Roberson: Paxil tapering; stick or back step?

[Roberson]

Hello.
I have been reading threads through this forum and finally I have the courage to ask for help.
I saw the wonderful work that you all do here, so first of all, I would like to congratulate all of you involved in helping people.

 

Since 2002 I use antidepressants intermittently.

 

In 2016, due to an undiagnosed withdrawal syndrome, I was gradually subjected to a multidrug regimen.

 

So, since April 2014, I'm on these  drugs:
Paxil - 20mg initially -
Depakote SR 1000mg
Modafinil 200mg
450mg lithium
Aripiprazole 1mg

 

In February 2020, I finally found a doctor who believed in me as having a withdrawal syndrome in 2016 and we started a regime of gradual decrease in Paxil.

 

I reduced it, in a 4-week way, to 18mg, then 15mg and 10mg. At 10 mg after 4 days, I had terrible symptoms and then went back to 15 mg.

 

I stayed on 15 mg for 4 weeks and it dropped to 13 mg. Five days ago, after about four weeks, I decreased the dose to 11.7 mg and yesterday I started to feel terrible. Anxiety, complete loss of appetite, lethargy, cold and so on.

 

 

I'm sure someone in this forum has asked that question before, but I'm so mentally altered that I can't look for it.
So my question is, should I stick with 11.7 mg or should I go back to 13 mg for a new 4-week course and try to reduce again?

 

I appreciate any help, guys!

Edited June 10, 2020 by Gridley

[Gridley]

Welcome to SA, Roberson. 

 

Since it's only been five days on 11.7mg, I would go back up to 13 and hold for several months to let your system catch up with all the changes you've made.  You should not taper any more until you have stabilized.

 

You are tapering too fast.  We recommend tapering by no more than 10% of your current dose every four weeks.  Your latest reduction was 10%, but some of your previous drops were larger. Withdrawal can be delayed, and the effects of these previous too-large reductions can add up. Your brain likes stability, to be treated gently.  It is ideal to accommodate it to lower and lower dosages, moving it  slowly down a ramp by gradually decreasing dosage by an amount it may hardly notice.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Paxil.

 

Tips for tapering off Paxil (paroxetine)

 

Here is some information on withdrawal and the healing process. The symptoms you describe are typical withdrawal symptoms.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

When we take psychiatric medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  

 

These explain the healing process really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

Brain Remodelling 

 

In addition to the Paxil, are you currently on the following drugs: Depakote SR 1000mg, Modafinil 200mg, Lithium 450mg, Aripipprazole 1mg?  

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems.

 

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

 

 

 

 

 

 

[Roberson]

Hello, Gridley.
thanks for your so quick response.
I started taking 13mg of paxil again and it was remarkable how I'm already feeling better. I'm wondering how a so tiny amount of medication could produce so much distress...

 

And yes, I'm on Depakote SR 1000mg, Modafinil 200mg, Lithium 450mg and Aripipprazole 1mg. They were added after I had my first WD symptons in 2016, as docs thougth these symptons were from my initial condiiton. 

 

Nevertheless I'm moving on. And my strategy is that in 3 months I'll try to decrease Paxil again to 11.7mg.  What do you think?

 

About supplements, I've just initiated omega 3 and already ordered magnesium.

 

Again, thank you so much for your support.

[Gridley]

15 minutes ago, Roberson said:

And my strategy is that in 3 months I'll try to decrease Paxil again to 11.7mg.  What do you think?

Let's wait and see how you're feeling in three months.  We always say go by what your body says rather than a schedule.  It may be fine to taper at that point or you may need a bit longer to stabilize.

 

That's great that you're already feeling better.