Jlynn: Paxil withdrawal panic attacks

[Jlynn]

Hello all,

 

I am new here and so glad I found this site in my research. I have been on Paxil 20 mg since college about 18 years ago when I was seeing the school psych for mild depression due to college and my young marriage breaking up. Sometimes I am so mad at the Dr. who put me on this stuff I just want to scream. I have spent many years with many different doctors trying their recommendations for getting off Paxil. They have included everything from cold turkey, to large drops, to alternating dosages on different days. All Epic Fails! I finally have a family physician who not only understands but has had to wean off an anti-depressant before herself. 

 

Now I have been using the liquid form for about three to four months and it was going very well. I have been dropping 2 mg from 20 mg about every two weeks. The first week I have some symptoms like head fog, dizzy, anger,etc. Then it seems to level out and the second week I feel great. I thought after many failed attempts of weaning off I was actually getting somewhere. Currently I am down to half of my original dose to 10 mg for the last two weeks and this weekend, BAM out of no where, I had my first ever panic attack. The last couple of days have been so out of whack with panic and fear and I really don't know what to do or why this is happening now after doing so well. Reading posts here I realize maybe I was going to fast, but I was having success and now I am ready to go back up because I am so scared.  Any advice or experiences would be welcome! I just don't know what to do.

 

[Fresh]

Hi  JLynn , welcome to the site.

 

What you describe is not unusual after tapering too fast   You think you're doing okay , then BAM.  My big bam came six months after I stopped , and everyone is different.

The reason this site recommends tapering by no more than 10% , then sitting at each level for 4-6 weeks , is to give your system time to adjust to each dose.

 

You may find that updosing , maybe to your last dose (12mg) will allow you to stabilize , before decreasing any further.  

 

Try reading threads "What is Withdrawal"  in Symptoms and Self Care , and "Why Taper By 10% of My Dose"  in Tapering.

 

Good to have you on board ,  Fresh

[mammaP]

Hi Jlynn, welcome to SA. Sadly as you've discovered you were tapering too fast for your brain. Your doctor is more understanding than most and was lucky that she managed to taper her AD so quickly and be ok. Some people do manage fine but others end up with withdrawal. This is why we recommend 10% of the current dose with at least 4 weeks between cuts to allow the brain and nervous system to catch up. It is good that you have the liquid to taper, it is much easier to get correct doses.

 

There is no need to go right back to the start, but as you started to feel withdrawal at 16 mg I might go back to 14, that may be all that is needed to settle the symptoms, then  hold until you have stabilised and stay there until you have been stable few weeks before making any more cuts. 

 

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

 

The 3 KIS. http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

[Rhiannon]

Hi Jlynn--

 

I agree with the above advice--you don't need to go all the way back up to 20 mg, a smaller reinstatement would work just as well. I think you also have the option, if you can stand it, of staying right where you are. Your symptoms should settle down within a few weeks.

 

The important thing is going to be to go slower as you go forward from here. You're down to a low enough dose that you can't just cut the same amount every time. It's not linear. You can see from these charts here that it's a curve: http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

and as your dosage gets lower your cuts need to get smaller. That is why we say to base your next cut not on your starting dose but on your current dose. If you make each cut a percentage of your current dose you will be able to replicate the curve better.

 

However, the most important expert is your own body, so to taper successfully you'll need to listen to your body and adjust your cuts and holds according to your symptoms, not according to a calendar.

 

Paxil is one of the hardest ADs to get off, but we've seen many people get off it successfully by doing a slow enough taper. You've been on it for quite a long while and your brain has changed itself, its chemistry and even aspects of its structure, to adapt to the chemistry that the drug creates, like a plant shapes itself around a trellis. You can't yank that trellis out and expect the plant to be okay, and it's the same with your brain. You have to remove a bit of the drug and allow your brain to regrow itself and find a new homeostasis with the new chemistry, then once it's stable you take a little more and it adjusts itself again, etc.

 

That's why it's important to pay attention to your symptoms. Those are your brain telling you it's not in homeostasis and needs some time to rebuild.

 

I'm glad you found us. You're in the perfect position right now to slow your taper down and actually get off this stuff for good this time. It will take a long time but it will be completely worth it. After 18 years, you've got to grow a new brain, and that's just not a fast process. Take it slow and you'll do fine.

[Altostrata]

Welcome, Jlynn.

 

Have you been tapering at a consistent 2mg reduction? Therein may lie the problem. To keep the taper gradual, you need to calculate 10% decreases on the last dosage, not the original dosage. The amount of the decrease keeps getting smaller and smaller.

 

For example, now that you're at 10mg, your next drop would be 1mg and your new dosage 9mg. The next decrease would be 0.9mg and next dosage 8.1mg. And so forth.

 

You might hold for a while at 10mg to let your nervous system settle down. If it doesn't seem like the withdrawal symptoms are going away, you might want to updose slightly, to 11mg, for example, and hold for a while there.

[Jlynn]

Thank you all so much! I don't know what I would have done if I had not found this site!

 

I spoke to my Doctor today as well and she also agrees with the information you all gave that I need to slow down my taper and liked the 10% idea. We agreed I am going to stay on the 10 mg for now and not set a date to go any lower until I am feeling better and confident my symptoms are subsiding. I do feel better today than yesterday so here is to small miracles for this moment! 

[Songbird]

You are very fortunate to have an understanding doctor!  Remember, 10% is the maximum recommended drop, it is okay to do smaller drops, e.g. 5% if you find 10% difficult.  It is also good to hold at a dose long enough to get stable before beginning another drop, listening to your body rather than sticking to a schedule.

[Altostrata]

If you feel you can recommend your doctor for tapering, please add her contact information here Recommended doctors, therapists, or clinics

[Jlynn]

Update: 

 

I am hoping someone can help me with what I am going through right now. My initial taper was going very well ( too well in fact) I got down to 10 mg and had a little bit of increased symptoms so instead of lowering at two weeks I decided to wait another week or so and see how I felt. I am telling this story in hopes someone might know what is going on with me. At the middle of week three on 10 mg I went to take my liquid paxil and coughed while giving it to myself and choked on it. Inhaled it, Coughed it up and had the typical post choking cough, runny nose, etc. It was within 30 min of that incident that I started the panic attacks that would lead to the non functioning anxiety and panic I am having. I have been dealing with this for a while now. I am having horrible thoughts which trigger the panic i.e. my dog getting sick, having to deal with sick parents in the future, any person suffering or abuse, sends me into a total tail spin. I waited a couple of days and thought maybe with the choking and burning lungs I just needed to heal. Couldn't function. Went back to 12 mg and didn't really have noticeable relief. Stayed there for 4 days because I read on here it can take that long to stabilize on a dose. Couldn't take it any more and went back to the last dose I knew I felt manageable at 14 mg. Been on that for 1 dose and I do have noticeable relief from some symptoms. Don't feel so panicked but still anxious. I am super dizzy and feel very disconnected and my stomach has stopped functioning over the last few days. I am not hungry and I have to make myself eat a little something. I constantly feel like I need to have diarrhea but there is nothing there (TMI, sorry!). While I am happy to no longer feel so panicked I just don't know what to do! There have been a couple of times I have wanted to say F@$% it and go back to 20 mg and just stay on it forever. I have always talked myself out of that but I am really struggling. 

[DLB]

You got to do what you can to be comfortable, i went higher for a couple of weeks and felt a little better and then went back down and i an kinda suffering. 10 mg. Is where i started from and I i have used a scale the whole way down and now im at a dose that is the size of a "." And i feel these micro drops. All i can say is go slow. I thought 1 year from 10 mg. Would be enough but am finding that was a dream..

[Altostrata]

Jlynn, I moved your post here. Please keep those questions particular to your situation in your Intro topic, as it forms a narrative of your progress.

 

As DLB said, you've got to take care of yourself. It's too bad you had that accident taking the liquid. At least you're feeling better now. After you stabilize, if I were you, I'd taper more gradually, don't push it, play it safe from now on.

[Addax]

Hi Jlynn. I totally get where you're at with wanting to say "f@$% it!"

 

From what I can tell through reading and posts here, now that you're at a low dose, if you decide to keep tapering, you'll want to make your cuts much, much, smaller. 12 to 10 mg is a substantial decrease (and beyond the 10% recommended by this site), which is probably why you were sensitive to the drop and felt the symptoms so intensly. At the lower doses there is a greater drop in the plasma level of the drug, and I'm guessing that with less drug to metabolize, it may be being metabolized more quickly... That's just a guess though.

 

Here are some charts that do a good job of illustrating what I'm trying to say: http://www.mediafire.com/view/f3h1ao5ijfj93/papers#0yp2c8pbjrziaab

 

Once you stabilize, if you want to continue tapering, make much smaller cuts, (I.e. 5% rather than 10%). I learned a similar lesson and now that I'm back down to 20 mg fluoxetine I will be holding for longer, and my cuts will get progressively smaller.

[Fresh]

Hi JLynn ,   "noticeable relief from some symptoms"   sounds promising.   I think you're on the right track.  

 

Hopefully some of those other symptoms will settle in the next few days too.

[Jlynn]

Thank you guys for being there for me!

 

Would anyone recommend going back to the original 20 mg dose and eliminating the symptoms and starting over or should I suffer through what I have now and wait? I wonder how long the symptoms will last now that I have gone back up. 

[Altostrata]

You will need to give 14mg at least 4 days to reach steady-state in your system. Then you should allow some days after that to see how it feels. You may find it's too strong.

[Songbird]

I would stay put at the 14mg for at least three weeks, preferably longer.  SSRIs are strange drugs in that you don't get their full effect straight away, it can take several weeks for them to really take effect, so changing dose from day to day doesn't work.  There is also no guarantee that updosing to 20mg would work any better than the updose to 14mg.  You need to be patient and give this dose a good chance to work, which means riding out the symptoms for a while to see if you get any improvement over the next few weeks.

[clarabella79]

Hi Jlynn,

 

How are you feeling today? It looks like we have a similar drug history (started taking Paroxetine in '97 at quite a young age). I empathise with how you're feeling and hope you gradually start to feel better on 14mg so that you can recommence tapering. I'm currently taking 10mg (original dose 20mg), which I've been on for almost 4 weeks. My taper down from 20mg was a bit slower than yours (lots of 0.5mg cuts), but faster than this site recommends so I've suffered a few mild withdrawal effects. Fortunately, they've not been as bad as you've had to endure. Fingers crossed you start to notice more relief from symptoms over the next few days   

[Rhiannon]

I also would recommend not going up to 20 mg. At this point what's causing your symptoms is not so much a deficiency in the drug that would somehow be fixed by having more of it, but the actual biochemical chaos in your brain caused by going down too fast in the past, which is not something you can go back and do over. (Unless you have a Tardis, I guess.) There's no quick fix for that; adding in some amount of drug or other is not going to fix it and is actually more likely to disrupt whatever healing and adapting your brain has managed to do so far.

 

Your brain has changed itself during the years you were on the drug. It has tried to remodel itself and adapt to the way the drug changed its natural chemistry. It has reshaped itself around the drug, the way a plant reshapes itself around a trellis that it's trained on. Now you are taking away the trellis. You yanked half the trellis out pretty fast and the plant has not been able to regrow its natural structure fast enough to keep up with that. Shoving more trellis back in won't help nearly as much as gently supporting the plant, protecting it from strong winds, tying up bits of it gently, and then feeding and nourishing it and allowing it to heal and grow with its own wisdom.

 

It's an imperfect analogy, but the brain is a complex living thing and like a plant it also has the ability to very slowly and gradually heal and rebalance itself. However, this is not a fast process, and it's not as regular and predictable as other kinds of healing, because we haven't had the benefit of millions of years of evolution to develop mechanisms for healing what these drugs do to our brains. So it's a bumpy and imperfect process.

 

It's typical at this point for this to be a very roller coaster process. Some days will be better and some will be worse, and there's not much you can do to control that. What helps most is being gentle to your nervous system. Avoid stress, keep a regular schedule, get gentle slow exercise, eat well.  http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

 

What seems to work best for people in your situation is to pick a dose and just stick with it rather than changing things around a lot, because every time you change your dose, your brain has to try to re-adapt to a new condition. We find that a small reinstatement (like the 14 mg) can help, but nothing is going to "fix" things now except time and gentle healing support.

 

Hang in there. You will be feeling much better in a couple of months and then you can take a look at doing a slow, controlled taper that works for you. 

[Rhiannon]

http://survivingantidepressants.org/index.php?/topic/6447-best-of-sa/?p=91582

[Jlynn]

I am still feeling pretty cruddy. Stomach has pretty much stopped working. I feel very disconnected and my emotions feel strange. I can't laugh at something funny or hold a conversation cause I feel trapped in my own brain. Very dizzy also. I have not been able to go to work for the last two days and I am really scared right now. I wanted to call my doctor several times but keep talking myself out of it because she won't really be able to do anything for me. Just hoping the meds catch my brain up soon.

[Fresh]

Hi JLynn , it looks like you had your first dose of 14mg on the 30th , so give it till at least till the 4th before changing anything.

You most likely missed the dose you choked on , and that affected you very badly.

 

I agree with those who suggest that going back up to 20mg is quite risky , and may not have the desired result.  

Your system is very sensitive now , and you may get an adverse reaction (horrible side effects)  from going up too much.

 

Sit tight , it's only 3 more days.

[Jlynn]

Update:

Doctor had be go up to 15 mg and hold there. She and I discussed after this severe withdrawal issue I am not willing to go down for a while and with the 15 mg she can prescribe the tablets because the liquid is so expensive. I am still having anxiety with total body internal shaking, head fog and confusion. Can't really focus long enough to have a conversation. Emotions are shut down. Can't laugh at anything without forcing the laugh and anything sad makes my anxiety worse. Been taking the fish oil and the magnesium but stopped all other supplements. On day 3 or 4 ( can't focus enough to remember) of the elevated dose 14/15 mg. Doctor did prescribe me Atavin to take at bed time to ease the anxiety and insomnia but to be honest I am scared to take it. Anyone have any advice on that? Other big problem is my stomach is still shut down. I can get Ensure, soup, and some soft foods down it but it is awful.  I am trying to stay strong as my doctor and the pharmacist told me the symptoms should subside in a week or so. 

[Songbird]

You could try relaxation exercises for the anxiety and insomnia, also some people find sleep CDs helpful for insomnia.  I would only take the Ativan if absolutely necessary, using the smallest effective dose and reducing it as soon as sleep improves.  (See http://survivingantidepressants.org/index.php?/topic/7862-reasonable-use-of-z-drugs-for-sleep/  although Ativan is really for anxiety, it is not really a sleep drug as such).  A small dose of melatonin might be worth a try, some people find it helpful, others don't.

 

You could try ginger for the stomach issues.  At this point I wouldn't worry too much about your diet, just eat whatever you are able to.  If that means just soup for a while, that's okay, it's only temporary.  I've got through several bad patches of having to eat whatever I was able to rather than a normal healthy diet.  I could only eat things that were bland and easy to swallow, e.g. spaghetti, baked beans, eggs, bananas, etc.  Other people mentioned eating things like toast and crackers, but I couldn't really face anything dry like that, so it is very individual, just go with what works for you.  You could also try eating small amounts more often rather than normal-sized meals.

[Jlynn]

I feel like I am starting to stabilize a bit from my traumatic withdrawal. After 8 days back on the 20 mg of Paroxitine today was a better day. I hope I am on the mend. Saw my doctor today and she really wants to switch me to Prozac to get me off the meds. She talked to a pharmacist who recommended just switching the drugs out. I have scoured the Prozac bridge form on this site but I am still terrified. She is a former co worker of Dr Mark Foster and she likes his recommendation for the bridging.

I am so scared I don't know what to do or if I did how to do it. There is so much information and different strategies out there. I need to stabilize first I know that. Dr said after my failed attempts and how much withdrawal I experience she thinks getting off by tapering is not a good option for me but the bridge to Prozac and then taper is.

[Altostrata]

If I were you, I would not rock the boat with any drug changes for quite a while.

[Songbird]

Glad to hear you are getting some improvement already.  I have seen the Prozac switch work okay for a few people, but in most cases I've seen it has not worked well.  Prozac is quite different from paroxetine, many people find it very stimulating, which can produce a lot of anxiety.  Many people find switching SSRIs very difficult as these meds do not always cover for each other, so you can still end up with quite bad withdrawal from one med even though you are taking another med.  Even after a successful switch, a slow taper will still be needed.  There is a belief that Prozac is easier to taper because of its long half-life, but it can be just as difficult to get off, the longer half-life can make withdrawal symptoms take longer to appear so you get hit with withdrawal later.  I think you just tapered the paroxetine too quickly, and if you try again with a slower taper you are much more likely to be successful.  Of course the decision is yours, but I think it would be a big gamble, and you'd be better sticking with the devil you know and taking it more slowly.

[Jlynn]

Thanks! I am not planning on doing anything for several months but take the 20 mg. Yesterday was a good day, today not so much. I am hoping I stabilize soon and these symptoms subside.

 

This has made me even more determined to get off this medication in the future even if it takes me years to do it! 

[clarabella79]

Hi Jlynn, I think it sounds like you've done the right thing going back to 20mg and stabilising before thinking about tapering or switching. I was considering the "Prozac Switch" too when I got to a lower dose of Paroxetine but I've decided against it now. Part of the reason was lack of availability of 10mg pills that can be cut in half with a pill cutter (I'm in the UK and our health service - the NHS - only prescribe the gelatine capsules, which my GP says cannot be split) but I was also concerned about how stimulating it might be compared with Paroxetine, which is a bit sedative and therefore might partly explain why we get so anxious when we taper too quickly/cold turkey from it. I'm inclined to agree with Alto and Songbird: keeping it simple with the one drug (which, after all, is a known quantity) in your system and a very, very gradual reduction might be the best way to go. 

 

Hope you get back to more of an even keel soon. Take care for now  

[Jlynn]

I agree with what everyone said about better the devil you know. I am not going to switch. Just stabilize for a few months maybe and then restart on a slow taper. 

[Jlynn]

I am at day 20 or so back on my original dose of 20 mg Paroxitine. I am still having some pretty bad side effects. My doctor talked to Dr. Styrut who is recommended on this site, a pharmacist, and a psychologist and they all recommend switching me to Prozac right away. They all think the Paxil has popped out and I need to switch sooner rather than later. I am scared just because of all the unknown.

[Altostrata]

Very few doctors understand withdrawal syndrome. With your recent history, it's unlikely you are experiencing "poop out."

 

It can take a while for the nervous system to stabilize after a bout of severe withdrawal syndrome. Switching to Prozac adds an additional risk, see The Prozac switch or "bridging" with Prozac

 

What is your daily symptom pattern like now?

[Jlynn]

Thanks Alto,

 

I am still having dizziness, confusion, shaking, insomnia, loss of appetite, and digestive upset. My doctor is recommending 10 mg of Prozac with my 20mg Paroxitine and then weaning the Paroxitine. I of course am just terrified of my own shadow right now lol. Very scary stuff. I did look a lot at the bridge forum you sent earlier today and there is a lot of information there. 

 

 My doctor got an email today from Dr. Mark Foster whom she went to medical school with. He now works in Emergency Medicine not private practice here in Colorado so I am not able to see him but she is consulting with him. She gave him my background and her plan and he also recommended the Prozac switch and doesn't think I am going to be able to taper the Paroxitine slow enough to avoid major withdrawals. His email to my doctor was:

 

This is  a good plan. I generally would recommend to wait at least 4-8 weeks on the Prozac before starting the paxil taper, and maybe slow down the taper to 2 mg every 4 weeks initially. Once you see how she's affected, you can speed it up, but not to exceed 2mg every 2 weeks. Once you get her off the paxil (this will probably be in 6 months or so), I would wean off the prozac over 1-2 months. Equally important: she needs to be eating healthy, exercising regularly, working with a counselor, try yoga and meditation. 

Make sure she has a good social support system in place. As far as side effects, she may initially see some more volatile mood swings, perhaps a little more difficulty sleeping. Keep a close eye on her mood

 

If  she is willing to drive, may I recommend this clinic?  www.wholeness.com

 

It is a one-of-a-kind clinic to offer Integrative Psychiatry, and it's located in Ft. Collins.  Dr. Shannon is a friend and a world renowned psychiatrist. He works primarily with children and adolescents, but his partners share his philosophy and see adults. It would be well worth it to her to make a trip to see them for an whole person approach to coming off meds and engaging in a med free (or med-lite) lifestyle.

 

Sincerely, Mark 

[Altostrata]

It might work, it might not. It's up to you.

 

The taper Dr. Foster is recommending is faster than the one we suggest here.

[Songbird]

What they are saying sounds logical if the Prozac would cover the Paxil.  Unfortunately, many people find that it doesn't, so they end up dealing with Paxil withdrawal and Prozac start-up effects at the same time. 

 

It is possible the Paxil has pooped out, and I have seen many people in poop-out try switching to this, that and the other thing, often unsuccessfully.  Often, once the body has reached poop-out stage from one med, the other meds are not very effective either, as neurotransmitter systems are so out of whack by then.  That is not to say that it does not work for anyone.

 

When they say they don't think you could taper the Paxil slowly enough, it's because their idea of a slow taper is 2mg drops every 4 weeks.  Many doctors have no inkling about very slow tapers using liquid, scales or compounding to do tiny dose drops.

 

If you've already had some improvement since reinstating the 20mg, it is possible you may get some more improvement with more time.  It can take some time to stabilise again after a reinstatement or updose.

 

Anyway, the decision whether to switch or not is yours.  Whatever you decide, we're here for you.

[Jonesy3]

Hello - I just wanted to give you some helpful advice if I can! But, please, in no way take only my advice. If your gut is telling you something then go with it! I am 28 and have been on Paxil since I was 13 years old. I went of cold turkey when I got pregnant with my daughter at 24. HELL! Because Prozac was considered safer, they switched me to that while I was pregnant. It did nothing to help my panic. I truly feel that you are still feeling the effects of your too fast taper. I was off meds for three years after the cold turkey quit, and now I have been back on for three years. My body has still not completely healed from the cold turkey. Don't mess with your poor brain anymore right now. I know how hard it is to wait. But I don't think its poop out and I don't think the Prozac is the magic pill. Just my advice from someone who has lived this! Praying for you!

[Jlynn]

So after spending the weekend in contemplation, prayer, talking to people who support me,  reading everything I could from this site, and researching everything I could find, I have decided I am not going to switch to the Prozac. If my doctor can't get on board I will find another one. I am willing to stabilize on the 20 mg and attempt the recommended 10% taper from this site. I am not willing to chance my physical and mental state to something that might make everything worse. I am starting now after 20 days to get relief from my symptoms. I still have headaches, dizziness/brain fog, and no appetite/ slow digestion, but everything else is easing up.  

 

I have realized there is no quick fix and I would rather deal with the drug I am on now than risk my brain to two drugs and two withdrawals right now.   

 

End of rant