chevalier: getting off Paxil

[chevalier]

Been on/off SSRIs and even a couple antipsychotics for several years. Always had some mild anxiety but major issue and reason for prescription(s) was OCD. None of the meds ever had a huge effectiveness for OCD, but within the last year or so discovered Dr. Michael Greenberg's rumination-focused ERP therapy for OCD and have learned to manage OCD using this therapy (highly recommend for others!). Have been on paxil for over a year and recently tried to taper off. Started at 40mg and went down 10mg per month, although when I got to 10mg I only stayed on for a couple weeks before stopping. Had no idea this med was notorious for withdrawals or what a problem this med is, or wouldn't have even started it. Started having very mild anxiety issues when I was sleeping while I was tapering off, but was able to go back to sleep. Kept getting worse while tapering and still while I was completely off.

 

Symptoms peaked around week 6-7 and was having full blown panic attacks at night and eventually just all day, weird pain in the forehead like a sinus headache but from panic/stress. Had bad hand tremors, dizziness, nausea and had to miss work but eventually just went back on paxil. This time 10mg in the am and 10mg at night according to doc's orders. Now on 30mg paxil. Been back on paxil for about two weeks. Noticed immediately it helped although still have heightened anxiety and twinges of pain like a sinus headache. 

 

Feels like no one really knows how long withdrawals from paxil last; have heard 2-3 weeks, 4 months, a year, etc. Don't think its relapsing because never had panic attacks and never had problems like this getting off or switching meds.

 

Really need to get off this med, especially because it makes me so tired which is a big reason I wanted to come off now that I have the OCD under control. Hoping to get stable again and then start tapering slowly, possibly with the liquid form so I taper in smaller increments. 

 

 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  What date did you quit the Paxil altogether, before the reinstatement?  Also, you said 

 

On 7/13/2022 at 9:22 PM, chevalier said:

This time 10mg in the am and 10mg at night according to doc's orders. Now on 30mg paxil.

10 plus 10 is 20.  Are you on 20 mg Paxil daily, or did you mean to say you are taking 15 mg twice a day (adds up to 30), or what? 

 

 

Can you please give us more specific information in your signature about the dates that you did your reductions of Paxil, and the date you went to zero Paxil?  You can say for example early March if you don't recall the day, and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our doses.  It sounds like your taper was more rapid, so that your brain didn't have time to adjust properly as you were reducing. 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. 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

 

Finally, going back on a small dose of your drug, which I see you've done, is the best way to reduce withdrawal symptoms.  It takes about a week for this to get into your system and register with your brain, but it can take another month or two for it to be fully effective.  A reinstatement is temporary, and after stabilizing you would then taper gradually off of this.  Here is some information about reinstatement.  

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

My suggestion would be to stay on this reinstatement dose for at least a couple of months, if not longer, and allow your system to really stabilize.  Then, you can commence a careful, gradual taper.  I will share some links with 2 different tapering methods to choose from.  Yes, using a liquid makes it very easy to taper, but if you switch to a liquid, be sure and switch over gradually.  I can give you info about that when the time comes. 

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

The other taping method is even gentler, and is called micro-tapering: 

 

The Brass Monkey Slide Method of Micro Tapering

 

This link explains how to dose and taper Paxil: 

 

Tapering and Dosing Paxil

 

I've given you quite a bit of information here.  Please read through it, and mull it over, and we will take it from there. 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. 

[chevalier]

Updated the signature. I've been back on 40 mg paxil with 50 mg trazadone for several weeks. Still have weird head pressures all the time, and now seems like I can't get off the trazadone either, which I was only started taking when the paxil withdrawals were so severe I was going to the ER, couldn't sleep, etc. Tried to decrease trazadone cause it makes me more tired, which is a big reason I was trying to come off paxil in the first place but notice within a day or less that I start having intense head pressure with pain and panic. So no it seems like I'm stuck on two meds instead of just the paxil. 

 

I'm wondering how long I need to stay where I'm at before I could try a 10% decrease in the trazadone, feels like my nervous system is definitely messed up so I don't know if I should wait until there is some healing, but the fatigue makes it hard to do anything. 

 

Also, would anyone have recommendations for talking to the doctors about whats going on? I met with my doctor a week ago, and of course he had never heard of anyone having such bad withdrawals from paxil and/or any protracted nervous system damage. In fact, he wants to add buspirone to try and combat the heightened anxiety I've now got since withdrawing. They're so dismissive its disheartening and I don't want to just keep medicating. 

[GiantsWSC]

@chevalier

 

Sorry to hear you're going through all these emotions and issues. I was on Paxil for almost 20 years and took Trazadone for literally no more than 2 weeks so hopefully I can shed some light.

 

40mg of Paxil at least from my experience is a fairly high dose but if that's what the doctor prescribed I can't really argue if they feel that's the right amount. I was initially prescribed 10mg and then it was bumped to 20mg and I took that for many years. When asked if I could lower my dosage after all those years and get off the meds, the doctor basically said "cut it in half for the next week, then take those halves every other day for the next week, then once a week on the 3rd week." Well, that was way to fast a taper and my withdrawal symptoms were horrible. 

 

If you want to taper off with reduced symptoms I would take the advice from getofflex, specifically the brassmonkey slide. As far as knowing how long to stay on a particular dose and percentage decrease your body will let you know. For example, there were times where I drop my dose but felt the symptoms come back so I sometimes would go back to the previous dose and hold it longer (maybe gave myself an extra couple weeks, sometimes a month). I didn't always do the 10% drops sometimes it was less like 5 or 7% for example but never more. Get yourself a few weekly pill boxes and prepare your doses so you can better track your schedule.

 

I wasn't on trazadone long enough to deal with much withdrawal but I do remember it making me very tired and groggy. I felt like a zombie on that stuff so it was a no go for me. 

 

You have to tell yourself that this isn't a race to see who can get off the meds the fastest. You want to get off the meds in a way that will still allow you to function in society if at all possible. Trust me, I've had my share of calling in sick just because I just couldn't deal with stuff/people.

 

Talking to your doctor can be tough. If they're understanding then great but unfortunately most docs don't have the time to spend on each patient so that's why I think they take the easy way out which is the prescription med route. I don't think you want to go down that road where they start prescribing you a new cocktail of drugs(which seems he already has) that will send your mind/body into a frenzy since you have your hands full with you current meds. 

 

I'll reiterate that you should try the brassmonkey slide, get a good amount of sunlight, take some supplements like multivitamin, vitamin D, magnesium, fish oil to boost immune system and help the healing process. Eat less sugar and absolutely NO DRINKING while on these meds as that is a recipe for disaster.

 

Hope this helps

 

[chevalier]

Thanks a lot for the response. 

[chevalier]

Still have not tried restarting a taper with paxil or trazadone. Has been a little over two months since I reinstated to full original paxil dose (had started taking the trazadone when I was withdrawing already). Have been relatively stable except for extreme fatigue and a sensation I sort of describe as burning. Sometimes it seems random, but I've noticed that too much caffeine can make it worse. When was I having the horrible withdrawals, I wasn't taking the trazadone, but started taking it during the withdrawals to just get to sleep. But now seems like I can't sleep even if I only take 3/4, and have fairly pronounced heightened anxiety. But the paxil was already sedating, and with the trazadone its hard to even get through the day at work, and i basically just crash until morning when I get home. Since this weird head sensation is somewhat mild/stable, would it be a bad idea to start something like the brass monkey tapering of trazadone to try and gradually get rid of the fatigue/drowsiness?

 

Posted a little bit about this before, but am wondering if its possible to find psychiatrists/hospitals who are aware of issues with withdrawal syndrome and helping people deal with it? Recently had an appointment with a different doctor, and it basically feels like I'm just going to have to find someone who is willing to work with me on something like a 10% reduction or the brass monkey taper. But of course docs don't like being told that I want to do something they're not familiar with, and always tell me they haven't had experience with anyone having withdrawal syndrome, which seems crazy. I haven't been able to find through searches a doctor or hospital near me that specializes in something like this. @getofflex

 

[getofflex]

20 hours ago, chevalier said:

Since this weird head sensation is somewhat mild/stable, would it be a bad idea to start something like the brass monkey tapering of trazadone to try and gradually get rid of the fatigue/drowsiness?

20 hours ago, chevalier said:

But now seems like I can't sleep even if I only take 3/4, and have fairly pronounced heightened anxiety.

 

 

So you have fatigue/drowsiness, but yet have trouble sleeping? You are having other symptoms, such as heightened anxiety, so if it were me, I would wait a while longer to begin tapering. 

 

Stability

 

You did a cold turkey off prozac back in April, it looks like from your signature.  It only takes 1 month for the brain to become dependent on prozac.  From what you describe, it sounds like your nervous system is still destabilized.  (fatigue, burning, sleep issues, anxiety). And you've done multiple drug changes since then, with starting trazodone, and updosing your Paxil.  Is the mild weird head sensation the only symptom you are having right now?  How is your sleep?  

 

Also, it would be advisable to taper the paxil before tapering the trazodone.  We suggest tapering the activating drug first.  See this link:  

 

Multiple Psych Drugs - Which to Taper First

 

20 hours ago, chevalier said:

Posted a little bit about this before, but am wondering if its possible to find psychiatrists/hospitals who are aware of issues with withdrawal syndrome and helping people deal with it?

The vast majority of doctors and hospitals know almost nothing of proper tapering methods and withdrawal.  Here is a link with a list of resources, perhaps you can find something.  

 

Recommended Doctors, Therapists and Clinics

 

 

 

 

 

 

 

 

[chevalier]

Thanks for the reply! I only have trouble sleeping if I try and cut down on the trazadone, I wasn't taking it before withdrawing from paxil so figured I hadn't been on it long enough to have problems coming off, and the doctor was telling me I should be able to halve or even not take it and do fine, but even taking 3/4 seems to cause the anxiety and insomnia. Yeah the burning is the only one I have daily or at least every other day, although the fatigue/sedation gives me the most problems with functioning at work, etc. 

Gotcha, sounds like the paxil would be the best to start with then; yeah, fairly nervous to taper anything when I think about the withdrawals. 

Thanks for the Drs. link as well, will definitely check out that. 

[getofflex]

14 hours ago, chevalier said:

I only have trouble sleeping if I try and cut down on the trazadone, I wasn't taking it before withdrawing from paxil so figured I hadn't been on it long enough to have problems coming off,

 

What dates did you cut your trazodone dose?  I would suggest that you not cut down on your trazodone dose at this time.  You've been taking trazodone since April, so your brain is dependent upon it.  It only takes 4 weeks for our brains to become dependent on psych meds.  It is very important to take the same doses of your drugs, every day, at the same time, in order to achieve and maintain stability. Only in this way will you be able to eventually start a successful tapering program.  Please carefully read this: 

 

Keep It Simple, Slow, and Stable

 

If you read the links I gave you in my first post to you, you will see why it's important to keep all your drug doses the same while trying to achieve stability. 

 

14 hours ago, chevalier said:

the doctor was telling me I should be able to halve or even not take it and do fine, but even taking 3/4 seems to cause the anxiety and insomnia.

Please realize that most doctors do not have good knowledge of how dependent we become on these drugs, withdrawal, how to taper people off properly, etc.  That is why this site exists.  As you can see, you doctor was wrong about saying you could halve it and do fine.  Cutting your trazodone dose is just causing you problems, and destabilizing your nervous system, and will make it take much longer for you to taper off of the drugs.  Please be extremely cautious listening to doctors advice about how to reduce and taper off these drugs.  Also, please realize that our protocol on this site is much different than what 98% of doctors will tell you.  You need to make a decision whether you want to follow your doctor's advice, which contradicts what we are suggesting, or our advice, as trying listen to both will confuse you, confuse, us, and cause us to waste our time trying to help you.  

 

Edited October 7, 2022 by getofflex

[chevalier]

Hi,

 

Am wondering if you can provide any advice on when to restart taper. I've kept my meds the same per your advice in order to reach a sort of stability; symptoms are pretty much the same day to day. So currently taking 20 mg paxil in the morning, and 20mg in the evening, with 50mg trazadone in the evening as well. 

 

Before having bad withdrawals I was drinking a lot of caffeine due to a lot of fatigue, drowsiness, and have realized that caffeine is maybe the biggest trigger that causes a lot of irritation to my nervous system. Even a small amount of caffeine makes my head 'burn' and anxiety worse. I notice within a short time after having caffeine that I start having concussion-like symptoms - noises, even such as a keyboard typing at work caused my head to ring and hurt quite a bit.

I've cut out basically all caffeine, and don't have the same head pressure, burning, ringing, etc.

 

The main issue now is the horrible fatigue, drowsiness, and it seems to be the same regardless of how much sleep I get. I wake up a lot at night, but that has been an issue for me for several years, even before I had tried to come off paxil, so I don't think this is necessarily abnormal or due to the withdrawals. 

 

But the fatigue is so bad I struggle to  work efficiently, and my mood and motivation is sapped, and often just go from work to sleeping over and over. 

 

Because my nervous system still seems really sensitive as evidenced by bad reactions to caffeine, I am wondering if I should wait till there is more noticeable healing there before restarting tapering? On the other hand, I am basically stable day to day and really want to start tapering in order to try and slowly get some relief from the horrible fatigue that I think the paxil and trazadone cause. I've been reading a lot of @brassmonkey's posts and would like to try this method. Is there a consensus on when its ok to restart tapering? @getofflex. Thanks again for the help you guys provide to people like me.   

[brassmonkey]

If you are pretty stable day to day, then it's time to go for it. I highly recommend the Brassmonkey Slide Method.

 

I'm just about to leave the country for a month, we can talk when I get back.

[Altostrata]

Hello, @chevalier It would not be unusual for paroxetine to cause fatigue. Please review Tips for tapering off paroxetine (Paxil, Seroxat)

 

If I were you, I'd start tapering the earlier daily dose, reducing it may reduce the fatigue you feel during the day. I'd get a prescription of 10mg tablets for the earlier dose and add 10mg in liquid to begin, then taper the liquid by 10% of your daily dose (initially 10% of 40mg, or 4mg), until you are down to 10mg for the early dose. Then start working in the same way on the evening dose.

 

Please let us know how you're doing.