Tyron: Switching Prozac to Trintillix

[Tyron]

Hello I am a 70 year old male!

After 20 long years on Paxil 20mg and 3 years of Mirtazapine 15mg, for Dysthymia, I feel the need to start weaning off one of them, but which one?

On comparing common side effects it appears the Mirtazapine could be the gremlin. It was prescribed to help me sleep but I still struggle so what's the point!

 

I take both meds after my dinner at 7pm, but continue to snack till midnight. I feel emotionally and physically flat with all artistic passion out the window.

 

I'm hoping my body would be better coping with just one poison! Any advice would be gratefully appreciated!

 

Edited October 7, 2017 by Tyron
white space; name update, increased font

[mammaP]

Hi Diehard, welcome to SA.  You are right mirtazepine does tend to have more side effects than paxil. Paxil can be activating so it might be better for you if you take it earlier in the day then you might sleep better at night. You could take it an hour earlier each day until you at a better time for you, morning would probably be better. Then wait a while to allow your brain to adjust before starting to taper mirtazapine.  Often side effects lessen as the dose lowers which is good, you don't have to wait until you are off completely to feel better. I lost all my artistic passion too, it's called anhedonia and I had no motivation whatsoever. It is very common with anti depressants. Some people taper one drug part way then start to taper the other so that side effects from both are less. Then go back to the first one and start to taper that one again and so on until both are gone. We recommend tapering 10% of the CURRENT dose with 4 weeks between drops. This allows the brain to adjust between drops and taper off with little discomfort. If there are any withdrawal symptoms it means that your brain is struggling and you need to slow down or make smaller cuts. You will soon get into the swing of it and be able to listen to what your body is telling you. 

 

First, we ask all our members to fill in their signature with their drug and tapering history. Include all prescription and over the counter drugs , this is because there can be interactions.  This link will take you to the signature block in settings, fill it in and click save. 

 

http://survivingantidepressants.org/settings/signature/

 

Tapering mirtazepine, it is available in a liquid in some countries, or you can make a liquid yourself from tablets. This makes it easy to get the lower doses.

 

http://survivingantidepressants.org/topic/5301-tips-for-tapering-off-mirtazapine-remeron/

 

 

[Tyron]

Thank you mammaP, I will take your advice on board!

[Tyron]

I has now been 20 years since I started antidepressants for persistent sadness and depression.

I've reached a point of total frustration feeling that instead of helping they may be exacerbating the problem.

I have absolutely nothing to be depressed about in my life yet I'm in a daily funk.

Does anyone think and feel the same? Perhaps I should start to taper one of them! 

 

Edited October 7, 2017 by Tyron
reduced font

[ChessieCat]

Have you every read the book Your Drug May Be Your Problem by Peter Breggin?  The drugs can cause the problems that they are supposed to help.

 

I have been on ADs continuously for 25+ years and it is only now that my dose is lower that I am starting to feel like I did before starting them.  I hadn't realised how numb I had been whilst taking them, but that is what they do.  Recently I experienced true excitement (19mg Pristiq) whereas back in May when I bought my new car the excitement I felt then was a dulled excitement (on 25mg at the time).

[ChessieCat]

Please follow these instructions and create your drug signature.  The allows the moderators to see your drug history at a glance and not have to read through your posts.  Please update it whenever you make a change.  Thank you.

 

 A request: Would you summarize your history in a signature - ALL drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly?

• Please leave out symptoms and diagnoses.
• A list is easier to understand than one or multiple paragraphs. 

• Any drugs prior to 24 months ago can just be listed with start and stop years.
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago)
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016.
• Link to Account Settings – Create or Edit a signature.

 

You mentioned in another topic that you are considering tapering.

 

Taking multiple psych drugs? Which drug to taper first?
If you're not having an adverse reaction from the other medications, taper the most activating drug first. This is usually an antidepressant or stimulant (ADHD drug).

 

Please also put your drugs in Drug Interactions Checker and copy and paste the results here in your topic.

 

Before you begin tapering what you need to know

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[Tyron]

Thank you ChessieCat, with the help of my GP I will start this week!

 

Edited October 7, 2017 by Tyron
reduced font

[Tyron]

Hello brave souls,
After various other antidepressants I started Paxil (20mg) seven years ago and augmented with Mirtazapine (30mg) 4 years ago. In the interim I still suffered feelings of hopelessness, worthlessness and all the signs of Dysthymia so what was the point of the medication?

Poor concentration and performance wrecked my career and emotional impulsiveness caused many problems in my marriage. I cannot understand why my dear wife of 37 years is still with me? I retired 4 years ago due to stress and depression but now at the age of 70, finally I have had enough antidepressants making me more depressed!

I’m in my third week of reducing Paxil down to 15mg, so far so good. Although I have read many horror stories about weaning off Paxil, I am confident I will succeed if I go slowly.
Drinking lots of water, daily walking, along with a good diet and reading all the brave success stories from this site will get me through. I know it! Once the Paxil is out of my system, Mirtazapine is next! I know it won’t be easy but I’m looking forward to the challenge. I thank all you brave soldiers for your encouragement and advice.
Peace be with you! 

[nz11]

Diehard what do you think about the idea of doing a drug sig

nz

[Tyron]

Hi nz11,

Please enlighten me, what is a drug sig?

[ChessieCat]

The drug sig is the drug history which is put into your signature and shows up below every post you make.

[Tyron]

Thank you Ccat, I think I have rectified that. Blessings!

[Tyron]

Hi Everyone,

12th day now after having tapered Paxil from 20mg to 15mg, feeling slightly better already!

Next week I start 12.5mg of Paxil and plan to reduce by 2.5mg every month to "0"

Staying on Mirtazapine till Paxil is out of my system, mean while I'm using Omega3, Tryptophan and MethylB Complex.

I feel confident I can do it!

[nz11]

Diehard have you read the link about tapering at 10% per month?

What do you think about that idea?

well done on doing the drug sig.

[Tyron]

Greetings nz11, I am somewhat baffled as to how I would manage to measure the suggested 10% per month tapering.

I have started off with a 20% reduction followed by 1mL per month using a syringe  that came with the liquid Paxil.

Each increment is 0.1mL which represents 1 mg. so with that I am only able to taper by 1mL each month.

The top part of the table is using the syringe increments and the bottom part using the suggested 10% reduction;

As you can see the 10% reduction measurements would be very tricky indeed!

This will be my third day from 15mg to 12mg, So far, (apart from a few dizzy brain zaps) I'm doing well!

However, I am concerned at the reduction from Oct onward.

2018	FEB	MAR	APR	MAY	JUN	JUL	AUG	SEP	OCT	NOV	DEC	JAN
mL	15 to 12	12 to 11	11 to 10	10 to 9	9 to 8	8 to 7	7 to 6	6 to 5	5 to 4	4 to 3	3 to 2	2 to 1
Percent	20%	8.33%	9.09%	10%	11.11%	12.50%	14.28%	16.66%	20%	25%	33.33%	50%
10% reduction in mL	15	13.5	12.15	10.93	9.84	8.85	7.97	7.17	6.46	5.81	etc	etc

[nz11]

Diehard your first post says Paxil for 20 years but drug sig says since 2011.

which one is correct

 

[nz11]

8 hours ago, Diehard said:

started off with a 20% reduction followed by 1mL per month

DH are you aware this is not the recommended way to taper as per sa.

What do you think about the sa taper method.

 

 

8 hours ago, Diehard said:

using a syringe  that came with the liquid Paxil.

I assume therefore that you are getting liquid paxil from the pharmacy 

Please confirm the mg : ml ratio in the bottle.

 

8 hours ago, Diehard said:

Each increment is 0.1mL which represents 1 mg.

As i say just to ensure we are all on the same page here please confirm the mg:ml ratio in the bottle of paxil liquid

 

8 hours ago, Diehard said:

As you can see the 10% reduction measurements would be very tricky indeed!

What about rounding?

 

 

nz11

 

 

[nz11]

On ‎1‎/‎17‎/‎2018 at 5:48 PM, Diehard said:

After various other antidepressants I started Paxil (20mg) seven years ago

 

Okay i think i got it 7 years on paxil and 20 years on ads, there exist others prior to paxil.

You know what i think ... i think the drop to 15 may well be too much.

If i were you i  would not  drop again as you have planned. 

 

If you put '10 days ago ' in your drug sig it is confusing could you help us out here and date this.

 

 

 

[Tyron]

Correction! 13 years on various ADs, then started Paxil 7 years ago, added Mirtazapine 4 years ago to help with sleep.
Decided to make changes due to anger issues and worsening depression, something wasn't right.
Started tapering Paxil from 20mg to 15mg - 3 weeks ago then down to 12mg three days ago.
Saw my Psych today told him I was getting Getting brain zaps, feeling nauseous but appear to be travelling ok.
He wasn't happy with the outcome and has put me on Lovan (Prozac) while tapering as it's easier to come off?

He wants me to reduce Paxil by 2mgs per month whilst gradually raising Lovan. It all sounds quite scary to me
but I'll see how it goes. I just want to feel "normal" and be artistically and musically creative again!
Thank you soo much for your caring responses. I'll keep you posted. Kind Regards 

[nz11]

I know that inspite of sa's advice to the contrary you have thought this through and decided to go with the psych advice.

 

These are two questions i would be asking the psych

Has he had success with this method in the past....if so, 

Is he able to put you in contact with one of his other patients with whom he has had success with this method so you can talk to them regarding how it went and how they are doing now.

If he cant put you in contact with another patient then that means you are either his first attempt at this or he has up till now not had any success with this bridging plan. I don't think these requests are too much to ask. 

 

Wishing you strength.

nz11

 

[Tyron]

Hello Again,
Due to my very sensitive system, now experiencing brain zaps and vertigo I have decided to follow the 10% tapering advice! 
Presently my wife is recovering from cancer treatment so I need to be fully "Compos Mentis" to be there for her.
The nearest I can get to 10% would be reducing by 1mg per month without the aid of Lovan.
Has anyone used natural supplements to help support their system?
 

Thanks for the caring advice.
Kind Regards
 

[ChessieCat]

The only supplements which SA recommends are Magnesium and Omega-3 Fish Oil .  Try a small amount to start and build up. Try each separately.  Only make one change at a time, ie don't make a reduction and start a supplement at the same time.  It's also a good idea to keep daily notes on paper.

 

20 minutes ago, Diehard said:

The nearest I can get to 10% would be reducing by 1mg per month

 

Many members find that the lower their dose gets the slower they need to go.  This topic discusses this:  Why taper paper: dose-occupancy curves

 

 

There as several options to get doses.  From Post #1 Tips for tapering off Paxil (paroxetine)

 

Precisely weighing tablet pieces or crushed tablets with an electronic digital scale
You may wish to precisely measure your dosage with an electronic scale that measures milligrams. These are available for under $30 US. See Using a digital scale to measure doses

Use Paxil liquid to taper
This is the easiest and most accurate way to taper Paxil.

See FDA prescribing information at http://www.drugs.com/pro/paxil.html

In the US, the ordering code for Paxil Oral Suspension (liquid),10 mg/5ml., in 250 ml bottles is

NDC 53873-043-00 (GlaxoSmithKline Paxil liquid) https://www.hipaaspace.com/medical_billing/coding/national.drug.codes/53873-043-00

NDC 60505-0402-5 (Apotex generic paroxetine liquid) https://www.hipaaspace.com/medical_billing/coding/national.drug.codes/60505-0402-5

 

 

Some people are sensitive to changes in the form of the drug. If you are taking tablets, you may wish to take part of your daily dosage in tablet form and part in liquid for a few days to ease the transition from tablets to liquid.

Use oral syringes to taper with the liquid, see http://survivingantidepressants.org/index.php?/topic/235-tapering-techniques/

Make your own liquid
You can make your own liquid with water. See How to make a liquid from tablets or capsules

 

[ChessieCat]

On 01/02/2018 at 10:17 PM, Diehard said:

Started tapering Paxil from 20mg to 15mg - 3 weeks ago then down to 12mg three days ago.

 

Please update your signature whenever you make a change.  Thank you.

 

If you are still experiencing withdrawal symptoms you might consider updosing by a small amount.  If you have been on 12mg for several weeks, taking just an extra mg may be enough.  Your brain will have already made same changes since you lowered your dose.  It is better to increase by a small amount and see if that helps rather than increasing by too much.  If you find after 1-2 weeks that you are still suffering you can always increase by a bit more.  Please see Post #1 of this topic:  About reinstating and stabilizing to reduce withdrawal symptoms

[nz11]

3 hours ago, Diehard said:

I have decided to follow the 10% tapering advice!

You have made a wonderful choice. 

 

Are you still taking Lovan? dosage? or have you ditched it?

 

[Tyron]

I will only take Lovan in 4 months if I start having a hard time.
Not sure how to edit the med signature!

[nz11]

Okay so you havent taken any lovan as yet. 

 imo the cut to 15mg is too much to start with.

 

[Tyron]

Hi Everyone,

I'm tapering off Liquid Paxil 12mg presently then down to 10mg on the 1st of march. I'm kind of doing alright, except for becoming moody and lethargic.

My GP has given me Lovan (Prozac) to start at a very low dose to help with the imbalance but I remain hesitant. Should I start with 5mg of Lovan when I get down to 10mg of Paxil or is that too much? Your advice would be appreciated, Thank you!

[Tyron]

Hi Everyone,

I'm tapering off Liquid Paxil, now down to 10mg from 20mg (3 months ago) also taking 10mg of Lovan.
I'm kind of doing alright, except for very low motivation and not wanting to do anything all day.
Tapering Paxil by 1mg per month, but would I have to match the Lovan dosage?

 

[Altostrata]

Diehard, I moved your post here, your Intro topic is the place for questions about your particular situation. We have to ask you a lot of questions that would throw other topics off-track.

 

How long have you been taking Lovan? Please update your signature.

 

How did you feel after you added Lovan? When did you cut Paxil to 10mg? How did you feel after that?

 

4 minutes ago, Diehard said:

would I have to match the Lovan dosage?

 

Please clarify. What do you mean by match?

 

Please note, if you're taking 10mg Paxil, 1mg is 10%. If you're taking 9mg Paxil, 1mg would be  11%. If you're taking 8mg Paxil, 1mg would be 12.5%. The decreases get proportionately bigger, which is not what you want in a taper. 

 

We advise calculating the 10% decreases based on the last dosage, not the first.

[Tyron]

Hello!
Three months ago I cut my 20mg tablet down to 15mg without any issues.

I am now on 10mg of Liquid Paxil without any major issues, I am in fact in a much better mood now than when I was on 20mg. 
I understand the percentages but the 'how to' is the tricky part. Next month 10% is easy enough, but dropping by 1mg per month

yes the percentages would be higher..4 down to 3 would be 33.33% and 2 to 1 is 50%

How do I accurately achieve 10% measures?

When I was on 15mg Paxil, I was also taking 5mg of Lovan (3 months ago)

Now on 10mg Paxil (since 4 weeks ago) - I am also on 10mg of Lovan (started 1 month ago)
No Major issues except for Lethargy and feeling sorry for myself! 

Would I need to raise Lovan as the Paxil dose gets smaller.

[Tyron]

Hi everyone!

I am 2 weeks short of my 3rd month off Paxil and I am going through horrendous depression and fatigue.

I would love to hear success stories of others who have come off Paxil please.

I am still on Mirtizapine 45mg at night and 20mg of Lovan in the morning.😢

I don't want to be on any meds but feel I'm destined to take them till I die.

[Lloyd]

Hi Diehard, sorry to hear you are not feeling well. One of the moderators should be along soon to help.

How long did you taper off of paxil for? Your signature says tapered to 10mg in March. Are you taking any at the moment? Are you experiencing brain zaps? Fish oil is quite helpful for reducing brain zaps.

I am in WA as well, there is quite a few people here from Australia.

[Leo1983]

Your intro is in the wrong place. 

 

Need to be in introductions.

[manymoretodays]

Hi Diehard,

I just noticed your most recent post in success stories and moved it on back here to your introduction.

 

Please update your signature in Account Settings

 

On 12/15/2018 at 12:02 AM, Diehard said:

Hi everyone!

I am 2 weeks short of my 3rd month off Paxil and I am going through horrendous depression and fatigue.

I would love to hear success stories of others who have come off Paxil please.

I am still on Mirtizapine 45mg at night and 20mg of Lovan in the morning.😢

I don't want to be on any meds but feel I'm destined to take them till I die.

 

How did you taper the Paxil from 10 mg to zero?

When did you increase the Lovan to 20 mg?

When did the symptoms of horrendous depression and fatigue start?

[Tyron]

Hi Manymoredays,

I have just updated my signature notes, sorry I'm not using this site as I should...I'll get there!
A month ago my psychiatrist tried me on Lamictal (Lamotrigine) 4 weeks ago which sent me spiralling down and feeling suicidal after a week.
Came off them immediately and fell into a very bad depression. It's a struggle but I'm coming good now! Started taking fish oil yesterday!

Magnesium is good and so is regular exercise which I struggle to get started. I also struggle with sleep (refuse to medicate sleep)

Don't have confidence with the Mirtazapine and Lovan, there has to be something suitable! Reducing Paxil in liquid form is the easy way to go but expensive.

So many battling souls on multiple medication that my heart goes out to! The mind plays many tricks on us all; we must keep trying and never ever give up.

Blessings to you my friend, God speed. I wish you good success and good fortune!

 

 

 

[Tyron]

Hello!

For eight years I have been taking Matazapine and Lovan but was still disgruntled as I was still feeling agitated and moody, so my psych suggested a blood test to determine which AD would be more suitable with my metabolism. The results indicated that Lovan could be the culprit so my psych recommended that I switch from Lovan (prozac) to Trintellix. however, since reducing just the Lovan from 20mg down to 10mg my wife noticed that I have been more creative and proactive. If I continue feeling this way reducing the Lovan then I would rather do without a new drug, so  can someone recommend a supplements to soften the discomfort whilst tapering?

I have an appointment with my Psych in four weeks.
Many Thanks