ViolinStudent: Tinnitus - Withdrawal Symptom?

[ViolinStudent]

Hi. I've been on 20mg Seroxat per day since my first panic attack in 2014. I have reduced the dosage according to my home doctor's guidance recently. I reduced to 10mg Seroxat per two days on 1st Nov 2019. Then, a serious tinnitus (a low, constant buzzing) in my right ear started on 6th Nov 2019. (I didn't take any Seroxat on 2nd, 4th and 6th)

 

The local doctors checked my ears and they say the eardrum is fine. So I continued the dosage reduction until 28th Nov. I finally contacted my home doctor and he said it is caused by anxiety (I've been bullied throughout Oct 2019) and Seroxat dosage reduction. He advised me to increase the dosage back to 10mg, or even 20mg Seroxat per day.

 

There's no change in my tinnitus even until now (neither better or worse), which my dosage has increased to 30mg Seroxat per day according to my home doctor's guidance.

 

The tinnitus affects me most when I'm asleep. I'm trying to not fall into a vicious cycle, but I have to wait until 5th Mar, 2020 to see the local Ear, Nose and Throat to have a checkup with professional equipment.

 

Do you think my stress lead to tinnitus?

Do you think the Seroxat dosage reduction leads to tinnitus?

How and when can it stop? I want to sleep normally!

 

Thank you

 

P.S. On another forum people said that my tinnitus is caused by Seroxat, and they asked me to not trust the doctor because doctors know nothing about tinnitus. Do you think I should do so?

[Gridley]

Welcome to SA, ViolinStudent.  I'm sorry you're suffering.  If you're a violin student, tinnitus must be especially troublesome.

 

Tinnitus is a recognized side effect of many psychiatric drugs, including Seroxat.  The package information that comes with Seroxat states:

 

"Common side effects, likely to affect up to 1 in 10 people

• sensations, including in the head, and buzzing, hissing, whistling, ringing or other persistent noise

  in the ears (tinnitus)"

Here is one of SA's threads on tinnitus:

 

Tinnitus, another ear problem. What does all that noise mean ...

 

Your doctor apparently  knows nothing about Seroxat side effects.  He/she also knows nothing about psychiatric drug withdrawal, of which tinnitus is a very common symptom, or safe tapering from psychiatric drugs.  Your doctor reduced your dosage by 50%, which is 5 times faster than we recommend.  We recommend tapering by no more than 10% of current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The fact that your tinnitus began after (and not before)  your 50% taper of Seroxat indicates withdrawal as the cause of your tinnitus, rather than side effects.  

 

What is withdrawal syndrome.

 

You will see that "ringing in ears and other noises" is a common psychiatric drug withdrawal symptom in the following link:

 

Glenmullen’s withdrawal symptom list.

 

To answer your questions:

 

No, stress or anxiety did not lead to your tinnitus. Withdrawal did.  Withdrawal possibly also brought into play the side effect aspect of tinnitus.

 

No, Seroxat dosage reduction does not lead to tinnitus. The exception would be if you reduced too fast, throwing you into withdrawal.

 

How and when can it stop?  As posts in the link about tinnitus indicate, it will stop eventually once you're off the drug and the effects of your too-fast taper fade.   However, that's the very tricky part.  You cannot, in your desire to get off the drug, simply stop it--cold-turkey it.  That could lead to withdrawal symptoms far more unpleasant than tinnitus.  It is very important that you taper safely according to the guidelines given above about the 10% taper.  This link give specific instruction about tapering Seroxat, including how to obtain the small, non-standard doses you will need for your taper.

 

Tips for tapering off Paxil (paroxetine)

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Edited December 20, 2019 by Gridley

[ViolinStudent]

@Gridley

 

Thank you for the detailed answer. I believe I can continue my violin studies even under the current situation.

 

Yes, my home doctor reduced my dosage by 50% (from 10mg per day to 10mg per two days). But it was due to my departure (studying overseas) and it caught him off guard. He didn't advice to taper like this from my memory. But, I will definitely be tapering slower next time.

 

As you have indicated my tinnitus being a withdrawal symptom, and I'm currently on 30mg Seroxat per day, living away from my home doctor, and having my conditions explained to a GP (I live in the UK now), do you think I should inform my GP I want to taper? (P.S. The current GP seems to think the Seroxat reduced my tinnitus perception, so the dosage reduction caused my tinnitus to sound louder???) Yet, I'd like to know how to make use of Seroxat to stop this withdrawal symptom, under the monitor of my GP ASAP.

 

Thank you for reading so many words.

[Gridley]

11 hours ago, ViolinStudent said:

(P.S. The current GP seems to think the Seroxat reduced my tinnitus perception, so the dosage reduction caused my tinnitus to sound louder???)

This doesn't make a lot of sense to me. The Seroxat wasn't preventing the tinnitus.   You didn't have tinnitus at all until you reduced by 50%. (Also the skipping doses on those three days exacerbated the situation, since that was a further 50% reduction each day.)  The dose reduction didn't cause your tinnitus to "sound louder." The reduction created the tinnitus as a symptom of withdrawal.

 

Regarding informing your doctor, that is a complicated situation.  As I said in my earlier post, doctors have no understanding of withdrawal (they don't believe it exists) or safe tapering.  (Your GP's analysis of the cause of your tinnitus doesn't inspire confidence.) Some members don't tell their doctors about their tapering and just use their doctor as a drug source.  Others tell their doctors and receive no help or active opposition to the 10% taper (since they've been taught there's no such thing as withdrawal and thus no need to taper slowly).  These doctors invariably try to convince their patients to taper dangerously quickly. Other patients receive cooperation if not understanding or useful advice.  Obviously, this latter arrangement is the preferable one.  

 

Of some help may be the fact that the United Kingdom's medical treatment arbiter National Institute for Health and Care Excellence (NICE) just revised its guidelines for the use of antidepressants, changing the 2009 guidelines stating withdrawal symptoms were usually "mild" and

"self-limiting " over a week.  The new guideline highlights the possibility of "severe" and long lasting withdrawal symptoms.

 

You might print out this article from the UK's Royal Pharmaceutical Society journal for your doctor, highlighting the relevant portions..

 

https://www.pharmaceutical-journal.com/news-and-analysis/news/nice-amends-depression-guideline-highlighting-severe-and-long-lasting-withdrawal-symptoms/20207226.article

 

Here's a synopsis.
 

  Quote

 

NICE amends depression guideline highlighting 'severe' and long-lasting withdrawal symptoms

 

The Pharmaceutical Journal 22 OCT 2019 By Julia Robinson

 

The National Institute for Health and Care Excellence (NICE) has amended its guidelines on depression in adults to highlight that antidepressant withdrawal symptoms may be severe in some patients.

 

The guidance, which was published in 2009 originally said that antidepressant withdrawal symptoms were usually “mild” and “self-limiting” over the course of a week.

 

The amendment, dated September 2019, clarifies that there can be “substantial variation in people’s experience” and that symptoms can persist for months or more and be “more severe for some patients”.

 

It also advises that before stopping antidepressant medication, patients should discuss the decision with their practitioner.

 

The amendments are in line with a position statement released by the Royal College of Psychiatrists (RCPsych) in May 2019.

... 

 

The first thing you'll need to decide is what method you'll use to taper.  The choices basically are to cut tablets and weigh them, to use a prescription liquid or to make your own liquid.  Details about these methods are in the link below that I previously sent you.  It appears from my Internet research that liquid Seroxat is available in the U.K..  This would be the easiest method but you would of course need to cooperation of your doctor.  If you choose to cut and weigh tablets, many members use the AWS Gemini-20 scale, available on Amazon.  

 

Tips for tapering off Paxil (paroxetine)

 

I'm sorry you're having to deal with this just as you're beginning your studies in a foreign country.  We will help you any way we can.

 

 

 

 

 

Edited December 20, 2019 by Gridley

[ViolinStudent]

@Gridley

I agree. I will inform the local doctor that, the home doctor mentioned tinnitus coincides during tapering, so, I want to taper according to https://www.survivingantidepressants.org/topic/405-tips-for-tapering-off-paxil-paroxetine/

 

Do you think the tinnitus (withdrawal symptom) will still stop if I don't taper? 

[Gridley]

1 minute ago, ViolinStudent said:

 

Do you think the tinnitus (withdrawal symptom) will still stop if I don't taper? 

 

It could.  Withdrawal symptoms eventually go away, but there is no way to predict how long it will take.  

 

 

 

 

[ViolinStudent]

@Gridley I've read the whole 10% tapering page. I've decided to tell my GP I want to taper on Monday while waiting for the tinnitus (withdrawal symptom) to go.

 

I live in the UK, do you suggest any model of pill cutter and electronic scale that measures milligrams?

 

I'm currently on 30mg per day (Dec)

So,

 

Jan: 30 x 0.9 = 27

Feb: 30 x 0.9 x 0.9 = 24.3

Mar: 30 x 0.9 x 0.9 x 0.9 = 21.87

Apr: 30 x 0.9 x 0.9 x 0.9 x 0.9 = 19.683

May: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 17.7147

Jun: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 15.94323

Jul: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 14.348907

Aug: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 12.9140163

Sep: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 11.62261467

Oct: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 10.460353203

Nov: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 9.4143178827

Dec: 30 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 x 0.9 = 8.4728860944

 

Is this correct?

 

Thank you

[Gridley]

I recommend the AWS Gemini 20 scale, available in the U.K. on Amazon.

 

The GEMINI-20 Scale

 

Using a digital scale to measure doses

 

Any kind of pill cutter is fine.  You can also use small scis

 

I'm not sure how you're calculating.  Remembers that it's 10% of current dose, not original dose.  As easier way to do it might be:

 

Jan. 30  30 X 0.9 = 27

Feb. 30  27 X 0.9 = 24..3   

 

Because months have different numbers of days, we use every four weeks as the time measure so the time frame is consistent.

 

 

Edited December 22, 2019 by Gridley
correct math error

[ViolinStudent]

2 hours ago, Gridley said:

I recommend the AWS Gemini 20 scale, available in the U.K. on Amazon.

 

The GEMINI-20 Scale

 

Using a digital scale to measure doses

 

Any kind of pill cutter is fine.  You can also use small scis

 

I'm not sure how you're calculating.  Remembers that it's 10% of current dose, not original dose.  As easier way to do it might be:

 

Jan. 30  30 X 0.9 = 27

Feb. 30  27 X .09 = 24..57   (in a situation like this, you might want to round up to 25 for the sake of simplicity.  Also, the scale 

shows just 3 places to the right of the decimal point, so again you'll need to round up to accommodate that)

Mar. 30  25 X .09 = etc.

 

Because months have different numbers of days, we use every four weeks as the time measure so the time frame is consistent.

 

 

Thanks. I'll get the brand you suggested.

 

I thought 27 x 0.9 = 24.3?

[Gridley]

19 hours ago, ViolinStudent said:

I thought 27 x 0.9 = 24.3?

You're right.

Edited December 22, 2019 by Gridley

[Giulietta]

Hello @ViolinStudent

 

Welcome to SA. I am sorry about your tinnitis. I essentially CT'd from duloxetine/cymbalta (20mg) in December 2018.  I probably went down to 18 mg overnight - it was a medical error - don't CT! I"m glad you are tapering.

 

I put some information about my tinnitus below and how I coped if youa re interested.

 

About my tinnitus...

I had 6 months of varying levels of tinnitus - it started promptly in the afternoon and was very loud - ranging from crickets, to tones of different pitch, to everything else. It abruptly stopped in June of this year (to be replaced by WD symptoms I would have traded for the tinnitus).   In February - the tinnitis was so bad (and mine often more prevalent in my left ear) - that I went to the ENT. I also had terrible sharp pain in my left ear (concurrently) - it woke me up at night and was brutal.

 

The first question the ENT asked was if I was getting off of ADs. Yes I was. He indicated the association between getting off ADs and tinnitis was common.  I asked why - and he indicated a link wtih anxiety but not much more than I could understand.  My auditory exam indicated that my hearing is quite good. I was thrilled. My physical exam was also fine.

 

I learned the ear pain was the result of TMJ. This is also related to the WD from the AD. I take gabapentin as well - and this drug is associated iwth TMJ. The  withdrawal exacerbated this at the same time. I occasionally get the ear pain.

 

The good news is that the tinnitus goes away. I have read other people having tinnitus - and it can last for months. I still do have it from time to time - but not like the first 6 months.

 

How I coped....I distracted myself. I found that using earbuds and listening to music helped. Sometimes watching the TV helped. In general - being in a somewaht noisy environment was useful.

 

And here's a link I found on youtube when I was desperately looking for information. 

 

 

Wonderful you are a student of the violin. I love classical music.

 

 

 

 

[ViolinStudent]

@Guilietta Thank you for the support!

[TonyW]

HI @ViolinStudent, I hope you are feeling better now. Please post an update if you feel like it.

[Wagen]

@ViolinStudent

 

Did your buzzing in head/ears resolve - Ive had in now for two months after stopping amitriptyline. It feels like very load electrical buzzing in my ears and head with intermittent tinnitus sounds in both ears. Im still taking mirtazapine and have horrible sleep problems. Could you please let me please know your experience. Thank you very much!

[ViolinStudent]

Hi. I have the AWS Gemini-20 scale, which I bought for paroxetine tapering plan according to https://www.survivingantidepressants.org/topic/405-tips-for-tapering-off-paxil-paroxetine/. However, when I put a 20mg tablet I got on the scale, it shows 0.247g??? I thought 1mg = 0.001g, so 20mg = 0.02g?

 

I'm so confused. Am I using it wrong and how do I calculate with this? Thank you.

 

[ViolinStudent]

On 5/15/2020 at 11:49 PM, TonyW said:

HI @ViolinStudent, I hope you are feeling better now. Please post an update if you feel like it.

I have managed to not let the tinnitus affect me, but it is still going on, haven't worsened but haven't lessened. I've finished my master's in music performance despite the tinnitus. I'm still on my paroxetine tapering plan and currently on 5.003154509899971mg‬ per day. I was supposed to go to the Ear, Nose and Throat on 5th Mar, 2020 but I couldn't make it due to traffic jam. One year later I've finally got my ENT appointment again (postponed again and again due to COVID), which is today afternoon. I'm a bit nervous now. Do you think withdrawal-based tinnitus can cause hearing damage?

[ViolinStudent]

On 2/25/2021 at 8:29 AM, Wagen said:

@ViolinStudent

 

Did your buzzing in head/ears resolve - Ive had in now for two months after stopping amitriptyline. It feels like very load electrical buzzing in my ears and head with intermittent tinnitus sounds in both ears. Im still taking mirtazapine and have horrible sleep problems. Could you please let me please know your experience. Thank you very much!

It hasn't stopped yet. How did you stop your amitriptyline? My tinnitus started when I went from 10mg per day to 10mg per two days according to doctors instructions. Unfortunately the doctors seem to not believe in tinnitus caused by antidepressant withdrawal. However I'm glad I've found this forum so I see a ray of hope.

[getofflex]

https://www.survivingantidepressants.org/topic/22067-violinstudent-tinnitus-withdrawal-symptom/?do=findComment&comment=529325

 

Quoted post merged from tapering forum to keep your history all in one place.

 

Please keep all your questions and updates about your situation in this one thread.  That way, we can keep track of your history and everything will be in context.  Thank you.  

[getofflex]

Measuring doses as we taper can be a challenge.  Here is a link that explains in detail how to do this using scale such as you have.  

 

Using a Digital Scale to Measure Doses Weighing

[ViolinStudent]

Update 15/04/2021:

My hearing is within the normal range after the hearing screening today; there is no hearing loss. However, I'm still waiting for the ENT appointment, which has been postponed forever since COVID.

[ViolinStudent]

14 hours ago, getofflex said:

Measuring doses as we taper can be a challenge.  Here is a link that explains in detail how to do this using scale such as you have.  

 

Using a Digital Scale to Measure Doses Weighing

I still don't understand why when I put a 20mg tablet I got on the scale, it shows 0.247g??? I thought 1mg = 0.001g (so 20mg should be = 0.02g)?

[DaBro]

I would think the 20mg (0.02g) is the active ingredient weight and the rest (0’227g) is fillers. 

[ViolinStudent]

8 hours ago, DaBro said:

I would think the 20mg (0.02g) is the active ingredient weight and the rest (0’227g) is fillers. 

Omg. Then how do I know how many mg I should cut out of the 0.247g to get 5mg?

[brassmonkey]

Hi ViolinStudent--  making the calculations for a dose can get pretty confusing at times until you get use to it. We are always here to help with the numbers.

 

As you have figured out a full tablet will weigh 0.247g according to the scale. By moving the decimal point we go from grams to milligrams and get 247mg. So the full tablet weighs 247mg. The strength of the tablet is 20mg. As DaBro pointed out this is part of the weight of the tablet. This makes the tablet a small part (20mg) active ingredient and the rest is fillers used to make the  tablet big enough to handle easily. Because the manufacturers of the tablets are very careful the active ingredient is mixed very evenly throughout the tablet so no matter what part of the tablet you take you get an equal amount of medication.

 

Your tablets have a strength of 20mg. If you are wanting a dose of 5mg you want to take 1/4 (25%) of a full tablet. 20/5=4 This means that you would take 1/4 of a full tablet to get the dose you desire. 247/4=62. If you weigh out 62mg or 0.062g according to the readout on the scale, you will be getting a 5mg dose.

[ViolinStudent]

13 hours ago, brassmonkey said:

Hi ViolinStudent--  making the calculations for a dose can get pretty confusing at times until you get use to it. We are always here to help with the numbers.

 

As you have figured out a full tablet will weigh 0.247g according to the scale. By moving the decimal point we go from grams to milligrams and get 247mg. So the full tablet weighs 247mg. The strength of the tablet is 20mg. As DaBro pointed out this is part of the weight of the tablet. This makes the tablet a small part (20mg) active ingredient and the rest is fillers used to make the  tablet big enough to handle easily. Because the manufacturers of the tablets are very careful the active ingredient is mixed very evenly throughout the tablet so no matter what part of the tablet you take you get an equal amount of medication.

 

Your tablets have a strength of 20mg. If you are wanting a dose of 5mg you want to take 1/4 (25%) of a full tablet. 20/5=4 This means that you would take 1/4 of a full tablet to get the dose you desire. 247/4=62. If you weigh out 62mg or 0.062g according to the readout on the scale, you will be getting a 5mg dose.

Thank you very much. Now I understand the mechanism of fillers and active ingredient. So the equation is as follows:

strength per capsule: 20mg

∵ actual weight per capsule: 0.254g (this one is different) = 254mg
∴ 254mg x (5.003154509899971‬ / 20) = 63.54006227572963mg

So, do I need to calculate the amount to cut and take according to individual capsules, or just take 254mg as the actual weight? Thank you.

[brassmonkey]

We find that it is easiest to use the average weight of 10 tablets and work from there.  Because the dose you weigh out will be smaller than the original tablet once the first calculations have been done the original weight of the tablet drops out of the calculation. The tablet becomes a "supply pile" from which you only take what you need.

 

You referred to you pills as capsules. Are they capsules containing powder or hard tables that you need to crush or cut up? If they are capsules with powder you will need to take the powder out of them to determine the "pill weight" or the weight of the bulk material. Even though the weight of the empty capsule is small it will throw off the calculations.

 

Also we follow standard rounding rules for most calculations with a preference to round up. For most medications we see, once you go one or two places past milligrams the amount of active ingredient is so small it doesn't have any impact on the dose strength. 

 

Would you please list the name of the medication in your signature.

 

When you are ready to start tapering I can show you some easy calculations for determining each new dose.

[ViolinStudent]

On 4/17/2021 at 8:12 PM, brassmonkey said:

We find that it is easiest to use the average weight of 10 tablets and work from there.  Because the dose you weigh out will be smaller than the original tablet once the first calculations have been done the original weight of the tablet drops out of the calculation. The tablet becomes a "supply pile" from which you only take what you need.

 

You referred to you pills as capsules. Are they capsules containing powder or hard tables that you need to crush or cut up? If they are capsules with powder you will need to take the powder out of them to determine the "pill weight" or the weight of the bulk material. Even though the weight of the empty capsule is small it will throw off the calculations.

 

Also we follow standard rounding rules for most calculations with a preference to round up. For most medications we see, once you go one or two places past milligrams the amount of active ingredient is so small it doesn't have any impact on the dose strength. 

 

Would you please list the name of the medication in your signature.

 

When you are ready to start tapering I can show you some easy calculations for determining each new dose.

The only type of tablets I have access to here is 20mg tablets.

I used the term "capsules" incorrectly; they are "cuttable" tablets.
Round up: can you give an example? Is it round off or always rounded up, and starting from which decimal?
I have updated my signature. I've always taken Paroxetine.
Thank you.

[brassmonkey]

For rounding we find it best to go to the next highest milligram. If your calculation ends up being 0.1536335 the next highest milligram would be 0.154. Any of the numbers past that will represent such a small dose that they will not make a difference in general tapering. In theory if you rounded down to 0.152 you would be getting less medication, making for a bigger than planned reduction and stand a better chance of triggering WD symptoms. We try to stay on the side of caution. Especially with paroxetine.

 

Paroxetine had a reputation for being the worst AD to try and get off of. It can be done but you have to pay attention. I tapered from 40mg with no problems and I have know people who have CTed from 60mg and recovered. I strongly recommend against CTing. There are several option available: taper using the tablets, make or buy liquid paroxetine and taper with that, or cross taper to prozac and taper that once stable. Each has it's challenges and it's advantages.

 

It appears that you are familiar with the 10% every 4 weeks that we suggest as a baseline taper. This works well, but may require some fine tuning. There is a variation called the Brassmonkey Slide Method which is 25% a week for 4 weeks with an additional 2 week hold for a total of 10% every 6 weeks. Both of these can be done with either powder from crushed tablets or with liquid.

 

The crossover to prozac is just that. Over the course of several weeks a person would replace the paroxetine with prozac eventually stopping the paroxetine and using just the prozac. Once stabilized they would then taper the prozac. Prozac is chosen because it is the easiest AD to taper. I have seen that this method has less than a 50% success rate and don't recommend it, while others here are very enthusiastic about it. 

[ViolinStudent]

Use the average weight of 10 tablets instead of individual tablets, I see.

 

0.1536335 to 0.154 instead of 0.152; I thought rounding down is to 0.153? However I get what you mean, just round up to the next highest milligram.
i.e. 254mg x (5.003154509899971‬ / 20) = 63.54006227572963mg = 64mg (rounded up)?

 

Prozac: I only have access to Paroxetine, and I plan to stick to the traditional 10% method.

 

Thank you. I will follow the guide.

 

 

[ViolinStudent]

On 4/19/2021 at 8:52 PM, brassmonkey said:

For rounding we find it best to go to the next highest milligram. If your calculation ends up being 0.1536335 the next highest milligram would be 0.154. Any of the numbers past that will represent such a small dose that they will not make a difference in general tapering. In theory if you rounded down to 0.152 you would be getting less medication, making for a bigger than planned reduction and stand a better chance of triggering WD symptoms. We try to stay on the side of caution. Especially with paroxetine.

 

Paroxetine had a reputation for being the worst AD to try and get off of. It can be done but you have to pay attention. I tapered from 40mg with no problems and I have know people who have CTed from 60mg and recovered. I strongly recommend against CTing. There are several option available: taper using the tablets, make or buy liquid paroxetine and taper with that, or cross taper to prozac and taper that once stable. Each has it's challenges and it's advantages.

 

It appears that you are familiar with the 10% every 4 weeks that we suggest as a baseline taper. This works well, but may require some fine tuning. There is a variation called the Brassmonkey Slide Method which is 25% a week for 4 weeks with an additional 2 week hold for a total of 10% every 6 weeks. Both of these can be done with either powder from crushed tablets or with liquid.

 

The crossover to prozac is just that. Over the course of several weeks a person would replace the paroxetine with prozac eventually stopping the paroxetine and using just the prozac. Once stabilized they would then taper the prozac. Prozac is chosen because it is the easiest AD to taper. I have seen that this method has less than a 50% success rate and don't recommend it, while others here are very enthusiastic about it. 

Follow up question: do I need to measure the average weight of 10 tablets everytime I have used up the 10 tablets?
This is because if I set the actual average weight per capsule always the same (the current 10 tablets: 241.8mg), I can ensure the dosage is always reduced 10% constantly in the next 28-days cycle?
Or is this decision wrong? Pelase advise.

Thank you.

[brassmonkey]

You only need to calculate the average of 10 tablets when you do your initial dose calculation to determine a starting place. From there all the subsequent calculations are chained off of the last number calculated. After the initial calculation and reduction the tablets then become a "supply pile" from which you only take the amount you need to make up the dose, so the actual weight of the tablets becomes irrelevant. 

 

It looks like you will be combining a whole tablet and a some that you weigh out to make up your dose using 20mg tablets. Using the average weight of the tablets you could determine the total weight of the dose needed. Place a whole tablet in the weight pan and add powder until the calculated dose weight is reached. This will counteract any differences in the weight of the whole tablets.

 

When you do the averaging for the whole tablets, you will find that they only differ by a few milligrams. You posted an average weight for a tablet as being 242mgpw (milligrams pill weight) and you have stated that they are 20mgai (milligrams active ingredient) in strength.

 

20/242 = .08

 

This is the ACI (Active Ingredient Concentration) for you tablets. If you change to different tablets this could change. This means that there is 0.08mgai in each 1mgpw of tablet.  So you can see that a few milligrams of difference in pill weight won't change your dose strength by very much. This tiny difference shouldn't be a factor until you get to the Endgame of your taper, or are extremely sensitive to the medication.  So I wouldn't worry about it.

[ViolinStudent]

14 hours ago, brassmonkey said:

You only need to calculate the average of 10 tablets when you do your initial dose calculation to determine a starting place. From there all the subsequent calculations are chained off of the last number calculated. After the initial calculation and reduction the tablets then become a "supply pile" from which you only take the amount you need to make up the dose, so the actual weight of the tablets becomes irrelevant. 

 

It looks like you will be combining a whole tablet and a some that you weigh out to make up your dose using 20mg tablets. Using the average weight of the tablets you could determine the total weight of the dose needed. Place a whole tablet in the weight pan and add powder until the calculated dose weight is reached. This will counteract any differences in the weight of the whole tablets.

 

When you do the averaging for the whole tablets, you will find that they only differ by a few milligrams. You posted an average weight for a tablet as being 242mgpw (milligrams pill weight) and you have stated that they are 20mgai (milligrams active ingredient) in strength.

 

20/242 = .08

 

This is the ACI (Active Ingredient Concentration) for you tablets. If you change to different tablets this could change. This means that there is 0.08mgai in each 1mgpw of tablet.  So you can see that a few milligrams of difference in pill weight won't change your dose strength by very much. This tiny difference shouldn't be a factor until you get to the Endgame of your taper, or are extremely sensitive to the medication.  So I wouldn't worry about it.

Thank you. The 242mg per tablet was just an example. I have calculated the actual average weight per tablet from 10 tablets; it is 241.8mg.

 

Here's my calculation for the current dose, please correct me if I'm wrong:

 

∵ actual average weight per tablet x (active ingredient according to 10% tapering plan / active ingredient per tablet) = actual weight to take [rounded up to the next milligram]
∴ 241.8mg x (5.003154509899971‬ / 20) = 60.48813802469065 ≈ 61mg

 

As a result, I've been cutting 20mg tablets (actual weight ≈ 241.8mg) to 61mg portions, measured by the AWS Gemini-20 scale every morning to take. (during the current 28-days period)

Thank you.

[brassmonkey]

My mistake about combining the whole tablet with some powder, for some reason I remembered that you were taking a larger dose.

 

Yes, that calculation looks fine. Now that you have established the weight of your initial dose (61mgpw), when it comes time to make your next reduction the calculation is much easier. Current dose weight X 90% = new dose weight. So 61mgpw X .9 = 54.9mgpw (rounded to 55mgpw). Because the strength of the dose is proportional to the weight it will also decrease by the same 10%.

[ViolinStudent]

On 4/24/2021 at 8:24 PM, brassmonkey said:

Now that you have established the weight of your initial dose (61mgpw), when it comes time to make your next reduction the calculation is much easier. Current dose weight X 90% = new dose weight. So 6

Thank you. Now I understand the actual average weight per tablet is constant. Hope the withdrawal symptom [tinnitus] stop once I've finally tapered successfully.

[brassmonkey]

Tinnitus is one of those symptoms that will come and go through out a taper. It will show up for a while, fade and then return at a later date. By the time you have completed your taper it should be pretty well gone.

 

One form of tinnitus I found interesting was the "phantom radio station".  Sometimes, when drifting off to sleep, I would hear Swing Music as if being played on the radio. It was really quite fun and relaxing.

[ViolinStudent]

On 12/20/2019 at 9:00 AM, ViolinStudent said:

Hi. I've been on 20mg Seroxat per day since my first panic attack in 2014. I have reduced the dosage according to my home doctor's guidance recently. I reduced to 10mg Seroxat per two days on 1st Nov 2019. Then, a serious tinnitus (a low, constant buzzing) in my right ear started on 6th Nov 2019. (I didn't take any Seroxat on 2nd, 4th and 6th)

 

The local doctors checked my ears and they say the eardrum is fine. So I continued the dosage reduction until 28th Nov. I finally contacted my home doctor and he said it is caused by anxiety (I've been bullied throughout Oct 2019) and Seroxat dosage reduction. He advised me to increase the dosage back to 10mg, or even 20mg Seroxat per day.

 

There's no change in my tinnitus even until now (neither better or worse), which my dosage has increased to 30mg Seroxat per day according to my home doctor's guidance.

 

The tinnitus affects me most when I'm asleep. I'm trying to not fall into a vicious cycle, but I have to wait until 5th Mar, 2020 to see the local Ear, Nose and Throat to have a checkup with professional equipment.

 

Do you think my stress lead to tinnitus?

Do you think the Seroxat dosage reduction leads to tinnitus?

How and when can it stop? I want to sleep normally!

 

Thank you

 

P.S. On another forum people said that my tinnitus is caused by Seroxat, and they asked me to not trust the doctor because doctors know nothing about tinnitus. Do you think I should do so?

 

Edit: 

 

Hi. I've been on 20mg Seroxat per day since my first panic attack in 2014, then 10mg per day until reducing the dosage according to my home doctor's guidance recently. I reduced to 10mg Seroxat per two days on 1st Nov 2019. Then, a serious tinnitus (a low, constant buzzing) in my right ear started on 6th Nov 2019. (I didn't take any Seroxat on 2nd, 4th and 6th)

 

Edited February 4, 2022 by ChessieCat
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