omnispan: hitting the slopes of paroxetine withdrawal

[omnispan]

Personal update:

 

Since my regular use of the space heater while I sleep, I haven't had any more of those miserable days that came about when the outside temp dropped.  Even when we had a few days well below freezing.

Good investment for me!    I wish I got this heater years ago.

I also started carting it along to my office room, and in there I keep it a toasty 85°, and i absolutely love it.

 

 

Moods been quite stable over the past week or two, with a few hiccups here and there.  Not the best but not the worst either, follows the usual moody morning into better evening pattern.

 

 

Winter blues been coming in for sure.

I can't tell what mood changes I can attribute either to winter or WD-shenanigans yet (except those two bad days pre-heater were weather-induced)

I can for sure tell that the increased sleepiness and demotivation over the last few weeks is from the weather, those happen every winter without fail.

 

 

Got a good rapport going with my therapist, still a lot of work to be done, I'm looking forward to it.

 

 

One month left of college till I'm done for good with double CS/math majors, oh boy!

 

[Carmie]

On 11/16/2021 at 3:35 PM, omnispan said:

Personal update:

 

Since my regular use of the space heater while I sleep, I haven't had any more of those miserable days that came about when the outside temp dropped.  Even when we had a few days well below freezing.

Good investment for me!    I wish I got this heater years ago.

I also started carting it along to my office room, and in there I keep it a toasty 85°, and i absolutely love it.

 

 

Moods been quite stable over the past week or two, with a few hiccups here and there.  Not the best but not the worst either, follows the usual moody morning into better evening pattern.

 

 

Winter blues been coming in for sure.

I can't tell what mood changes I can attribute either to winter or WD-shenanigans yet (except those two bad days pre-heater were weather-induced)

I can for sure tell that the increased sleepiness and demotivation over the last few weeks is from the weather, those happen every winter without fail.

 

 

Got a good rapport going with my therapist, still a lot of work to be done, I'm looking forward to it.

 

 

One month left of college till I'm done for good with double CS/math majors, oh boy!

 

Hi omnispan, 

 

I’m glad that your space heater is giving you some comfort. So happy too that your moods haven’t been too bad and you get on well with your therapist. How do you feel your therapist has been of benefit to you?

 

Have a happy day☀️☀️☀️

 

 

[omnispan]

On 11/26/2021 at 4:39 PM, Carmie said:

I’m glad that your space heater is giving you some comfort. So happy too that your moods haven’t been too bad and you get on well with your therapist. How do you feel your therapist has been of benefit to you?

She's okay.  Its hard to accomplish much in a 1 hour session every week when so much is going on with WD.  She's open minded (but hesitantly) to the concept of WD, I got her some white papers from the site here that she went out of her way to read in her off hours!

[omnispan]

And a brief case history update, building upon my discussion of the compound crossover I discussed many weeks ago, and a silver lining:

 

(On an aside, my dose split is currently at 9am and 3:45pm, still pecking away at it until the second is at 9pm)

 

The completion of my crossover to the compound brought upon a strong increase of negative symptoms the day after the crossover, that I'm slowly recovering from.  Not unfamiliar symptoms, but more intense and present more hours of the day than before.  That started around the 16th, several weeks ago.

Interestingly enough, the week and a half during the crossover (before the completion) was actually very stable.  After that, well, that sucked.  A lot.

 

But things changed a lot on December 1st, in a very very good way.  I started practicing...

Mindfulness!

About a week before, I had purchased the book Peak Mind by Amishi Jha, a researcher who focuses on ways to strengthen/improve people's' attention and focus.  Shes been in the field for decades, and her go to training program is based on mindful meditation, of which she has refined her program over many years.

I had slowly been reading the book, and I planned on starting the program when the first exercise was introduced, which was several days before the 1st.

 

Once I started actually applying the practices to dealing with WD symptoms, it was an absolute gamechanger. 

Literally my entire life, my approach to dealing with anxiety was to relentlessly think about the triggers, over and over and over and over.  In some vain attempt to force myself to think about it "better", or something.  I don't know.

It never occured to me that I don't have engage with the thoughts to begin with.  Engaging with the negative thoughts would just lead to downward spirals of doom and despair.  Once I learned to cut it off before the spirals grow into an issue, well, things got so much easier to manage.

 

In terms of WD, the spirals would be something about the duration of suffering I would have to endure until im done with WD, and endlessly ruminating over that and every associated negative hypothetical my brain could conjure.

A key thing I learned once I started managing these spirals better, was that the spirals were a self-fufilling prophecy.  Worrying so much about WD was literally making WD worse.

There a definitive contrast in WD intensity (both mood/mental and physical symptoms) in weeks before the 1st, and the days since the 1st.

WD stills kicks my butt when it wants to, but now I have the tools to be able to not let it get the better of me.

 

I'm back in the driver seat again.  And I actually feel like I have the means to succeed, for the first time in a very long time.

 

[omnispan]

Hey SA, it's been a bit.  I'm chugging along, not great, but things have been stabilizing to a place I can deal with.

Until however, the past few weeks I have been dealing with a severe new issue that I need rapid advice on.  I'm wondering if any of you have dealt with issues with Magnesium supplementation.  

 

Two years ago I started taking Magnesium glycinate lysinate chelate tablets (100 mg daily) as recommended after my initial failed rapid taper.  Three to four months ago I switched to taking half in afternoon and half in evening.  No noticeable issues with the Mg until about a month ago, although I was dealing with fluctuating other symptoms that may have masked Mg symptoms.  A couple weeks ago I made the connection, my regular spike in symptoms each afternoon were happening shortly after the mag dose.  They included, but were not limited to:  DP, disinterest, confusion, eyes feel uncoordinated, tingly pressure in the forehead (and sometimes extending into the scalp), cognitive issues, memory issues.   Symptoms varied inconsistently day-to-day, varied in both presence and severity. None of the symptoms were severe, but disrupting all the less.  The spike would come on quickly over about half an hour, in stark contrast to the usual slow variation of everything else through the day. 

 

Looking back at my symptom logs, it's pretty obvious to me that the spike in symptoms is happening 15-45 minutes past my early afternoon magnesium dose.   I tried skipping an afternoon dose and didn't have typically afternoon spike of symptoms.  However, later afternoon/early evening, I had different cognitive issues that I hadn't experienced before, primarily confusion.  I wrote in my journal that it was "like how if you take a sentence and randomly swap some words around, that's what my entire conscious thinking ability feels like".  I also noted that "Things have felt weird and new, like a completely new experience" . This included some tight chest/difficulty breathing, a strange 'clammy' front of tongue (completely new), general weakness along front of chest and upper arms, a strong sense of feeling off, weird, very unpleasant.  A sadness/crying urge come on, peak, and stick around through the evening.

 

Since then, I tried to wean off of Mg by reducing by 5 mg/day, until I stopped at 25mg when major issues arose.  I've also tried spreading the dosage throughout the afternoon by mixing a powdered form in water.  Things settled down for a few days with the initial decreasing dose.  However, I started increasingly react to each dosing in the afternoon, when I would intake even just ~1 mg and immediately start experiencing "electrical" feelings along the top of my scalp, and a pressure in my forehead.  The severity seemed to correlate with the dose.  Shortly after that I would feel a brain fog, kind of like depersonalization.  Directly paired with the cognitive issues was a distinct increase in visual snow in my peripheral vision. 

 

Oddly enough, my usual 50mg evening dose caused minor/no issues.

 

I theorized that perhaps, spreading the magnesium dose over several hours dissolved in water, ended up increased the magnesium I was absorbing, which might've been the cause of the increased reaction.  As such, yesterday, I dropped my afternoon dose from 25mg to 5mg, and my evening from 50mg to 25mg. The severe afternoon-demolishing reactions got far more manageable, and made yesterday probably the best day in the last week or two.  I felt like I figured it out!  Except, I immediately had a severe reaction to the evening dose, which was completely uncharacteristic.  I almost feel like the bigger afternoon doses primed my body so the evening one was no big deal, but the lower afternoon dose mitigated it.

 

Today, things got even weirder.  At 11am, before I had taken any magnesium, I experienced a rapid onset of what basically was my usual severe afternoon reactions.  Since then things have behaved exactly like the severe reaction, even as my 5mg over the afternoon didn't have any strong immediate reactions.  Several new symptoms showed up today, including a cold flash, return of the clammy tongue feeling (first and last time it showed was two weeks ago), strong memory issues, temperature sensitivities (especially hands/feet), and others I could find if I dug through my journal.  Googling magnesium deficiency symptoms shows some parallels.

 

This feels totally unrelated to the paroxetine issues.  Granted, the taper probably caused the sensitivity, but the paroxetine doses itself don't seem to affect this situation.  Many of these symptoms I haven't experienced before this week.

 

I'm worried about changing my Mg intake, even though the mere taking of it creates severe issues.  I cannot tell whether the correct choice is to decrease, increase, change back to tablet, or another option.  It feels like I'm reacting to both the presence and the absence of the magnesium.  I feel completely lost in a situation I feel needs to be addressed rapidly.

 

Have any of you experienced something similar?  Any suggestions?


 

[omnispan]

So that magnesium mess was an ordeal, but I've stabilized a lot better from it by now.   I've stopped the afternoon mag and take 25mg at night.

 

A handful of symptoms I was experiencing in the months past and more so during the magnesium tampering have gone away and not returned, a good sign that the mag was indeed causing some issues.

 

Most of the new symptoms that sprung up with the tampering have diminished a lot, but still hang around.  Mostly all happen around the several hours of the day past the time I used to take the afternoon mag at.

 

Most of it is sensory nervous system stuff, very akin to neuropathy.  Mostly in my hands, sometimes arms.  All of it has been progressively improving over the past weeks.  Its annoying but doesn't get in the way as it did.

 

Hopefully they won't take too long to fade away into the background.  Only time will tell, I was taking all that mag for 2 years and its been just two weeks since I reduced it by the 75%

[omnispan]

Okay I am in an urgent paradoxical reaction situation.  @Altostrata I'm so sorry for pinging you directly but I need some rapid advice from someone who has probably seen similar situations.  I have extensive documentation about a lot of this whole mess.

 

One month ago (Feb 23) I had started 1mg Prozac daily in order to assist the Paxil issues.

After two severe waves I stopped the prozac (12 days ago, Mar 19), immediately had an amazing window for a week, then things slowly slid down into a more consistent ugly place where I am right now.  I am currently severely struggling, ideation is a severe issue, and hospitalization is increasingly seeming a necessary avenue.

 

I need to figure out if the best option is reinstatement (in case I adapted to the Prozac and am now withdrawing from it) or just waiting it out (because it was just 1mg).

 

 

 

Background:

My new psychiatrist has had experience with people having issues removing Paxil, and her standard regimen was to do a substitution to Prozac first, and go from there. 

She convinced me to try it, she wanted to do 5mg, I said start at 1.

 

Things went smoothly the first week, I actually saw some mild improvements on day #3-#6 that were very nice.

 

But then all hell broke loose start of week 2 (day #7).  Several brand new symptoms and some severe intensifications of others in a way I hadn't experienced before.   

Most prominent one was severe cognitive issues directly accompanied by strong depression.  Other ones include heartbeat/breathing issues, abnormal visual sensations, excessive sweating intermixed with a strong cold sensitivity, very strong arm/leg weakness, appetite issues, drowsiness.  The intensity of most of them is directly correlated to each other.

 

 

Daily summaries:

#0, Feb 23 : Start prozac

#3, Feb 26 (Good?) : Start noticing improvement

#4, Feb 27 (Good) 

#5, Feb 28 (Good)

#6, Mar 1 (Okay)

 

#7, Mar 2(Severe): Pain.  All the new stuff comes rapidly, in a very messy and chaotic form.

#8, Mar 3 (Moderate):  Same stuff, not nearly as bad

#9, Mar 4 (Severe): Like #7, much less messy, but worse mood (gravity of situation setting in)

#10, Mar 5 (Moderate): Like #8 but a bit better

#11, Mar 6 (Severe) : Like #9 but mildly better

 

#12, Mar 7 (Moderate->Mild): Bad morning, but settles well in the afternoon

#13, Mar 8 (Mild) : Better

#14, Mar 9 (Mild) : Small improvement

#15, Mar 10 (Mild) : Small improvement

#16, Mar 11 (Moderate) : Flare up, bit yucky

#17, Mar 12 (Moderate) : Same thing, but bit more questionable/unstable

#18, Mar 13 (Moderate) : Same thing, but bit more questionable/unstable

 

#19, Mar 14 (Moderate->Severe) : Same thing in the morning. Late in the evening things break apart, cognitive-issues/depression rushes back onto the playing field.

#20, Mar 15 (Severe->Mild) : Lingers into the morning, improves over the day into the evening

#21, Mar 16 (Mild) : Mood still fluctuating a lot, but manageable.

#22, Mar 17 (Moderate->Severe): Morning spike, improves a bit into the afternoon, then falls back into the gutter.  Obsessively ruminating.

#23, Mar 18 (Severe) : Fairly unchanging day, but Profound cognitive issues w/ depression, feel like a broken man soon to become a casualty.  Don't really even want to revisit the memories of this day, one of the worst days of this whole taper experience. Decide to stop prozac.

#24, Mar 19 (Severe->Moderate): Stopped Prozac.  Yucky morning into a calmer evening

 

#25, Mar 20 (Moderate->Mild):  Even better of a day

#26, Mar 21 (Mild) : Good day

#27, Mar 22 (Mild) : Good day, a hairline of questionable stuff returns.

#28, Mar 23 (Mild) : Same story, a bit more of a hairline of stuff

#29, Mar 24 (Moderate) : Same story, but I also start waking up an hour earlier than I usually do.  Marked symptom instability.

#30, Mar 25 (Mild) : Very good day

#31, Mar 26 (Moderate):  Bit of an "average" of #29 and #30, in between the two.

#32, Mar 27 (Moderate):  Bit of another average of #30 and #31, effectively better than #31.  Morning cortisol spike comes two hours earlier, stronger than usual.

#33, Mar 28 (Moderate) :  Noticeably stronger symptom instability, morning spike a lot stronger.  Woke up sweating and uncomfortable.

 

#34, Mar 29 (Mild->Severe) : Morning is great, start noticing stuff around noon, degrades severely in the afternoon/evening.  Late night becomes affected far more than it usually does.  Wasn't a horrible night, but haven't had that bad of a night in a very long time.

#35, Mar 30 (Severe) : Woke up twice in the night, been months since that has happened. Whole day is just cognitive depressive yuckiness.  A brief reprieve around noon but deteriorates quickly after.  Late night calms

#36, Mar 31 (Severe) : A lot of the same stuff. Sleep over the night wasn't an issue, initially woke up even earlier though. Very minor improvement into the evening. Stuck in a cognitive limbo, don't see anyway out.  Wishing I knew what I could do.  This wave is more prolonged than the previous, my hope is being dashed against the rocks with each bad day in a row.

 

I'm in desperate need of guidance.  I have my intuitions but I fear like I can't trust them.  I'm sorry I'm asking so much.

I'm so conflicted over reinstatement of the Prozac or waiting it out.  I know that if reinstatement (probably at a lesser dose) is the correct choice, then the sooner is the better, hence my rapid request.

 

Thank you, I'm looking forward to any and all replies.

 

 

 

 

 

[Altostrata]

3 hours ago, omnispan said:

After two severe waves I stopped the prozac (12 days ago, Mar 19), immediately had an amazing window for a week

 

1mg Prozac was too strong for you, you felt better when it wore off a bit. Then your underlying withdrawal returned.

 

Do not see a paradoxical reaction.

[omnispan]

Thank you so much for your reply, Alto.

And sorry again for the shotgun of information, I wasn't in a clear headspace at that time. 

I rehashed my main question in a more approachable way below.

 

1 hour ago, Altostrata said:

1mg Prozac was too strong for you, you felt better when it wore off a bit.

I agree that was likely what happened there.  I had said it felt like my body was giving a "sigh of relief."

 

1 hour ago, Altostrata said:

Then your underlying withdrawal returned.

My concern is that a lot of what symptoms are troubling me now weren't an issue before starting the Prozac, so I am trying to figure out what if anything is actually the underlying WD.

And from that, figure out what is the best remedy, if thats holding my prozac dose or letting it metabolize out the rest of the way.

 

 

 

The most important thing I'm trying to figure out is how common are WD reactions from 4 weeks of 1mg Prozac? 

I've spent a couple hours looking through the forum but was unable to find any good conclusions.

 

That would help dictate my next steps based on what forces are at play:

1. If things are being triggered by Prozac WD, that would warrant me reinstating and holding steady state close to where I am at now serum-level wise.
2. If things are being caused by the mere presence of Prozac, that would warrant metabolizing it out.
3. If things are being caused by my WD-sensitized system freaking out from the drug changes, that could go either way.  Could metabolize out to go for a "reset", back to what my system had been used to before a month ago, and let it stabilize, if it's not too late to do so.  Or could hold steady state to give my body a break from the changes, and stabilize with the prozac present.

 

My guess is that it is at least some combination of the last two, with an emphasis on #3. But I don't know how applicable the first concern is.  Nor do I know the best way to approach #3, as being one month out makes it a lot more tricky.

I understand that unfortunately I won't be able to find what the specific proportions of the three concerns are, thats just the part of the game we're all playing.  I'm just doing what I can to guess, hence I'm looking for further input.

 

 

Sciency stuff:

I got a Genesight test done a while back, gave some interesting insight, and I derived some results as follows:

 

Based on my enzyme alleles (Regular CYP2D6(*2A/*41), Intermediate CYP2C9(*1/*3)), I believe my current serum levels of fluoxetine are ~25%, and norfluoxetine ~60-30%.  Not too confident about the norfluoxetine level, because it was hard to find literature about enzyme-based elimination half-life for it. 

So If I were to hold, it would probably be around 0.3-0.4mg Prozac.  That would also be closer to the levels when I had seen some marginal improvements from the Prozac presence.

The issue with holding is that would probably close the window on a quick removal of the Prozac, and might warrant a slow taper down the line, which isn't that big of a deal as long as the presence of Prozac itself isn't causing issues.

 

 

[omnispan]

Another important concern I forgot to mention, is that this wave is acting different to the previous ones.

The day-to-day variation in this wave is much less to than the previous waves, which is stabilization, which is good.

But it is having the effect of making the wave last much longer than the previous ones.

Daily improvements have become marginal, but still noticeable.

[Altostrata]

What are these new symptoms? How are they different from before you took Prozac?