Bouvie's Introduction

[Bouvie]

I am Bouvie and this is my introduction. My immediate issue is SSRI withdrawal. Here is my history:

 

I began taking 25 mg Paxil and 0.5 mg clonazepam around 1995. The clonazepam was prescribed for anxiety and has been very effective for me. Until recently, I have been very conscientious about not increasing the dose. The Paxil was more of a "why don't you try this" taken from a drawer full of samples. I was in a persistent depression at the time and the Paxil helped.

 

All was more or less well until I entered perimenopause about 7 years ago. I returned to treatment for help dealing with premenstrual dysphoric disorder (PMDD), mainly mood and anger issues, spending binges, and heightened anxiety and despair. I tried Effexor for 2 months, did not tolerate it well, and switched back to Paxil. The doctor suggested that I might be bipolar. I had seen this doctor 3 or 4 times, never for longer than 20 minutes. I do not believe I am bipolar (I know several people who are bipolar) but I know that PMDD can present with symptoms similar to bipolar.

 

I'm in university health care system, so care is typically provided by residents (who aren't around forever, obviously). With a switch to a new resident, there was no more discussion of bipolar. It was suggested instead that I increase Paxil for 5 days during my menstrual cycle. I didn't experience any benefit and discontinued this. In the meantime, I increased clonazepam to .75 to 1 mg a day to help control irritability and anxiety. I also saw a psychologist for therapy. I didn't experience any improvement and felt that things were worsening for me. I was prescribed a small dose (1/4 of a 50 mg tablet) of Trazadone for sleep.

 

Switched to another psychiatrist when my resident moved on and to a clinical psychologist 6 months ago. After several discussions about PMDD, decided to transition from Paxil to Celexa. During the process I experienced mania (agitation, unable to sleep, muscle pain) and we agreed to stop Celexa. At that point I suspected that I am no longer able to tolerate SSRIs. I had already tapered down to 10 mg Paxil, and decided to continue until I was off Paxil. The doctor was reluctant but agreed.

 

I have been very assertive about tapering slowly, since I experienced a lot of side effects, but I wasn't provided any guidance other than to try to get off as soon as possible. I decided to decrease in 2.5 mg increments, with a decrease staged out every 3 weeks. I would experience withdrawal the first week, then stabilize. Finally after 3 weeks on ~ 2mg Paxil, it was time to go cold turkey. I was feeling much better as I tapered down, with less irritability and more hope.

 

After stopping Paxil, withdrawal has kicked in big time. After reading what I can find on this topic, it seems silly now that I didn't expect this, but since the tapering had gone relatively well, I was truly unprepared for what happened. I had a week of very high anxiety, shaking, nausea, gagging, and wondering what on earth was going on before I figured out that this was either discontinuation or relapse. Now it has been just over 2 weeks. I have a workbook on anxiety, I exercise and eat well, but have been completed knocked over by the anxiety and other symptoms that just won't quit. I see my doctor for the last time next week (doctor is moving to a different practice) and I don't know what to do. Go back to 5 or 10 mg Paxil, and resume tapering but at a much more conservative pace? or stick it out? I welcome suggestions from anyone who has been in a similar situation.

 

I have been going to work, but start every morning with raging anxiety, gagging and nausea. I always took Paxil in the morning, so I guess it makes sense that it is worst in the morning. I am taking .5 mg clonazepam at night and again in the AM to deal with the anxiety. Still taking the 12.5 mg Trazadone for sleep. My self-confidence is shattered but I am trying to be good to myself, eating as well as I can with nausea. I have always exercised, and now have taken it down to very soothing routines (yoga, qi gong) to avoid triggering a panic attack. Since I am having to switch doctors, I know there won't be any recommendations for anyhing new, but I need to advocate for myself and decide whether or not to go back on a low dose of Paxil. If I try to tough it out, will the withdrawal potentially last longer and be more severe? And for that matter, having been on Paxil for so long, is it even realistic to hope to be off it altogether?

 

Thank you, and I am grateful for this site.

[areyouthere]

Hello and welcome. I'm sorry that you are going through this. This is not your fault and it's apparent by your comments that you are used to taking care of yourself by self advocating and that is great and likely why you wound up here.... good choice! You will get excellent advise.

 

Now I'm not an expert...actually just joined in August but I think that you are fortunate in that it has only been two weeks since your last dose of paxil? You may be able to reinstate and then taper more slowly... but wait until someone with more experience can evaluate your history and be specific with an educated recommendation. Someone will be along either tonight or tomorrow.

 

Please put your history with the drugs , dosages and timeline in your signature. here is how to do that:

 

http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

This will make it much easier for the wise sages to give you advice.

 

In the meantime.... check out the symptoms and self care thread. Yoga and anything soothing is great and it is excellent that you are keeping up with that...

 

I think you are going to be just fine!!!!

 

RU

[lindamorellato]

Hi welcome! I'm bipolar too NOT! It's nice to see someone with PMDD issues as well. I wish you the best. I feel we are in the right place for help and support.

 

Linda

[Altostrata]

Welcome, Bouvie.

 

At the very end of a taper, it's difficult to judge when to just jump off. Since you'd been experiencing withdrawal symptoms with 2.5mg decreases, it seems a 2mg drop was too much for your nervous system. Paxil is a notoriously difficult drug to quit.

 

There is no reason to put your nervous system through the stress of withdrawal symptoms. Paxil comes in a liquid. If I were you, I'd get the liquid, take 2mg right away, stabilize for a month, and start to decrease by 10% (.2mg to start; progressively smaller decreases after).

 

See http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

[Jemima]

Welcome, Bouvie, and ditto what Alto said. There's only a narrow window to reinstate after cold-turkeying off of an SSRI, about a month, so please get back on that 2 mg. ASAP. If you aren't able to get the liquid right away, here are some instructions on how to make it yourself:

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Your problems in the morning may be due to elevated cortisol levels, which seem to be a particularly painful feature of withdrawal syndrome. The bright light in particular made me very irritable and what helped was keeping my bedroom as dark as possible at night and wearing sunglasses during the day. If there's any way you can avoid bright light in the morning, that might be worth a try.

 

You've come to the right place. This forum was a godsend for me when I got off Lexapro far too fast.

[Bouvie]

Thanks everyone for the kind replies, encouragement, and very helpful advise!

 

Was going to wait until next week, but took 2 slivers of Paxil tonight (my best guess 1.5 mg), the last I had of the 10 mg tabs I had been whittling down. I have plenty of larger tabs to work with. Since my doctor is out I can't get my scripts filled until next week, so I'll look at the instructions for making the liquid.

 

This is quite dramatic, but my way of coping has been to pretend that I am receiving chemotherapy, and to treat myself accordingly by accepting the nausea and just trying to think of this as a necessary healing process.

 

I've been crying daily since stopping Paxil, but I don't mind because I couldn't have a good cry when I was on Paxil.

 

Thank you all again.

[Wingbatty]

Wow, Bouvie. You are in the thick of it.

 

What else are you doing to help you with the anxiety?

 

I have anxiety also - it led to the depression & the pills merry-go-round - and I have to manage this daily with yoga, meditation, walking. I'm also cutting coffee back down - I'm a terrible addict but coffee does such bad things for anxiety!

 

Without a plan for how you'll manage the anxiety on your own, it can be overwhelming to go off the meds.

[Altostrata]

Yes, make the liquid and make sure you can precisely measure your dosage, since it seems you're sensitive to a 2mg decrease.

[Bouvie]

Thanks again for the replies. I told a friend yesterday that I feel much less alone in what I am going through.

 

I purchased a pill crusher, crushed a 30 mg tablet, mixed with 15 mL warm ater and drank 1 mL which should be 2 mg. I will request plenty of Paxil in the liquid form to stabilize then continue decreasing.

 

Taking the Paxil had an immediate effect, I am calmer and had far less nausea and gagging today. I am truly grateful for the advice, as I was on the fence about which way to go.

 

Anxiety has been a lifelong issue for me, even as a child I demonstrated social anxiety. This continued to be a significant problem for me, hence the meds. The problem is that now well into perimenopause the SSRIs seem to be exacerbating my anxiety and to be honest, I do not have the best coping skills in spite of years of therapy. I over-analyze everything, I'm a veteran negative thinker and I have a lot of residual self-hatred. One book that I read that really helped me understand myself was The Narcissistic Family.

 

I cut my caffeine down to 1 cup of coffee and 2 to 3 rows of good quality dark chocolate a day about 5 years ago. Now the coffee is slowly being reduced (but taking benzos and trazadone at night almost makes a few sips of coffee in the morning a must!).

 

In the past, what has worked best for me was intense cardio exercise. With age, I recognized that I needed to ease up before I injured my joints and switched to lifting weights and walking daily (I walk about an hour a day). Action seems to help. Going outside helps. I am physically inflexible and find most yoga frustrating, but enjoy kundalini yoga in small doses. Qi gong is similar to Tai Chi. These are soothing activities, but I tend to get angry if I do them for longer than a few weeks. In the non-winter months, I get a lot of enjoyment from gardening. I check out cuteoverload daily

 

I listen to Pema Chodron a lot. I appreciate her sense of humor and her stance that everyone should try things out for themselves and see if it really works or not. I meditate in very very small increments. Paying too much attention to myself can be a problem. I carry index cards with copying statements, emotion regulation statements, and reminders to myself. Because of my social anxiety, my interpersonal skills are not great but I am consciously learning to be assertive without being aggressive. I am highly introverted, and make sure to allow myself plenty of time alone.

 

I appreciate the point that I need a plan for managing anxiety (and knowing myself, I also need a plan for staying with the plan). Right now I tell myself daily that my first priority is taking care of myself and (from the Anxiety Workbook) that "I deserve to feel OK." My biggest concern is the PMDD which is when things flare up. I'm trying to be more consistent with taking notes and keeping a journal, and I track my cycle so I can remind myself where I am and try to keep things in perspective. I am capable of feeling great compassion and empathy for others and my struggle now is to develop the same feelings toward myself.

 

Typing these entries is a great help. If I should be putting this elsewhere, please let me know. I truly do appreciate the responses and guidance with respect to the tapering.

[cmusic]

Hi Bouvie,

 

I'm also a recent subscriber to the forum and in the thick of Prozac withdrawal.

 

For me the single biggest issue is the anxiety and resulting nausea I get in the mornings. The anxiety is so bad that I can barely get moving, and the smell or thought of food makes me gag. This is of course a terrible thing because then you don't eat and it makes itself worse.

 

The low blood sugar from not eating combined with intense fear and panic quickly goes to depression and crying spells. Seems like a pattern you are experiencing too.

 

Other than a benzo to break the cycle, I haven't found a great way to cope with this. I workout but can only get myself up for it at night. Meditation helps. Forcing yourself to interact with people, even though tough to get there, usually results in feeling better after.

 

Hang in there. And taper slowly. For me, I was doing terrible while on Prozac, it's worse now but I'm stuck because I don't think going back on and tapering would provide relief. But I might try anyway.

[Altostrata]

What a relief that a reinstatement of a partial dose has helped your symptoms.

 

Yes, you're putting your posts in the right place. This is your topic for tracking your progress, like a journal.

[Bouvie]

cmusic, thank you for your post! The sudden onset of nausea and anxiety completely floored me. I'm sorry you are going through the same thing. I am a big fan of eating so this is very unusual for me. I know nausea is typical the first week going on an SSRI, and I remember it from way back when I started Paxil, but that lasted one week. There doesn't seem to be any justice in getting just a week of nausea when going off.

 

I really need the clonazepam right now to keep stable. Altostrata, I have had good relief from resuming a partial dose, but when I reduced my clonazepam from 1 mg (split AM/PM)) to .75 mg a lot of the symptoms came back, so it seems I need the clonazepam to hold steady. When I resumed the 2 mg Paxil I felt better, then I felt relatively drugged and thought I could back off the clonazepam again to where I had been. Wrong.

 

I have no plans of going off clonazepam. I might just be in one of the small (?) percentage of people who feel worse, the harder they try to "think themselves well." Or I just need more practice and less cynicism.

 

I interact with people daily. Thankfully I am able to go to work (I say thankfully, because ever since the anxiety kicked in, I think about quitting which is ridiculous but a "flight" thought that won't go away), and although work has been extra stressy lately it is a familiar routine. I talk to my coworkers and people enjoy my sense of humor. I have a friend who is in a care facility and who I take out and about weekends. That can be very stressy (not the easiest person to be around) but it gives me more interaction with people at the places we frequent. I am actually not particularly shy, just very introverted and very avoidant (which I am trying to address). I'm fortunate that many of the people around me are good people and good company.

 

So journal-wise, I was pretty sad yesterday that minus .25 mg clonazepam sent me spinning off again, but I'm not messing around anymore trying to tolerate high levels of anxiety. I just took the .5 mg for relief. I know from experience that my anxiety can go for hours and deep breathing doesn't make a dent. I also cried a fair bit, finding daily life issues difficult to cope with and sleep was difficult. I am sticking to my coping statements and trying to feel compassion for myself instead of judging myself. Today began with shoveling snow. Still sticking to easy exercise routines and looking at adding some variety so I don't get fed up with doing the same thing over and over. If I don't exercise, I don't sleep so that's good motivation.

[basildev]

Hi Bouvie,

 

Welcome to the forum. I'm a fellow citalopram 'addict'

 

I LOVE Pema Chodron! I have all her books and many of her talks as well. She's one of my favourite teachers.

 

I hope you get the relief you need from reinstating.

 

Take care

 

Sonia

[Altostrata]

Bouvie, benzos like clonazepam sometimes require very, very gradual tapering. It sounds like you are getting benzo withdrawal when you reduce it.

 

Let's put that on the back burner for now and deal with the Paxil.

[Bouvie]

Hi Altostrata,

Thank you for your good advice. I'm used to going up or down by .25 or .5 mg with the clonazepam depending on where I am with my menstrual cycle, anger, etc. (it's what I was told to do, increase as needed, take it back down as soon as possible). In general, I try to take the lower dose (.5 or .75 mg a day) but when the going gets rough I don't hesitate to take another .25 mg. I accept that I am thoroughly addicted to clonazepam and I have no self-judgment on that. This is the one drug that when I first took it truly was an epiphany. It was the first time I knew what it was like not to feel crushing anxiety. Anyway, now I know that at this time I am far too fragile to be changing any dose so I am sticking to 1 mg a day. I've also started taking it first thing in the morning, the second I wake up just to keep the anxiety from escalating. If I sound defensive, I apologize. I really do appreciate what you say and everyone else as well. I admit that I am having a hard time coming to terms with where I am right now, and thinking that I "should" be "better." It is amazing how one's mind can work against one.

 

Today's update: final visit with doctor before being assigned to a new doctor. I started crying in the waiting room, but managed to stop and did some visualizations (again from Pema Chodron, visualizing emotions as clouds or weather patterns moving across the sky, something I can't control but that will come and go). I started coming up with my own visualizations as a child as a coping mechanism so this is a good technique for me. I pretty much lost it when the doctor came out and it took a few minutes to be able to stop sobbing. I expected this to happen and psych time is usually 15-20 minutes, so I was prepared with my notes all printed out. At my previous appointment I was on 5 mg Paxil and feeling much better, very self-confident and collected, happy about the change. Given the turnaround, going off Paxil is no longer on the table at the moment. I'll be edging back up to 5 mg and see how I am there. If it helps with the anxiety and I don't have all the other side effects, I am OK with being on 5 mg or 10 mg. I also wonder if I should allow myself a full year to taper down, if I can do 5 mg for several months, that would be a good base. The doctor thinks I need something more than the clonazepam for anxiety, given my history and behavior today.

 

Other drugs mentioned: lithium, depakote, lamotragine. I am too scared to try anything now. I took lithium for a 6-month period back in 1990 and it had no effect on me, so I see no point in doing that again. I am now too old and know too many people on different meds--I really think long and hard before trying anything. As one doctor told me, "I've seen too much." I am anti-lamotragine based on what I have read and the side effects a friend had (taking it for seizure disorder). One thing about the anxiety is that is has dramatically reduced my piss and vinegar, otherwise I would have had a few words to say about how (in my opinion) there really is no such thing as a "mood stabilizer" and these are for the most part anti-seizure meds being pushed into broader markets by the drug companies. Welbutrin came up once in the past.

 

This is a high pressure week at work and usually I numb down in anticipation of these weeks. The crying is mostly the after shocks of having felt relatively good and then getting slammed and having no idea what was happening or why. And frustration that I can't numb down like I usually do just through thinking. I'm still enjoying that I can cry at all. I told the doctor that every medication takes away as much as it gives, and for me it is a question of balance. The doctor was very kind and listened to everything I said and in no way pushed me.

 

If anyone has had success with meds for PMDD, I'm interested in learning more. I've tried to read whatever I can find, and usually the anti-depressants are the first line of attack. Birth control pills or the nuova ring aren't good options for me at my age. I know that bipolar is heavily diagnosed right now, so I am wary of that diagnosis, especially since my issues really started when I got deep into perimenopause.

 

Final note: I'm not going from 2 mg right up to 5 mg with the Paxil. Tomorrow I'll take 2.2 mg liquid if I don't chicken out and stick to 2 mg. Usually I wait for the weekend to make changes. I have a good healthy fear of making any sudden movements right now. (I also have to say that crushing pills is oddly satisfying).

[Altostrata]

Bouvie, your new doctor does not realize you are experiencing withdrawal symptoms, and is trying to treat you as though you have a psychiatric disorder.

 

It's very common that people get caught in a cycle of polypharmacy when they have misdiagnosed withdrawal symptoms.

 

You may wish to avoid adding any new psychoactive drugs while you are experiencing withdrawal symptoms. And adding them while you're tapering to go off psychiatric drugs would, of course, be counter-productive, as you'd have to taper off any additional drugs as well.

[Bouvie]

Darnit, I signed out before submitting my post.

 

I agree. I do not want to try anything new any time soon. I was traumatized by my attempt to switch over to Celexa (caused high agitation) and traumatized by the Paxil withdrawal. I really think many of my symptoms will ease up when I go through menopause. If I start new drugs now, I'll have to fight to get off them later and face withdrawal.

 

Waiting to be assigned a new doctor, I guess I have to call again or be lost in the shuffle. You are correct, my (now past) doctor did not want to discuss withdrawal at all.

 

I'm just under 2.5 mg Paxil now. Irritability is increasing (this is likely PMDD kicking in), bad dreams (that's the Paxil). Horrible week at work. All the suggestions to not anticipate the worst make me laugh because I have been in this job long enough to know pretty darn well how things will play out, the only surprises are when it is worse than I expected!

 

Good thoughts to everyone on the east coast, stay safe.

[Altostrata]

Since you are experiencing withdrawal symptoms, you may wish to hold at your current Paxil dosage or even updose a little and hold until your nervous system settles down.

[Bouvie]

Yes, I agree. Thank you for your reply.

 

Tomorrow I will be at 3 mg Paxil. I hope I am reaching my sweet spot with this. No nausea yesterday or today for the first time since I went off Paxil, and my appetite has returned.

 

I am able to do my regular workouts again, which feels good.

 

I was stunned last night to realize that I felt: fine. Just stunned. No racing heart, no need to force myself to breathe deeply. I need to tell everyone about this, so that I don't allow myself to forget that it is possible for me to feel fine!

 

This morning was the usual anxiety rush but now I don't feel like this is never ending and relentless. I am still not able to bring the anxiety down without a benzo and I am fine with that. I'm not quite sure what my nervous system is so to speak but I don't believe being so anxious for so long is good for my health. And I don't care what the Anxiety and Phobia Workbook says, yes you CAN be so anxious that you lose consciousness (I did years ago during a massive panic attack, went to the ER, they found nothing).

 

Probably going from 5 mg to 2.5 mg was in itself too much of a jump for me.

[Altostrata]

You may wish to take fish oil and magnesium to help your nervous system calm down, use Search in our Symptoms and Self-Care forum.

[Bouvie]

I am quite a supplement taker. I have been taking 2000 mg fish oil daily for over a decade. I also take magnesium, multivitamin, calcium, coq10 and vitex (chasteberry) for pms symptoms although I would like to stop taking it since it isn't really working. It's recommended for PCOS which I was diagnosed with at one point, but it was never really a clear determination. And I take probiotics. My diet is OK (not heavy on sugar, I eat whole grain, not much wheat, not much meat). I'm down to 4 oz max coffee a day.

 

Here is a question. Would it be better to split the paxil between an AM dose and a PM dose?

 

I had a bad day today. I am no longer able to sleep in. I wake with immediate anxiety even on days when I am not working. So far, I have never had to take clonazepam at exactly the same time every day. I could vary the morning dose, or split between morning and mid day, and I could vary the time I took it by several hours. This morning I did not take the clonazepam immediately when I woke up. I worked with trying to empty my mind of thoughts and was able to doze off. However, when I got up I was very shaky and very anxious. I mixed the crushed paxil with water. I have a 1 mL syringe, so I'm doing 4 syringe full right now (it's a 1:1 mix paxil to water).

 

My hands were shaking and I was so jittery that I spilled the solution after 1 syringe. I had enough for the 3 remaining syringe-fulls, but I wasn't certain of the concentration, since I stir it every time before I fill the syringe. I was out most of the day, feeling sick to my stomach, anxious, and physically weak, like my legs would buckle under me. When I got home, I took a sliver of a pill that I have left and that helped with the nausea. I have one pill left to crush, then I will be splitting 10 mg tablets.

 

My hope is that if I take some paxil at night, it might help with the AM horrors. On the other hand, I don't want to feel like crap all day having taken just 1/2 dose in the AM. I see new doctor in a few weeks.

 

I really feel like a prisoner to my meds right now which is ironic since I didn't feel that way the decade+ that I was taking the full dose. Still taking 1 mg day clonazepam, split AM/PM and 1/4 50 mg trazadone PM. I'm scared of how critical the clonazepam has become. I'm just scared in general right now, I don't seem to have much resilience. I keep reminding myself that I have been through far worse situations.

 

I've learned that I am very proficient at hiding my anxiety from others which may have been a great survival tool at one time, but right now I'm having to really make an effort to communicate to those who need to know what I am going through. Even the people who know me best can't tell when I'm freaking out inside.

[Altostrata]

What is your daily symptom pattern?

 

Yes, I agree. Thank you for your reply.

 

Tomorrow I will be at 3 mg Paxil. I hope I am reaching my sweet spot with this. No nausea yesterday or today for the first time since I went off Paxil, and my appetite has returned.

 

I am able to do my regular workouts again, which feels good.

 

I was stunned last night to realize that I felt: fine. Just stunned. No racing heart, no need to force myself to breathe deeply. I need to tell everyone about this, so that I don't allow myself to forget that it is possible for me to feel fine!

 

This morning was the usual anxiety rush but now I don't feel like this is never ending and relentless. I am still not able to bring the anxiety down without a benzo and I am fine with that. ....

 

You just updosed to 3mg Paxil, is that right?

 

What is your schedule for taking clonazepam?