StrongEnough: hurdles of the last 5mg~ of Paxil

[StrongEnough]

Hi!

I'm so glad to be here😊 

I've been reading a lot of valuable info here and look forward to your insight and help!

 

I'm a 30yo female,

Med history as described in signature.

Progressively more symptoms as I taper, mainly panic attacks and anxiety attacks that I haven't had in years,  GI problems and heat / stagnant air / high humidity severe intolerance, morning cortisol spikes  mild insomnia, more painful pms and BIG sensitivity to any stressor.

Most of it wasn't even present when I was on 8.1mg ... 

For that reason I thought it would be good to hold for a while starting from 29/09/19 and so I did.

So far cortisol morning spike is what has almost resolved. Others have improved.

Still, about very other day I'll have a few hours of great discomfort from GI mainly 

 

I have a severe issue accompanied with panic attacks. It immediately triggers intense nausea for me that if not immediately taken care of progresses to vomiting. This unfortunately happens for any big stressor or even excitement now. This is the only lingering problem from my CT attempt in 2013 which I never had before that!

 

To my unfortunate luck, I've had to deal recently with a big stressor, mimicking just the same environment and symptoms of the CT attempt and back then the solution I chose was to leave the situation and return home which gave me comfort. I could easily stabilize and continue with my taper if this stressor wasn't present, but I'm afraid I can't deal with both, aggravating each other and I'm so afraid itll become an uncontrollable spiral.

So at this point I would like to ask for the best solution to an immediate relief. Yes, in the best scenario it would be just to leave the house that's causing the stress, but moving away will trigger panic attacks until I settle down and I'm so dreadful of that. Funny that this time it's the opposite solution for the CT attempt I had. Leaving instead of returning to my house.

My options:

Right now I can control the nausea with phenergan 12.5mg but the agony in waiting for it to work (1-2 hours) is big. I'll need this for perhaps a couple of months until things will settle down in my current house situation together with my stress sensivity. Powerful drug so not a very nice solution IMO.

Other option I'm thinking about is to updose by 2.5%, just to make me less sensitive to stress I guess?  I saw that this is what @Altostrata has suggested 2 days ago to my friend @embd with the option to divide the dose due to fast metabolism in the lower doses. So how do I go about that divide?

 

I just dont know what my best shot is here so i would appreciate a moderator's advice. I have some interesting general questions prepared from a while before the stressor even begun, I'll save those for later as they're not urgent.

Thanks For reading thus far 😚. Looking forward for your replies.

 

 

 

 

 

[Sassenach]

Hello     Strong and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved

 

I am sorry you are having such a rough time but you are now in the right place.

 

Paxil is one of the hardest drugs to taper particularly at lower doses.

A switch to an A/D with a longer half life is sometimes used when someone is struggling.

 

However that will be a matter for the future and irrelevant in your current circumstances.

As you have quoted Alto I will flag this for her attention.

 

In the meantime I suggest you look in the symptoms and selfcarer forum for coping strategies to help with your domestic situation.

 

In the meantime DO NOT MAKE ANY CHANGE TO YOUR CURRENT MEDS please.

Please feel free to browse the site, it is a wealth of info.

Other members threads will give you an insight and the opportunity to share experiences.

 

Again welcome.

 

Sassenach

[Altostrata]

Welcome, Strong.

 

Do you feel nauseous regularly every day or is it occasioned by situational stress?

 

As you're down to 8.1mg Paxil -- as Sass said, a very difficult drug to taper -- rather than updosing it, you might try adding 0.5mg fluoxetine in preparation for switching to fluoxetine, which is somewhat easier to taper. Fluoxetine comes in a prescription liquid so you can take small amounts.

[StrongEnough]

Thank you both !

Sure I don't plan on changing the dose now, I learned from you the best (=.

 

The nausea was triggered by this stressor and since then is coming and going, and when it's not there I'm left with severe lack of appetite. The thing is I'm thin and don't have many extra lbs to lose so I'm stressed about that and in general about all the familiar feelings that I had back in 2013 after CT, it all feels the same and it brings me PTSD vibes to be living this again, but trying not to dwell on that as I'm in a different place (literally!) and time now

 

@Altostrata I'm at 5.5mg, not 8.1mg, sorry if I confused the numbers. I agree I shouldn't updose for now. I can try and wait to stabilize and the stressor itself to calm down. Will that be a wiser choice over adding a tiny bit of fluoxetine, which I read can be risky ?

And very importantly, what about the use of phenergan along with Paxil ? Both are anticholinergic and I'm kind of worried about a daily use of 12.5mg phenergan (luckily I managed to not need it yesterday, so it might not be used daily).

 

I trust this site's moderators WAY more than I trust drs now, so hail goes to all of you here, really ❤

[Altostrata]

When did the lack of appetite start?

 

Hard to tell what's related to withdrawal because, as you say, the external stressor. That can definitely add to nervous system upset when it's already stressed from tapering.

 

Adding a tiny bit of fluoxetine is far less risky than adding a lot of fluoxetine. The last bit of paroxetine is so difficult, this is often the best way to go off. Still, I cannot promise the results will be good -- there is a risk.

 

Not sure about adding phenergan, see  https://www.drugs.com/interactions-check.php?drug_list=1800-0,1949-1259

 

What symptom are you trying to treat with phenergan?

[StrongEnough]

@Altostrata the severe lack of appetite + nausea bouts begun as soon as the stressor appeared. I was having progressively harder time the lower I went (and I went very slow) but it's nothing comparing to now, and the relation to the stressor is obvious.

I cross my fingers that it'll still be possible to see improvements and healing even though the stressor exists, hoping the stressor will improve soon. I guess that the body still continues to heal but just slower?

 

Thanks for the info on fluoxetine. I might have to wait 3 weeks for the psych appointment for this to happen, but it's good because itll give me more time to try and solve things without fluoxetine, just because I'm so worried itll make me agitated and restless at first? So until the appt, will it be helpful to split the current dose to tackle fast metabolism? If so, how to go about that, 5.5mg is my whole dose taken at evening time?

 

The phenergan thing is actually replacing klonopin because once I'm so distressed I feel very nauseous and sometimes vomit and once I stop this symptom I usually calm down on my own. Klonopin isn't working in situations when I already feel even a bit nauseous unfortunately. Also used it once since all hell broke on Thursday, for sleep, I was shaking and couldn't fall asleep and half a pill (low dose) knocked me out.

Again, I'm trying my best no to touch promethazine every day, so far it's working.

Also, I read that some drs dont even warn about this combo! Perhaps because I'm on a low paxil dose I should worry less?

 

Will keep you posted on symptoms, thanks a lot again !

 

 

[Altostrata]

What Klonopin? When did you start taking it, at what dosage? Please put information about ALL your current drugs in your signature.

 

What times of day do you take your drugs, with their dosages? Please answer this before adding fluoxetine.

[StrongEnough]

Hi Alto.

Klonopin was used PRN twice a year maybe, never in withdrawal so didn't bother to mention it as replaced it with promethazine, usage as described in the updated signature.

 

I take the Paxil 5.5mg at night.

I notice that I do have daily windows, this pattern has been like this throughout all the taper. I used to have symptoms that usually didnt persist all day, just a few hours of it and it has been like this also now, although I'm left very tired from the major struggle when I do have symptoms, due to their increased intensity.

Because of this pattern, and because I see the outern stressor calming down a bit, I'm thinking to try and let my system stabilize before I try to add Fluoxetine so I won't stress the system too much. Would that be a good idea in your opinion ? Just ordered l theanine, I saw a lot of good comments about here and I'm sure this will help too, together with a possible dosage split ?

 

daily update on symptoms :

rough night, woke up at 3.3am shaking, not feeling panicky, just med induced idk, tried to stay calmed for 2 hours but then the nausea started and got worse so I had to take promethazine 12.5mg. 

got back to sleep, woke up with slightly shaking still, this passed and the day only improved from there, increased appetite, managing to eat somewhat better today.

 

[StrongEnough]

 

today's summery (the day comes to an end in my timezone):

slept well, woke up only slightly shaking at my regular time, conitnued to shake very slightly this time but with great head fog, head pressure, racing heart (while feeling no anxiety, so weird) and sickness feeling, flu like feeling most of the day, only mostly lifted by night time. (All this is new except the shaking)

Lump feeling in throat but this I always get before having a runny nose/throat bug.

No nausea.

Appetite comes and goes.

 

*awaiting your input on my yesterday's questions, @Altostrata

thanks 

 

 

 

 

[Altostrata]

Does this symptom always occur at 3:30 a.m.?

 

I need more information. Please post at least 24 hours of notes at a time in this topic: Times of day you take your drugs, dosages, and symptom pattern in this form Keep daily notes of drug schedule and symptoms to track patterns and progress

[StrongEnough]

October 30th diary:
12:30pm - woke up after falling asleep only at 4.30am, until then I was shaking. No anxiety (begun as soon as it was bed time at around 12am 😿). Promethazine 12.5mg to the rescue.
Racing heart while I sit down, at 80-90bpm vs normally 75~, no anxiety.
1:30pm -took magnesium bisglycinate 100mg + vitamin d and went to sit outside in the sun.

3pm - pulse calmed a little, doing housework, feeling better.
5pm-iron+b12+folate.
got the common cold, itchy throat with low fever but head is clear and I actually feel better than yesterday! Head very clear, no appetite but no nausea as well.

6pm - boom ! The stressor that brought on this wave (my twin sis who is btw mentally unstable and thus all the problems) is torturing me again. I burst and cried (cant cry on the med, only in extreme cases). Felt akathsia feeling because I can't act all my feelings out when my parents deal with their twins struggle so much so I had to gather myself back quickly.
12.30am - normal pulse. bedtime.
Taurine 750mg + magnesium.
Not really tired despite sleeping only 7 of my usual 9 hours of sleep. That's weird. Itching throat, basically expecting another night of very late sleep but somehow I fall asleep and sleep peacefully with no shakings

[StrongEnough]

Hi @Altostrata

posted the diary above but needing help with the main issue here.

I'm just seeing a very clear connection between onset of physical/mental symptoms and the flare ups with the stressor. It's an unstable family member that each time that is acting up, I end up severely depressed (never had tendency to it! ) and hopeless for the day (luckly I manage to gather myself within a day), or in a bad wave of physical symptoms and panic attacks. I see a clear connection, comes immediately or a day after.

The withdrawal made me SO much more sensetive to stress than I've already been (HSP here)!

I might see a counselor to learn how to desensitize myself from that person, but knowing that this person causes me such a heavy mental struggle will make the counsling work very hard.

Bottom line is I can't go on with the sensetivety to this stressor, it makes some days (not all thankfully) mentally indescribably hard .once I gather myself back, within a day at max usually, it's a matter of days until the person is acting up and I'm crashing again mentally. I'm basically looking for the fastest route to relief and unfortunately time is the slowest one of them I guess, so what's my best shot here :

○adding prozac

○ trying a benzo on those unbearable days of mental torture (pattern of a day or two a week). Nausea very much subsided so I might not need promethazine so much anymore (been taking 4 in 7 days until the nausea subsided)

○ updosing from 5.5mg paxil to 5.6mg

 I know you suggested adding prozac but now that I have better explained my main struggle (only realizing it now), which is the mental part, is it still my best route to a relief, over the added benzo PRN (I know it's a no no in wd) option I was thinking about?


Thanks a lot ⚘⚘

[Altostrata]

I don't know what to suggest.

 

If you're experiencing withdrawal symptoms or adverse effects, an unsettling family situation may cause outsized negative symptoms. I can make suggestions about adjusting for the withdrawal symptoms but I cannot suggest a drug combination that will resolve stress from the family situation. You'll have to resolve that another way.

 

Please report daily notes in this format

 

Quote

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

[StrongEnough]

@AltostrataOk I understand that, thank you. Will edit diary later.

Do you know if we become less emotionally sensetive as we stable on the current dose?

I'm a fast matobilizer like my friend embd so perhaps splitting the dose will give me some relief? Is it something risky to try? How should I split it?

Thanks

[Altostrata]

Since you've had a bad drug reaction, you probably will be sensitive for some months.

 

As I said before, Paxil is very difficult to go off. That is why I suggested considering a switch to Prozac (fluoxetine).

 

Splitting the Paxil dosage may or may not help.

 

Adding a benzo to Paxil tends to present the challenge of tapering off two difficult drugs instead of one.

[StrongEnough]

Gotcha.

Last thing I want is to end up on a cocktail or get addicted to a benzo. I've become so anti medicine and btw I'm helping spread awareness to correct tapering in the facebook tapering group for Paxil.

 

I'll consider my acts the coming days and will update here. Itll be probably be the prozac addition in preparation for crossing.

Will keep journaling so we can track improvements in physical symptoms and to help and inspire others, hopefully.

 

God bless you and your cat ⚘👼😼😻

[StrongEnough]

Hi @Altostrata 

This time it's not even about the stressor

The stressor just brought me into a situation where I'm scared for my life.

neuro emotions ?? only time in my life I have felt so hopeless, scared for my life and depressed is when I CT lexapro.

I'm in the start of a vicious cycle of not eating well, not sleeping well (I'm thin) and being terrified of ending up on more medication, and terrified of the medical counquences of the lack of both.

so terrified to address those issues to psych ever again. It was just like this at my lexapro CT attempt, and paxil and 1 month of remeron saved my life so I'm thinking to updose Paxil so that the emphazied emotions will stop basically. I know it's not what the site is about but right now I see no way out of this. 

My question is whether updose can stabilize and reduce neuro emotions ?

If so, is 4% ok?

Thanks a lot

 

 

 

[Altostrata]

You are experiencing withdrawal from Paxil, known to be even more difficult to taper at low doses. When people art at that point with Paxil, doctors often switch them to fluoxetine to finally go off.

 

Family conflict is a very difficult environment for a taper or a switch to fluoxetine.  Because of the external problems, I cannot predict if a Paxil updose or switch to Prozac will help. The anxiety in your environment will continue until you do something to resolve it.

 

If you have been taking Paxil to cope with your family problems, that may not be successful again.

[StrongEnough]

Ok. Thank you so much for your help

[Rhiannon]

Take a look at the charts in this thread: survivingantidepressants.org/topic/6036-why-taper-sert-transporter-occupancy-studies-show-importance-of-gradual-change-in-plasma-concentration/

 

to see why the last 5 mg are so hard. It's not a straight line. It's much easier to taper at higher doses. At the bottom, every change in dose causes a considerable change in transporter occupancy.

[StrongEnough]

For sure, @Rhiannon, I'm very aware of that since I began tapering a year ago. I have gathered a lot of info from here through my taper and went very very slowly as you can see and still crashed although I see a clear relation to symptoms and outern big stressor that hit (don't wanna scare others that they'll crash too at those doses)

[StrongEnough]

Hi

Update and a question for @Altostrata

For the first time after a week from hell in which each day looked much worse than the other, I finally got a clear window this afternoon (12:30am already here). I was so worried that the detoratation pattern will never break. 

Def something that gives me a big hope and will make things more managable.

 

The thing, out of desperation I updosed 4% two days ago, meaning took 2 doses already. The updose didn't have time to register, so the window must not be from it and thus it might be worth getting back down and try and ride this out but I'm afraid to mess my system.

What is your suggestion here? Thanks.

Will it be more wise to return back to 5.5mg or should I keep the new dose?

Thanks !

[Altostrata]

What are the amounts and dates of your updoses? What drugs and dosages are you taking now?

[StrongEnough]

See signature update but I guess I spoke too soon and that the window didnt include sleep time.

Just can't fall asleep despite feeling very calm 😿 so keeping the updose,

Will see what can be done in the sleep symptom thread, 

Thanks

[StrongEnough]

Hey @Altostrata

Update &question :

From the lowest bottom you can only go up they say? So that's what happened. Yesterday I found a solution as to dealing with my stressor and so yesterday when I was finally eating and sleeping normally, I felt asymptomatic ALL day, that's after to remind you that I WAS improving before the stressor escalated.

Tonight, hours after taking my 4th dose of updose, my stomach feels so weird (I'm close to begin the week before my period, but still) and sleep is a bit broken again so my question is - can this indicate a bad reaction to the updose ?

Should I wait 1-2 more days to see a pattern when stressor is gone and if not improving, go back down to 5.5mg or would that be even riskier ?

Thanks a lot ⚘

[Altostrata]

Is this the only updose? 11/1/19- updosed 4% to 5.72 because of severe insomnia.

 

Can you think of any other reasons your stomach might feel weird?