Caprica: Paxil, Seroquel and now Valdoxan?

[caprica]

Hi

 

I am a newby here.  I have have been struggling with MDD for a couple of years now, with a bit of agoraphobia on the side.

 

In January 2013 I started my journey into the world of shrinks, meds, etc.   20 mg of Paxil and exposure therapy helped me get over my agoraphobia, but not my MDD.   Over a period of a year and many downs, my dose eventually went to 50mg of Paxil.  50 mg of Paxil is at the top of the therapeutic range for Paxil, so my shrink added 50 mg of Seroquel a day. I have been on 50mg Paxil / 50 mg Seroquel a day now for a year and free of MDD for about 6+ months.  

 

In December 2014, I told my shrink I am tired of feeling sedated all the time. So the shrink said try cutting back on the seroquel.   I dropped to 50 mg of Paxil a day and 25 mg of Seroquel a day in early december. Unlike SSRIs discontinuation of seroquil is "apparently" not as difficult.   Cutting back to 25 mg of seroquil a day gave me a major boost of energy and I felt great.  

 

A few days ago I cut out my Seroquil completely. Cutting out the last 25 mg of Seroquel has been a challenge.  I am exhausted all the time as I have had a lot of trouble sleeping. It seems that a year of seroquel has messed around with my natural sleep patterns.   

 

I have been struggling a bit, so I checked in with my Shrink.  The shrink said that maybe cutting the last 25mg of seroquel may leave me open to a relapse of MDD.  The shrink suggested I stay off the seroquel for now to see how I fair and booked me to come back next month for a review.

 

The shrink said that if I relapse, they might start me on Valdoxan to see if that helps.  Valdoxan is meant to be less sedating, but it does not work for everyone, so I could end up back on seroquel.

 

Has any one here had any experience with coming off seroquel?

 

thanks, caprica 

[Frustrated]

Hi there.  Welcome.  You dropped your seroquel very quickly and it is very likely to affect you.  A mod will arrive soon and they will give you advice.  They are smart and they will let you know what you should do.  My son is coming off seroquel and I have been tapering his dose 10 percent every 2 months.  It will take years but so far he has not suffered any serious withdrawals. (knock on wood).  I think it is necessary so that his brain can adapt slowly around the new doses before I cut another 10 percent.  I hope you will find this site helpful.  Again welcome.

[mammaP]

Hi Caprica, welcome to SA. Sadly most doctors don't know anything about withdrawal and believe that symptoms are relapse or a return of the illness. Science has now proven that is not true, it is withdrawal, or discontinuation syndrome.  You tapered seroquel very quickly and that is why you are feeling bad. 

I would reinstate the 25mg of seroquel and stay at that dose for a few weeks to stabilise then start a slow taper.  Are you thinking of tapering the paxil too? If you are we usually suggest tapering the AD first. You can read why here.... http://survivingantidepressants.org/index.php?/topic/2207-taking-multiple-psych-drugs-taper-the-antidepressant-first/

 

About reinstating to stabilise http://survivingantidepressants.org/index.php?/topic/3079-about-reinstating-and-stabilizing-to-stop-withdrawal-symptoms/

 

Tapering seroquel http://survivingantidepressants.org/index.php?/topic/1707-tips-for-tapering-off-seroquel-quetiapine/

 

Tapering paxil. http://survivingantidepressants.org/index.php?/topic/405-tips-for-tapering-off-paxil-paroxetine/

[caprica]

thanks for the pointers Frustrated and MammaP.

 

The conversation I had with my shrink in 2014 was that the shrink said I should be looking at coming off of 50mg of paxil and 50mg of seroquel as that dose was more suitable when my MDD was acute.  Shrink would rather see me on 40 mg of paxil and 25 mg of seroquel. 

 

The first drop from 50mg to 25 mg of seroquel was great as I gained more energy back.   Rather than following the shrinks advice I dropped the seroquel again hoping things would improve again.  Seems it hasn't and my sleep is still stuffed up. So the shrinks advice of staying on the 25 mg of seroquel and working on tapering the Paxil was right all along.

 

I have a couple of follow up questions:

 

Q1) When I return to my shrink in a couple of weeks, do you think it is worth taking the offer of trying the Valdoxan instead of seroquel?  or do you think I should go back to the original plan and go back on to 25 mg of seroquel a day and work on tapering my paxil slowly down to 40 mg?

 

Q2) The other thing I wanted to ask was about Prozac vs Paxil.  The shrink had said if I had trouble tapering my paxil, we could look at tapering out paxil and tapering in prozac first.  The advantage being that prozac has a longer half life and will make tapering down easier. Is that worth trying?   

 

thanks again, Caprica 

[mammaP]

To answer your questions, I would avoid changing the drug as you did feel better with the lower dose of seroquel.

It is better the devil you know than one you don't! I would go back on the 25 of seroquel.

It is great that your shrink said to taper the paxil first. 

 

Regarding cross tapering to prozac. Some people do that if they have problems but again it is better to stick with

the one you are already taking to taper. If you do a slow taper there may not be any problems and could come off

with little discomfort.  Most doctors advise tapers that are too fast which means there are problems, then they switch 

to prozac.  It is a possibility but we would recommend sticking with the paxil for tapering. 

[caprica]

Hi,

 

My last taper of seroquel was doctor controlled.  It was quite fast by this groups standards.  And yes it didn't work.  Things got a bit screwy and I had to increase my seroquel again.  

 

After spending a month stabilising,  I am trying a new slower taper again.   Based on the advice in this group and talking to my shrink I am focussing on reducing my SSRI this time and leaving the seroquel alone. My new taper is slower, with a 10% reduction from 50 mg of Paxil to 45 mg of paxil.

 

Things were going quite well for thee weeks until yesterday, when things got screwy again.

 

What do I mean by screwy? It is this name I have for when my thought process are really starting to screw things up for me - hence screwy.  

 

When I am screwy, I become extremely inflexible and anything outside my range of expectation, sends me spiralling downwards in to self blaming, arguing with people around me over silly things, lots of rambling and lots of lost time spent ruminating.  Sometimes when things get really screwy, it tips over intro suicidal ideation.  

 

So yesterday was a screwy day. Yesterday, I could not even remember my ride home because I was internally ruminating so much.  It scared me because I cycled through peak hour traffic.  

 

Continuous stress for long periods of time and lots of screwy periods, led me to the high(-ish) doses I am on now.  I am now also sensing that withdrawal syndrome from a taper mixed with some stress can also be enough to trigger me as well.  

 

So here comes my potentially screwy thinking. I am starting to get concerned that screwy means psychosis and I may not have just MDD, but it may be psychotic depression.

 

I asked my wife today and asked if she thought I was speaking yesterday using "word salad". She said yes.  I asked her if my thinking was irrational / bizarre.  She said yes.  I was fortunately not hallucinating nor taking anything to cause me to hallucinate. So the signs are there.

 

The psychotic diagnosis also explains why my shrink placed me on an anti-psychotic in the first place. 

 

Am I over thinking things?  Are my screwy thoughts normal? or I am right to be really concerned about my thought processes?

 

Should I just do a slower taper. e.g. wait 2-3 months before attempting another 10% taper down to 40.5 mg of paxil? or just back off from tapering for a while?

 

Does anyone here have any experience with psychotic depression at all?  Does anything I talk about resonate?

 

I would appreciate your thoughts, because my brain is tired from trying to figure out what is going on.

 

thanks in advance, Caprica

 

p.s. No - I am not feeling suicidal at the moment. 

p.p.s. Yes - I am going to talk to my shrink very soon to talk about what is going on.

p.p.p.s.   thanks for asking, but I hate being asked both of those questions.    

 

 

[primrose]

I don't know about psychotic depression.

My friend has been diagnosed with that, and when she gets too stressed she goes psychotic and has to be sectioned.

She loses touch with reality.

Last year, I tapered seroquel and I felt ok, but for a couple of months, I got it into my head that I owed the council tax about £20k, as I had not put my paperwork in for five years and worried myself sick.

Eventually I got the courage to go to the council with all my paperwork, and they did not know why i thought I owed £20k, I was convinced I owed it, dunno if this is paranoia.

I had amphetamine induced psychosis once, and I got paranoia with it. There was a siimilarity.

I am now well of seroquel, I take promethaizine prn, and it suits me much better.

[Petunia]

Hi caprica,

I moved the topic you started in the symptoms section to your introduction thread because it was related to your own situation specifically, if we have all your information together in one place, its easier to see your entire situation and answer questions.  Please add information and updates about your changing circumstances, and ask questions here.

 

From what you have described, it sounds like you have been having ruminations, and problems with obsessive thoughts.  These are common symptoms of withdrawal and can also happen when the nervous system become destabilized by drug changes and making dose changes which are too big.

 

Over the last two months you went CT off 25m seroquel, then you started taking it again.  Then you cut paxil from 50mg to 45mg.  I think all these changes may have caught up with your nervous system and have cause some destabilization.  It would be a good idea to hold until things settle down again.

 

When you do start tapering the paxil again, perhaps you could try a 5% cut rather than 10%

 

Please see:     The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

This topic about rumination may also be helpful:   http://survivingantidepressants.org/index.php?/topic/546-ruminations/

 

Petunia.

[caprica]

Thanks Primrose and Petunia for your feedback.

 

Having never been sectioned, I am thinking that psychotic depression is unlikely and as Petunia suggests, that compulsive rumination is more likely.

 

I spoke to my Shrink this afternoon.   The shrink thinks that my current meds are not working for me.  While the seroquel works to calm me down when things get a bit screwy, it is a blunt instrument that was never meant to be taken long term.  My shrink also thinks the paxil is not right for me either.  Shrink  and said I should look into moving from paxil + seroquel over to efexor.

 

I said I would think about it and booked an appointment for early next week.   

 

Anyone here had experience with efexor?  should I give it a go?  or just look at getting off the anti-depressant tread mill all together?

[Altostrata]

Welcome, caprica.
 

....
When I am screwy, I become extremely inflexible and anything outside my range of expectation, sends me spiralling downwards in to self blaming, arguing with people around me over silly things, lots of rambling and lots of lost time spent ruminating.  Sometimes when things get really screwy, it tips over intro suicidal ideation.  
 
So yesterday was a screwy day. Yesterday, I could not even remember my ride home because I was internally ruminating so much.  It scared me because I cycled through peak hour traffic.  
 
Continuous stress for long periods of time and lots of screwy periods, led me to the high(-ish) doses I am on now.  I am now also sensing that withdrawal syndrome from a taper mixed with some stress can also be enough to trigger me as well.  
 
So here comes my potentially screwy thinking. I am starting to get concerned that screwy means psychosis and I may not have just MDD, but it may be psychotic depression.
 
I asked my wife today and asked if she thought I was speaking yesterday using "word salad". She said yes.  I asked her if my thinking was irrational / bizarre.  She said yes.  I was fortunately not hallucinating nor taking anything to cause me to hallucinate. So the signs are there.
 
The psychotic diagnosis also explains why my shrink placed me on an anti-psychotic in the first place. 
 
Am I over thinking things?  Are my screwy thoughts normal? or I am right to be really concerned about my thought processes?
 
Should I just do a slower taper. e.g. wait 2-3 months before attempting another 10% taper down to 40.5 mg of paxil? or just back off from tapering for a while?
 
Does anyone here have any experience with psychotic depression at all?  Does anything I talk about resonate?
 
....

I'm sorry, the part about asking your wife if you're psychotic, and then taking her response to be a definitive diagnosis, makes no sense at all. And I don't mean that in a psychotic way, I mean it in a self-damaging way.

 

Getting a prescription for an antipsychotic has nothing to do with whether you are psychotic. Millions of people are prescribed these drugs as "shut up pills." A combination of Paxil and Seroquel is not a typical prescription for any known psychiatric disorder.

 

On this site, we can't answer your questions about which drugs to switch to. We haven't the faintest idea of what will work for you.

 

If I were you, I'd get serious about Dialectical behavior therapy (DBT) and find a psychiatrist who isn't drug-happy.

[caprica]

Thanks Altostrata.

 

I agree with you that seroquel at 25 mg is nothing more than an add on / sleeping pill.  It just does not have a high enough dose to get to the antipsychotic effects.

I think my wife and I are just searching for answers, because I have been agitated for a while and now very down.

 

I saw my shrink yesterday.  We talked a bit about if the latest events are to do with withdrawal and she doubts it.  She suggests that my SSRI's are not working that well for me anymore. Now I have now been moved over to a SNRI (150 mg effexor) and left me on half the dose of the SSRI (paxil 20 mg).  She still wants me off the seroquel, but she didn't want to take me off the 25 mg seroquel for now as she does not want to change too many things at once.   I will go back in a week, to see how I am faring.

 

I am reluctant to change shrinks at the moment as I have been working with her for the last 3-4 years and she knows me when I am well and when I am not.  I think continuity of care is important at the moment. I will however look into DBT. 

 

kind regards, caprica

[Altostrata]

25mg Seroquel is not insignificant, it can still do damage in adverse effects and will require tapering.

 

It's very possible you have been feeling "agitated" because of withdrawal syndrome from quitting 25mg Seroquel too fast in January.

 

In short, you are suffering drug adverse effects misdiagnosed and treated as a psychiatric condition. Many people here have taken rides on the psychiatric merry-go-round for years under this premise.

 

Good luck. I have no idea what your shrink is doing, and I suspect she doesn't either.