Vonnegutjunky: Paxil 10 mg for 8 years - partial wean with reinstatement

[Altostrata]

On 5/5/2015 at 7:08 PM, Altostrata said:

VJ, it's impossible to tell what's causing your symptoms. Since you added the 5mg and after a bit, new symptoms arose, it could be 15mg is too much for you.

 

You may wish to decrease to 14mg and see if symptoms reduce. Keep notes on paper about your daily symptom pattern relative to when you take your drugs. (Are you taking anything other than Paxil?)

 

Does your doctor want to switch you to Prozac to go off Paxil? See The Prozac switch or "bridging" with Prozac

 

How exactly is your liver being affected? Have you had liver function tests?

 

VJ, have you gotten abnormal liver function tests recently? Why do you think your liver is damaged?

 

The liver has an amazing ability to heal. If you're only taking that low dose of Paxil, it probably can handle it if you don't have liver disease.

 

I see you've been worrying about this for several years. Is this an aspect of your health anxiety?

 

As we've discussed before, Paxil is very, very difficult to go off. Many doctors would switch to Prozac to go off Paxil.

 

I've requested that chapter from Dr. Cosci. It's about withdrawal syndrome.

Edited February 27, 2019 by Altostrata
updated

[Vonnegutjunky]

Hi Alto, yes I was diagnosed with non alcoholic fatty liver disease - enzymes are high and other liver function tests indicate my liver is not functioning at a normal rate - also I was diagnosed with chronic fatigue syndrome with my crp levels being 3 x normal - so my metabolism is shot and my liver isn’t functioning normally - 

 

I do believe this is because of the Paxil - I hope my liver does bounce back - that would be great a I just want to work again- I loved working so much- 

 

i would in a second taper prozac but my geno mind test shows polymorphisms at my liver - I am an ultra rapid metabolizer for the cyp219 enzyme - so they say not to use SSRIs- 

 

I would like to hear your option on the generic tests and their reliability, if

you have time 

[savinggrace]

Vonnegutjunky, 

Would you mind sharing what test you had done (where, etc) that gave you info on how you metabolize various drugs?

 

i had a genetic test at Mayo 15 years ago. They only tested how I metabolized 2D16 drugs because they said this enzyme was most important predictor of how one metabolizes most psych drugs. Not true though, or at least they should have tested all the major players including C219, C1A2, and C3A4/5. Might have helped my doc make better decisions for me...,

 

hope you get to feeling better soon. 

 

Grace

[Vonnegutjunky]

Hi grace, 

yes I got my test done through my integrative medicine doctor, it was the genomind

genecept assay 

 

here is the link that shows what all is tested 

 

https://genomind.com/the-genecept-assay/clinicians/genes-analyzed/

[Altostrata]

VJ, those Genomind tests are a mass market product with very general recommendations. The SSRIs are metabolized by different liver enzymes, some by several, some are not metabolized by cyp219 at all.

 

Fluoxetine is primarily metabolized by CYP450 2D6 and CYP450 2C9, plus a little CYP450 3A4. It is an inhibitor of CYP450 2C19. If you don't have anything else metabolized by 2C19, the effect of this is null; even if you did, the "fast metabolizer" characteristic would cancel out the inhibitory activity.

 

Look at Predicted ADMET features for fluoxetine on this chart https://www.drugbank.ca/drugs/DB00472

 

For paroxetine https://www.drugbank.ca/drugs/DB00715

 

Are you taking any other drugs?

[Vonnegutjunky]

Thanks alto,  I appreciate your expertise in this. 

 

no, no other drugs, 

 

my biggest issue is clearing drugs and hormones, 

becuse my metabolism is so slow, I’m not even properly metabolizing hormones, being in menopause for over a year now and all of my estrogen, progesterone, and testosterone keep being in the normal, non menopausal range,  but I have menopausal symptoms. 

 

the doctor explained this as the hormones being on the high side in my blood becuse I’m not actually breaking them down and metabolizing them at a normal rate.

 

Thsts just what I was told, I didn’t know this was an actual thing. 

 

I would like like to cross taper to Prozac, I am going to talk to my psychiatrist about  it. He listens, believes in ssri withdrawal,  and is supportive of my slow taper. I am very lucky in this aspect. 

[savinggrace]

Just because I am interested, Vonnegot, I looked up fluoxetine a paroxetine on a couple of CYP450 charts that are pretty up-to-date (but always changing) and neither of them showed either of those drugs as being substrates of 2C19.  So I guess the generic statement to avoid SSRI's is just that...kind of all-encompassing to be safe...but it looks like your drugs are primarily metabolized by 2D6 which Alto said, so that explains why Paxil made me very very sick as I am a slow metabolizer of 2D6 but I did not know that at the time.  So maybe a cross-over for this purpose just isn't worth the upset it will likely cause?

 

For what it's worth...

Grace

[Vonnegutjunky]

Thanks Grace, 

 

paxil also made me sick- well it gave me akathisia - after I had tolerated it very well for 8 years - during a rapid taper I went back on it and increased it to a previously tolerated dose and the next day I had akathisia and felt so weird and bizarre like I was on an acid trip - 

 

my biggest issue is wondering why this happened and the only possible logical explanation was my poor liver function- 

 

Also ultra rapid metaboliszers of the 219 get severe adverse reactions to SSRI meds because of the way we breakdown the drug very quickly but don’t clear it out of our systems - so basically it builds up and we kind of overdose on it - that’s what I have read anyway - I’m by no means an expert nor am I well versed - just read a couple of articles online - but that’s my basic understanding- I guess if you have a med that gets activated by the metabolic process of the 219 this can happen if your an ultra rapid metabolizer  - 

 

but snri would be ok for me to take because they are already active before the 219 breaks it down? But I won’t take them. Or anything else - I can drive my kid to school now- I don’t want to do anything that will set me back 

[savinggrace]

There is something I don't understand about this slow versus fast metabolizing thing.  I am a slow metabolizer which means it takes a long time to break it down, and, I thought, it would also mean it takes a long time to clear it.  Not true?

 

Grace

 

[Vonnegutjunky]

No your correct

 

check out this chart 

 

 

heres the link that I got the chart from 

https://selfhacked.com/blog/cyp2c19/

 

 

I process meds similar to you 

[savinggrace]

Really interesting.  Thanks!  I am grateful that I got my kids raised by the time these drugs hijacked my life.  That said, the last ten years of raising them was very hard on me because I was becoming sicker and sicker and still trying to do it all...

 

Grace

[Vonnegutjunky]

Was looking back from 5 years ago on my very first posts, reading them, and I wish I could go back and tell that person to shut the **** up. 

 

I was was such a whiny ridiculous know it all. 

 

Lord. 

 

I havent  had a window in over a month, which is unusual for me, but I’m sure it’s becuse I’m actually withdrawing now, and not having an adverse reaction anymore. 

 

Praise the lord I’m in withdrawal......

god this sucks, I’m in withdrawal.....

 

I did slightly updose a few weeks ago, I went from taking 3.7mg  off my 10mg pill, to taking 3.3mg off my pill. 

 

The worst, the thing that really made me updose was the intrusive thoughts. Good gracious I thought I was losing my mind. I go to a therapist and he explained they are a side effect of the primitive part of our brains, the area that causes anxiety, and that’s all they are, just anxiety, but thye are so intense I can physically feel the thoughts, and they feel like so consuming and overwhelming, I get obsessive about them.

 

Anyway so I updosed becuse of that. So far I am feeling kind of the same, maybe ever so slightly better? But not worse, but the anxiety is still so intense 

 

I will always remember Altos words, “what was the last dose that you felt functional at?”

 

👍✌️

[Altostrata]

On 2/28/2019 at 9:18 AM, Vonnegutjunky said:

I would like like to cross taper to Prozac, I am going to talk to my psychiatrist about  it. He listens, believes in ssri withdrawal,  and is supportive of my slow taper. I am very lucky in this aspect. 

 

Did you discuss the switch with your doctor?

 

Metabolism of drugs may be slowed by your liver condition. You might consider yourself a slow metabolizer on those grounds, regardless of the genetic tests.

[Vonnegutjunky]

10 minutes ago, Altostrata said:

 

Did you discuss the switch with your doctor?

 

Metabolism of drugs may be slowed by your liver condition. You might consider yourself a slow metabolizer on those grounds, regardless of the genetic tests.

Yes, I am a slow metabolizer for sure, even with food....but I am also a fast metaboliser only at the cyp219 function, which is why I break it down too fast, it builds up in my system and I don’t break it down fast enough at the other points of the metabolic phases....so it overdoses me. 

 

I thought about cross tapering, but decided against it for now. The adverse reaction Paxil gave me was too much. I feel better now, and will always worry that Prozac will backfire on me, and then I will be stuck ina withdrawal hell that has no end. I’m not completely against it, just not ready to make a big descision like that yet. 

 

Also so is my signature ok like it is? Or do I need to put everything right in the signature line? It didn’t fit. So I put it all in a pdf. 

 

 

 

[Altostrata]

Yes, there are no guarantees with a Prozac switch.

 

With your liver condition, could be you've lowered Paxil enough so the side effects have reduced.

 

Can you put your current drug take in your signature, so we can see it at a glance? I can open the pdf from your signature, thanks.

[Vonnegutjunky]

Yes - the side effects are gone - luckily - now the withdrawal is kicking in- 

 

i was just in the car and had a horrific panic attack and thought I was going to lose my damn mind. - I get severe severe depersonalization and derealization with them, and I thought I was genuinely losing my grip on reality - I cannot stand living like this - but what else can I do? The days of magic pills are gone for me..... I can’t take meds anymore - I am almost 100% certain they won’t work - I just have a feeling in my gut - because I think I don’t have enough auto receptors for the serotonin - so that extra serotonin is going to go to other parts of my brain and cause a dopamine decrease and give me akathisia again- I could be way wrong about that - but I think that’s what is happening - and will happen - with any serotonin increasing drug, med, supplements. 

 

I hope I can grow new auto receptors 😞 I worry I will one of the few that can’t or doesn’t for some reason 

[Vonnegutjunky]

I have a question, does magnesium glycinate raise serotonin? 

 

I am am asking because everyone touts magnesium as the chill pill, calming supplement....but I believe it gives me anxiety and panic. As I was reading more about it I saw some one on a site say that it increases serotonin, and it makes sense if it does. 

 

The day day I took it, that evening I had a nice night and felt calm for the first time in a long time....then I took the other half of the pill and had horrible anxiety and panic about 8 hours later. It was bad....I thought it couldn’t be the magnesium..... 

 

but  maybe I took too much 100mg, 

now that I read it raises serotonin, that could be the cause....I basically overdosed my brain on serotonin with that damn Paxil.....maybe low dose mag would be helpful for me, but I took too much and it raises serotonin too much causing me anxiety? 

 

I want  to give it another try if it’s probably not the cause and maybe a coincidence? 

 

Becuse that evening adfter I took 50mg that morning I was feeling really happy and positive, that was just 8 days ago....

 

want to to see what everyone here thinks about mag glycinate giving me anxiety and panic.....

[Carmie]

Hi Vonnegtjunky, 

 

I just wanted to say after I took even a small amount of magnesium glycinate it ramped up my withdrawal symptoms straight away. My system is extremely sensitised though, as I’ve been put on and off a myriad of meds. Maybe a different type of magnesium might work for me, I’m not sure. 

 

If you found that you were calm after taking a small amount, just try that small amount again or even smaller. Work your way up and see how you go. 

 

A lot of people have found magnesium beneficial, so if you find it calming just start with really tiny amounts. 

 

Take care💚

[Vonnegutjunky]

Thanks so much for your input - 

I thought maybe it was something else since magnesium seems to help so many others but maybe I am like you and too sensitive right now - 

 

 I’ll try again with 25mg and see if it helps at all with this anxiety - 

 

thanks again 🙏

[Vonnegutjunky]

Just need to vent -

 

today has has been one of the worse days I have experienced in a long time - 

The depression and anxiety is so bad I am almost resolved to trying something/ anything- I feel so so desperate - 

 

I haven’t been fully functional for 5 years - and I thought this past December I was finally turning a corner - 

 

i dont know if this is a natural depression because of everything or withdrawal- 

 

i remember feeling like this before I took Paxil- it was the reason I got on it - 

 

i just feel like I’ve been trying for so so long and it’s just not working - I can’t function- 

 

since I had an adverse reaction to my med I am petrified to take anything- anything at all- I have bottles of Valium, Ativan, and propranolol that I have never even touched and am so afraid to even try to take - I don’t want to get worse - I have read that Ativan can cause amnesia and increased depression- 

 

and according to my genetic testing, I cannot take any kind of SSRI- I am only able to tolerate snris, tcas and maois- 

also a few mood stabilizers and benzos

 

 

I tried to to stabilize on 10mg of Paxil for a year, I never was able to- (that was my dosage for 8 years that I did well on) 

 

please  I need help - I am so desperate - I need some kind of suggestion- I have done everything I can think to help and nothing is working - I have been bad like this since the end of  December - it hit me out of the blue - I try to be positive but I can’t anymore - 

 

please i I need help 

[direstraits]

14 hours ago, Vonnegutjunky said:

I haven’t been fully functional for 5 years

yeah,neither  have I...it's terrifying.

I can't offer any help,I'm just as lost as you...it seems you're getting better then,bam you're dragged down again..so sorry you're suffering like this.

just wanted you to know you're not alone .🤗

 

 

paxil is the worst.

[Vonnegutjunky]

Thank you dire straits - I appreciate the comradeship - 

[Vonnegutjunky]

It just occurred to me, and maybe I’m wrong, but I think I’ve been experiencing a type of brain zap...that’s different....I have been calling them brain blips, they don’t hurt, but they make my cognition go funny for a spit second, I get super scared when they happen....I have been getting less of them, but they are worst during waves. 

 

I kept thinking maybe there was something really wrong with me and they were some type of brain damage symptom, but I think they really might be some sort of brain zap. 

[Altostrata]

VJ, Paxil is very, very difficult to go off. It could be your liver condition is a complication here.

 

If I were you, I'd consider a cross-taper to Prozac. As we discussed before, metabolization of Prozac does not depend on CYP450 2C19.

 

It could be that because of its comparatively long half-life, you can get by with less Prozac than Paxil. Plus, the liquid will be easier to measure.

 

In terms of accuracy, the Genomind drug recommendations are pretty close to astrology. Look carefully at your liver enzyme results, do you have any issues with CYP450 2D6, 2C9, or 3A4?

 

On 2/27/2019 at 5:01 PM, Altostrata said:

VJ, those Genomind tests are a mass market product with very general recommendations. The SSRIs are metabolized by different liver enzymes, some by several, some are not metabolized by cyp219 at all.

 

Fluoxetine is primarily metabolized by CYP450 2D6 and CYP450 2C9, plus a little CYP450 3A4. It is an inhibitor of CYP450 2C19. If you don't have anything else metabolized by 2C19, the effect of this is null; even if you did, the "fast metabolizer" characteristic would cancel out the inhibitory activity.

 

Look at Predicted ADMET features for fluoxetine on this chart https://www.drugbank.ca/drugs/DB00472

 

For paroxetine https://www.drugbank.ca/drugs/DB00715

....

 

Also, could you put your taper schedule into a Google doc with a link in your signature, so I don't have to keep downloading the pdf?

[Vonnegutjunky]

9 minutes ago, Altostrata said:

VJ, Paxil is very, very difficult to go off. It could be your liver condition is a complication here.

 

If I were you, I'd consider a cross-taper to Prozac. As we discussed before, metabolization of Prozac does not depend on CYP450 2C19.

 

 

Ok thank you, I am going to the doctor on April 15, I am afraid but I will talk to him about a cross taper. 

 

 

9 minutes ago, Altostrata said:

 

It could be that because of its comparatively long half-life, you can get by with less Prozac than Paxil. Plus, the liquid will be easier to measure.

 

In terms of accuracy, the Genomind drug recommendations are pretty close to astrology. Look carefully at your liver enzyme results, do you have any issues with CYP450 2D6, 2C9, or 3A4?

 

 

 

 

it looks like I do for 34A, says High activity there, but none of the others.

 

 

When I was pregnant 12 years ago, I came off Paxil 20mg with virtually no issues, I had only been on it for 2 years at that time....

and even 5 years ago with my too fast taper, the withdrawal effects were not near this awful, this adverse reaction made everything so so so much worse . 

That is exactly why I am so afraid to cross taper, but if I get that desperate I will. 

 

Thanks for for your advice Alto. 

[Vonnegutjunky]

17 minutes ago, Altostrata said:

 

 

 

Also, could you put your taper schedule into a Google doc with a link in your signature, so I don't have to keep downloading the pdf?

 

 

Yes maam 😊

[Vonnegutjunky]

Alto, 

 

i looked at the drug bank site and CYP219, the enzyme that I ultra metabolize with, 

there are other drugs on there that primarily use 219 to activate, I’ve taken some of those drugs many many times with no issues. 

 

Can I conclude that my 219 cytochromes are not really affecting anything ? 

 

 

[Altostrata]

3 hours ago, Vonnegutjunky said:

Alto, 

 

i looked at the drug bank site and CYP219, the enzyme that I ultra metabolize with, 

there are other drugs on there that primarily use 219 to activate, I’ve taken some of those drugs many many times with no issues. 

 

Can I conclude that my 219 cytochromes are not really affecting anything ? 

 

 

 

CYP2C19 has not been crucial to anything you've taken before. If you are a fast metabolizer, it would be speeding the drug out of your body.

[Vonnegutjunky]

56 minutes ago, Altostrata said:

 

CYP2C19 has not been crucial to anything you've taken before. If you are a fast metabolizer, it would be speeding the drug out of your body.

 

 

Thank you. 

 

I’ve taken substrates inhibitors and inducers of 219 and they worked fine (proton pump inhibitors, steroids, Benadryl) never had any issue in these not working right. 

 

You have helped quell some of my fears in doing a cross taper to Prozac. 

 

 

So so my question, what in your opinion causes such an intense adverse reaction to a previously well tolerated medication? 

 

I don’t see it often but a few of us here have experienced this and it’s mind boggling to me. 

[Altostrata]

17 minutes ago, Vonnegutjunky said:

So so my question, what in your opinion causes such an intense adverse reaction to a previously well tolerated medication? 

 

What reaction and medication do you mean?

[Vonnegutjunky]

3 minutes ago, Altostrata said:

 

What reaction and medication do you mean?

 

Paxil, or ssris in general. 

 

Akathisia, paradoxical reactions, when I started my Paxil I felt great on it, it was only after trying to reduce it that reinstatement went bad. 

This doesn’t happen with other medications does it ? 

Why does it happen with antidepressants? And it doesn’t happen to everyone, many times people can go back and stablize rather quickly. 

[Vonnegutjunky]

I have gotten much better since my little updose a few weeks ago. My obsessive intrusive thoughts are now less debilitating. However I now have a symptom that is so strange and bizarre, I cannot explain what it is and I’ve searched looking for something similar on here and I still cannot find anything even close to what I’m experiencing. 

 

I hope its it’s benign and related to wd and will go away and not get worse. 

 

Sometimes if if my phone is sitting to the left of me it bothers me....it causes severe internal discomfort and anxiety, in ways I cannot explain. It is bizarre to the max, the only thing I can possibly equate it to is some sort of ocd or autistic feeling. 

 

Additionally, when I watch tv, certain movements, like from the actors, make me feel extremely anxious and panicked, and I cannot concentrate or distract. It is bizarre beyond anything I can really explain. 

 

Also just now I said something to my husband and the movement of my head and switching between doing things, like typing then stopping to say something to him, causes severe anxiety and strange feelings. 

 

And sometimes my iPad looks like it is concaved, not flat, like it’s wavy. 

 

I also have reslly bad electrical shock sensations thoughtout my whole body. 

 

I just want want to put this here in hopes that someone else understands even a little becuse i feel like I have brain damage or withdrawal is triggering something to cause me to become autistic, and I know that sounds insane, but I feel insane.

 

in all honestly I am better than when I was in the throws of my adverse reaction, many of those symptoms have gone, but I do still have left over stuff from the akathisia, unfortunately  now, I am getting new weird stuff. 

 

New stuff is always scary. Becuse you wonder, is this my life now? A melange of never ending symptoms that keep coming? 

 

 

 

 

 

[ChessieCat]

You could post in this topic:  aspergers-autism-like-symptoms

 

Edited March 20, 2019 by ChessieCat
changed link after merging 2 similar topics

[ChessieCat]

And you might find this interesting:  “pseudo-autism”-as-a-result-of-psych-drug-injury-another-consideration-in-protracted-withdrawal-syndrome-from-psych-meds

 

[Dejavu]

@Vonnegutjunky, I have a couple of these. The other day, hubby had a hockey game on and I just happened to walk into the room. I was suddenly triggered into a wave of anxious dread by that game - I have no idea why. I have no "hockey issues" at all. I still suffer this from time to time.

 

I also have the "things just don't look right" symptom at times. A couple of days ago, it looked like my refrigerator was leaning to one side. Another time, a blank wall looked like it was "bulging out" in one spot. It also looked odd to me that the wall was blank, even though there's never been anything on that wall ever. I haven't had this in the last few months.

 

I haven't had the phone thing, but I have heard of a syndrome (non withdrawal related) where people report a sensation of feeling their phone vibrate in their hand or pocket when the phone is actually not there. Perhaps your symptom is related? 

 

There is seemingly no end to the randomness and oddness of the symptoms we get. For me, it seems to get weirder all the time. For instance, I get my full bladder sensation contemporaneously with a burning tongue. Every time - never one without the other. How strange is that?

 

I'm betting your new symptoms will settle as you get used to the updose. Hang in! As you've reminded me - it gets better!

[Vonnegutjunky]

5 hours ago, ChessieCat said:

You could post in this topic:  aspergers-autism-like-symptoms

 

Thank you so much chessie! Didn’t realize we had a thread like that!