LongTermPaxil: Should I Reinstate?

[LongTermPaxil]

You can view my history in my signature, but to briefly review: after experiencing reduced efficacy on my 30mg/day Paxil regiment, I spoke with my PCP about cross-tapering to Lexapro. I reduced my Paxil doseage to 20mg and introduced 5mg Lexapro. This unfortunately caused intense symptoms including heightened anxiety, despair, bouts of crying/sobbing, nausea, headache, and stomach upset. I relayed this to my PCP and they suggested I take 10mg Lexapro with 20mg Paxil. I have been doing this for the past several days.

I realize now that this taper was likely too fast. I have been on Paxil for over 10 years. My symptoms have improved since I increased the Lexapro doseage, but I am still experiencing severe morning anxiety and mild headache/brain fog

Would it be a good idea to maybe reinstate to overcome these withdrawal symptoms, or should I continue forward with the improvements I've been seeing? I was considering reinstating to 25mg Paxil with 10mg Lexapro but I'm worried about serotonin toxicity and the other impacts of these drugs mixing. I have been feeling better clarity of focus by 11am until I go to bed, but this cycle of intense morning anxiety is exhausting and frightening. I also don't want to do any additional damage to myself. 

[Onmyway]

Welcome to SA @LongTermPaxil

 

I am so sorry that you are going through this. It must be very frightening given your history of anxiety. It does look like it is withdrawal combined with the starting effects of the new drug. 

 

Thank you for filling in your signature. Could you please simplify it so we see easily which year things were prescribed? Please exclude diagnoses, symptoms;  just year, drug dosage and every change. This will help us help you better. 

 

It is unclear from your intro whether you are trying to come off of ADs and asking for advice on how to do that or whether you are asking for advice on the right drug regimen. We can give you advice on how to safely taper to minimize and manage withdrawal symptoms but we are not psychiatrists and can't provide advice on which drugs to take and in what doses. 

 

In general, we have discovered through many histories that switching drugs can cause significant issues and Paxil is one of the hardest drugs in terms of withdrawal effects. Lexapro is slightly easier but not by very much. If you decide to eventually taper your drugs, I would suggest that the best way to do that is to go back on the original Paxil dosage and then try to taper off very slowly at 10% per month. 

 

Unfortunately, many of our members discover that ADs do poop-out on them - i.e. lose efficacy over the long term and while the approach is to then switch to new drugs, it is highly questionable in efficacy and often leads to exacerbation with the ensuing withdrawals and the subsequent addition of more classes of drugs such as benzodiazepines, antipsychotics and others (usually used off-label). This makes doctors feel like they are doing something and leaves patients in turmoil. 

 

What are your symptoms currently? 

Have you tried other ways to manage or treat your anxiety? Anxiety can be hard to manage but there are ways in which people can see improvements - CBT can work for some, other therapies work for others.

 

Paxil should never have been prescribed to you as it increases suicide risks in young adults (there is a black box warning from the FDA on it) and is not approved for kids under 18. 

 

I would advise you to search for the term poop-out to see how others have approached this issue and what they have learned from going through it. 

 

Hope you get some relief soon, 
OMW

 

 

 

 

 

 

 

Edited July 29, 2021 by Onmyway

[LongTermPaxil]

@Onmyway, I appreciate the response. All that you've said has been very insightful. I updated my signature for brevity so hopefully that makes my history a bit more understandable.

 

To further clarify my goals, I am hoping to get down to 0mg Paxil and convert over to Lexapro use via cross tapering (hopefully staying at 10-15mg of Lexapro). This was based on my doctor's recommendation to treat the "poop-out" as well as get me on a relatively "safer" medication. 

 

I understand that switching my SSRI could very well be a band-aid solution, but I felt it was the best choice for me to transition to an AD that is not Paxil before I try to reduce my dosage of any AD through a slow taper. This is based on my current mental health. Once I am fully on Lexapro I want to try and treat my anxiety more aggressively through therapy and diet changes. Ideally I will be off of AD'S completely in the future. If that takes a few years on Lexapro, I can accept it.

 

When I first reduced my Paxil I experienced profound despair and bouts of crying, as well as reduced ability to concentrate, intrusive thoughts, and worsening depression. Some physical symptoms were nausea, headache, and stomach upset. 

 

Now that I have been on Lexapro 10mg for several days I am seeing definite improvements. My mood and focus are better, and I haven't cried yet today (first day in months). I am still having bad morning anxiety but today was a day of improvement too. My appetite is better and so is my mood and clarity. I still have some hand shakiness and occasional mild headache. 

 

Obviously starting with a slower taper would have been more ideal. I was in contact with my pharmacist yesterday and she said we can wait until I stabilize before pursuing a much milder taper, so that is a success! I will bring up a 10% tapering schedule to her when we talk again in two weeks time. 

[LongTermPaxil]

@Onmyway

 

I guess in conclusion, I am looking for advice in how to manage withdrawal symptoms and continue on a safer taper to avoid what I experienced initially. I'm encouraged by the improvements in my mood over the last few days with Lexapro, so I'm hoping it will enable me to eliminate Paxil and act as a stepping stone to being AD free. I'd love to hear from some other long term Paxil users about their experience moving away from the drug. I also wanted to catalogue my experience here for my self benefit and for others.

[Altostrata]

Welcome, @LongTermPaxil

 

On 7/29/2021 at 8:17 AM, LongTermPaxil said:

When I first reduced my Paxil I experienced profound despair and bouts of crying, as well as reduced ability to concentrate, intrusive thoughts, and worsening depression. Some physical symptoms were nausea, headache, and stomach upset. 

 

Yes, you got withdrawal symptoms from decreasing Paxil. Have you conferred with your prescriber about your difficulties with the drug switch? It's their responsibility to monitor you and help you decide on next steps. What did your doctor say?

 

Paxil is a very difficult drug to go off. We usually don't advise switching unless a gradual direct taper isn't going to work, and then fluoxetine or citalopram is preferred over escitalopram which, milligram for milligram, is 2-3 times stronger than paroxetine -- so in effect, you're taking a much larger dose of serotonergic than 30mg paroxetine.

 

Escitalopram (Lexapro) will ramp up to steady-state over 3-4 days, so you may just now be experiencing the effect of the increase you made on July 26, or it may get stronger.

 

It sounds like your original intent was to switch to a drug because of Paxil "poop-out", continuing to stay on an antidepressant for purportedly therapeutic reasons. Ordinarily, we do not assist in counseling through drug switches for this, it's what your doctor gets paid for. If you do not feel your doctor knows what to do, that should be a warning sign to you.

 

We don't treat mood disorders here and cannot guarantee you'd stay in a good mood if you taper off an antidepressant. Being drug-free means you'll need to cope with any mood symptoms, as well as withdrawal symptoms, throughout the tapering process. If maintaining your mood is your goal, your prescriber is the person to talk to.

[LongTermPaxil]

@Altostrata

 

Thank you for your reply. I am currently in communication with my PCP and pharmacist regarding my difficulty in adjusting to this new regiment. My pharmacist agreed I was likely experiencing discontinuation syndrome and said if I wanted to move forward on this path I could pursue a much milder taper. 

It has been about two weeks since I started the Lexapro and aside from dealing with GI upset I have not seen any improvement in mood compared to pretreatment (though I no longer think I'm withdrawing, or as severely). 

May I ask why you have found Celexa to be a safer choice in cross tapering? I know Prozac is often utilized for its longer half life, but Celexa's is fairly short. If you have any literature on this I'd love to read it. That drug might be a better option for me than Prozac because it is non-energizing (and I don't need any more nervous energy).

[Altostrata]

That would be a longish explanation.

 

I understand no one you're talking to has the faintest idea of what they're doing. However, we do not assist in drug switches for "therapeutic" purposes here. Your communicating your problems to your doctors will assist in educating them.

 

Please let us know if you ever want assistance tapering off your drugs in order to live without drugs.

[LongTermPaxil]

I've returned to post a (quite lengthy) update regarding my progress over the past several months. I've updated my signature to reflect recent medication changes, but I will go into more depth about how I got to where I am now along with a description of my withdrawal symptoms.

 

The Doctors

 

It will probably come as no surprise to you that my psychiatric care was woefully mismanaged by several different medical practitioners, beginning with those who thought it was advisable to initiate a cross-taper at high doses of both Paxil and Lexapro. I have never felt so mentally unhinged in my life as when I was on both of those medications. I was almost constantly sobbing and in hysterics, particularly at work. The dizziness and exhaustion I felt were so extreme that at my lowest point, I laid down in a secluded place at my work and actually woke up in a confused daze 30 minutes later with little recognition of where I was or how I came to be lying down in the first place. I suffered constantly from gastrointestinal distress (morning diarrhea), panic attacks, and compulsive/disturbing thoughts. There wasn't a day that I didn't cry on my drive home. This regiment was under the advice of both my PCP (a NP) and a pharmacist. Needless to say I ended up "firing" those individuals, discontinued the Lexapro after only a few weeks on the medication, and sought help elsewhere. I even at one point went to a mental health urgent care in hysterics, but there they could only suggest that I immediately begin yet another cross-taper to another drug (Zoloft) while taking Gabapentin to calm my mental state. I refused both drugs. I remained on my original dose of Paxil and made about two dozen phone calls before finding anyone who could see me within a reasonable timeframe.

I currently am working with a formal psychiatrist. Unfortunately, while the psychiatrist I am working with now recognizes that my previous attempt at a cross-taper was mismanaged, she also does not recognize the need to wean patients off of antidepressants over a period of many months versus weeks. We tried initially to increase my Paxil dosage from 30mg to 40mg, but of course that did not resolve the anxiety I was experiencing (which, of course, was now much worse than when I had sought a medication change to address it originally). I sincerely regret wasting time doing this, but at that point I was so desperate to be pulled out of my tailspin I was willing to try anything. The increase dose did not resolve my anxiety, but it gave me side effects that are common for Paxil but I personally had never experienced before. 

 

It was at this point that I 1000% decided that the psychiatrists I was able to speak with would never act in a way which supports my best interests. I was exhausted of doctors mishandling my care and only providing "solutions" which involved either a.) an increase in dosage, or b.) addition of an adjunct drug/switch to a new drug. After an increased dose failed to improve my mental health, my new psychiatrist wanted me to reduce my Paxil dosage to as low a dose as possible before switching me to a low dose of Prozac. She said this drug has run its course for me and clearly is not affording any therapeutic benefit even at a near maximum dose. Her proposed tapering regiment was over 4 weeks, from 30 mg to 20mg, 20mg to 10mg, and then 10mg to 5mg, whereupon I was instructed to jump off completely.

 

I told her I wasn't going to do that. I sent her journal articles I found on this forum examining the hyperbolic relationship between dose and SERT (serotonin transporter) binding occupancy (which is thought to be the main mechanism of SSRI pharmacokinetics). I told her that at high doses, larger reductions might be tolerable because serotonin binding would only shift from perhaps 90% to 80%, but that this is not the case for lower doses. I asked if I could try this type of tapering regiment. She said she felt that would be unnecessary. 

So what am I to do? This is shameful to admit, but I had to lie. I told her I would follow her regiment when really I was making smaller dose adjustments over longer periods using extra Paxil I had ended up with over this whole ordeal. I postponed follow-up appointments to accommodate my extended timeframe. She asked me what was taking so long for me to get off of my medication and I told her the withdrawal symptoms were too much. So she relented a bit, but still pushed for me to work quickly toward my goal of getting onto Prozac. But that was no longer my goal.

Somewhere in the middle of all this, I decided that if I'm going to go through all this trouble of lowering my Paxil dose, then I might as well just see  if I could be all right without it. I'm damn sick of these drugs. I want to be free of them and at least try to resolve my anxiety on my own. Any therapeutic benefit is outweighed by all of these awful side affects and potentially permanent physical damage. I never want to be in a position again where my drug stops working and I have to go through this torture again. So I decided I would try a hyperbolic taper (as per my signature). 
 

 

[LongTermPaxil]

Tapering

The first large cuts were relatively easy. I experienced a lot of physical withdrawal symptoms, namely (in order of severity):

• Dizziness (so dizzy, it feels like I'm rocking on a boat. I love to mountain bike, and sometimes I felt like I would crash into a tree because I would become so suddenly dizzy)
• Fatigue (particularly after eating a meal)
• Headache (mild to moderate tension headaches almost all the time)
• Myoclonus (head jerks [side to side], hand tremor)
• Bruxism (I only began experiencing this recently, but I have never clenched my jaw at night before but now I have recurring muscular aches in my jaw and odd facial numbness during the peak of withdrawal after a reduction)
• Muscle Ache
• Distraction/Difficulty Focusing

Mentally, my anxiety is still very much present. Around 10mg, I felt really good. A lot more optimistic than I have been in the past 6-8 months. But subsequent reductions have seen my mental health and mood dip during withdrawal:

• Anxiety/Rumination/OCD
• Paranoia
• Depression
• Anxiety upon waking (exaggerated cortisol response?)
• Melancholy/Dysphoric Mood/Bouts of Crying
• Irritability 

It seems like I've reached a point, at my current 5mg dose, where I can't push myself as much as I had done initially. I expected this would happen eventually. I tried recently to reduce a bit further, to 3.75mg, but I was greeted with such severe dizziness and (strangely) nausea that I know now is time to stop and allow myself to heal a while. I was so invigorated by my earlier success that I pushed a bit too far, I think. Two days ago I up-dosed back to 5mg and am feeling a bit more stable today. I think I will hold at this dose until the first of the year at least, likely more towards mid-late January. Then I will proceed with more moderate, 10% reductions. Now is not the time to rush. I finally am seeing slivers of my normal self again. Some of my original symptoms have improved. Here are some of my successes:

• Improved digestion - normal bowel movements
• Greater sexual satisfaction (drive and sensitivity) - things I didn't even know I was missing!
• Fewer bouts of crying (I went a month without any at all)
• Higher self-esteem - I feel empowered that I am working towards this change for myself
• Fewer headaches

I would love to have a dialogue with other forum users from the perspective of my new goal - to be free of AD medication. Particularly those who have experience with Paxil, or who were prescribed medication at a young age. I am holding out hope that my brain was not too molded by the presence of Paxil throughout its development that I can never be free from it. I am hopeful that I can be medication free someday.

[Heath]

@LongTermPaxil. I’m sorry you are going through this! But know this you will come through this and get back to life ! 
i experienced paxil withdrawals in 2006 and again in 2013.
 

In 2006 I didn’t know about withdrawals and unfortunately chased drs that new less than I for about 4 or 5 months. Reinstated and back to normal Paxil user on about 8 months. Continued taking Paxil for another 6 years just plugging along with Paxil side effects with no interest in life. Decided to get off Paxil. But I was smarter this time but not smart enough evidently. so I dropped 5 msg every 3 or 4 months. I had some heavy withdrawals but most cleared at end of 3 months each time. When I got to 5 mgs within 1 week withdrawals hit me like a train. The withdrawals you listed I had too. Again chasing drs multiple drug changes trying to get off. Finally I found SA and discovered the correct way to taper. It seems you know that the lower dose the more trouble when tapering. You would probably want to slow that taper down to no more than 10% a month or maybe even less. 

as far as getting a dr to believe you and support you that will most likely not happen. I will say highly highly unlikely! So what I have learned is and what most people here do is basically go to dr “yes I’m getting better I’m ok, a few side effects, I want to stay on this dose, yady yady, etc” . You get the point. Then get your prescription. Continue tapering with help of SA. The only reason we have to go to dr. Is to get the drug unfortunately this is the way it is. 
 

these drs were not trained on getting you off the drug. They were trained to get you on the drug maybe unintentionally maybe not.

 

I would get help and advice from a moderator here, and I would read all I could here, that’s where I would start. I am not a moderator or a dr this is only what I experienced. You can see in my drug history where I had some real good drs 🙄. 
I wish you the best and hope you get to feeling better soon. 

[LongTermPaxil]

@Heath 

 

Thank you for your kind and thoughtful response. I'm sorry to hear that you suffered the same withdrawal symptoms as me when you were reducing your Paxil, but at the same time it is somewhat reassuring to hear that I'm not strange for feeling these things. A lot of doctors give off this incredulous vibe that tells me they think these feelings are psychosomatic, whether or not they say as much. Clearly that's far from the truth!

 

It's so disappointing that we have to go about speaking with our doctors in such a deceitful way just to get medication for the amount of time we need. But you're right - I see no other way of doing it, and I've tried asking time and again for a doctor to agree to a regiment which will work for me. 

 

I'm definitely committed to holding and stabilizing at my present dose of 5mg Paxil before tapering more slowly. In the beginning my pattern of withdrawal symptoms indicated that I was able to move a bit more quickly, but now that is no longer the case. And that's fine. I'm not in the mindset of trying to race to the finish line anymore. I just want my withdrawal symptoms to be a bit more mild as I move forward, especially next summer when I have a lot of outdoorsy trips and physical activities planned. 

 

I've been feeling a bit better symptom wise since I made that slight increase in dose, so hopefully that will continue. I hope you're feeling well on your taper also! 

[LongTermPaxil]

After a few more days back on my 5mg dose of Paxil, things are a bit up and down. Mornings are definitely the most difficult time for me. Lately I've been sleeping through the night up until 4 - 4:30am in the morning (which is about an hour before my alarm will go off) with a pounding heart and sense of dread. I've had morning anxiety off and on before, over the stretch of about a year now beginning with my relapse, but this is an unwelcome return. Has been going on for 2, 2.5 weeks. I've covered the window in my bedroom with an opaque sheet so now it is -very- dark. Hoping that will help.

 

Dealing with fatigue and brain fog, but around 3pm I start feeling a bit better. I feel great for about an hour after my 3-4x weekly gym sessions, but after the endorphin rush fades I feel tired again. Dizziness and a flushed/warm feeling on my skin, particularly my face, is frequent. Anxiety is very volatile and feelings of panic will surge up in response to trivial things often throughout the day, sometimes abating quickly but sometimes not. Sometimes tearful on the drive into work.

 

It hasn't quite been a week yet since my up-dose back to 5mg, so I'm hoping I will continue to feel better and stabilize in another week or so.

 

 

[Ian1234]

I was on Paxil for 12 years and I tapered successfully over 18 months.  What I did, is that I cut my dosage 2mg at a time and I waited for all of the withdrawal effects to go away.  It easily took 2, sometimes 4 months before I would drop to the next dosage.   

 

I had stomach issues (loose stools) that starting during my tapper but would resolve each time after a few weeks.  I've been off of Paxil completely now for 9 months and I feel really great other than that I'm STILL having stomach issues.  It has improved significantly over the last 9 months but its something I deal with on a daily basis.  Now it seems like I'm just having excessive gas, and gas pains.  It's very minor, like a 1 out of 10, more of a minor discomfort, but I feel like I'm absolutely obsessed with it and I'm constantly looking it up online.  I had myself convinced that I had color cancer at one point.   I'm going to my doctors for the first time in several years next week and I'm going to see what they say.  

[LongTermPaxil]

@Ian1234

 

I'm happy to hear that you're doing so well for the most part after stopping Paxil. It's always reassuring to hear from others that this is indeed possible.

 

When you got towards the end of your dose, were you still able to make 2mg cuts? It may just have been that, unlike you, I have not perhaps waited sufficiently long enough between cuts to be stable. That's why I've been holding steady for now. For me, things have been more difficult the lower I've gotten. 

 

When I'm anxious I experience loose bowel movements as well. Are you feeling anxious without Paxil? Otherwise it might be wise to speak with your doctor, as you've already planned. Something as mild as you're describing could simply be a dietary issue. I hope that appointment goes well for you!

[Ian1234]

@LongTermPaxil

 

The thing about the way that I tapered is that I had absolutely 0 expectations about when I was going to make the next drop.  I never took the next step down unless I had several weeks of feeling "ok."  I know that I was on the 2mg and 4mg dose for a very long time, so in that respect, I would probably agree that those drops were more difficult.  I had already failed a taper twice (with Dr. support) and I was determined that I was going to get off the med no matter how long it took.

I definitely still have anxiety and depression issues but I'm lucky enough to have made a lot of life changes that really help.  I had a very stressful job that I quit.  I don't really put a lot of expectations on myself anymore and I try not to commit myself to anything.  I've gotten really into exercising and hiking and both of those are tools I can use when my mental health goes down.  

 

In the past when I had really bad anxiety I would basically just shut down.  Because I shut down I was unable to do the things that helped me improve my mental health.  I find that it's really important for me to address my anxiety/depression before I get to that "shut down" point.  I'm extremely lucky to have a wife that is very in-tune with my mental health and can let me know if she sees some red flags.  She will often notice that I'm not doing well days before I will.  

I've been having really bad anxiety over this doctors appointment that I have coming up.  I made the appointment 6 weeks ago and honestly I'm having a real hard time not thinking about it almost non stop 24/7.  My mind is just racing that it's going to lead to more tests, and then more anxiety because of the tests, etc.  Rationally I know that I'm probably 100% ok.  I'm feeling better physically than I have in 20 years.  I have tons of energy and my weight is very healthy.  I feel like that my anxiety still there but it's just shifted to different things.  Overall I think it's easier to manage but it definitely isn't gone.  

 

You were on the drug for a very long time and it looks like your taper was quicker than mine.  I wouldn't put any pressure on yourself to make the next drop.  

 

Did you lose any weight?  I had been ~155 lbs my entire life and I ballooned to 190 while I was on Paxil.  It was a very slow steady gain, not all at once.  I literally dropped back to my normal weight before I was even done with my taper.  In the 9 months that I've been off I haven't gained any of it back.

[LongTermPaxil]

@Ian1234

 

It sounds like you went about your taper in a really smart way. In retrospect I wish I had gone a bit slower, especially once I got around 10mg. But when I initially began tapering I feel like my dose was too high, so when I made those first few reductions the change was actually of benefit to my nervous system. Now I'm at the point where my brain has to restructure itself to adjust to a truly sub-therapeutic level of the drug. I've been holding at 5mg for about 10 days now, though, and I'm seeing some gradual improvements with my biggest symptoms (dizziness and fatigue). This afternoon was especially good. Maybe by the end of January things will be even better.

 

I'm glad to hear you're no longer working a stressful job and have found other healthy coping mechanisms. What actually triggered my changes in medication was a toxic work environment, so I can certainly relate. I'm happy to be working in a better place now too. I try to exercise at the gym at least 3 times per week during the winter, and I mountain bike very frequently (and vigorously) during the summer months. I sure wish it were summer now. Winters in Michigan don't have a lot of mild, biking weather type days!

 

I can certainly sympathize with the worries you're having about your upcoming doctor's appointment. I have a lot of health anxieties too, and I know it's really hard to cope when your mind constantly circles back to the same worry or fixation over and over again. I almost get angry at myself, because my conscious mind wants to let such things go but my anxiety won't let me.

 

My boyfriend was actually having some mild digestive issues this past year which actually resulted in him requesting a colonoscopy (which by most accounts was a stronger measure than a doctor might have taken). Regardless, he wanted absolute certainty so he could let his own worries go. The procedure was really easy and his colon is perfectly healthy. I'm not sure what the doctor will recommend in your case, but know that those types of imaging procedures are always an option and in my boyfriend's case they offered him a lot of relief from worry!

 

I never experienced any weight gain I could associate with Paxil. I was overweight as a teenager, but that was likely due to lifestyle choices. I'm at a healthy weight now (135 lbs, 5'7"). I know that Paxil causing weight gain is extremely common though. 

[LongTermPaxil]

It's been about two weeks since I updosed back to 5mg of Paxil, and my physical symptoms seem to be improving (albeit quite slowly).

 

When I was in the midst of withdrawals, it felt like I was on a violently rocking and swirling boat. My field of vision was narrowed and a bit blurry. The vertigo has improved quite a bit, as well as the fatigue, but I still get touches of both throughout the day, along with occasional headache. 

 

I've still been waking up with a pounding heart. This is one of my more disruptive symptoms, since it is alarming to wake up from a peaceful sleep to immediate feelings of panic. Especially since my withdrawal seems to abate the most in the evenings. It's like being thrust back into the thick of things every morning. I've blocked out the window in my bedroom to eliminate light but that hasn't seemed to improve things. Any other tips for blunting this cortisol spike would be appreciated!

 

Dealing with quite a bit of health related anxiety lately, perpetuated in no small part by the escalation of COVID cases due to the new variant. I have some palpable lymph nodes near my collarbone that I like to worry at. I'm quite slim in this area, so that's most likely why I can feel them at all, since they're not swollen in any way. I had an ultrasound of a lymph node under my chin several months ago which came back normal. The doctor thought it might just be enlarged now due to a previous infection. But of course my mind loves to run away with these things and it's difficult to keep those thoughts from spiraling. 

 

[LongTermPaxil]

A bit of an update - I titrated my dose up to 7.25mg of Paxil after some residual dizziness failed to resolve after holding at 5mg for several weeks. This seems to have resolved those symptoms and I am feeling much more physically normal. Morning anxiety is still persistent, but perhaps improving. I've been slowly waking up a bit later and later. This morning was only 15 minutes before my alarm, which would be totally normal for me and was quite the pleasant surprise. My mood is mostly normal by the afternoon, but dark thoughts and sadness tend to permeate the mornings in association with this cortisol spike.

 

I had a very disappointing conversation with my psychiatrist last week. I expressed to her what I had been experiencing over the past few weeks in terms of my waking anxiety as well as concerns about my nocturnal bruxism which had never been a prior issue until I got down to about 8mg. She basically expressed, in so many words, that she felt her proposed 4 week taper (which I did not follow) was more than adequate and that any resurgence in anxiety should be resolved by taking klonopin as needed until she can transition me onto a new medication. Nevermind the fact that would require me to take klonopin for several months and likely developing a dependence during that time (my thoughts, not hers)! I told her that my withdrawal symptoms are heavily physical as well as emotional, and she responded with some degree of sympathy but expressed that "discontinuation syndrome" sometimes just needs to be pushed through. I was so intensely dizzy during my last wave that it was almost dangerous for me to drive, but sure, let's push through with the added disorientation of klonopin on top of that. Great idea.

 

Needless to say I did not agree to any of that and expressed a desire to stay on my present dose. So frustrating. If anyone knows of a more reasonable psychiatrist in Michigan, please let me know. I'm starting my own search for a more compassionate provider. 

[Ian1234]

@LongTermPaxil

 

I just wanted to give you an update as we seem to be in a fairly similar situation (I responded a few times above back in December).

 

I went to my Doctor and told him about my stomach issues and how I thought it was from the Paxil withdrawal.  He didn't really seem to think so and thought that it was most likely related to the fact that I was on it for 12 years and now I'm experiencing anxiety like I haven't in a long time.  I sort of dismissed him because I don't necessarily subjectively feel like I have anxiety.  I still have racing thoughts and I still get worked up about some things but I think I have really normalized my anxiety to the point that I don't even really know what anxiety means to me anymore.  

 

I have a prescription for Klonopin that I almost NEVER used.  I have 90x 1mg pill per month and I had taken 2-3 per month max.  I was having really bad stomach issues for a few days and I decide I would see if the Klonopin helped.  I took half of a 1mg pill (.5mg) and my issues almost completely disappeared within an hour.  I was having really bad stomach cramps and they just went away.  I've been taking .5mg doses twice per day (one around 9AM and one around 5PM) and my stomach issues have improved by about 90%.  They are not completely gone but it's so much better.  

 

Another thing I started taking was CBD oil.  I don't really want to become dependent on the Klonopin and I had read that CBD oil worked well for anxiety.  I honestly had thought it was snake-oil before but I decided to give it a try.  You put the oil under your tongue for 1 minute and then swallow it.  It's not as effective as the Klonopin but it definitely helps.  The downside is I guess it's possible to test positive for marijuana on a drug test, but luckily I don't need one for my employment. 

 

I feel happy that I might have almost solved my stomach issues but on the other hand it kind of shows me that I'm dependent on Paxil/Klonopin or some type of medication to control my anxiety or I'm going to have stomach issues the rest of my life.  

[LongTermPaxil]

Hi @Ian1234, I'm happy to hear from you again. Thank you for updating me on your medical situation. I was hoping you would be able to reach a resolution after meeting with your doctor. Waiting and worrying about seeing someone for an issue is no fun. 

 

I am not surprised to hear that your anxiety was manifesting itself as gastrointestinal issues. My anxiety often presents that way as well (with IBS-type symptoms in the mornings, when I am typically most anxious). Even though we might feel as though our anxiety is well-managed or "baseline," it's crazy how much our body still responds to stress (whether or not we consciously perceive ourselves to be stressed out).

 

I'm glad you were able to see your issue resolved through use of the Klonopin and CBD. I understand your feelings of disappointment, however, in realizing that there still might be aspects of your mental health which are not responding 100% to lifestyle changes alone. This isn't anything to be ashamed about. You haven't been off of Paxil for a tremendously long time, so your mind might still be adjusting. You might discover some routine or coping skill down the road that will eliminate that extra bit of worry which is contributing to your stomach issues. 

 

But in the meantime, I wouldn't think utilizing CBD as you have would be a bad idea if you have found it to be personally helpful. Cannabinoids may very well be our next line of antidepressant pharmaceuticals. There's a lot of promising research being done into those, along with other botanical compounds, as safer forms of alternative treatment. They at least initially seem to be very less likely to cause withdrawals like SSRI/SNRI'S. 

 

It has been a very stressful time for everyone with the pandemic and other global events, so don't feel bad that you're feeling anxious. You should feel proud for how far you've come. I'm still holding at 7.25 mg. I don't think I'm suffering from any more acute withdrawals, but I'm waiting to stabilize for a bit longer just to be sure. Plus I want to resolve some of the issues I've had with nighttime teeth grinding first before I make another reduction. Finally finally FINALLY I'm able to get a mouthguard this upcoming week. I've been waiting 3 weeks for it to be made by my dentist. Fingers crossed it works to resolve my jaw/neck pain.