Noisette: paroxetine, buspirone, quetiapine, pregabalin, clorazepate dipotassium and I am ADHD

[Noisette]

Greetings, I have been on Paroxetine for 21 years. Two years ago diagnosed ADHD so started on Concerta LP 72mg. Am also on Buspirone (reduced 2 weeks ago from 20mg to 10 mg per day). The Paroxetine stopped working. My psychiatrist here in France has been treating me with rTMS (including accelerated rTMS which is 50 ten minutes sessions in a week = exhausting) and has tapered to zero the Paroxetine. He had already started me on Quetiapine and increased it up to 400mg per day and also introduced Pregabaline which he has increased from 50 to 450mg per day. The withdrawal from the Paroxetine has been hell. The last dose of 10mg was 24 days ago. Symptoms have not diminished. He tapered too quickly with only 10mg reductions every 2 weeks. Symptoms have not abated in spite of the increase of Pregabaline (now 450mg per day) and Quetiapine (now 400mg per day). The aggression is being treated by increasing the Dipotassium of Chlorazepate from 10mg per day to PRN max 90mg per day. His objective is to simplify my meds to treat my Major Depressive Disorder with only Quetiapine and Pregabaline. Has anyone heard of this? Does anyone know if this is a protocol followed anywhere? I cannot find literature about it. Does long term (21 years) use of Paroxetine cause brain changes which are irreversible? Thank you for any advice that you might have.

[Onmyway]

Dear Noisette,

welcome to Surviving Antidepressants. I am so sorry that you are going through so much turmoil with all of these changes. 

To help us understand your history, can you succinctly summarize your drug history and changes in the last couple of years. This allows us to see quickly what might be causing your symptoms and make suggestions. 

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

 

Having said that, I want to emphasize here that we don't give opinions on the right cocktail or what you should be taking. We are strictly interested in helping people withdraw from psychotropic medications in the least harmful way if and when they decide to do that. So I can't tell you that what you are doing is the right or wrong medication.

 

In my personal opinion, what your doctor is doing is dangerous. You are on many drugs that interact with each other, he does not seem to care about the withdrawal effects and I am not even sure what he aims to do with these drugs - the chemical imbalance theory of depression is a myth and so trying to fine-tune an incredibly complex system by throwing a bunch of chemicals at it is outrageous but unfortunately not uncommon. 

Am I to understand that right now you are on the following drugs: 

 

buspirone 

concerta

quetiepine 

pregabalin

clorazepate dipotassium

 

You can check the interaction of these drugs here https://www.drugs.com/drug_interactions.html

 

 

From all of the experience of people here we see that time and time again people recover from the harm done from psychiatric drug withdrawal. It can take a long time but usually being patient, not making any more changes, staying away from other psychoactive substances like alcohol, marijuana and recreational drugs (and a few other drugs) allows the system to recalibrate and find a new balance. So fear not, you have not permanently damaged your brain. The symptoms you are experiencing, are in fact the brain's way of healing. 

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

How psychiatric drugs remodel your brain - Symptoms and self-care - Surviving Antidepressants

 

People have an easier time coming off of psychotropic drugs if they do it very slowly - reducing by no more than 10% of the previous dose every 4 weeks and letting their system rest when symptoms emerge. Here are a few links that help explain why. There are also gentler methods of microtapering. 

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

 

One way to deal with withdrawal effects is to reinstate a small dose of your drug - like 1-2mg. This is best done soon after stopping the drug and does not always work but often does work. You could try doing that with paroxetine right now. You can read more about this here: 

 

About reinstating and stabilizing to reduce withdrawal symptoms - Symptoms and self-care - Surviving Antidepressants

 

Finally, maybe this thread will help give you some hope. 

Success stories: Recovery from psychiatric drug withdrawal - Surviving Antidepressants

 

What are your current symptoms? 

 

Hope you get some respite soon, 

OMW

Edited December 1, 2021 by Onmyway

[Noisette]

Dear Onmyway, I greatly appreciate your message and so sorry for the long delay before response.

 

It is hard for me to remember all that I have taken but here is the best summary that I can provide:

 

Work burnout in 1997. Hospitalised. Major Depressive Disorder diagnosed. All types of anti-depressants were tried including MAOIs and others. I had six sessions of ECT to try to shift the depression. That was a disaster. Eventually found that Paroxetine was the drug which really allowed me to live again. Suddenly there was colour and it was the most amazing experience. For 21 years or so I have been on Paroxetine in varying doses up to 60mg per day. But most recently in the last few years it has been 40mg per day. Two years ago I was also diagnosed with ADHD and am taking Concerta 2 x 36mg. That was another life-changing experience. The Paroxetine stopped working so my doctor tapered me off - I think a bit too rapidly after 21 years on the meds. It was tapered down 10mgs every two weeks. I think but cannot be sure that I remember that correctly. My doctor here in France has also given me rTMS. I also suffer back pain from 2 herniated discs in 2013 and an operation which was only partly successful. My psychiatrist has been treating (with great success) the back pain. He was using brain stimulation for that. I do not know if the rTMS is helping the depression. Most recently, I had a week of 50 sessions of it, that is ten sessions per day for five days. I cannot say that I felt enormously different afterwards. The list of medications that you have written is correct. The last one is Tranxene. And I can now take that as needed up to 90mg/day. At the most, I have been taking one every few days to calm down. In 2003 when we moved to France from the UK, I started to have panic attacks which were enormously debilitating.. The medication Omeprazole helped a lot. The panic attacks seem to have disappeared.

 

At the moment, I am on day 35 since my last Paroxetine. I have been tracking my symptoms using the DESS criteria (not sure if it is called that but it is something similar) which I pulled from some article that I read.  It has been helpful to track the withdrawal symptôme as well as my usual depression/anxiety symptoms and also noting activity level etc. The current symptoms from withdrawal are: ataxia, lack of coordination, lightheadedness and dizziness, blurred vision and eye flickering, confusion, memory problems (like I have never had before - my memory has always been bad but nothing like this), tinnitus, fatigue that is overwhelming, decreased concentration,, attention difficulties, anxiety is high, irritability, suicidal ideation has diminished, mood swings, impulsivity, outbursts of anger (I am not an angry person), outbursts of crying (usually in frustration at not being able to do something simple like putting a duvet cover on to a duvet) and sleep issues including some insomnia. I can feel that there is a manic side to my behaviour. (My mother was bipolar and it was suspected at one point that I was also bipolar and then was sent out on the horror medication of Lithium. That was about three or four years ago. I think that the impulsivity might be related to the withdrawal. I really hope so. My impulsivity has manifested itself in going crazy buying plants for the garden. Then I have not enough energy to plant them. Understandably this is causing some irritation for my husband. He is a saint and also knows how to care for his needs.

 

The Paroxetine withdrawal symptoms have meant that I cannot drive as i used to. I think that I have driven maybe six times in the last 35 days and only very short distances. I am feeling out of control:  I have no idea how to remember commitments / responsibilitys. I write them down. I set alarms. I try to start. And then I get distracted. My feeling is that the ADHD meds needs adjusting. But my shrink is, I think rightly, seeking to simplify my depression meds before tinkering with the ADHD meds. His aim is to use only Pregabaline and Quetiapine to manage my Major Depressive Disorder which has been treatment revisitent at times.

 

Please could you help me? Is this site set up to help people dealing with anti-depressant medication on the basis that depression is not a chemical imbalance in the brain? If so, what is the cause of the depression? And why does it seem to respond to certain medications?

 

I am so grateful for your help.

 

Thank you also for your links.

 

Yours,

Noisette

 

Edited December 10, 2021 by ChessieCat
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