Osloensis: My story

[Osloensis]

Hi,

 

I'm a 32 year old male, Norwegian. Have been on paroxetine for approx. 14 years. Last years on minimum dosage (10 mg). I have never experienced (before now) any pssd, on the contrary, the meds have had a positive effect (desentivisation). I have quit two times before- in 2003 (one year) and 2008 (one year). I didn't have any pssd when I quit then.

 

A year ago I tried quit paroxetine. Did this in December, my Dr. wanted me to quit in spring/summer due to days being longer/ more daylight. I had pssd symptoms after five days from withdrawal which I at first thought to be related to prostatitis. These were first sensitivity and PE, then just "dead down there". However, I suspected that this could be a result of quitting the meds and after 7-10 days I resumed 10 mg. After some days my functionality were back to normal and this have persisted through 2014. My Dr and I agreed that I should try to taper from 10 mg to 5 mg and I was thinking this should work as I have tapered before (although this was years ago) from 40 mg at the most to 30, 20 and then 10 without any problems. However, after withdrawing a week ago, I am experiencing the same pssd symptoms as I did a year ago.

 

I really want to quit as I have used these meds for quite some time now and I worry about the side effects, mostly fertilty. I have read some research suggesting that sperm quality is significantly reduced by ADs and also that the quality is worsened by prolonged use. I'm not aware of research regarding reversibility of sperm quality after withdrawal after several years, the only research I have come across regarding this was a study that looked at a quite imited time of AD use. Here, the sperm quality was reversible after withdrawal.

 

I have agreed with my Dr to wait and see for a couple of weeks if the symptoms improve and then, if they don't, resume 10 mg and then try to taper from 10 mg to 7-8 mg. However, I suspect this not to have a huge effect as the dosage now anyhow is quite low. I am also worried that I wont get back to normal when I resume 10 mg, although I did a year ago.

 

I am now worried that I could find myself in a situation where I have to choose between normal sexual functioning or low sperm quality/infertility (if, of course, I really can resume my normal state after resuming to 10 mg). I know that a couple of weeks is a short time and that I should give it more time, but after reading about pssd it seems that these symptoms are quite accurately descring what I experience and I am worrying that my brain has gotten used to the meds and is permanently altered after such a long time of usage, even at the low dosage.

 

If you have similar experiences or have some advice, this is welcomed.

[cymbaltawithdrawal5600]

Thank you for starting an Intro topic. If you could work on a signature line that would be great. See the instructions in my sig line below.

 

The information about your drugs and dosages and dates is important for us being able to advise you properly. I have a feeling that your 'tapers' were in actuality so fast as to be a 'cold turkey' as far as your body is concerned and that has sensitized you to the meds at ANY dosage and you are in danger of developing wd syndrome. The emerging pssd may or may not be a sign of this.

 

We recommend a slow taper of no more that 10% of your CURRENT dose every 4-6 weeks only if you feel 'stable' (this varies from person to person). According to your synopsis above it does not appear that you tapered this slowly. If you were at 10 mg, your next drop at 4 weeks (lets round it out for teaching purposes) would have been 9 mg in Jan, let us say. Feb = 8.1 mg, Mar would be 10% of 8.1 (.81 mg) subtracted from 8.1 mg leaves 7.99 mg. So you see, you would be nowhere close to being 'off' at this point in the year. Furthermore, you cannot expect to get back to 'normal' in such a short time. Our nervous systems are not made of rubber, they just do not bounce back that quickly.

 

Please read the 3KIS topic and tell us what you are hoping to do at this point and maybe we can give you some better advice.

 

I am concerned that with all of your dosage changes in such a short time you risk destabilizing your nervous system further. If you read my sig line you can see that protracted wd can take a very long time to manifest and a very long time to abate. I have been very lucky so far but I will always have to be diligent. I don't even take OTC meds like ibuprofen for headaches like I used to, I don't want to risk the symptoms coming back.

[Martin]

I have some insight in this area in reguards to fertility...

 

http://umm.edu/health/medical/altmed/condition/sexual-dysfunction

 

look in the herb section of that article - panax ginseng is very powerful when it comes to libido. 

[Osloensis]

Thank you for your quick replies.

 

I will work on the signature.

 

To clearify, I have not for approx 3 years tapered more than from 20 mg to 10 mg. For 3 years then, I have been on 10 mg. Do you mean, then, that that the reduction from 20 mg to 10 mg three years ago was a "cold turkey taper" (just to make sure that you don't think that I've for - let's say a six months period of time have gone from 40 to 30 to 20 to 10% and then quit).

Also, to clarify, I have stayed on whatever dosage I've been on for a certain period of time (let's say at least 6 months, most of the times for a year or several years). I've tapered 10 mgs at the most at a time, according to the Drs advice. Is this then a too quick taper? It has worked well for me all the times I've done it and I've had no major taper symptoms, including no PSSD. Do you mean that this tapering over time, although no symptoms have been experienced along the way, can be an attributing factor for mye problems now?

 

When you say "sensitized you to the meds at ANY dosage" - when I a year ago went from quitting (10 mg to 0) and then went back to 10 mgs again - and restored my normal functioning, is this compatible with "sensitized to meds at any dosage?

 

Thank you for slow tapering suggestions. I will "confront" my Dr with this. As I mentioned he didn't have much knowledge about this so suggestions are welcomed. We also touched upon this at my last appointment and agreed that I would resume 10 mg after a couple of weeks if things does not improve. It seems like a way forward - to resume 10 mg and then taper down 10% at a time - however, I think it will be difficult to cut the pills into such dosages (cutting a 20 mg pill into four pieces is diffult enough) so experiences/suggestions are welcomed.

 

I have a Drs appointment next week but are now wondering if I should directly resume 10 mg. I think I will wait until next week and talk to my Dr (it's just a pity that Drs are so inexperineced in this field).

 

Martin, thanks for the link. I couldn't see any advice on fertility, there, though? Do you have any experience of this your own that you can share?

 

Thanks again for your advice.

[Martin]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

[cymbaltawithdrawal5600]

A year ago I tried quit paroxetine. Did this in December, my Dr. wanted me to quit in spring/summer due to days being longer/ more daylight. I had pssd symptoms after five days from withdrawal which I at first thought to be related to prostatitis. These were first sensitivity and PE, then just "dead down there". However, I suspected that this could be a result of quitting the meds and after 7-10 days I resumed 10 mg. After some days my functionality were back to normal and this have persisted through 2014. My Dr and I agreed that I should try to taper from 10 mg to 5 mg and I was thinking this should work as I have tapered before (although this was years ago) from 40 mg at the most to 30, 20 and then 10 without any problems. However, after withdrawing a week ago, I am experiencing the same pssd symptoms as I did a year ago.

 

 

This is the paragraph I am referring to. When did you start and stop the drugs? What were the dates and doses that you were on?

[cymbaltawithdrawal5600]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

 

Martin, I have a medical background (I used to be a nurse) but I have to admit, that citation was difficult to read and understand. With your familiarity of it, could you just quote the relevant piece where it says that "ginseng" has an effect on fertility? In your post above you also say that it has a "powerful effect on libido"? Could you show me that in the article?

 

What has been your experience with ginseng?

[Zang909]

Hello and welcome Osloensis.

Just seven months ago I finished tapering off Escitalopram/Lexapro, but I was on Paxil for many years, longer than I was on any other antidepressant.

The worst side effect of Paxil for me was anorgasmia - the inability to orgasm while on the medication. For a long time I would take drug holidays (go off the medication when I was anticipating sexual activity (this was before I married)), and that would suffice; within days of stopping the meds, my ability to orgasm would return. In fact, my orgasms would be off the charts in intensity.

However, in recent years, things got a little worse. After stopping the meds in recent years, my ability to orgasm would return, but my orgasms would be much reduced in intensity, volume, etc. I don't know how much of that is due to some cumulative effect of years of the meds and how much of it may be due to age (I'm now 47 years old). Does age impact men negatively in this area? I don't know.

I've now been off all antidepressants for seven months, but my quality of orgasm, volume of ejaculate, and force are all still diminished. I'm fairly certain I've got some numbing in the pertinent area as well. I don't know whether my functioning will ever be what it was.

 

As regards fertility, you may be encouraged to know that my wife and I conceived three times within a few years while I was on Paxil, seven, nine and eleven years ago.

[Martin]

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

 

Martin, I have a medical background (I used to be a nurse) but I have to admit, that citation was difficult to read and understand. With your familiarity of it, could you just quote the relevant piece where it says that "ginseng" has an effect on fertility? In your post above you also say that it has a "powerful effect on libido"? Could you show me that in the article?

 

What has been your experience with ginseng?

 

 

That is cool. - I guess I'll find an easier to understand article on it.

 

http://www.peaktestosterone.com/Male_Libido_Supplements.aspx

 

My experience is that after taking high quality ginseng for about a week, I can almost not get any sleep due to too much sexuality, so there's that. 

Other than that, i'd say blueberries and acai are also great for libido, but they aren't backed sciencetifically like ginseng is. Jasmine tea is another too powerful aphrodisiac. I'm a bit of a herb enthusiast - lately I'm feeling too bad to touch anything but for quite a while I did tons of research on stuff to augment my therapy and have tried quite a few things. Used to go out into herb stores and just buy stuff and try it for the giggles. Only thing I'm still taking now is curcumin which while not very powerful as an aphrodisiac, has been shown to be about as powerful as an antidepressant as prozac, so I'm hoping it'll help me with withdrawal. 

 

If there's one thing I've learned herbs can help with, its sexuality, so if one is afraid of losing their sexuality it would be the perfect place to look I'd say, that has been my experience atleast.

[Rhiannon]

 

Thank you for slow tapering suggestions. I will "confront" my Dr with this. As I mentioned he didn't have much knowledge about this so suggestions are welcomed. We also touched upon this at my last appointment and agreed that I would resume 10 mg after a couple of weeks if things does not improve. It seems like a way forward - to resume 10 mg and then taper down 10% at a time - however, I think it will be difficult to cut the pills into such dosages (cutting a 20 mg pill into four pieces is diffult enough) so experiences/suggestions are welcomed.

 

 

 

You should be able to get paroxetine in a liquid formulation which will allow you to measure out gradually decreasing doses with the precision and accuracy that you need.

[Rhiannon]

When recommending supplements to others, I would just like to remind folks that over the years we have found that something can be great for one person and harmful for another. So if you try a supplement, please try only one new thing at a time, and start with a small dose, until you're sure it's not going to aggravate your symptoms.

[cymbaltawithdrawal5600]

 

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

 

Martin, I have a medical background (I used to be a nurse) but I have to admit, that citation was difficult to read and understand. With your familiarity of it, could you just quote the relevant piece where it says that "ginseng" has an effect on fertility? In your post above you also say that it has a "powerful effect on libido"? Could you show me that in the article?

 

What has been your experience with ginseng?

 

 

That is cool. - I guess I'll find an easier to understand article on it.

 

http://www.peaktestosterone.com/Male_Libido_Supplements.aspx

 

 

Oh dear, Martin. The gentleman who owns the site does not even take any of the supplements he recommends:

 

 

And, for the record, I also take no erectile supplements, i.e. none of the relatively safe supplements I mention on my site such as Pycnogenol, Korean Ginseng, Citrulline, etc.

 

And he hedges his bets anyway by saying they are "relatively safe".

 

Please note Rhi's excellent advice above. Any further discussion can be done in your thread, we will Osloensis have his back.

[Osloensis]

Hi again

 

cymbaltawithdrawal5600, see my signature.

Zang909, Sorry about your problems. I don't know if age is a factor and whether this could be the reason as much as PSSD. Great to hear you have conceived.

Martin, thanks for the ginseng and herb tips.

Rhi, thank you for your tip.

 

Yesterday, my functionality was actually back to a relatively normal state and has been today as well. So, I hope this will continue and that the PE and ED I experienced was just temporary. I was considering to go up to 10 mgs and then taper more slowly, as you suggested, but will now wait and talk to my Dr. But I will suggest that I taper 10% from the 5 mg I'm on now, I can't see how that can hurt, so thank for your advices.

 

Ive read a bit about PSSD and saw that Wikipedia has taken pssd down from their website about withdrawal side effects. Does anyone know why? It seems to me that although research is relatively scarce in this field, there are several findings support the existence of Pssd so I wonder why this has been withdrawing from the site....

[cymbaltawithdrawal5600]

Hi again

 

cymbaltawithdrawal5600, see my signature.

 

 

 

perfect sig, thank you!

 

 

Wikipedia has taken pssd down from their website about withdrawal side effects

 

you mean withdrawal side effects from Paxil or SSRIs as a class? Don't forget WkP is done by individuals, could be that they could not find the right evidence to substantiate what you refer to. Can you link to what you mean?

[Osloensis]

 

This is what -as far as I can see- is written;

 

Sexual dysfunction occasionally persists after discontinuing SSRIs. The frequency with which this happens is unknown.[35]

 

http://en.m.wikipedia.org/wiki/Selective_serotonin_reuptake_inhibitor#Sexual_dysfunction

 

At

http://wp.rxisk.org/post-ssri-sexual-dysfunction-pssd-wikipedia-stumbles/

the deletion is discussed. These quotes are from the person that I think is responsible for/initiator of the deletion, there are also much else to read;

 

It lacks references that would support the conclusion that the existence of this syndrome is an accepted part of mainstream medical thought, and there are only about a dozen published case reports from among the >100 million people who have taken these drugs over the last 20-30 years. As such, it seems questionable to me whether it is undue wt to include a discussion of this proposed syndrome in the SSRI article, let alone give it its own freestanding article

 

I’m open to acknowledging that it is possible that this is a real effect of SSRIs but usually stuff doesn’t go into Wikipedia until its established as mainstream medical thought. Also, if we create a separate article for each side effect of every drug, no matter how rare that side effect is, things are going to get crowded around here

 

This is probably common knowledge to you, but I just wondered

[Petunia]

Here are a couple more links where the discussion continues:

 

http://wp.rxisk.org/post-ssri-sexual-dysfunction-wikipedia-falls/

 

http://www.madinamerica.com/2014/08/reports-post-ssri-persistent-sexual-dysfunction/

 

The Polish version of the article is still up.

[Osloensis]

Hi

 

Thought I would give you an update now, two months after I experienced my problems.

As I probably mentioned, my doc and I agreed to increasingly the dosage from 5mg to 9mg to see whether this would alleviate the problem. We discussed to go back to 10'mg (my normal state) but agreed to try 9mg. After some days mye problems became better. However, it wasnt 100 %, I still experienced those problems I had but now less frequently and not to the same extent. If my function on 5mg was 10 %, now it was about 80-90 %. So I would say I have ups and downs and the down parts are very frustrating (no libido, ED, PE). When it works I have less libido but somewhat less strong erection, no PE. It idiot like my brain can't get "in the zone" (arousal) and I almost feel like a zombie - no feelings at all (this was more prominente when I was on 5mg though) I haven't been with a women in this period, I don't think i would be able to.....

 

I was hoping tapering from 10 mg to 9mg would be so little difference that my body/brain would adjust, but it doesnt seem that way. Im hoping more light in the spring (we have had a long dark winter) will make it better, but I have a feeling that's not going to help much. I'm unsure whether I should stay at 9mg even longer (I planned to decrease 10% a month but now I have soon been on 9 mg for two months because it hasnt been stabilized. Do you have any suggestions? My doc and I talked about waiting a couple of weeks and then reduce the dosage but now these weeks are soon over. He seems pragmatic though and it doesnt seem that he want to rush the reduction (also, he has never experienced this with any patients).

 

Puh....it is really frustrating....I hope my brain aren't permanently damaged and that I can get out of this mess....

[Fresh]

Hi Oslo , sorry to hear about the problems you've been having.

Are you meaning that you don't feel as good on 9mg as when you were stable on 10mg?

 

If you decrease further now , you'll know pretty soon if that was a bad idea.  If you choose to do that and feel bad , you can always go back to 9mg.

 

I would be nervous about decreasing further at the moment in your situation.

But I agree that as you've been on this 9mg for two months , this may be as good as you'll get on that dose.

 

Best wishes ,   Fresh

 

.

[Petunia]

Hi Oslo,

You may need to slow your taper down even further.  Some people need to really slow down as the dose gets lower.  Possibly making cuts between 1% - 5%.

 

Please read through: 

The slowness of slow tapers 

Also see our topic on micro-tapers Micro-taper instead of 10% or 5% decreases

 

If I were you, I would continue to hold until your symptoms improve some more.  You may be right that with the return of warmer weather and more light, you may start to feel better, especially if you are able to go outside and exercise.

 

With the updose, your symptoms improved, so that seems to indicate that there is no permanent damage, but its probably going to take longer than you would like, to come completely off without having symptoms increase again.

[Osloensis]

Hi,

 

Thank you so much for your replies and advice.

 

Fresh: yes, there is a difference between 9mg and 10 mg. Although there was clear improvement when i went from 5-9mg, my libido is not the same on 9mg and while I haven't had difficulties with ED and PE several times (I'm not sure exactly, but let's say60-70%) I have had difficulties with ED and PE. Of the 60-70% when I don't have difficulties, I however can feel that the erection (sorry, but there is no way around it:) isnt quite what is was at 10mg.

 

I don't think I will decrease further before I see my doc. As far as I can understand, it is perhaps worse to go too fast than to go more slowly, and I don't think my doc will have a medical reason to claim I should keep the tapering we discussed/agreed on.

 

Petunia: sounds interesting with the even more slow tapering. I will discuss it with my doc when I see him. You don't have to taper every four days (as I saw was suggested) but you can administer the tapering according to when you feel stable?

 

I was happy when I saw the improvements from 5mg to 9mg (and when I regained my normal function a year ago when I went from 5-10mg). I'm a bit disappointed now though as I would hope that I could achieve the 10mg function entirely at 9mg. If it doesnt get better, do you think I should go back to 10 mg (I hope its possible to regain my normal function now at this dosage....) and try microtapering or should I wait and see if I can "handle"the. 9 mg dosage?

 

Thank you again for your answers. I feel like there is not much medical expertise on this subject so your advice means a lot.

[Petunia]

If you decide you want to updose, you could first try going up to 9.5, perhaps that would be enough to bring back your normal function.  It may be a matter of having to make very small changes as you taper off so as not to disturb your nervous system too much.

 

 

You don't have to taper every four days (as I saw was suggested) but you can administer the tapering according to when you feel stable?

 

 

Yes, the time frames we suggest are just a guide, its best to listen to your own body and symptoms and wait until you have felt stable for at least a week before making another cut.  If you are doing a micro taper, with the smaller cuts, theoretically you should be able to make the cuts more often, but some people find that they still need to go quite slowly.

[Osloensis]

Thanks for your reply. I will wait and see if it improved and if not I will try 9,5.

 

Its been worse the last 1-2 weeks and Im starting to wonder whether the reason could be prostatitis (I was diagnosed a couple of years ago) as I've read that prostatitis could cause sexual dysfunction. I've been drinking more coffee the last weeks and in this period the prostatitis flared up. What I also experienced when I tapered from 10mg to 0 mg a year ago and 10mg to 5 a couple of months ago was that the prostatitis flared up (actually I thought this was the reason for the sexual dysfunction a year ago). As I remember it, the prostatitis went away when i updosed, so I wonder whether this could be a factor for the ED and PE. The tapering would likely not be a reason for my prostatitis problems now though, as I've been stable on 9mg for two months now, it would be the increased intake of coffee.

I just think it is would be strange if the SSRI level would be the cause now, as my function has been pretty stable (though not 100%) the last two months.