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Dreamingaboutbetterdays: Possible adverse reaction to St John's Wort while in protracted withdrawal from paroxetine


Dreamingaboutbetterdays

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Hello dear People,

 

I just wanted to share with you my recent story and find some hope. 

 

I am a female, 30 years old, living in Germany. I will try not to make my story too long. 

 

I was on various SSRI for 11 years and CT'd 5 months ago. My last drug was  paroxetine 10 mg (I was taking it for approx. 2,5 yrs, starting at 20mg).

 

11 years ago, when I was firstly prescribed SSRI, I was insecure, emotional, very often sad and cried a lot. Besides I was functioning pretty well, had friends, boyfriend, started uni, etc. I was just always very melancholic and kind of a shy introvert. SSRI helped me being more calm, more centered, less anxious and more confident. So, why I quit 5 months ago? I simply felt that it doesn't work any longer. It worked great for about 5years and then I was changing meds to find a happy pill that will make me feel like at the beginning of my "journey" with SSRI...how naive I was..I didn't have any psychoteraphy back then, I was just relying completely on meds. I was totally into that thinking that I have a chemical imbalance that require me to take my meds until the rest of my life and I was quite okay with that. You know, I was told that SSRI is like an insulin for diabetics. So....to the point.

 

My last drug was paroxetine, I was still highly functional with no signs of depression, but I was tired all the time to the point that I was sleeping 14 hours a day. I felt like an old lady, having no motivation to do anything, I felt that I am stuck in my life, had no energy, started  to feel more and more anxious, had some problems with sleep and muscle pain.

 

I was desperately looking for an answer, doing blood tests, seeing various doctors, but my results were great. Occasionally, I had an issue with low iron. I wanted to feel better and found a new psychiatrist who told me that I should switch to Mirtzapine due to my issues with sleep (I had some sleepless nights, could not fall asleep easily, but nothing too serious. I was often sleeping during the day as well).

 

He told me to stop paroxetine at 10 mg (and after a week start with Mirtzapine), as this is such a small dose that it won't be a big deal. I did not think much and trusted that it may be a good switch (previous psychiatrists wanted to try me on higher doses plus more medications, so I really thought Mirtazapine was a good option). Of course it was not true that 10 mg paroxetine was nothing, after two days I started experiencing acute WD, did not know what is happening with me.

 

I was suicidal for the first time in my life and it scared the hell out of me. I wanted to go to the hospital, because my psychiatrist was not a big help anymore. But after week or so, I started to feel better than ever. I decided to stay away from SSRis, as I was now sure that they were doing more bad than good. In the next three months I was full of energy, I was experiencing also some issues typical for protracted withdrawal, but I was functioning pretty well, socializing with people, doing a language course, living my normal life.

 

Because I had some sleep issues I was taking low doses of German medication similar to tricyclics called opipramol. It helped me a lot with sleep and anxiety. However, after discontinuing paroxetine, I had developed nasty and painful PGAD. It was so painful, I could not cope with that. Also, due to some family issues I was a bit low (that was totally normal to be sad, but I was already used to the thinking that a magic pill can help me feeling better).

 

So since my psychologist told me that I can try St.Johns wort because it is harmless and I can "always go back to SSRI", I gave it a try, discontinued opipramol I was taking regularly for approx. 2weeks, and for the next day started with St. John's Wort capsules. (It was in the third month of discontinuing paroxetine). I took it for three days  (each day one capsule of 900mg), and on the third day all the hell broke loose. It was 1,5 month ago and my life since then is a nightmare.  It started with panick attack out of the blue, severe anxiety, massive depression, insomnia, tremors, total lost of appetite, incredible thirst, sensitivity to sounds, light, eyes floaters, constant suicidal thoughts and intrusive thoughts, being histerical and more.

 

I went back to opipramol hoping it will help a bit to calm me down, but it didn't. I have some better days now or rather hours, but even then it is nothing like being my normal self. I can now fall asleep and sleep for 6-7 hours, but I wake up with awful tremors and rapid heart beat. I feel like my mind is deteriorating and I am more and more out of this world. I am living in my head, fighting with suicidal thoughts and depersonalisation. I can not do simple tasks, even making a dinner makes me shaky and anxious. 

 

I am totally petrified of what I have become. I am not myself with no life inside of me. But I really want to live. I want to be happy, want to be here for myself an my family. My psychiatrist, does not believe in adverse reaction, he thinks that it is my depression coming back, but of course it is not the case, I know it. He wants to put me back on SSRI or another mediation, that does not work on serotonin, Valdoxan. I do not know what to do. Sometimes I feel like it will be better with time, but then I feel like something is seriously messed up in my brain, and I am really scared of living like that. Any advice would be much appreciated. Any hope.  I am sorry for any mistakes in grammar, English is not my first language. 

 

Edited by ChessieCat
added spacing for easier reading

First diagnosed with depression disorder (dysthymia)
On SSRI since 2009 (fluvoksamine, 6yrs, escitalopram 2 yrs, paroxetine last 2,5 years),
Decided to stop paroxetine (10mg) on the 28th of May 2021, cold turkey (doctor's advice...)
Acute WD phase for around 2 weeks (mostly physical), then protracted WD symptoms but mentally I was doing good
After two months advised by psychologist to take opipramol(2 x50mg) to help with anxiety and insomnia caused by WD, low doses, it helped pretty well

Paroxetine withdrawal caused super painful PGAD and I started to feel more and more tired, exhausted and irritable

Decided to stop taking opipramol  on 17.09 and on the next day started with St John's Wort (also advised by psychologist), after 3 days (each day 900 mg) the hell started stopped SWJ and went back to opipramol on the 23rd of September (2 X 50mg) but it did not help

currently on opipramol 75mg, weaning off

 

 


Since then severe anxiety, sleep issues, inner trembling, restlessness, SI, depersonalisation, crippling depression etc. 

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  • ChessieCat changed the title to Dreamingaboutbetterdays: Possible adverse reaction to St. John's Wort while in protracted withdrawal from paroxetine

Please, can anyone advise should I just keep going like that hoping that recovery is happening or is it too messed up to be able to heal itself and I now need antidepressant to stabilize even a tiny bit? I know that people here are going through hell and no matter what, they go further. I truly admire them, but I am not sure if I can keep going like that. On the other hand, I am scared of taking any other meds. I take ocassionally benzo (no more than once a week) when it is so bad that I can not take it any longer. It does get slightly better after. But of course it is not my intention to start with benzos now. All my life I wasnted to take the smallest dose of SSRI and here I am....

 

I would be thankfull for any answer. 

 

Take care all of you. 

First diagnosed with depression disorder (dysthymia)
On SSRI since 2009 (fluvoksamine, 6yrs, escitalopram 2 yrs, paroxetine last 2,5 years),
Decided to stop paroxetine (10mg) on the 28th of May 2021, cold turkey (doctor's advice...)
Acute WD phase for around 2 weeks (mostly physical), then protracted WD symptoms but mentally I was doing good
After two months advised by psychologist to take opipramol(2 x50mg) to help with anxiety and insomnia caused by WD, low doses, it helped pretty well

Paroxetine withdrawal caused super painful PGAD and I started to feel more and more tired, exhausted and irritable

Decided to stop taking opipramol  on 17.09 and on the next day started with St John's Wort (also advised by psychologist), after 3 days (each day 900 mg) the hell started stopped SWJ and went back to opipramol on the 23rd of September (2 X 50mg) but it did not help

currently on opipramol 75mg, weaning off

 

 


Since then severe anxiety, sleep issues, inner trembling, restlessness, SI, depersonalisation, crippling depression etc. 

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  • Moderator

Welcome @Dreamingaboutbetterdays

I’m glad you decided to share your story. I'm so sorry for all you have gone through and are going through, but relieved you have found this forum. At least you have an understanding that the drugs are causing problems, not a chemical imbalance.

 

What date did you take the last dose of paroxetine? What date did you start and quit St. Johnsworth? What drugs or supplements do you take now?

 

To help us better advise you, can you please create a signature with all of the drugs that you are taking and have been taking in the last couple of years following these instructions:

How to List Drug History in Signature

 

I found this post helpful to understand what is going on and why healing takes time:

How Psychiatric Drugs Remodel Your Brain

 

About withdrawal:

What is withdrawal syndrome?

Dr. Joseph Glenmullen's withdrawal symptom checklist


Please do not start any new drugs or supplements. Your central nervous system (CNS) has become sensitized from psychiatric drug use and can react unpredictably. Alcohol, caffeine, nicotine and other mind altering substances can make the condition worse.

 

Here is our symptoms and self care section, you may find some useful ideas to help manage symptoms as you recover. 

Important topics about symptoms

 

The search function on this site doesn't work very well.  The best way to search this site for specific information  is to use your favorite search engine. Type in survivingantidepressants.org then the symptom, treatment, supplement or information you wish to search for.

 

To make sure someone sees your post write @ and then start typing their username so it becomes blue like this @Kiasofia

 

In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through. Please know that the brain is amazing in it's healing abilities. It takes time, but healing can and will happen. 

 

 

These are my opinions based on my own experience and what I have learned, not medical advice.

 

Drug history

2002-2019 Citalopram/Escitalopram, Lamictal
2019 April Escitalopram, quit at 10mg (withdrawal), Oct Escitalopram 10mg reinstated, quit after a few days (adverse reaction)

2019 Oct Lamictal cut from 200mg to 100mg
2019 Dec Lithium 83x2 mg

2020 Aug-Nov Lamictal tapered to 50 mg

2020 Nov 24 Lithium taper started, 30 Jan off Lithium

2021 15. March-31. May Lamictal tapered to 32.5 mg (holding)

2022 10. Jan started taking 25mg+5mg+2mg+0.5 liquid, 22. Jan went back to taking 25mg+5mg+half 5mg

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Hello @Kiasofia and thank you for your kind reply. 

My last dose of paroxetine was on the 28th of May 2021. Since the second month of my WD (August) I was taking also low doses of German tricyclic drug called Opipramol. I was told by my psychologist that it is pretty harmless and can help with anxiety and sleep issues and it did help pretty good. I was taking it quite irregularly at the beginning, then 2x 50 mg (in the morning and in the evening). Stupidly, I decided to stop it abruptly on the 17th of September, because I started to feel very tired, I had very strong PGAD from paroxetine WD and I though that opipramol can even make it worse. Then on the next day I started SJW, and I took it for three days until all the hell broke loose. I was recommended to take a pretty hefty dose of 900mg a day and this dose has sent me into hell. I was desperately trying to get better so after few days I went back to opipramol, two times a day, and I am still on it, but it seems it does not work and I am afraid that it is only making me worst. So I am tappering down, but I am not sure should I tapper it or just stop taking it or leave it like that for a longer time. 

I feel that my case is hopeless, I made so many mistakes and now I feel so far away from myself that I can not even function normally. 

 

First diagnosed with depression disorder (dysthymia)
On SSRI since 2009 (fluvoksamine, 6yrs, escitalopram 2 yrs, paroxetine last 2,5 years),
Decided to stop paroxetine (10mg) on the 28th of May 2021, cold turkey (doctor's advice...)
Acute WD phase for around 2 weeks (mostly physical), then protracted WD symptoms but mentally I was doing good
After two months advised by psychologist to take opipramol(2 x50mg) to help with anxiety and insomnia caused by WD, low doses, it helped pretty well

Paroxetine withdrawal caused super painful PGAD and I started to feel more and more tired, exhausted and irritable

Decided to stop taking opipramol  on 17.09 and on the next day started with St John's Wort (also advised by psychologist), after 3 days (each day 900 mg) the hell started stopped SWJ and went back to opipramol on the 23rd of September (2 X 50mg) but it did not help

currently on opipramol 75mg, weaning off

 

 


Since then severe anxiety, sleep issues, inner trembling, restlessness, SI, depersonalisation, crippling depression etc. 

Link to comment
  • ChessieCat changed the title to Dreamingaboutbetterdays: Possible adverse reaction to St John's Wort while in protracted withdrawal from paroxetine
  • Moderator

What symptoms are you having now that you think are caused by Opipramol? Please add the date you restarted Opipramol to your signature so we see how long you have been taking it continuously.

 

What other withdrawal symptoms than PGAD have you had since August? How is sleep and anxiety now?

 

As we are recovering, we suggest keeping things slow, simple, and stable. This is extremely important. 

 

Keep it simple, slow and stable

 

It is advised to not taper until you have felt stable for minimum 4 weeks and then follow these guidelines:

Why taper by 10% of my dosage?

NEVER SKIP DOSES TO TAPER

As you know from your experience with SJW, a brain in withdrawal can react badly to supplements. We therefore don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. It is suggested to add one at a time, and start with a low dose to see how it affects you. 


Magnesium 

Omega 3 Fish Oil

 

SJW is specifically mentioned as a problem here. I don't know how helpful it is for you, but at least you can know that reacting badly is not uncommon.

Important topics about tests, supplements, treatments, diet

These are my opinions based on my own experience and what I have learned, not medical advice.

 

Drug history

2002-2019 Citalopram/Escitalopram, Lamictal
2019 April Escitalopram, quit at 10mg (withdrawal), Oct Escitalopram 10mg reinstated, quit after a few days (adverse reaction)

2019 Oct Lamictal cut from 200mg to 100mg
2019 Dec Lithium 83x2 mg

2020 Aug-Nov Lamictal tapered to 50 mg

2020 Nov 24 Lithium taper started, 30 Jan off Lithium

2021 15. March-31. May Lamictal tapered to 32.5 mg (holding)

2022 10. Jan started taking 25mg+5mg+2mg+0.5 liquid, 22. Jan went back to taking 25mg+5mg+half 5mg

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Hi @Kiasofia

 

to be honest I have no idea if opipramol is causing any symptoms right now. I restarted it few days after my last dose of SJW hoping that it will help with this bad reaction to SJW. So that was on the 23rd of September when I started taking Opipramol again. At that time I had no idea what is happening to me and I thought that maybe my symptoms are caused by discontinuating Opipramol, but I do not longer think that it is the case since I took it for about 3 weeks regularily before taking SJW. I am taking 1,5 pill Opi a day (half in the morning and one before sleep, 25 mg plus 50 mg --->75mg in total) just because I do not want to make any abrupt changes anymore.  

 

When I stopped paroxetine everything was fine with me mentally, I had some though days, but it was pure withdrawal - neuro emotions, increased energy etc. Only this horrible PGAD and sleep issues were worrying me. PGAD was becoming more and more painful, I could not deal with that any longer and none of my doctors knew what I am talking about. I was sure that it was caused by paroxetine, so I even started thinking about going back to paroxetine only to stop the pain. But I remembered that my psychologist told me to try with SJW before going to meds (cause I can go back to them anytime, as also my psychiatrist said). So i tried. I had no idea that it can cause any harm. Then I crashed. One day I was fully functional and the next day I was a a total mess. Surprisingly, my PGAD became less and less intensiv and for the time being it is kinda gone. So it is the only thing that I am no longer dealing with.

 

Currently I have an impression that each day is making me worse, I can barely function. Since I took SJW I have severe anxiety and depression, lost of appetite, dry mouth, severe depersonalization which is progressing  (copule months ago I did not even know what does it mean), feeling dead inside, severe anhedonia, sleep issues - sometimes I sleep 7 hours, sometimes 4, some nights are sleepless, waking up around 6 am with racing heart and can not sleep any longer, since few days I am expereincing also pressure in my head, floaters in my vision, intrusive and suicadal thoughts are with me almost everyday. 

 

I am trying to deal with it as much as I can. At the beginning I was even trying to excercise, listening to podcasts and meditations, now most days I am lying in bed and can hardly do a meditation. I am not even able to describe my suffering. I can not believe that this is all about me. 

I do not want to play a victim, I am far away from being that person. I am trying to accept my situation but this is so difficult. I have a wonderful boyfriend, loving family and precious dogs and they are everything to me. But I am suffering even stronger knowing that they have to go through this hell with me. 

 

I know I need a lot of time to heal and I want to believe it is possible. But at the same time I am afraid that my brain is damaged, because my symptoms are so sever. Sometimes I have small windows of hope or feeling something, but these are short moments. I have an impression that it was slightly better in the early days after my reaction, even though it was still hell. 

The worst issue is depersonalization and anhedonia. All my life I was very emotional, had very strong feelings, even on AD and I always felt like myself. 

 

Thank you for all your help and links, I hope that we will all heal one day. And I am sorry for any grammar errors but it is really difficult for me to concentrate. 

 

First diagnosed with depression disorder (dysthymia)
On SSRI since 2009 (fluvoksamine, 6yrs, escitalopram 2 yrs, paroxetine last 2,5 years),
Decided to stop paroxetine (10mg) on the 28th of May 2021, cold turkey (doctor's advice...)
Acute WD phase for around 2 weeks (mostly physical), then protracted WD symptoms but mentally I was doing good
After two months advised by psychologist to take opipramol(2 x50mg) to help with anxiety and insomnia caused by WD, low doses, it helped pretty well

Paroxetine withdrawal caused super painful PGAD and I started to feel more and more tired, exhausted and irritable

Decided to stop taking opipramol  on 17.09 and on the next day started with St John's Wort (also advised by psychologist), after 3 days (each day 900 mg) the hell started stopped SWJ and went back to opipramol on the 23rd of September (2 X 50mg) but it did not help

currently on opipramol 75mg, weaning off

 

 


Since then severe anxiety, sleep issues, inner trembling, restlessness, SI, depersonalisation, crippling depression etc. 

Link to comment
  • Moderator

Can you see if this is correct and then update your signature so it looks like this. Also add the name and dose of the benzo you occasionally take:

 

Since 2009 (fluvoksamine, 6yrs, escitalopram 2 yrs, paroxetine last 2,5 years)

2021 May 28 Paroxetine 10 mg (quit CT)

Early Aug - Sept 17 Opipramol(2 x50mg) (for anxiety and insomnia) helped pretty well
Sept 18-20 St John's Wort 900mg (adverse reaction)
Sept 23  Opipramol 75mg reinstated  (2 X 50mg) did not help
Currently on Opipramol 75mg, weaning off

 

What these drugs do to the brain and the shock of SJW is a form of brain damage, but the brain does heal. It is harder to determine the best course of action when more than one drug/supplement has been added inn. SSRI withdrawal can last a long time and Paroxetine is known for causing bad withdrawal. But you are also recovering from an adverse reaction to SJW and on opipramol.

 

According to medical knowledge, reinstatement is the only way to alleviate withdrawal. The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis. Reinstatement should ideally be within 3 months of quitting. After this it is more uncertain if it should be done or not. You can read more about it here and we can discuss it more if it is something you want to consider. We advise a much smaller reinstatement than most medical professionals. No more than 1mg to start with. And because paroxetine is so difficult to quit, sometimes fluvoksamine is advised instead.

 

About reinstating and stabilizing to stop withdrawal symptoms


In the meantime, take care of yourself, and take heart.  We in this forum have been through this, and we understand first hand the pain and discomfort you are going through. Please know that the brain is amazing in it's healing abilities. It takes time, but healing can and will happen. 

 

These are my opinions based on my own experience and what I have learned, not medical advice.

 

Drug history

2002-2019 Citalopram/Escitalopram, Lamictal
2019 April Escitalopram, quit at 10mg (withdrawal), Oct Escitalopram 10mg reinstated, quit after a few days (adverse reaction)

2019 Oct Lamictal cut from 200mg to 100mg
2019 Dec Lithium 83x2 mg

2020 Aug-Nov Lamictal tapered to 50 mg

2020 Nov 24 Lithium taper started, 30 Jan off Lithium

2021 15. March-31. May Lamictal tapered to 32.5 mg (holding)

2022 10. Jan started taking 25mg+5mg+2mg+0.5 liquid, 22. Jan went back to taking 25mg+5mg+half 5mg

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