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Jules66: Coming off paroxetine after 21 years


Jules66

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Hi everyone.
 

I’m trying to come off 15mg Paroxetine after 21 years as it seemed to be ineffective. Doc has prescribed Sertraline to support the withdrawal. I started with a 25mg dose of Sertraline two weeks ago and one week ago I dropped to 10mg Paroxetine. At the same time I upped the Sertraline to 50mg. By day 6 I was having some pretty unpleasant withdrawal symptoms - mainly panic attacks (which I have rarely had in the past), constant anxiety (which is triggering old scripts) and some bleak dreams / thoughts. I was supposed to drop to 5mg Paroxetine today and go up to 75g Setraline but have not done that!

 

Kinda wondering what to do now. 
 

 

2000: 20mg Paroxetine 

Between 2000 & 2005: dose reduction and increase between 20mg and 10mg depending on mood (no withdrawal noticed)

2005 - Dec 2017: 20mg Paroxetine

Jan 2018 - Jun 2018: alternate days 20mg / 15mg

Jun 2018 - Sep 2021: 15mg

10/9/21: 25mg Sertraline & 15mg Paroxetine 

17/9/21: 5mg Sertraline & 10mg Paroxetine 

 

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Update: have spoke to the doctor and he has now proposed an 18 month plan to reduce Paroxetine. I’m hoping this will help.

2000: 20mg Paroxetine 

Between 2000 & 2005: dose reduction and increase between 20mg and 10mg depending on mood (no withdrawal noticed)

2005 - Dec 2017: 20mg Paroxetine

Jan 2018 - Jun 2018: alternate days 20mg / 15mg

Jun 2018 - Sep 2021: 15mg

10/9/21: 25mg Sertraline & 15mg Paroxetine 

17/9/21: 5mg Sertraline & 10mg Paroxetine 

 

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  • Moderator

Hi @Jules66, welcome to SA! 

 

 

Sorry that you are having a hard time coming off of paroxetine - it is one of the hardest ADs to quit. That is probably why your doctor wanted to switch you to sertraline but that doesn't always work as the drugs are a bit different.

Can I please ask you list your drug/supplement history in your signature so we can advise you better if issues arise without having to read the whole thread. This is best done now but will be helpful in the future. 

How to List Drug History in Signature - Introductions and updates - Surviving Antidepressants

 

I think a very slow taper off of paroxetine is probably the best way to come off. When I say a slow taper that would be over 2 years. We recommend lowering your dosage at no more than 10% from your previous dose every month. So if you are at 15mg paroxetine, your next cut would be 1.5mg to 13.5mg and then in a month from then it would be a cut of 1.35mg to 12.15mg and then another cut of 1.21mg to 10.94mg and so on every 4 weeks. This is to minimize the withdrawal symptoms. 

 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants (this has links to studies that your doctor may need to read)

 

Another option is to lower by 2.5% of the previous dose every week for four weeks and then hold for extra 2 weeks. It's called Brassmonkey's slide method here. 

The Brassmonkey Slide Method of Micro-tapering - Tapering - Surviving Antidepressants (microtapering - an alternative to the 10% a month tapering)

 

Please read these carefully as well: 

Important topics in the Tapering forum and FAQ - Tapering - Surviving Antidepressants  

Tips for tapering off Paxil (paroxetine) - Tapering - Surviving Antidepressants (read this very carefully)

How to calculate dosages and dilutions? Spreadsheets and calculators - Tapering - Surviving Antidepressants

 

But before you start tapering, since your system has been destabilized now, I'd suggest that you give it a break for a few months and not make any changes - keep it simple, slow and stable. That way, you will start from a place of strength and not neuro-chaos. 

 

You might also want to keep track of your symptoms so that you know when to slow down. We do not suggest you speed up at any point as sometimes effects can emerge later - after a few drops. When things get too much even at the 10% rate we suggest holding for some time, i.e. not lowering your dose for a while. 

Recording drug schedule and symptoms to track patterns and progress - Tapering - Surviving Antidepressants

 

It might be useful to put your name down for therapy with the NHS - this will take months before you get access but it might be helpful when you do need it later down the line. You can always refuse when your turn comes or you can try it and see if you learn some skills to manage the difficult emotions that emerge during withdrawal. 

You can self-refer here. 

Find an NHS psychological therapies service (IAPT) - NHS (www.nhs.uk)

This thread below will also help you learn ways to manage symptoms. While slow tapering is supposed to minimize the symptoms, it might not eliminate them. 

Non-drug techniques to cope with emotional symptoms - Symptoms and self-care - Surviving Antidepressants

 

This explains what to expect and what is happening in your brain: 

The Windows and Waves Pattern of Stabilization - Symptoms and self-care - Surviving Antidepressants

What is happening in your brain? - Symptoms and self-care - Surviving Antidepressants

 

Please take care and feel free to read around and engage with other members. If you do have a question to one of the moderators you can use the @ symbol to get our attention. We are volunteers and don't get to see every post. 

 

Good luck on this difficult journey and please reach out for support when you need to. And remember to read the most important thread of all: Success stories: Recovery from psychiatric drug withdrawal - Surviving Antidepressants

OMW

 

 

I am not a doctor and this should not be considered medical advice. You can use the information provided in whatever way you want and all decisions on your treatment are yours. 

 

If you would like to get a response from me directly please type @Onmyway some place in your message so I get notified of your post. I am not able to follow all of the threads all the time.

 

Aug  2000 - July 2003 (ct, 4-6 wk wd) , citalopram 20 mg,  xanax prn, wellbutrin for a few months, trazodone prn 

Dec 2004 - July 2018 citalopram 20 mg, xanax prn (rarely used)

Aug 2018 - citalopram 40 mg (self titrated up)

September 2018 - January 2019 tapered citalopram - 40/30/20/10/5 no issues until a week after reaching 0

Feb 2019 0.25 xanax - 0.5/day (3 weeks) over to klonopin 0.25 once a day to manage severe wd

March 6, reinstated citalopram 2.5 mg (liquid), klonopin 0.25 mg for sleep 2-3 times a week

Apr 1st citalopram 2.0 mg (liquid), klonopin 0.25 once a week, 

citalopram (liquid) 4/14/19 -1.8 mg, 5/8/19 - 1.6 mg,  7/27/19 -1.5 mg,  8/15/19 - 1.35, 2/21/21 - 1.1 (smaller drops in between), 6/20/21 - 1.03 mg, 8/7/21- 1.025, 8/11/21 - 1.02, 8/15/21 - 1.015, 9/3/21 - 0.925 (fingers crossed!), 10/8/21 - 0.9, 10/18/21 - 0.875, 12/31/21 - 0.85, 1/7/22 - 0.825, 1/14/22 - 0.8, 1/22/22 - 0.785

 

Supplements: magnesium citrate and bi-glycinate

 

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Thank you so much @Onmyway. I will read all the attachments tomorrow as I’m super tired today 🙏🏻

2000: 20mg Paroxetine 

Between 2000 & 2005: dose reduction and increase between 20mg and 10mg depending on mood (no withdrawal noticed)

2005 - Dec 2017: 20mg Paroxetine

Jan 2018 - Jun 2018: alternate days 20mg / 15mg

Jun 2018 - Sep 2021: 15mg

10/9/21: 25mg Sertraline & 15mg Paroxetine 

17/9/21: 5mg Sertraline & 10mg Paroxetine 

 

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  • getofflex changed the title to Jules66: Coming off paroxetine after 21 years

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