embd: updosing or holding for a bad wave?

[embd]

@Altostrata I am considering doing another Paxil updose to try to stabilize further so I can reduce/get off Doxepin for sleep sooner than later. I updosed to 5.25mg on 10/27/19. When would you recommend I do my next updose? Do I need to wait four weeks like when one is reducing, or should I do it sooner? Also, is 5.5mg a suitable updose amount (about 4.5%)?

 

Thank you!

[Altostrata]

I don't know. If you added doxepin before finding out if 5.25mg Paxil was sufficient, I have no idea if an updose will help.

[embd]

19 minutes ago, Altostrata said:

I don't know. If you added doxepin before finding out if 5.25mg Paxil was sufficient, I have no idea if an updose will help.

I guess my question is, when people updose in my situation to try to get relief, do they typically wait a full four weeks before updosing again if the first updose isn't sufficient? Or do they updose again after a week or two?

 

The psychiatrists wanted me to go up to 10mg, which I know is too much and too fast. But could I try updosing to, say, 6.5mg? 

[Altostrata]

If you added doxepin, you can't tell if you need to updose Paxil.

 

Highly likely your doctor doesn't know anything about tapering or withdrawal and thinks he or she is treating "depression."

[embd]

17 minutes ago, Altostrata said:

If you added doxepin, you can't tell if you need to updose Paxil.

 

Highly likely your doctor doesn't know anything about tapering or withdrawal and thinks he or she is treating "depression."

I only added the Doxepin because I had gone four days without sleep (after 11 weeks of 0-5 hours of sleep) and was getting psycotic/suicidal from sleep deprivation. I'm hoping to taper off of it over the next month or so. I'm considering updosing on Paxil regardless of whether I "need to" in the meantime, to ensure I can get off Doxepin and sleep starts to stabilize. 

 

So my question is still, how many weeks apart do most people do another updose? In other words, can I updose again after two weeks, or do I need to wait four weeks? Also, my question is can I go up to 6.5mg from 5.25mg? Or is that too much?

[Altostrata]

People updose, downdose, cold turkey whenever they want. Seems like you've made your decision, not sure what I can add.

[embd]

3 minutes ago, Altostrata said:

People updose, downdose, cold turkey whenever they want. Seems like you've made your decision, not sure what I can add.

I'm so sorry if it sounds like I've already made my decision. That's not the case at all - I'm just terrified of this complete insomnia and am doing everything I can to resolve it quickly so I don't need to get dependent on another drug like Doxepin. 

 

I know people go up and down in dose willy nilly, but what do you recommend? Is it typically best to wait four weeks to updose again, or is two weeks okay? And what is the risk in updosing by 1 or 2 mgs rather than a small 5% updose? I'm just trying to get a baseline idea of updosing, since I've never done it before.

 

I am so grateful for all of your help, Alto. Please don't think I'm making my own decisions regardless of input - I'm just trying to learn how this all works. People on SA told me to just keep holding two months ago when my symptoms were starting to get severe, and now I wish I had updosed back then since everything has only gone downhill since then. I've heard people on the FB Paxil tapering page (https://www.facebook.com/groups/204732929546136/) saying they only got relief from symptoms when they updosed a couple of mgs, not from tiny updoses. So I'm not sure which direction to go. That's why I'm looking for your input.

[Altostrata]

We advise people to change only one drug at a time. Since you added doxepin at the same time you updosed Paxil, I can't tell what the updose did. It could have been that updose would have been enough without doxepin.

 

You didn't give the updose enough time to see its effect. I cannot tell you when to updose Paxil, I don't even know if this is called for. I don't know what will happen if you go up to 6.5mg or any amount. Your guess is as good as mine.

 

This was my best guess, there's nothing more I can add:

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.