StrangeAnimal: Deeply Concerned about Next Steps following Paxil Tolerance

[StrangeAnimal]

Greetings to all members of this community...

 

I am a new member. Unfortunately, I have joined this forum during a time of personal crisis, as I assume is often the case. Before requesting your advice and input on my current predicament, I would like to make it clear that I fully intend to participate in this community as a source of comfort and support when my personal experience is relevant, not just a beneficiary of the comfort and support that I have noticed is such a defining aspect of the courageous individuals that define this community.       

 

In the fall of 1999 during the first semester of my first year in University, I saw a Psych and I was diagnosed with OCD (Mostly Pure O) and panic disorder and prescribed Paxil. I'm hoping my medication history appears as a signature once I post this discussion, I included it while signing up. In a nutshell, after 15 years on Paxil my psych believes I've reached tolerance and wants me to switch to another medication. I am extremely concerned about this. First of all, I always intended to ween myself "properly" off paxil one day, regardless of how long it took to succeed. Unfortunately, this has to be the worst relapse I have ever experienced; my anxiety and OCD are terrible, I'm very depressed, I feel extremely depersonalized, and I'm really lacking focus and concentration. I literally feel like I'm losing my mind. 

 

Because of the way I feel, my main objective at the moment is simply to feel better. This has always been my main focus during past relapses, however, the one significant difference this time around and a major addition to my anxiety is the fear that now consumes me regarding the length of time and long term effects of being on an SSRI. It may not mean too much with regards to the long term damage I've most likely suffered, but I always took a little comfort in knowing that the first psychotropic drug (Paxil) I was prescribed had worked and remained the only one I'd ever been on. I had always felt for sufferers who had been through the chemical gambit of multiple SSRI's, SNRI's, Benzo's and other drugs, desperate for just a little salvation.

 

To wrap this up, what clearly concerns me the most at the moment is the lack of clarity in mental health with regards to next steps. Notwithstanding my strong intention to get off this crap one day, what I'm hoping for at the moment is advice and input as to what you guys believe is the quickest and smartest option for me to reach mental stability. I just want to feel somewhat sane again. Below is a list of options that I've compiled, the first two were received as "professional" advice. Please feel free to ignore them all if you favour an additional option.

 

1. Stop the Paxil cold turkey and immediately switch to another SSRI or SNRI the next day - My Psych's preference

2. Increase the Paxil to 40mg, then to 50mg if necessary - A 2nd opinion I sought from my family doctor

3. Gradually withdrawal off the Paxil while starting and gradually increasing a new medication at the same time - Information I came across.

4. Add Wellbutrin as an add-on medication to help boost the Paxil's effect and deal with the depression component - Information I came across.

5. Just stop the Paxil and withdrawal properly - Not sure how I'd feel better any time soon with this option 

 

 

Thank you in advance for any advice and/or comforting support.

 

Cheers 

[StrangeAnimal]

I don't see my medication history appearing as a signature so here it is:

 

*1999: Prescribed Paxil for OCD (mostly Pure O), Anxiety, and panic attacks. Also prescribed Ativan until Paxil started working. Ativan would also be prescribed for short periods during future relapses until Paxil kicked in again.

*Nov 1999-Sep 2011: 20mg Paxil (except for roughly 4/5 times at 30mg for roughly 3-4 weeks during relapses).

*Oct 2011-Dec 2011: Tapered off Paxil, 20mg-15mg for a month, 15mg-10mg for a month, 10mg-5mg for a month, then stopped. Felt fantastic throughout entire withdrawal until I stopped. 

*Jan 2012-June 2012: Reinstated Paxil and needed to gradually increase back to 30mg to get through a terrible relapse. 

*July 2012-Oct 2014: Tapered from 30mg to 10mg in 3 months and stayed on 10mg for 2 years without problem. The last taper was still too fresh for me to try a complete and "slower" withdrawal again.

*Nov 2014-Present: Currently experiencing a major relapse caused by months of work stress that led to multiple panic attacks and a nervous breakdown. Worked my way back up to 30mg and have been on it for over a month, since Dec 30. For the first time, 30mg Paxil has failed to get me through a relapse.

[Fresh]

Hi  Strange Animal ,    Welcome to SA.    I'm pleased you've found your way here , this site has loads of information which you may find useful.

There is a whole section on Tapering and how to do it safely , but that's for later.   As you say your "main objective at the moment is simply to feel better".

 

Am I understanding it correctly :      you increased Paxil from 10mg to 30mg in December 2014 , and things have not stabilized yet ?

 

I would cross options 1 and 5 off your list - do not stop the paxil abruptly.    This can't turn out well.    

Apart from that I don't have a lot to offer , but others are sure to offer advise based on understanding the chemical processes involved.

 

Best wishes   ,    Fresh

[ladybug]

Welcome, Strange Animal!

 

When you've hit tolerance, the only way to go is down. I would not attempt to switch to another drug or cold turkey off Paxil. I have seen more than few people in tolerance feel better as they reduce their dose, but you have to do it SLOWLY. No more than a 10% reduction of your dose every 4-8 weeks. You might want to take a look at Brassmonkey's Journal. He has also been on Paxil for 15+ years. He hit tolerance and had many symptoms but after a while of reducing his dose he began to feel better and he is now close to being off Paxil after a slow taper. I know you are probably feeling awful but unfortunately there are no quick fixes in these situations. All you can do is come up with a sensible plan and stick to it.

 

I can relate a bit to your story as I've also been on Paxil since I was 18 for OCD and mild panic and I don't think the Paxil really helped me that much when it came to those issues. I wish I had chosen therapy instead of a pill, because Paxil only harmed me in the long run. If your goal is to be drug free (and none of these drugs work forever anyway) then you should try a slow taper rather than switching to another drug.

[Cheeky]

Hi strange Animal,

 

Welcome to this great site.

            I too have been on Paxil for a long time and completly understand what your going through. The similar thing happened to me and my doctor thought it would a benefit to change me to another drug. I ended on Cymbalta for 6 weeks that didnt stop the bad Paxil withdrawels and then I was put on another ssri which is Zoloft for 6 weeks and that didnt stop the withdrawals either. I ended up going back on Paxil and I'm going to withdraw slowly.

The people here will be able to help you out, trust them they no more than doctors. Personally I would go up by 10mg anf than wen you stablize reduce by 10% of your dose, but I'm not a professional .

Stay strong you will be okay xx

[StrangeAnimal]

Thank you for the replies everyone, they're much appreciated.

 

Fresh, your understanding was close enough, I went from 10mg to 20mg Nov 15 and went from 20mg to 30mg Dec 30. I agree with you that options 1 and 5 are not wise.

 

Ladybug and Cheeky, thanks for your input. As I mentioned in my posting, I can't stand the arbitrary use of medication to treat mental illness. I completely respect both of your opinions, isn't it funny though that one of you says increase the Paxil and the other says to start tapering. It's so difficult to feel confident with your next step when those with good intentions simply have different experiences and therefore differing opinions. It's too bad there isn't a textbook one size fits all process with this stuff. 

 

Cheeky, when you went back on the Paxil did it provide any relief, even temporarily?

 

Btw, can someone please show me how to add my medication history as a signature, I must be blind.

 

Cheers

[Meimeiquest]

At last an easy question . To make your signature, click on your name in right hand corner, click settings, click signature, and save it when you're done writing.

 

Can you do anything about the work stress?

[brassmonkey]

Hi strangeanimal-- welcome to the group.  As ladybug mentioned we need to talk.  I'm at work right now so don't have much time, but I will write more this evening.  I've been on paxil for 23 years now, topped out at 40mg and went into sever poopout (tolerance) and then three and a half years ago started to taper.  I'm feeling the best I have in years.  No reason you can't too.

[StrangeAnimal]

Thanks Meimeiquest! Regarding work, I'm actually on short term disability at the moment. 

 

Brassmonkey, your time would be much appreciated; I look forward to any advice you can offer. I'm glad to here that you're doing well.

[Rhiannon]

Given the disclaimer that I don't really know much about what meds to take and how to take them, I would say either do a gradual transition off the Paxil and onto another med over a couple of months, or try a slow taper down off the Paxil (given your history that needs to take at least a year and maybe a couple) and see if you get any improvement as you go. This is a less-educated guess than my advice about tapering, though.

 

The problem with these meds is that over the long term they can end up causing as many problems as they are supposed to be solving.

 

It's possible that a slow taper would allow your brain to sort of "reset" its sensitivity to the medication and you might do well maintaining on a lower dose. No guarantees, of course, and if you're not highly motivated to come off the med, it's going to be hard to summon up the determination and patience required to do it safely. In that case I'd go with option 3, but just be sure to take it slow.

 

I'm afraid that advising people on how to take meds, what meds to take etc. is not really what we do here and is definitely not MY strength for sure.

[Rhiannon]

I should add that like brassmonkey, I find that I am just doing better and better the lower my doses get. No recurrence of the horrible depression "relapses" I used to get when I tried to reduce my meds erratically and too fast. And I've gotten back aspects of my personality that I had not seen in 20 years. It's great!

[StrangeAnimal]

Thanks for the advice Rhi, I really appreciate it!

 

Ladybug, I agree that our backgrounds are similar, being initially prescribed Paxil for anxiety related issues (OCD/Panic) rather than pure depression. I'm curious how your OCD and Panic symptoms have changed during your taper and how you're currently feeling?

[ladybug]

 

Ladybug and Cheeky, thanks for your input. As I mentioned in my posting, I can't stand the arbitrary use of medication to treat mental illness. I completely respect both of your opinions, isn't it funny though that one of you says increase the Paxil and the other says to start tapering. It's so difficult to feel confident with your next step when those with good intentions simply have different experiences and therefore differing opinions. It's too bad there isn't a textbook one size fits all process with this stuff.

 

 

Actually, I was going to suggest the same thing that Cheeky has and I thought I did but I must have changed my mind at the last minute. Some people in poop out find that increasing their dose a little bit will improve their symptoms, but it is usually only a temporary improvement. The "logic" in this approach is that if you do a small updose and improve some then you will be able to begin your taper from a more stable place. However, not everyone feels this improvement and if you are one of the ones who doesn't then it's just that much more Paxil that you have to taper from. It's really up to you whether you want to take this chance.

 

 

 

Ladybug, I agree that our backgrounds are similar, being initially prescribed Paxil for anxiety related issues (OCD/Panic) rather than pure depression. I'm curious how your OCD and Panic symptoms have changed during your taper and how you're currently feeling?

 

Well I don't believe the Paxil really ever helped that much with the OCD. It only helped in the sense that it numbed me to everything including my obsessive thoughts and mental compulsions. I have dealt with anxiety issues since I was child, but when I was 16 I started smoking weed and when I was 17 I started smoking it heavily and I don't think it was a coincidence that a year or so later is when my anxiety issues got bad enough that I sought out help.

 

I never had full blown panic attacks, but I did start having panic symptoms like dizziness, lightheadedness and racing heart when I was in public places. I wonder if I had just quit smoking weed instead of going on Paxil if my symptoms would have improved. I have felt that both my anxiety and OCD are much improved at these lower doses, but only when I am in a window. When I am experiencing a wave all of my symptoms are increased, including anxiety and OCD. When I am in a window at these lower doses I feel better than I ever did on a full dose of Paxil! But as you can see from my signature, my taper is VERY slow going, but do not let that deter you. I am someone who seems to be sensitive to even small drops, but most people are not like this. Most people are able to taper off Paxil in 2-3 years.

[Altostrata]

Welcome, StrangeAnimal.

 

The situation where you are suffering poop-out from Paxil yet don't want to risk going off is a difficult one.

 

This is a site for going off drugs. We can't advise you about switching to a new drug, except that as Rhi mentioned, a cross-taper tends to be kinder to the nervous system.

 

Tapering off means you will need to commit to non-drug methods to control your symptoms. Unfortunately, poop-out can produce symptoms of anxiety and obsessiveness; in essence, withdrawal syndrome. Your underlying condition has not necessarily broken through.

 

It's your choice...."Tolerance" or "poop-out" -- what happens?  Let us know if you would like support in tapering. See Tips for tapering off Paxil (paroxetine)

[StrangeAnimal]

Thanks for the replies Ladybug!

 

Thanks for the input Altostrata! I have every intention to begin tapering off everything as soon as possible, I just want to feel stable before I proceed. If I do cross-taper I won't be requesting advice on this site for which drug I should switch too. I shouldn't have mentioned option 4 that I came across because it mentioned a particular med.

[Altostrata]

No foul, you can mention, we just can't advise.

 

So you intend to switch and then taper?

[StrangeAnimal]

I think I'm leaning towards a cross-taper Altostrata. All I know is that I'm really scarred about both the way I'm feeling at the moment and what lies ahead with regards to Paxil withdrawal.

[imac]

Just my experience - I crossed tapered when I pooped out on PAXIL to Zoloft. It ended in a nightmare. We tried for almost a year to stabliZe me ( while I lived in daily acute torment no doubt from adding another drug to my brain) . I believe adding the new drug damaged me much more. Had I known then what I know now, I Wouldn't have cross tapered and just slowly tapered the PAXIL, Id be in a much better position today. I was so desperate by the time I was done trying for so long to stabilize with the zoloft that I tapered fast and then lived in acute WD for 3 years afterwards. It just makes no sense to me when you're clearly damaged by a psych med, why would you add another one to the mix? Only to confuse your brain even more? I wish to GOD I knew all of this back then! I bet if I went slowly down from PAXIL none of this would have happened to me other than having to wait a bit to feel better from the drops. I've also seen ALOT of unsuccessful attempts to cross taper where the person ended up worse off. I have on the other hand seen a lot of success with slow tapers from poop out. Just like Brassmonkey and Cheeky ( I think?) stated earlier. A quick way to relieve the pain now may end up even worse in the long run. That's just my 2 cents. You're going to get different opinions on this. Weigh your options and make the right decision for you. I'm not a fan of taking higher doses either but Id certainly do that before switching drugs.

[brassmonkey]

After finishing work and spending two hours in a dentists chair I'm finally getting a chance to get back to you.  As you can see there are a lot of people here willing to help and they have really done their homework, both book learning and practical.  I have a real good idea about how you feel.  I started out on 20mg and was very happy for about ten years.  Then things started to go south.  After talking with the Dr. we upped it to 30mg and things improved a bit for a while but still weren't right. This lasted several years until it was bad enough to try going up to 40mg.  After hardly any improvement things really went down hill until I hardly had any short term memory, was in constant pain, disoriented, limited cognitive function and drank like a fish.  I was looking into changing to cymbalta when I figured out the paxil was causing my problems and the only way out was to get off of it.  I learned about the 10% taper method and was ready to try it.  I was scared to death, I figured that I would be just sitting in a chair rubbing a worry stone repeating "it's only withdrawal" over and over again for years.  It didn't turn out that way.  The 10% taper was gentle enough that I didn't particularly notice the drops.  I also developed a system of sneaking up on the 10% so the effect was a lot milder.  It took about three drops before I started noticing any improvements, but slowly they did start to show up and have steadily increased the entire time.  I not off yet, but I am feeling better now then I did back when I was on the 20mg.

 

One thing I learned from all my reading was that switching drugs rarely works and frequently causes a lot more trouble.  The drugs are not interchangeable, they all work in slightly different ways so they never really mask each other.  So you frequently end up with WD symptoms from the one you quit and start up symptoms from the new one.  Not a pleasant combination.  I was very luck in that I had only been exposed to one drug.  Reading other peoples threads showed me that the ones who had tried switching only kept on trying to switch, chasing the illusive "magic combination" and suffered greatly for a long time because of it.  Sure I've been tapering for close to three and a half years now and have the best part of a year left to go, but I haven't been in sheer misery the entire time.  There have felt like there were many setbacks along the way, but each one gave way to higher ground.

 

It is all uncharted, strange territory, so naturally it is going to be scary.  However, you are in a good position to gain the upper hand and take control of the situation.  

[Babs]

Hi StrangeAnimal,

 

I agree with those who say in poop out, your best option is to taper off the med.  You're only buying time if you updose, and often not a whole lot of time.  And sometimes updosing doesn't bring significant relief anyway.  Starting another med is a risky proposition, for the reasons others have mentioned.  Of course the choice is always yours.

[Cheeky]

Stange Animal

I have just gotten out of hospital becouse my stupid doctor thought by switching to another drug was going to work , well it didn't , I have had 3 months of hell becouse of the Paxil Withdrawel and the new side effects of the new drugs. The doctor in the hospital agreed I was withdrawing badly from the Paxil and put me back on it . It's been a two weeks back on it and I feel back to normal except I'm getting headaches and I think it's becouse all the changes my brain has had in such s short time.

I really believe when your in the poop out and your feeling so desperate to be normal again , I would up my dose by 5 mg and then when your all stabilized I would give your nervous system a break for a few months and then start to tapper like brassmonkey has.

I think the aim is to feel back to normal than you can make a better decision . I have just been through this and in s couple of months I will be following brassmonkey's tapering as I have read a lot of people say that worked well for them.

I too will start this journey, so your not alone . If you need support message me anytime .

[StrangeAnimal]

Brass Monkey, thank you very much for your time and invaluable information, it's much appreciated!

 

 

Thank you for your advice Imac, Babs and Cheeky; also much appreciated!

 

As I mentioned in my first post, I've never been sure how relevant this is to my struggles ahead, but it has always been slightly comforting for me knowing that I've only ever been on one med. I've noticed that a lot of the advice I've received seems to suggest that is in fact relevant, being that no two drugs are identical and each affects our brains in different ways. I feel for members like Cheeky and Imac for what they've experienced by cross-tapering following their physicians advice. I'm also extremely grateful that they shared their stories with me; I only hope that my experiences can also assist others who feel as confused and scarred as I've been feeling lately.  

 

 

The more I've thought about it after reading all the advice I've gratefully received, I've narrowed my options to two choices, either immediately begin a sloooooow and lengthy taper, or temporarily increase the Paxil for a short period in hopes that I feel more stable before proceeding to withdrawal. The concern I would inevitably have about the effects of starting a new med is additional stress and confusion that I simply don't have room for at the moment if I want to avoid a complete breakdown. I would drive myself crazy wondering if any adverse affects were due to Paxil tapering or the new med. As difficult as Paxil withdrawal will eventually be, at least I'll know what I'm dealing with.

 

 

The truth is, when I saw my Psych earlier this week, my knowledge had reached a point over the years where I had questions and concerns about every single option he presented. It also scarred me that he was providing me with options in the way an ice cream vendor would ask you what flavour you want. Don't get me wrong, I consider myself a rather prudent individual who prefers to weigh all factors for each respective option before making a decision. Nevertheless, for something as important as my health, I inevitably want the conversation to end with professional guidance and a clear direction from the "specialist" sitting across from me. After I told him this, his reaction confirmed what I had already suspected, I wasn't going to find what I was looking for in that room, I was on my own.   

 

 

Then again, since joining this site, perhaps I'm not on my own after all.

 

 

Thanks again! 

 

[Fresh]

"We are all in This Together" ....   song by Ben Lee , Australian musician , check it out on you-tube 

[Cheeky]

Take care and please keep us updated and tell us what your doing, we can all support each other .

[StrangeAnimal]

I certainly will Cheeky, cheers.

[LexAnger]

Hi SA, did you experience additional symptoms or situation get even worse since you up dosed to 30? You made a huge increase from 10 to 30, so what I am trying to find out is, whether you had bad reaction to the increased dose. If yes, you would not want to increase even more for the hope of help of it with the 'relapse'. It most probably not even a relapse anyway. Have you thought about the possibility your worsened feeling is actually caused by the high dose?

 

Just a reminder in case your focus is only on WD, relapse, and thinking higher dose is for better control of symptoms. Many ppl got bad reaction to increasing dose with lots more and worse symptoms.

 

As a matter of fact, I'm one of those.

[StrangeAnimal]

Hi LexAnger, the relapse started while I was on 10mg Paxil, which I had been on for just over 2 years. Ongoing work stress and panic attacks caused a relapse in my ocd and depression. I didn't increase from 10mg-30mg, I increased from 10mg-20mg for 6 weeks and then from 20mg-30mg, which I'm currently on. 30mg has always gotten me through past relapses, at which point I gradually decrease back down to 10mg when stable and feeling good because of the side effects. This is the first time that 30mg has been ineffective. 

[imac]

Hi SA, in my experience over the years, what you describe is poop out ( not a relapse of any sort). Your body hit tolerance with the MEDS. In the past updosing worked but only for a limited time. My guess is after you stabilized you went down in dose and this could have also started the roller coaster. You were in WD from big drops or too quick of drops. Plus, once people start having issues with these MEDS they begin to just have all kinds of problems and you'll most likely never achieve stability again for any long amount of time. Which is why the best thing to do is not confuse the brain anymore and start a slow taper down. You will most likely see yourself stablizing the the lower you get as long as it's slow and small drops in order to allow your Brain to adjust. The 10% method seems to work for a TONNE of people. Just don't let your doc tell you otherwise or laugh it off.

[StrangeAnimal]

Hi Imac. Do you really think it was just a cooincidence that I was fine on 10mg for over two years and then by cooincidence I hit tolerance after the most stressful few months I may have ever had? The other thing I'm concerned about is that I've never been on Ativan as long as I've been at the moment (just under 3 months) because the anti-anxiety properties of paxil would not only stabilize me during past relapses but also made it easy to stop the ativan, which I had only ever been on for 3-4 weeks until the paxil kicked back in during relapses. Prior to my past relapse, in which I weaned too quickly off the paxil, most of the prior relapses were caused by missing a dose or two (that's all it takes with such a short half-life to leave one's system) or quitting cold turkey when I was feeling good; this happened in the earlier years when I was young and naive.

[imac]

Strangely, we seem to also hit nasty waves in WD during stressful times too so no, I'm actually willing to bet you were in tolerance and it was waiting to pounce as soon as you hit stress or it just exacerbated the stress a lot more.

I too took Ativan years ago. Once for 3 weeks during my first poop out and my doc switched my MEDS. I tapered it after 3 weeks because I was afraid to become tolerant. Then I was given it again when I RI'd PAXIL after I cold turkey'd 4-5 months before that. I had delayed protracted WD. I took it again for 3 weeks and then tapered. I have never touched ativan again since then because once I stabilized again it only lasted 3 months and I hit tolerance. I entered hell after that and am just recently (5 years later from when that hell began) better and I am now 3.5 years Med free now. I didn't want to add Ativan into the mix again. It's been a very long road but I'm finally coming out the other end. How often do you take the Ativan? Is this regular use? Because Benzo's can also be very dangerous to WD from. You can also hit tolerance with those too. I think you've mentioned it's been under 3 months but how much do you take and how often?

[StrangeAnimal]

I had taken 2mg Ativan daily (1 in the morning and 1 at night) for the first two months. I have now been taking 0.5 in the morning and 1 at night for the past 3 weeks. I had planned on taking 0.5 in the morning and 1 at night for only a one week and then continue tapering but by the evening I felt like I needed the 1 because my anxiety was so bad. However, I've also been depressed so I haven't done much to help myself; been sleeping too much, not exercising and not eating well. I just need to toughen up and continue the Benzo withdrawal regardless of how I'm feeling because long term Benzo use is simply NOT an option.

[StrangeAnimal]

 I have never touched ativan again since then because once I stabilized again it only lasted 3 months and I hit tolerance.

 

Were you referring to Ativan here or Paxil?

[imac]

 

 

I have never touched ativan again since then because once I stabilized again it only lasted 3 months and I hit tolerance.

Were you referring to Ativan here or Paxil?

Once I stablized on RI'ing PAXIL it only lasted 3 months and I hit tolerance.

 

What I meant was I decided then to not use Ativan the next time for stablizing ( or ever again). I felt very uncomfortable using it, seeing as it's a narcotic. I only took 1mg per day. .5 twice a day. That's good that you are tapering that. I would suggest ( and by no means do you have to follow my advice) to taper one for a bit, then hold it and taper the other for a bit then hold it. I'm not very experienced with benzos but I belong to a benzo forum as well because there are some incredible WD stories there too and people in protracted WD. ( basically a psych drug is a psych drug. Whether it's an ssri or a benzo). My thought is that if you try tapering both at once you may have a harder time stablizing. They are both very powerful drugs. If it were me I think I would alternate the tapering ( while holding one each time I taper the other a tiny bit) because Id want off both. Tbh. Ativan can cause major rebound anxiety so it may be contributing to the issue.

 

I know this must all sound like a lot and unachievable but believe me it CAN be done and has been done. All you need to do is keep your focus on getting lower with the doses and ALOT of patience. Set the expectation that there is not ever going to be a quick fix for this and that you will have some uncomfortable symptoms ( like now) but I am very confident that the lower you get the better you may feel. It just may take some time. I always told myself when I hit bad waves that although I feel terrible and I want to take something for relief, if I do, I could mess up by brain even more and things could get much much worse, or stay put and and let time heal me!

[Fresh]

Hi guys ,       nz11 posted an interesting article about doing an alternating taper which made a lot of sense to me.    I'm sure he can make it available if someone messages him.

[StrangeAnimal]

I think I'm leaning towards tapering the Ativan completely before I start with the Paxil.

 

One set of issues at a time.

[LexAnger]

Great everyone chimed in helping with analyses. That's what needed before a proper strategy.