Sybilgirlus: Long time antidepressant user

[Sybilgirlus]

Hi!  I am a 47 y.o female who has been on antidepressants and anti anxiety medications since 1990, except during my two pregnancies in 1992 and 1995.  For about the last 15 years, I have been on Paxil 60 mg, Wellbutrin 400 mg, Buspar 60 mg and Klonapin .125-.50 (since 2004.)  Recently, I felt as if the Paxil was no longer doing anything and possibly even making me more anxious and depressed.  I started a slow taper in November, 2014.  I have been Paxil free since March 22, 2015.  The withdrawal was manageable until I hit the 3 week point.  I have been very ill since then with nearly every possible side effect.  Kept taking the other meds as prescribed, but every time I took the Wellbutrin dose, I seemed to become even more dizzy/nauseous/anxious.  Two days ago, I decreased the Wellbutrin SR to 300 mg (150 mg/twice a day to see how this would affect the nausea.  The dizziness and nausea seem a bit better, but now the anxiety is nearly unbearable.  I don't know where to go from here.  My psychiatrist is not very helpful because he mostly just writes prescriptions and talks about himself.  But he is the only local psychiatrist that my insurance will pay for.  My therapist is great, but she would like to see me come totally off the Wellbutrin as well as the Paxil.  So, I have pretty much been doing this by myself.  I'm at the point where I don't know what medicine or lack of medicine is causing which symptoms. Can anyone help me?  Has anyone else been in this antidepressant/antianxiety cocktail nightmare?? 

[Fresh]

Hi Sybilgirlus , welcome to the site.

 

You're probably right that the Paxil stopped helping , but I'm afraid your "slow" taper of 60mg between Nov.2014 and March 2015

was actually very fast.

This site recommends decreasing by no more than 10% every 3 to 4 weeks. It sounds like you're experiencing protracted withdrawal

syndrome since you stopped.  "Dizzy , nauseous , anxious"  are all  part of the w/d package.

 

The only way to stop this process is by reinstating a small dose of Paxil.  

Try reading "Reinstating to Stop Withdrawal Symptoms" , in the Tapering section.

The idea is that you halt the w/d process , let yourself get stable , then begin to taper s-l-o-w-l-y.

 

Decreasing your Wellbutrin by 25% further complicates the situation.  As it's only been 2 days , I'd be inclined to go back to your

previous dose until your w/d symptoms settle.

 

Try reading some threads in the Tapering section that will help you to understand why you're feeling so terrible.

It's only been one month since you last took paxil , so hopefully a small reinstatement will keep you out of the woods.

 

Good to have you on board ,  Fresh

[Sybilgirlus]

Thanks for your response, Fresh!  Because I had not yet found this site, I was like you in the matter that I didn't know the correct meaning of slow when it came to tapering off  antidepressants.  It seemed slow to me at the time.  Since I am five just about five weeks out from being Paxil free, I really don't want to reinstate at this point.  I had seemed to be slightly improving until I started the Wellbutrin SR taper.  I believe that I will take your advice about waiting to decrease  the Wellbutrin.  I really only began that taper because my therapist was very concerned about it causing anxiety and wanted me to come off it.  Do you have any idea why my WD symptoms get worse every time I take a Wellbutrin dose?  I was a little worried that the Paxil being out of my system had caused some sort of Wellbutrin overdose.  Thanks for your help!

[Sybilgirlus]

Hey, Fresh!  Since my last post, I have read Maplegirl's experience.  She had to go back on Paxil at 11 months off.  Do you think that is where I will be headed if I do not reinstate a small amount of Paxil now? 

[Addax]

Found your thread. I responded to your PM, but I'll write more here.

 

Reinstating can be tricky and some have found it not to be helpful, while others, myself included, have done it with success. Still others have found its made symptoms worse. The complication, as I wrote in the private message, is that Wellbutrin is known to cause an increase in plasma concentration of the SSRI it is taken with. In other words, it's like it makes it more potent. I think I explain it better in the response to your private message.

 

Here's the thread about reinstating: http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-stop-withdrawal-symptoms/

 

Read that, and if you have more questions, ask them here.

 

Also, I have found relief from anxiety with Magnesium supplements and several people here seem to be having some success with high doses of vitamin C. Those may be options for you as well.

[Altostrata]

Welcome, sybilgirlus.

 

It does sound like going off Paxil put your nervous system in a sensitized state. As far as reinstating, even 1mg might help reduce the withdrawal symptoms from that.

 

Because your nervous system was sensitized by Paxil withdrawal, it sounds like you started to have adverse effects from Wellbutrin. Then, reducing Wellbutrin that much added to the destabilization.

 

If I were you, I'd go up a little on the Wellbutrin, too, maybe to 350mg to reduce the Wellbutrin withdrawal factor. Since you have Wellbutrin on hand, I'd make this correction right away. For titrating Wellbutrin, see Tips for tapering off Wellbutrin, IR, SR, XR, XL (bupropion)

 

Paxil comes in a liquid form for titration, see Tips for tapering off Paxil (paroxetine)

 

I would stay on a very low dose of Paxil while tapering Wellbutrin, as Wellbutrin tends to be activating, see Taking multiple psych drugs? Which drug to taper first?

 

The dosages of all your drugs are quite high. I would want to see how they interact. Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.
 

[Sybilgirlus]

Thank you so much, Alto!  I'm having a hard time hanging in there today.  Panic and tears all over the place.  :-(  Thank you for the links.  I have read them and will continue to use them as guides.  I'm going to the Drug Interactions Checker now. 

[Sybilgirlus]

Well, I did the interaction checker.  Results aren't too good.  Two major risk interactions: 

buspirone ↔ paroxetine

Applies to: BuSpar (buspirone), paroxetine

Using busPIRone together with PARoxetine can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

bupropion ↔ paroxetine

Applies to: bupropion, paroxetine

Talk to your doctor before using buPROPion together with PARoxetine. Combining these medications may increase the risk of seizures, which may occur rarely with either medication. In addition, buPROPion can increase the blood levels of PARoxetine, which may increase other side effects. You may be more likely to experience seizures with these medications if you are elderly, undergoing alcohol or drug withdrawal, have a history of seizures, or have a condition affecting the central nervous system such as a brain tumor or head trauma. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. You should avoid or limit the use of alcohol during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

 

As well as 10 moderate risk interactions between all the various other medications.   Most of the interactions have to do with seizures and blood pressure changes.   I have only had issues with seizures a couple times:  once when I took too much cough syrup and once when I was given Demerol for wisdom tooth extraction.  I guess that I can be very thankful that there haven't been more times after reading the above. 

 

But what kind of care have I been under???  I feel hopeless and sick and stuck.  I will try Alto's suggestions and see how it goes.  What doesn't kill you makes you stronger?????

[Altostrata]

Looks like your doctor is drug-happy.

 

A little bit of paroxetine is not going to have the risks of those larger doses you've been taking.

 

Why was the Buspar added?

[Sybilgirlus]

Buspar was always prescribed along with the Wellbutrin SR.  I think it was to counteract some of the Wellbutrin side effects of anxiety.  I am a military dependent.  All this care has been under military doctors and their contractors. 

[Altostrata]

If the Wellbutrin was making you anxious, that's not a good effect on your nervous system.
 
Do you have any Paxil left? If you do, I might try 1mg Paxil rather than adding to the Wellbutrin.

Use the liquid form of Paxil to take 1mg, you can make your own liquid, see Tips for tapering off Paxil (paroxetine)

[Sybilgirlus]

I do still have Paxil left; 20 mg tabs.  I was thinking about cutting a tablet in half and then half again and taking 5 mg along with increasing the Wellbutrin up to 350 mg.  I was thinking that maybe I could stabilize on that and then eventually taper the Wellbutrin before going back down on and then off the Paxil.  I still take the Buspar and Klonapin as well, so actually decreasing the Wellbutrin has made me WAY more anxious than I ever felt while taking it.  Alto, what do you think of this plan?  Do you think the 5 mg Paxil is too much?  Am I reinstating or just trying to lower the nervous system sensitivity? Thanks for your continued help!

[Sybilgirlus]

Bad night. Bad morning. I took the 5 mg of Paxil last night. The first two hours, I could feel my body relaxing. I couldn't sleep, but at least the constant panic was waning. Then, slowly over the next couple hours a terrible rage built up inside me. If I hadn't been home in bed with my husband, I think that I or someone else could have been in grave danger. I finally got up and took some melatonin and fell asleep within the next hour. I woke up very angry and nauseous. Upon smelling food, I began dry heaving. Blech! So, I got up, took my full morning wellbutrin and buspar dosages and have been lying in bed waiting to feel better since then. Alto, I think you were right about not needing much paxil. Does it sound to you like too much of that was the problem?

[Altostrata]

You may note I suggested 1mg Paxil.

[Sybilgirlus]

Yes, I did note that. Thanks. Sorry to have strayed from your advice. I was just confused at bedtime last night and wasn't sure if my objective was to reinstate or just counteract the Wellbutrin.

[Altostrata]

No problem. You might try 1mg tonight.

 

If it works, a little Paxil might reduce your withdrawal symptoms overall.

[Sybilgirlus]

Found your thread. I responded to your PM, but I'll write more here.

 

Reinstating can be tricky and some have found it not to be helpful, while others, myself included, have done it with success. Still others have found its made symptoms worse. The complication, as I wrote in the private message, is that Wellbutrin is known to cause an increase in plasma concentration of the SSRI it is taken with. In other words, it's like it makes it more potent. I think I explain it better in the response to your private message.

 

Here's the thread about reinstating: http://survivingantidepressants.org/index.php?/topic/7562-about-reinstating-and-stabilizing-to-stop-withdrawal-symptoms/

 

Read that, and if you have more questions, ask them here.

 

Also, I have found relief from anxiety with Magnesium supplements and several people here seem to be having some success with high doses of vitamin C. Those may be options for you as well.

Thanks for your response, Addax.  Sorry I didn't reply earlier.  Feeling pretty crappy.

[Sybilgirlus]

Can anyone please tell me that if reinstating works, will this crippling panic and anxiety go away?  Sometimes I don't know if I can make it through another day.

[Dan998]

I know it is possible. I've CT'd a few times now and always recovered after about a month of going back on. Just wish I'd known the difference between relapse and withdrawal, and been told about slow tapering.

[Altostrata]

We wouldn't suggest it if it didn't help people at least sometimes.

[Fresh]

How are you doing sybilgirlus?