Mac25: Persistent vivid dreaming from missing/tapering paroxetine

[Mac25]

Hi everyone,

 

Thank you so much for this forum existing. I’m in a bad way, and hope for connection and advice. Starting out here, all I have to contribute is my own story. Please bear with bad grammar and wording as I’m not a native speaker of English:

 

I’ve taken paroxetine since 2008, 40 mg, then 50 mg since 2017. Few problems until recently. But then many doses missed during 2020, in many instances followed by a night’s vivid dreaming. Decided in Spring 2021 to try and go off, then observed a strict 40 mg a day, with no misses, for many weeks prior to lowering the dose more. Noticed the vivid dreams being around during all that time, but not too disturbing. Then during summer 2021, lowering to 30 mg, then 20, then 10 mg, with perhaps four weeks between each lowering, observing a tapering plan devised by my doctor. Vivid dreaming perhaps increased a bit, generally woke up once nightly. Then in early Sept 2021, doctor put me up on 20 mg again, impressed by my vivid dreaming, also prescribing melatonine. This didn’t change things much. But since I accidentally missed a dose on Oct 1, and then one again on Oct 11, vivid dreaming has increased, making me wake up two or three times a night, causing considerable emotional distress, even keeping me away from work some days. I may have also taken a double dose on Sept 23, accidentally. Have a hard time figuring out what might be going on in my nervous system and what might consequently be the best course of action going from here. I suspect melatonine, now discontinued, might have interacted badly with the paroxetine. But above all, I fear my vivid dreaming has more to do with dose missing (which can’t be undone) than with changing dose size. Going back to 20 mg from 10 didn’t improve things, and now, following October’s melatonine and two missed doses, it’s worse. As it happens, recent months have been stressful to me on the job and elsewhere, and anxiety level is high. But I’m not sure that explains my more frequent awakenings, with rapid heartbeat, at night as well as when I try to take a nap during the day. Maybe they’re due to the anxiety I feel generally over the scarily vivid dreaming that menaces me — if not due to the dreaming itself, which is my spontaneous experience. Tiredness, headache and emotional hangover during the daytime now.

 

I’d be grateful to hear from anyone who has experience with vivid dreaming related to paroxetine dose missing and tapering, who has an idea of what is going on, or might have advice on what to do in this difficult situation.

[Mac25]

Small update:

 

Over at Quora.com, Mark Herbst gives one plausible explanation to vivid dreaming arising from skipping an SSRI dose. But it’s not clear to me from what he writes why vivid dreaming would continue even if care is at one point taken not to skip doses anymore. What might be the mechanism preventing the nervous system from “catching up” (as he puts it) following many occasional single-dose skips?

 

Probably, going from 50mg to 40mg at the same time as never skipping doses again wasn’t a good idea — might perhaps have given my nervous system better time to “catch up” on the missed 50mg doses if I had gone on taking 50mg for a while. Instead, just 40mg was what I took stably for some months, with a little vivid dreaming still there, eager to taper, naively believing coming off the drug entirely and rapidly would end any adverse effect.

[Altostrata]

Welcome @Mac25

 

On 10/21/2021 at 5:24 AM, Mac25 said:

But I’m not sure that explains my more frequent awakenings, with rapid heartbeat, at night as well as when I try to take a nap during the day.

 

This is a typical withdrawal syndrome pattern. You might updose to 25mg paroxetine and see if that helps. You'd do well to stay there for several months before attempting another reduction. Please let us know how you're doing.

 

5 hours ago, Mac25 said:

What might be the mechanism preventing the nervous system from “catching up” (as he puts it) following many occasional single-dose skips?

 

I added to Quora responses. It's because skipping doses causes drug blood level fluctuations, which in turn cause neurological instability as receptors and other systems attempt to catch up with variable receptor occupancy. Your neurology is a large, complex system and adaptations do not turn around instantaneously.

 

If you keep skipping doses, you set up larger and larger disturbances in neurological stability. We have people here who have developed severe withdrawal symptoms from this -- persisting even if they go back on the drug.

 

Paroxetine is a particularly risky drug to take inconsistently. Your nervous system is not made of rubber.

 

 

[Mac25]

Many, many thanks for your feedback, Altostrata, and for your very valuable insights. Although you kind of confirm my worst fears. I certainly am doing my best not to skip doses anymore — but understand that the damage already done likely isn’t reversible at all. That’s a very tough one.

 

My doctor suggests going back to 30mg, but it sounds like that would be too much, in your experience. I wouldn’t mind it, though, if it isn’t too risky, all things considered. Switching to Prozac for its longer half-life has also been suggested but probably would be too risky.

 

Interestingly, my doctor, as I’ve understood it, also belives occasional dose skipping is normal and not to worry too much about. Clearly this is not this forum’s experience. And clearly, judging from this forum, my doctor had me taper far too fast. If this is so, then how can doctors not know these things?

[Altostrata]

Dose skipping is common but there's a substantial literature warning against it because of withdrawal symptoms.

 

Paroxetine is a bear to go off, regardless. Rather than increasing the dose at this point, you might consider adding in a little fluoxetine or citalopram to initiate a crossover to another SSRI, over a few weeks. See The Prozac switch or "bridging" with fluoxetine

[Mac25]

Thanks again, Altostrata!

Having read your elaborate post on bridging, I feel this strategy might be too risky with the rather volatile current state of my nervous system — in case the body might count the bridging replacement of paroxetine as yet another dose skipping.

 

It’s extremely interesting you write that the litterature on dose skipping is substantial. I’d be most grateful for any references here!

[PsychologicalSafe15]

@Mac25 Do you get vivid dreams when even take a nap ??