upon a great solution for this phase of the WD symptoms. I do notice that the nighttime urination frequency seems to be dying down and I'm naturally drowsier now at bedtime many nights, so perhaps the autonomic nervous system is finally settling down a bit. That, and lots of prayer for God's healing power to do its work in my body!! :)

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RachelSusan

This is great news.  I hope it continues to work.

 

RS

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embd

Thanks, RS! Last night's sleep wasn't so grand but it was more due to that time of the month arriving, which brought light sleep and its own set of challenges. I was able to use the icy pads again to help with the leg cramps, though, so I think that will be a good solution going forward, for as long as the leg cramps persist.

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embd

@Gridley, I was curious as to your thoughts about whether my Ativan taper (from April 2017 to May 2018) would still be having any impact on my CNS at this point in the game. I had followed Prof. Ashton's recommendation as to waiting a month after finishing the benzo taper to start my AD taper. Looking back now, I probably should have waited closer to six months, but what's done is done. I did experience a wave of insomnia four months into the AD taper which I attributed to the Ativan taper, but other than that, had pretty smooth sailing until recently.

 

I am definitely seeing gradual improvements this week at last (though each day is still rocky), so it seems I'm on the road to stabilization (though that road seems to have a lot of roadblocks and detours), but was just curious: do you think at this point, almost 18 months out, any of my current wave/instability could be attributed to the fact that I'd done a recent Ativan taper when I started tapering from Paxil? In other words, do you think all the healing that needed to be done from the benzo is done at this point, or could some of that healing still be continuing while I'm also trying to heal from Paxil cuts?

 

Thank you for your input! You'll be going in the other direction it looks like - once you finish tapering your AD, you'll start your benzo taper. How much time do you plan to put between them?

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embd

@Gridley, I'm sorry, I thought I had tagged you in my question yesterday, but apparently I did not. Here it is again. It's not a big deal, but I was just curious about the rate of benzo healing from my previous Ativan taper:

 

22 hours ago, embd said:

@Gridley, I was curious as to your thoughts about whether my Ativan taper (from April 2017 to May 2018) would still be having any impact on my CNS at this point in the game. I had followed Prof. Ashton's recommendation as to waiting a month after finishing the benzo taper to start my AD taper. Looking back now, I probably should have waited closer to six months, but what's done is done. I did experience a wave of insomnia four months into the AD taper which I attributed to the Ativan taper, but other than that, had pretty smooth sailing until recently.

 

I am definitely seeing gradual improvements this week at last (though each day is still rocky), so it seems I'm on the road to stabilization (though that road seems to have a lot of roadblocks and detours), but was just curious: do you think at this point, almost 18 months out, any of my current wave/instability could be attributed to the fact that I'd done a recent Ativan taper when I started tapering from Paxil? In other words, do you think all the healing that needed to be done from the benzo is done at this point, or could some of that healing still be continuing while I'm also trying to heal from Paxil cuts?

 

Thank you for your input! You'll be going in the other direction it looks like - once you finish tapering your AD, you'll start your benzo taper. How much time do you plan to put between them?

t. 

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Gridley
4 hours ago, embd said:

whether my Ativan taper (from April 2017 to May 2018) would still be having any impact on my CNS at this point in the game.

There's no way I can say for sure.  My best guess would be there's still some residual effects/healing going on from the benzo..  I haven't seen a lot of post-zero information for benzos like we have for AD's, but, as with AD's, I would guess there still some healing going on in your case.  It's very good you're seeing some gradual improvements.

 

My plan is to wait several months after my Lexapro taper before beginning my benzo taper.  At least three, perhaps more, depending on how I'm feeling.

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embd

@Gridley, that's a good idea to wait at least three months. I probably should have done that - ah well. If it's any help to you for future reference, the only real post-zero wave I experienced after getting off Ativan was at the four-month mark (increased insomnia for a few weeks).

 

Also, I was wondering about the nerve pain I've been having in my legs over the last three weeks. Prior to that, and throughout my taper, I had felt muscle pain from time to time that responded to gentle massaging before bedtime. This is an entirely different kind of pain, deeper, shooting pains or pins and needles, with a feeling of electricity sometimes. It doesn't respond to much, except cold and heat applied, and sometimes to compression stockings if it's not too bad. With the fact that it appeared much later than the other symptoms in this wave, would you guess that it's a sign of nerves/receptors coming back online (so a sign of healing, similar to when you get feeling back in your foot after coming close to frostbite), or is it a sign of nerve damage that still needs to be repaired? Typically you read about neuropathic pain being a sign of nerve damage, but this seems to me more like a reflection of healing going on in nerves somewhere. I wonder why it manifests in the lower legs, when I would assume most healing is happening in the brain and gut.

 

I know we don't know a lot about some of these things, but I always find it helpful to try to understand a little bit about what is causing symptoms. It doesn't take away the pain, but it helps me understand what my body is doing.

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Gridley
33 minutes ago, embd said:

it's a sign of nerves/receptors coming back online (so a sign of healing, similar to when you get feeling back in your foot after coming close to frostbite), or is it a sign of nerve damage that still needs to be repaired?

 

It sounds like paresthesia--pins and needles or tingling, which is a common withdrawal symptom and would indicate healing as your system comes back to normal and your nervous system re-regulates itself..  As far as it showing up in your legs, there's no rhyme or reason where, when or how these symptoms pop up.   It can come to a stop at any time and we can't really predict when that will be.  I've had the tingling, as well as numbness, in my hands and fingers.  It comes and goes.

 

 

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embd

@Gridley, what is the best thing to take for a bad headache? I don't want to take something that will ramp up symptoms but have had such a bad headache the last few days that I need something.

 

I was feeling so good Friday morning after a fairly good week overall that I thought I might be starting to turn a corner. I went for a walk that afternoon and by the time I got home, I was so weak I had to crawl into bed. Since then, including all day yesterday and last night and this morning, I have felt about as ill as I've felt since this started back in August - perhaps as ill as I've felt in my life. Absolutely crushing fatigue, a feeling of being poisoned in my stomach, endless diarrhea, hot all over, and a headache in the center of my head (where I've never had one before). It's all I can do to watch movies from bed to pass the time.

 

I'm so discouraged. I know the waves and windows pattern of stabilization, but to be feeling the worst that I've felt at this point, 10 weeks in, makes me wonder if I'll ever stabilize. Does everyone stabilize at some point? Have you ever known someone going through catch-up withdrawal like mine to take longer than 4 months to stabilize? Is it common for symptoms to get even worse than they have been this far in? I'm afraid they will get worse as time goes by... I'm taking it one day at a time, but some days I wonder how much deeper I can dig for strength. The lack of sleep makes everything so much harder to bear, and makes me wonder if my body is even able to heal being so fatigued.

 

Have you ever gone through a bad wave from tapering too fast? I thought I read that you had before you found SA. How long did that take you to stabilize, and what did you feel like along the way? Did you feel this horrible the whole time, or good and bad days?

 

I feel so sorry to be dragging my husband and little girl through this. They keep wondering how long it will be until I feel better and act normal, and I have no idea what to tell them. It is rather terrifying.

 

I'm sorry to be posting bad news today, but that is where things seem to be at. Looking for a bit of encouragement from people who have been here...thank you!

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Gridley
6 hours ago, embd said:

Have you ever gone through a bad wave from tapering too fast? I thought I read that you had before you found SA. How long did that take you to stabilize, and what did you feel like along the way? Did you feel this horrible the whole time, or good and bad days?

 

I tapered Imipramine too fast before discovering SA and had to reinstate.  It took me about 4 months to stabilize, maybe a bit longer.  My main symptom was anxiety with pretty good days and bad days, not all horrible.

 

I don't know what to recommend regarding painkillers.  I've seen some old posts by Alto saying low doses of paracetamol and aspirin are okay.  But paracetamol has an effect on serotonin and it didn't agree with me.  Basically I stay away from all of them.

 

I wish I could give you a timeline but I can't.  I'm sorry you're feeling hopeless, but it's not hopeless.  You will stabilize, which doesn't mean no symptoms but bearable.  

 

 

 

 

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embd

I am currently in a very bad place and need some advice from the moderators, particularly @Altostrata (since I know you have lots of experience with the hyperalert and sleeplessness problem) and @brassmonkey (since you were on Paxil). As my signature shows, I tapered down from 20mg Paxil at 10% every 4-6 weeks starting June 2018. The taper went very smoothly until I hit 5.05mg in July. Ten weeks ago, I got hammered with severe withdrawal symptoms such as insomnia, muscle spasms, nerve pain, stomach distress, anxiety, body shakes, etc. I decided to do a good long hold and thought I could tough it out. Some of the symptoms had started to get better (though the insomnia was still pretty bad), but last Friday everything suddenly took a turn for the worse. Before that, I was able to get at least a few hours of sleep each night most of the time (with maybe one night a week of 0-2 hours), but as of last Friday I have completely lost my ability  to sleep. The other symptoms have also ramped up considerably, with my heart beating out of control, lots of head pain, and my stomach feeling like it's been poisoned.

 

I finally ended up going to the ER on Monday of this week because my body was in such distress. I hadn't slept in three days, my heart rate was 128, the body shakes wouldn't stop, and I could barely walk. They had me talk with the ER psychiatrist nurse practitioner, who said the most important thing for me to do initially was get some sleep so my body could stabilize. I refused benzos (which she was happy I did) since I tapered off of Ativan in 2017=2018. She told me to try Seroquel (which I had never heard of) at 100mg to see how I did, and they kept me there for observation for a few hours. I was able to get some sleep (broken and not refreshing) with the Seroquel, but then I came home and read here on the forum about how it's an antipsycotic and a nasty drug. Obviously I do not want to get on another drug and continue the merry-go-round, but I am desperate. I do not know what to do. Complete sleeplessness is not somethig you can live with. I don't understand why the broken sleep pattern I've had during this wave (which let me get generally 5 hours a night) suddenly nosedived into complete sleeplessness 10 weeks into a wave. And I don't know how this type of thing resolves. Will it resolve on its own? And what do I do in the meantime? I obviously need something to help me sleep or I will not make it. I did have to take it again last night as I was unable to sleep at all on my own. I took 50mg at first to see if that did enough, but it wasn't so I had to take another 50mg a few hours later. I maybe got 6 hours of broken sleep, but kept waking up with the racing heart (again at 128 heart rate). I don't like the way Seroquel makes me feel, and I know it's dangerous to introduce a new drug when you're already in withdrawal syndrome from Paxil.

 

What do you advise? The ER referred me to the local behavioral health center and I will be meeting with their psychiatric team within a week or two. I know I need to be under the care of a professional right now because my system is in such a mess, but I'm so leery of any more drugs. It's been nearly 16 weeks since my last cut to 5.05mg. Should I try updosing to 5.25mg Paxil to see if that helps me stabilize? That's the only thing I can think of. And should I stay on the Seroquel short-term, low dose, to help my body get at least a little sleep? Can I take Seroquel as needed to try to avoid creating a dependency (like you would an Ativan)? Or is there another medication you recommend to get me over this hump - maybe gabapentin? I know it's risky introducing anything else during withdrawal syndrome, but it's even riskier to go psycotic from absolutely no sleep.

 

My biggest concern is how to get the complete insomnia to resolve. I know you had this at one point, @Altostrata, and it is terrifying. I don't understand how I went from being able to grab a few hours here and there to an utter inability to sleep. Will it change back on its own, or is this some kind of tardive insomnia that will continue at this level?

 

Please help. I'm quite terrified and don't know which move to make next. Thank you!

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brassmonkey

Hi Embd--  I sorry to hear that you are having such trouble sleeping.  I went through similar for many months before my taper and can totally understand. People can and do survive on very little sleep for a a very long time.  It can be very uncomfortable and distressing while it is happening but it does resolve itself and get better.  Acceptance of the situation goes a long ways in helping, as secondary stress can be a big factor in not sleeping.  I found that when things were at their worst that if I let sleep happen when ever and where ever it happened it really helped work things out. So if your are watching tv and feel the desire to sleep, don't get up and go to bed, just close your eyes and let it happen.

 

You are right to be concerned about using the seroquel and I would avoid it as much as possible.   Gabapentin is going to be just as bad, it's a real bear to get off of and many people report that it isn't much help.

 

As for updosing, it might be something to try.  It sounds like your symptoms have been harsh enough that a tiny updose might help.  Updosing to 5.25mgai would be a 4% increase, which sounds reasonable.

 

As for why it is happening. who knows.  It's just how some of the symptoms play out during WD.  We have had a number of members who have had mild sleep problems and then BAM out of the blue they can't sleep at all.  But they have all gotten through it, so I'm quite sure that you will be able to also.

 

The main thing is to not let this freak you out and roll with it as best as you can. Keep us informed.

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Altostrata

You've been taking Seroquel only a few days? If so, you can simply stop it.

 

I agree with brassmonkey, I would try updosing paroxetine a bit before adding any other drugs. if you've got paroxetine liquid, you could do this right away. (Check the label on your liquid to make sure it's still current.)

 

Paxil is a very difficult drug to go off, with real hazard at a low dose -- it's metabolized more quickly (inhibits its own liver enzymes at higher dosages). Since you're down to 5.05mg, I would try 5.25mg. Because of the fast metabolization, it's possible a split dose of 5mg and 0.25mg per day will be more effective.

 

After you stabilize, you might consider a switch to fluoxetine (Prozac) as a bridge to going off completely -- perhaps 4mg to substitute for 5.25mg Paxil.

 

10 hours ago, embd said:

The ER referred me to the local behavioral health center and I will be meeting with their psychiatric team within a week or two.

 

If you go to the meeting, I'd be interested to hear if they have any insight into Paxil tapering and withdrawal problems at all. If so, you might ask them about switching to fluoxetine. I'd keep expectations low.

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embd

@Altostrata and @brassmonkey, thank you for your words of advice. After going back to the ER due to severe sleep deprivation last week, I was sent over to a community crisis center for seven days. It was not what I wanted to do (as I knew they would try various meds on me), but I did not know what else to do as I had become rather psycotic due to lack of sleep. They trialed low dose Zyprexa, Ativan, and Doxepin. I explained to them that I do not want to go on any medication long-term as I am trying to taper off Paxil as it is, so they didn't really know what to do with me as I didn't fit their mold of a patient looking for an addition to a drug cocktail. They finally discharged me yesterday with an order to stay on Doxepin (100mg - seems so high!) and Ativan .5mg as needed. I had only tried the Doxepin at 50mg while there. It worked okay at that dose - not great, but maybe 5-6 hours. When I took the Doxepin last night at 100mg, it seemed to wire me instead of sedate me. Today I am trying to get a script for 50mg instead.

 

I am getting a hormone panel run today to see if I perhaps have early onset perimenopause (I'm only 44), as my period came five days early this month and I spotted a few days while in the crisis unit. I also have constantly blocked ears (like when you're on an airplane), which I understand is a symptom of perimenopause. If so, I will start hormone treatment for perimenopause and see if that helps the sleep. I also updosed to 5.25mg Paxil five days ago, so perhaps that will help the sleep in the near future. Other withdrawal symptoms from the bad Paxil wave seem to be fading now, aside from a racing heart at night and this insomnia.

 

What are your thoughts on Doxepin? I know no med is the ideal, but it seems I do need something to help me short-term while I try to repair my sleep, as I am completely unable to sleep without any sleep aid at the moment. Doxepin seems better than the alternatives (Zyprexa and Ativan). I will likely need to take Ativan 1-2 times per week, as the Doxepin doesn't really help me fall to sleep, just stay asleep. I believe you need to take Doxepin every night rather than as needed, which is unfortunate, but the psychiatric nurse practitioner assured me it was not habit-forming and was easy to taper off of. Is this the case? I have such a hard time believing them.

 

My other thought was to take an Ambien as needed, too, since that seems to be more of a heavy hitter. (I've never tried it personally.) I know it works on GABA. Does that mean it's doing the same thing as Ativan in many ways? In other words, if I take Ativan sporadically and Ambien sporadically over the next 1-3 months as my sleep issue hopefully resolves, is that really working on the same area of the brain and so dependency would build faster? I'm so scared to build up dependency on any drug when I've worked so hard to cut my doses. I'm not sure if it's better to just stay on Doxepin for a few months while I try to get my sleep sorted, or to try a different sleep aid every night (Ambien, Ativan, Zyprexa, Doxepin) to avoid dependency. I know juggling around is not healthy for the nervous system, so perhaps that's not wise and Doxepin is the safer route, with an occasional Ativan as needed (no more than once or twice a week, for a month or two).

 

Any other advice? I'm just taking things one day at a time at the moment. I'm not worried about tapering off Paxil for quite some time at this point, just trying to get stable. When I do taper again, I'm probably going to be ultra-conservative and do only four drops or so a year. Since I'm already at a low dose of Paxil, I'm in no rush to get off if stability is such a risk. (I'm a very high metabolizer, which also may be making my situation more difficult at the low-dose Paxil. But I don't want to think about bridging over to Prozac while I'm so unstable.)

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Altostrata

What are you doing for exercise? If you're not getting much, your leg symptoms might improve with at least a half-hour of walking each day and stretching exercises. Are you taking magnesium or using magnesium oil on your legs? That can relax muscles.

 

2 hours ago, embd said:

I also updosed to 5.25mg Paxil five days ago, so perhaps that will help the sleep in the near future. Other withdrawal symptoms from the bad Paxil wave seem to be fading now, aside from a racing heart at night and this insomnia.

 

What are your thoughts on Doxepin? I know no med is the ideal, but it seems I do need something to help me short-term while I try to repair my sleep, as I am completely unable to sleep without any sleep aid at the moment. Doxepin seems better than the alternatives (Zyprexa and Ativan). I will likely need to take Ativan 1-2 times per week, as the Doxepin doesn't really help me fall to sleep, just stay asleep. I believe you need to take Doxepin every night rather than as needed, which is unfortunate, but the psychiatric nurse practitioner assured me it was not habit-forming and was easy to taper off of. Is this the case?

 

Yes, you need to taper doxepin if you take it regularly. It seems that community crisis center staff has the usual knowledge of tapering and withdrawal, which is to say -- none.

 

This was my last suggestion:

On 10/23/2019 at 3:01 PM, Altostrata said:

Paxil is a very difficult drug to go off, with real hazard at a low dose -- it's metabolized more quickly (inhibits its own liver enzymes at higher dosages). Since you're down to 5.05mg, I would try 5.25mg. Because of the fast metabolization, it's possible a split dose of 5mg and 0.25mg per day will be more effective.

 

After you stabilize, you might consider a switch to fluoxetine (Prozac) as a bridge to going off completely -- perhaps 4mg to substitute for 5.25mg Paxil.

 

Generally, we do not advise adding other drugs such as doxepin, benzodiazepines, Ambien, estrogen, etc. when you can reduce symptoms by adjusting your taper. You'll end up on a drug cocktail instead of reducing your drug burden, and have to taper a handful of drugs instead of one.

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embd

@Altostrata

1 hour ago, Altostrata said:

Yes, you need to taper doxepin if you take it regularly. It seems that community crisis center staff has the usual knowledge of tapering and withdrawal, which is to say -- none.

How long is "regularly"? If I take it for just a month or two, would I be able to do a quick taper?

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Altostrata

I cannot promise you can easily go off doxepin after a month of regular use. If you have to take it, strongly advise trying lowest effective dose, which could be 5mg, 10mg, 25mg rather than 50mg.

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embd

@Altostrata

 

I have a very fast metabolism. That being the case, is my only hope of stabilizing on Paxil to updose and then bridge to Prozac? In other words, will I stay in a constant state of withdrawal at this low dose if I just keep holding, or will I eventually stabilize? I can't split my dose to twice daily because I use a compounding pharmacy rather than liquid or measuring with a scale.

 

If you suggest I updose again, what dose do you recommend I go up to, and how long should I stay at 5.25mg (which I've been at for five days now) before updosing?

 

Also, what are the risks involved in bridging to Prozac? By that, I mean what symptoms might occur and at what severity? Are such risks only for a minority of folks, or is it an overall risky proposition? Is it better to bridge to Prozac from a higher dose, or can it still be done at a lower dose of Paxil?

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embd
9 minutes ago, Altostrata said:

I would not make assumptions about your doxepin metabolism.

 

I apologize for the confusion...I was talking about my Paxil metabolism. You mentioned it metabolizes quickly at low doses. Since I'm a fast metabolizer, will I remain in a constant state of withdrawal at this low dose of Paxil (and thus unable to stabilize), or am I better off updosing on Paxil? And if so, how far up do you recommend I updose, and how long should I stay at each dosage before updosing again?

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Altostrata

I would not make assumptions about your Paxil metabolism. Paxil inhibits its own metabolism in everyone.

 

On 10/23/2019 at 3:01 PM, Altostrata said:

Paxil is a very difficult drug to go off, with real hazard at a low dose -- it's metabolized more quickly (inhibits its own liver enzymes at higher dosages). Since you're down to 5.05mg, I would try 5.25mg. Because of the fast metabolization, it's possible a split dose of 5mg and 0.25mg per day will be more effective.

 

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