StrangeAnimal: Deeply Concerned about Next Steps following Paxil Tolerance

[Altostrata]

Also see http://survivingantidepressants.org/index.php?/forum/29-members-only-benzo-tapering-discussion/

[StrangeAnimal]

Hello again,

 

I think I've decided to star a cross-taper back to paxil tomorrow in the same two week transition I used to switch from paxil to celexa. So stay on 20mg celexa for a week while adding 10mg paxil, then upping paxil to 20mg and reducing the celexa to 10mg for the second week, then removing the celexa and holding paxil at 20mg in week three, at which point I will continue to monitor the paxil. The way I'm feeling right now, I cannot take this whole "psychiatry is not an exact science" any longer, I literally feel like I'm hanging by a thread. It's the doubt that's killing me. I know there's no guarantee that switching back to paxil will work but the fact that paxil has worked so many times in the past (and at never more than 30mg) provides me with the ever so slightly more confidence that I'm desperate for at the moment. I don't think I have the fortitude left to raise celexa to 30mg and continue to wait on complete blind faith without the precedent of success I've had with paxil. 

 

The other thing is that since I've needed as much as 30mg of paxil during past relapses I wouldn't be surprised if I needed at least 40mg of celexa to stabilize (if it did eventually work). I read that 30mg paxil is equivalent to 40 mg celexa, not sure if that's true. In any case, 40 mg celexa is the adult 18-64 limit because of the blackbox warning about QT interval prolongation. I don't think I'd be comfortable with that. My doctor says that if you've had a recent cardiogram that came back fine (I did) then there's nothing to worry about, the warning is more for those with a prior QT or other heart issue. Well, yeah know what, "I don't think I trust you anymore doc", so that's that.

 

I know the decision is mine but I welcome anyone's input, I'm still slightly contemplating my "not exact science" conundrum. Any thoughts on back to paxil vs raising celexa? FYI, I've been on celexa for 4.5 weeks now, 1 at 10mg and 3.5 at 20mg.

 

Thanks in advance!

SA   

[Altostrata]

I don't know what you mean by "worked." It is possible the Paxil will reduce withdrawal symptoms you may be feeling from Paxil.

 

It's also possible you will never again get the same kick from an antidepressant you once did. Your serotonin receptors are tired out.

[StrangeAnimal]

What I mean is that it stabilized my prior relapses and allowed me to feel like myself again. I'm not a paxil fanboy, if I could go back in time with what I know now I would have never started ssri's. Nevertheless, my objective at the moment is the quickest route to stabilization, only at that point can I begin the necessary slooooow and patient taper off this poison.

[Altostrata]

Reinstatement of Paxil may only partly relieve your symptoms -- those that are due to withdrawal.

[StrangeAnimal]

Hey everyone,

 

Just an update for anyone who may be going through a similar situation as mine. My cross-taper to celexa for the purposes of stabilizing was an absolute failure. After the two week cross taper, my little more than 5 weeks on just celexa (3 weeks at 20mg and 2+ weeks at 30 mg) took a turn for the worst 5-6 days after my last paxil dose (I suspect paxil withdrawal finally kicked in) and continued downhill from there. This past weekend I walked into the emergency room of my local hospital , I simply could no longer take the constant nausea, lightheadedness, lack of appetite, and ocd/depersonalization. I was starting to get significantly concerned about the physical effects surrounding my lack of eating (which was getting out of hand), as well as the level of mental disconnection I was feeling, I was literally lying in bed day after day feeling like my time was almost up.

 

Anyway, after not eating anything all day and waiting 4-5 hours to be seen by the resident psych on duty, I began to feel lightheaded and faint and subsequently had a major panic attack. I'm actually pretty glad it happened when it did (just before he was ready to see me) so that the full extent of my suffering was on display. Although I take three daily doses of ativan 0.5mg and I had just taken one when I felt the panic attack coming on, they insisted I take another 1mg of quick acting sublingual ativan, that's how bad I appeared. Once I was calm enough to converse we had a fairly lengthy conversation, at the end of which I was told to immediately stop the 30mg celexa and reinstate paxil at 20mg the following day. My trust in the medical community is almost beyond repair but I did stop the celexa and reinstate the paxil the next day because I had nothing to lose, I could not have felt any worse than I was and if part of the problem was paxil withdrawal than perhaps I would at least feel a little relief from that.

 

A funny (actually sad) side note: the evening of the second day off celexa and back on paxil I had a fairly significant window in which I was feeling so good (relatively speaking) that I didn't bother taking my evening dose of ativan, and I slept great. Unfortunately it didn't last, it was actually a pretty big tease. At least the nausea is mostly gone, I'm not too surprised because the resident psych confirmed what I had already read regarding nausea often being a significant issue with celexa.

 

To finish off here, after 15.5 years with the same psych, I received a referral for someone else. My current psych is lost for why the celexa didn't work and his advice the last few visits is too seek a second opinion. I'm not surprised, he's packing it in soon and not accepting new patients. Probably just counting down the minutes till retirement. You know it's time to move on from any doctor when you feel 10 times worse walking out then you did walking in. I really hope that I eventually stabilize on paxil because I will not be trying another antidepressant of any sort. I just want to feel stable enough to begin a proper paxil taper. I wish I had listened to most of you who cautioned the cross-taper. What can I say, I was desperate, scared, and felt I had nothing to lose by trying.

 

Cheers to everyone for better days ahead!

 

SA           

[StrangeAnimal]

Hi everyone,

 

I was just wondering if there is a chance that I'm experiencing Celexa withdrawal after being on it for only a little more than 5 weeks (details above)? My switch back to paxil (20mg) was immediate, not a cross-taper.

 

Thanks in advance for your thoughts

 

SA