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emdb: updosing or holding for a bad wave?

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embd

Thank you for all your wisdom shared in this forum! I had an updosing vs. holding question. I am currently tapering off 20mg Paxil using a 10% taper method (I do two cuts for four weeks and then hold the third cut for six weeks.) It has gone smoothly until I reached 5.61mg in June, when I started feeling more symptomatic. I cut down to 5.05mg the first week of July and four weeks later started experiencing severe symptoms (insomnia, shakiness, lack of concentration, anxiety). I've held for 8 weeks now and still no subsiding of the symptoms, so my question is do you recommend I updose? If so, should I go back to 5.61mg or higher, since this crash was likely building a few months before I hit 5.61mg? And then should I hold it for four weeks or more before resuming a taper? (I'm going to start tapering at 5% per month now, since I'm hitting the lower doses.) Do you expect the WD symptoms to ease up if I updose, and does that typically happen fairly quickly?

 

Also, is it common to hit this kind of a wall in the 5mg range?

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Gridley

Welcome to SA, embd,

 

It is better to start with a small amount and increase if needed than to risk taking too much, which can be further destabilizing.
I'd recommend updosing no more than to 5.61.  
 
It takes about 4 days for a dose to get to full level in the blood and a bit longer for it to register in the brain. You might get some relief within a couple of days, but sometimes it takes longer.  It may take some weeks or months for your nervous system to settle down but symptoms won't be as intense.
 
The idea of updosing isn't to get rid of withdrawal symptoms completely but to bring them to a bearable level.

 

 
I'd forget about tapering until you've stabilized.  It could be several months.  You're wise to slow down your taper when that time comes.
 
It's not uncommon to hit a wall, though where the wall is varies.
 
Please keep up updated.
 
This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.
 
Edited by ChessieCat
changed member name to lower case from all caps

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embd

Thank you! I'll try holding a while longer and see if that helps. If not, I'll consider going up to 5.2mg.

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embd

I ended up holding at 5.05mg and symptoms have finally started to subside. Decided to stay here for another 8-9 weeks until sleep significantly improves and I can rest up to continue. At that point, I'll switch from a 10% taper to a 5% taper every 4-6 weeks to see if that helps.

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Gridley
3 minutes ago, embd said:

I ended up holding at 5.05mg and symptoms have finally started to subside. Decided to stay here for another 8-9 weeks until sleep significantly improves and I can rest up to continue.

 

That's great that symptoms are subsiding. 

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embd

I had a few questions about what to expect during my Paxil taper. It had been going fairly smoothly with a 10% cut every four weeks, then another 10% in four weeks, then another 10% and hold for six weeks, then repeat the pattern.. My symptoms up to 5.61mg were manageable and fairly predictable. The bad wave I've been in for the last four weeks (down at 5.05mg) came out of nowhere and has really surprised me with its intensity. The worst symptom has been horrible insomnia, but I've also had an overactive autonomic system (hot flashes/chills at night, frequent urination at night), some panic and depression, and lots of head fog and blocked ears. So here are my questions:

 

1) Is this a typical pattern in a taper that has been going smoothly up to now? Is it because of cumulative too-quick cuts that finally caught up to me, or just that I need to go slower at these lower doses? (I'm assuming 5.05mg is considered getting to be a lower dose?)

2) If I slow down to a 5% taper rate after I come out of this wave, will that likely help prevent this bad of a wave again?

3) How long should I expect this wave to last before I stabilize and sleep improves? Weeks or months?

4) How long should I stay at this dose after I stabilize and start to sleep better before I try going down in my taper again?

5) During a bad wave, is it common to have a sleep pattern of one halfway decent night (6 hours) followed by a bad night (0-4 hours)?

6) Does anybody find that their varicose veins are extra sensitive and even burn a bit during withdrawal?

7) On a very slow (5%) taper off Paxil that will likely last another three years, what percentage of that time should I expect to be in acute withdrawal vs. just feeling manageable or no symptoms?

8. If anyone has done an Ativan taper as well as a Paxil taper, which did you find to be more difficult? I tapered off Ativan in 2017-2018 and whileit was very difficult, it was ultimately successful on my first try. I had assumed that the taper off Paxil would be eaiser (though longer), but after this bad wave, I'm reconsidering that thought!

 

Thank you for any input, feedback, or firsthand experience you wish to share!! :)

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Gridley
27 minutes ago, embd said:

1) Is this a typical pattern in a taper that has been going smoothly up to now? Is it because of cumulative too-quick cuts that finally caught up to me, or just that I need to go slower at these lower doses? (I'm assuming 5.05mg is considered getting to be a lower dose?)

2) If I slow down to a 5% taper rate after I come out of this wave, will that likely help prevent this bad of a wave again?

3) How long should I expect this wave to last before I stabilize and sleep improves? Weeks or months?

4) How long should I stay at this dose after I stabilize and start to sleep better before I try going down in my taper again?

5) During a bad wave, is it common to have a sleep pattern of one halfway decent night (6 hours) followed by a bad night (0-4 hours)?

6) Does anybody find that their varicose veins are extra sensitive and even burn a bit during withdrawal?

7) On a very slow (5%) taper off Paxil that will likely last another three years, what percentage of that time should I expect to be in acute withdrawal vs. just feeling manageable or no symptoms?

8. If anyone has done an Ativan taper as well as a Paxil taper, which did you find to be more difficult? I tapered off Ativan in 2017-2018 and whileit was very difficult, it was ultimately successful on my first try. I had assumed that the taper off Paxil would be eaiser (though longer), but after this bad wave, I'm reconsidering that thought!

 

 

1.  It could be either but probably is a combination of both.  5.05mg is considered to be a lower dose.

2. Yes.

3. Unfortunately, there's no way to predict the length of waves.

4. In my opinion, 3 months.

5. I have seen other members report this sleep pattern.

6. I don't know about varicose veins, but burning/sensitive skin issues are common in withdrawal.  There's virtually no limit to the ways WD can manifest itself.

7. If 5% is a good rate for you, the percentage of time in acute withdrawal should be small or nonexistent.  After a drop there usually will be an uptick in symptoms that will smooth out after a few days.  Mostly it will be in the "manageable" category which we call WDnormal.  

8.  Opinions vary on benzo vs. AD difficulty.  Paxil has the reputation of being one of the more difficult antidepressants to go off, but it's eminently doable.  Take a look at Brassmonkey's thread.  He's over a year out after a slow Paxil taper and is doing very well.

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embd

Thanks, Gridley! I've been on Paxil for 2.5 years. Is that considered long-term usage, or is that still in the shorter-end range?

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Gridley
2 minutes ago, embd said:

Is that considered long-term usage, or is that still in the shorter-end range?

Shorter-end.

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embd

Quick question: could a bad case of poison ivy last month have set off this recent bad wave? Does that kind of thing affect WD symptoms? It seems the wave started around the same time.

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Gridley
49 minutes ago, embd said:

could a bad case of poison ivy last month have set off this recent bad wave?

For sure.  Physical illnesses, and definitely something as bothersome as poison ivy,  can have a big effect on withdrawal and waves.

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embd

So interesting. Why would that be? Does something like poison ivy or a cold affect the CNS too?

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embd

By the way, I read your thread yesterday to become more familiar with who you are and the journey you're on. Nice to "meet" you, Gridley! Thank you for your time and all the best in your continuing tapering efforts. My husband grew up in Ecuador. His parents were missionary teachers at a school in Quito.

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Gridley
2 minutes ago, embd said:

Why would that be?

Illnesses are a stressor, and stressors put an extra burden on an already sensitized CNS.

 

Nice to meet you, too, embd!

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embd

Hi Gridley, just out of curiosity - do you know what causes those full-body shakes that are uncontrollable? I don't get them often, but when I do they go on for 15 minutes or so. I'm not really cold, it's just that my body goes into a quivering fit. Is it my nervous system trying to stabilize?

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Gridley
26 minutes ago, embd said:

- do you know what causes those full-body shakes that are uncontrollable?

 

They are yet another withdrawal symptom, apparently quite common.  

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embd

So my integrative medicine doctor put me on a new supplement two months ago called MT Complex. It strips metals (copper, etc.) from your body. After doing some labs, she noticed my copper levels were high and thought that might be causing a harder time of withdrawal from Paxil, so she advised I start taking this supplement twice a day.

 

Now that I think back, my bad wave started a couple of weeks after I started the supplement. Do you think it may be contributing to this rash of symptoms? Is that considered a detox, or is stripping copper actually a good thing to help my body function better during withdrawal?

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Gridley
37 minutes ago, embd said:

Do you think it may be contributing to this rash of symptoms? Is that considered a detox, or is stripping copper actually a good thing to help my body function better during withdrawal?

 

Yes, that could be considered a detox, and we strongly advise against detoxing during withdrawal.  It is a stressor and makes withdrawal worse.  WD is not the time for detox.  Integrative and holistic doctors don't understand withdrawal, any more than allopathic doctors, and tend to throw supplements at their patients.  Our systems are highly sensitized during withdrawal, and supplements and protocols that might be fine for those not in withdrawal often are counterproductive for us.

 

Your rash of symptoms could very well be a result of the supplement.  The only supplements we recommend are omegas and magnesium.

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embd

That's what I was thinking. Do I need to be careful how much magnesium I intake? I take magnesium tablets in the morning and at dinner. Last night I also tried a magnesium-based sleep aid called Natural Calm at bedtime and ended up having a pretty bad night, 2 hours of sleep.

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Gridley
7 minutes ago, embd said:

Natural Calm

Natural Calm, in addition to magnesium, also contains lemon balm and lavender.  Listen to your body.  It may be that those ingredients are activating for you (paradoxical effect).  Ashwaganda, which is supposed to be calming, had a paradoxical activating effect on me.

 

Becaause of our sensitized systems, we advise staying at the low end even of recommended supplements like magnesium and omegas.  Too much magnesium can have a laxative effect.

 

Some members have found Melatonin helpful with insomnia.   
 
 
 It's best to start at a very low dosage, such as .25mg, and gradually increase if needed to the lowest effective dose.  Higher doses can have a paradoxical effect. 
 

 

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embd

Thank you so much! Insomnia during a bad wave usually works itself out on its own with a long hold, right (assuming I've been doing the normal 10% taper every 4-6 weeks)?

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Gridley
37 minutes ago, embd said:

Insomnia during a bad wave usually works itself out on its own with a long hold, right (assuming I've been doing the normal 10% taper every 4-6 weeks)?

 

A hold helps, but insomnia is one of those symptoms that can continue to be a problem in WD, off and on.  Mine has gotten much better.

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embd

Do you think your insomnia's improved because you're at a lower dose now? Or just with time?

 

Guess what? I just looked at the ingredients on that MT Complex supplement for the first time. Two of them are Glutamic Acid and L-Glutamine. Can you believe it? Wouldn't that explain the increase in symptoms like insomnia, alertness at night, frequent nighttime urination, etc.? I'm stopping this today!!

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Gridley
43 minutes ago, embd said:

Do you think your insomnia's improved because you're at a lower dose now? Or just with time?

 

Guess what? I just looked at the ingredients on that MT Complex supplement for the first time. Two of them are Glutamic Acid and L-Glutamine. Can you believe it? Wouldn't that explain the increase in symptoms like insomnia, alertness at night, frequent nighttime urination, etc.? I'm stopping this today!!

 

Very probably my insomnia is improved because my dose of the activating Lexapro is lower.

 

Members have reported bad reactions to L-Glutamine, and that could be one cause of your symptoms, though garden-variety withdrawal may also be the culprit.  It's good that you're stopping the Glutamine. As always, supplements and protocols that are fine for others are counterproductive for those of us in WD.

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embd

Good to know. I'm sorry I'm so full of questions today - I'm in a real rough patch it seems. Today for the first time symptoms have felt a bit manic - an impulse to keep moving, agitated, can't do anything for more than a few minutes. Have you ever had this symptom? Is it common in withdrawal? Does it pass with time?

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embd

Hi Gridley. I hope you are doing well. How is your taper going?

 

I've been experiencing a new symptom during this recent wave. I have a constant gnawing sensation in my stomach, almost like I'm very hungry - but I have to force myself to eat, as my appetite itself isn't great right now. Even after I eat a big meal, it's still there. It never really goes away. Is that a symptom others have experienced?

 

I've also been experiencing diarrhea (very soft stool, not liquid) rather than solid stool for the last three weeks. Is this something I should be concerned about, or is it normal for WD and will pass eventually?

 

Thank you for your feedback!

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embd

@brassmonkey, I noticed in your thread you talked about 6mg-3mg being a very difficult range for you as you tapered off Paxil. You weren't posting regular updates in your journal during that time, so I was just wondering if you could explain some of what you experienced during those periods so I know what to look out for. I'm having a really tough time at 5.05mg of Paxil - symptoms are suddenly all over the place, ones I've never experienced before or old ones at much greater intensity.

 

Did you slow down your taper at all during that period?  Was the 2mg and below range significantly easier?

 

Thanks for your valuable input!!

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Gridley
On 9/12/2019 at 1:02 PM, embd said:

an impulse to keep moving, agitated, can't do anything for more than a few minutes.

 

It sounds like akathisia, which is an inner restlessness and is a common WD symptom.  It can come and go and resolves in time.  

 

Regarding the gnawing feeling in your stomach, I haven't encountered that specific symptom, but digestive problems are common in withdrawal.  Diarrhea is common.

 

Thanks for asking about my taper.  I just completed a crossover to a new brand of Lorazepam, so had to suspend my Lexapro taper for 5 weeks but will resume it this Thursday.

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embd

It's good you were able to take a bit of a break from the Lexapro taper, but glad you can start it up again soon. Have you found the lower doses (under 5mg) to be harder coming off Lexapro too? I know it's the case with Paxil and apparently with some of the others. Are you still tapering at 10% or have you decreased that percentage as you've gotten lower?

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Gridley
4 minutes ago, embd said:

Have you found the lower doses (under 5mg) to be harder coming off Lexapro too?

 

Yes, once I got to around 3.5mg, I noticed increased symptoms and had to hold longer.  Many members have found that as they get lower in dose, they have to slow down, either by dropping a lesser percentage or holding longer.

 

Instead of the 10% taper, I do the taper that Brassmonkey devised, which is four 2 1/2% tapers (one per week) then a two-week hold to let things settle down.  It's a bit gentler than the 10% taper since the 10% decrease doesn't hit all at once.  Here's a link:

 

 

 

 

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embd

I've read up on the Brassmonkey Slide - great idea! Unfortunately, I use a compounding pharmacy and they only go as low as 30 pills per order, so I can't order amounts by the week. Instead, I'm planning to try a 5% drop every 8 weeks once I resume tapering (which won't be until sometime in early 2020). Do you think that will be gradual/gentle enough?

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Gridley
4 minutes ago, embd said:

Do you think that will be gradual/gentle enough?

That sound like a good plan.

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brassmonkey

Hi embd-- I just realized how long ago that was so specifics are pretty hazy.  I remember that I had a big uptick in my symptoms in general. Cog fog, balance issues, concentration, physical pain in back, legs and arms.  Things tended to cycle a lot too, big mood swigs during the day.  It was all pretty harsh and unpredictable.  I kept to the taper schedule I had established because each drop resolved pretty well by the end of each six week period, so I saw no need to slow down.  Once I broke below 2mgai things really started to settle out and there was noticeable improvement, slowly at first and then accelerating as the dose decreased.

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embd

@brassmonkey thanks for the info. I know what you mean - I tapered off Ativan last year and already the specifics are hazy. I truly appreciate your input, knowing you were where I am now not all that long ago. "This too shall pass." :)

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embd

@Gridley, when you suggest that a wave could take up to several months to resolve, are you meaning 3-4 months or 5-6 months...or more? What do you often see with others? (This is just a wave caused by my last few tapers catching up with me, and getting into the difficult 5mg range - not by a cold turkey/reinstatement or anything like that.) Just trying to wrap my head around what I might need to prepare for. Some of my symptoms have started to resolve from the wave that started around August 6, but a few (specifically, the insomnia) are still pretty bad. Is sleep usually the last symptom to resolve? I remember that was the case when tapering off the Ativan in 2017-2018.

 

Thank you for your so-helpful answers! I appreciate all the time you give to this site, when you are going through your own WD issues. You are amazing!

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Gridley
7 minutes ago, embd said:

are you meaning 3-4 months or 5-6 months...or more? What do you often see with others?

 

With catching-up symptoms, I would say at the low end of 3-4 months to resolve (maybe less), though of course we can't predict for sure but that's my best guess.  Insomnia is a tough one, not necessarily the last to resolve, but a symptom that can be persistent.  It does improve though.  

Edited by Gridley

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