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Hazel

Hazel: struggling with Paxil to Prozac bridge

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Hazel

Hi all,

 

I have been struggling off and on over the last 14 years with what I thought was anxiety the whole time, but am now realizing it was more likely withdrawal from stopping antidepressants too quickly. The first SSRI I was put on was Paxil. I tapered off after 7 months because I never really liked the idea of being on an antidepressant. I started having anxiety a few months later and was switched to 50 mg of Zoloft. I tried multiple times over the next 13 or so years to stop Zoloft, but the anxiety always returned, so back on I would go.

 

In the fall of 2015 I had a return of anxiety after reducing the Zoloft to 25mg and tried to go back to 50, but it wasn't helping, so ended up going to 150mg before I felt relief. I again tried tapering last summer and got down to 25mg and experienced increased anxiety as well as insomnia. My doctor switched me to Lexapro last October, but it only made me more anxious, so after 10 weeks he switched me to Paxil. I got up to 20mg of Paxil for 3 weeks and wasn't feeling any better, so finally decided I had enough and wanted off the antidepressants.

 

I started tapering at the end of January down to 15mg for 2 weeks, then 10 for 2 weeks, then to 7.5, and after about a week and a half at 7.5 started feeling really anxious again. I found this site and decided to go back up to 10mg of Paxil and stabilized for about 2 weeks and then started tapering 10%.

 

Was doing pretty well for a couple of weeks at 9mg and then started feeling a little anxiety creep in. I talked to my doctor about switching to Prozac to make the tapering hopefully easier, so a week ago this Friday I started taking 4.5 mg each of Paxil and Prozac. I have experienced some ups and downs with anxiety since then, and am having a particularly difficult time right now. Feeling quite anxious and can't sleep.

 

I took .5mg lorazepam tablet and am feeling a bit better, but not sure what to do now. I was going to switch to just 9mg of the Prozac and eliminate the Paxil tomorrow, but not sure if I should continue with the half and half mixture I have been doing or maybe even just go back to the Paxil alone?

 

This just sucks so bad. I know I have probably screwed up my system so much with all of these changes and can only pray the damage is reversible. I was feeling pretty good earlier today, but then started feeling terrible as the evening went on. Haven't felt this bad in a while. Any suggestions would be greatly appreciated.

Edited by Petunia
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nz11

Hi Hazel

Its been 24 hours and no one has welcomed you or commented yet and your post is about to go to page two. So lets bump this back to page 1 shall we.

 

After reading this i feel like i have read everybody's story including my own.

i can relate to so much you have written.                                                 

I am so sorry you have been put through this pharma assault by doctors and i think you are right on the money when you say,

"I have been struggling off and on over the last 14 years with what I thought was anxiety the whole time, but am now realizing it was more likely withdrawal from stopping antidepressants too quickly. "

and also

"This just sucks so bad." You can sure say that again.

 

With all the drug switches your cns has been subjected to and now weakened to a degree you may well be  entering some risky (bridging) waters thats for sure.

The thing is it appears you have never given slow tapering a go.

 

In the penultimate paragraph in your post it infers to me that this bridge is all up to how  YOU decide to pull it off, i see no doctor plan mentioned does the doc take a whatever attitude to this?

 

You have noted the possible options (maybe there are others i dont know) at this stage.

1. Complete the bridge to prozac by removing the existing drug

2. continue a bit longer on the half and half, or

3. back out of it completely and go back to paxil.

 

I wish you every success with your or your doctors bridging plan or whatever plan.

 

nz11

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nz11

Welcome to sa.

Forgot to welcome you.

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PoetJester

Hey Hazel,

 

hello from MN. I was on Zoloft for about the same amount of time (14 years)as you and tried to get off it many times as well only to develop nausea and insomnia by the 2nd or 3rd day not taking it (I was also on Zyprexa). I quit both drugs in 2014. the insomnia and resulting fatigue and cognitive problems have been pretty awful since then even though I felt clearer in the head originally getting off the meds. a lot of people have a terrible time with poor sleep and insomnia after lowering doses or quitting anti depressants altogether. I don't think your brain is necessarily permenantly screwed up although it does often seem that way (a lot of us have horrible problems with short term memory and remembering names and words in wd), I think it's probably just a case of not getting good sleep anymore because of the drugs.

 

Poetjester

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Petunia

Welcome Hazel,

I'm sorry you didn't receive a reply right away. Thank you nz11 for saving this thread from dropping off the page, and for your helpful comments.

 

I agree the reason you're probably struggling with increased symptoms at the moment is because of too fast tapering, followed by all the recent changes. The nervous system does best in an environment of stability, with drug changes made slowly, especially if there is already some sensitization caused by previous withdrawal issues.

 

When you started tapering in January, you were making reductions too fast, this would have been a shock for your nervous system. Going back up in dose was a good idea, but you probably needed longer than 2 weeks to stabilize before starting to taper again. Switching to prozac shortly after would have caused more disruption. We generally recommend tapering off the original drug, rather than switching, unless there are reasons which make this impossible. There is no guarantee Prozac will stop Paxil withdrawal, and it comes with side effects of its own. It tends to be a very activating drug and this effect can be magnified in a sensitized nervous system, its no wonder you have increased anxiety and problems sleeping.

 

If I were you, I would go back to 10mg of paxil and hold your dose there until you stabilize. This may take several weeks to months. Then I would begin a slow taper off the paxil. When you think you are ready, maybe start with just a 5% cut to minimize the risk of symptoms arising.

 

I will list some links with information relevant to you. Take your time reading through them and come back here to your thread if you have questions.

 

Why taper by 10% of my dosage?

About reinstating and stabilizing to stop withdrawal symptoms

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

The Windows and Waves Pattern of Stabilization

Tips for tapering off Paxil (paroxetine)

 

There are a few other things I would like to suggest. 

 

You probably know this already, but be careful with lorazepam, as with all benzos, you can develop a physiological dependence on it, in as little as 2 weeks with regular use, less if you have a sensitized nervous system. Rebound withdrawal and paradoxical reactions are more likely also. You may be safe to take it once or twice a week. If you become dependent, this will also need to be tapered.

 

B group vitamins can be activating, you might want to stop them while in withdrawal. Its not recommended to take 5htp while using an SSRI. Aside from a high quality fish oil and magnesium, its best to avoid supplements when trying to stabilize, many of them can increase symptoms.

 

Here is the link to our symptoms and self care section, you may find some useful ideas to help manage symptoms as you stabilize. Especially read the topics pinned at the top.

 

You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again.

 

Please stay in touch and let us know what you decide, we will be here to support you.

 

Petunia.

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Hazel

Thanks so much for replying. I didn't have a good title, so thanks to whoever fixed that:) My doctor-who is a psychiatrist, doesn't seem to have a clue about how to taper slowly. He said after a month I can stop the Prozac since it is self-tapering. I obviously will not do that.

 

I decided yesterday to stop the Paxil and took 9mg of Prozac. Still felt anxious early on in the day, but actually started feeling better as the day went on and slept good last night. I woke up with anxiety this morning, but that is typical. I am starting to feel better as the morning goes on. I am thinking I will stay on the Prozac for at least a week and see how I feel. I am hoping the worst from making the switch is over, but if things get bad, I will likely go back to Paxil.

 

I know I've gone too quickly in this tapering process. As I was writing my intro that became painfully obvious. I hope to stabilize on the Prozac and then hold for at least a month before making any adjustments.

 

I am just so happy to have found this site. It is so amazing to have support and feedback from people who understand what this is like. The information is life-changing a well. I would have never known that all of the struggling with trying to get off SSRI's was withdrawal and not a return of anxiety. My doctor certainly never told me this. It's just so sad that so many people are suffering unnecessarily.

Thanks again!

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SkyBlue

Your doctor told you Prozac is self-tapering? Oh my dear Lord. 

 

I have a similar story/history so I'll follow this thread -- feel free to ask me any questions.

 

It is very likely that the damage can be healed. 

 

I like Petunia's idea of holding for now--it's a really good idea. These drugs are really powerful(in contrast to what most doctors tell us).

 

Welcome.

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Hazel

Having another bad night. I was feeling good during the day, but increased anxiety as night went on, and now can't sleep. Thinking I will go back to the 10mg of Paxil and hold for a while, but not sure if I should give Prozac more time? I just don't want to wait too long to reinstate the Paxil. Any thoughts?

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ChessieCat

I agree with Petunia about sticking with Paxil.

 

The big issue with changing drugs is that you can end up with withdrawal symptoms for the previous drug and start up/side effects from the newer drug.  It is then very difficult to work out what is causing what.

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Hazel

Thanks Chessie. I am going to go back to the Paxil today. I really wish I didn't try to switch in the first place. Hopefully I won't have issues going back to Paxil.

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Hazel

I just had another thought, should I go straight to 10 mg of Paxil, or start at like 5 mg and gradually increase over the next few days?

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ChessieCat

Some members have had problems if they start taking too high a dose.  It is better to start low and then only increase gradually if needed.

 

You could try starting with 5mg Paxil and keep daily notes.  It takes about 4 days for a dose change to get to full state in the blood and then a bit longer for it to register in the brain.  We generally suggest staying on a dose for 2 weeks.

 

If you find that after about 1 week you are still getting unbearable withdrawal symptoms you could then updose.  Sometimes increasing by even 1mg may be enough to bring the symptoms to a bearable level.  Depending on the severity you could try going up to 6mg.  I wouldn't take more than 7.5mg and do the same as above.

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Hazel

Thanks for the feedback. I only took 5 mg of the Paxil this morning and have been feeling pretty good today other than some dizziness. I will stay at 5 and see how I feel over the next few days. Praying the worst is over. I really appreciate the advice.

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nz11

Having another bad night. I was feeling good during the day, but increased anxiety as night went on, and now can't sleep. Thinking I will go back to the 10mg of Paxil and hold for a while, but not sure if I should give Prozac more time? I just don't want to wait too long to reinstate the Paxil. Any thoughts?

I assume that at this moment in time you are no longer taking any prozac in other words you have ditched the prozac and are just taking 5 mg paxil ?

If so and if i were you i would consider going immediately back to the 10mg of paxil holding there and stabilizing there for several months.

If we just forget this prozac glitch for a moment and take it out of the equation say  and count all other things equal then essentially you have dropped your paxil by a whopping 50%. I personally (from my own experience and from reading your past experience ) think you will be unable to cope with the wdl  after making such a big cut, the wdl will be delayed and it will carry the weight of what looks like 15 yrs psychotropic drug exposure behind it. You are already now reaching for a benzo this is a slippery slope and if you start taking that for a week or two then that will have to be tapered too. If you are leaning on a benzo to get you over and through  this then you are opening the door to a benzo trap. If i were you i would refrain from taking a benzo.

When you do stabilize i also think you should taper at the 5% rate.

Finally if you hang around on 5 mg and wait for wdl to hit then it may be so rough you may run back to the doctor and are pushed onto a cocktail of much higher doses still.

 

You have asked for thoughts and these are mine.

Whatever you decide to run with i wish you strength and stability for the journey ahead.

nz11

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Hazel

Thanks NZ for the input. I was thinking about this as well. I worry that going down to just 5 of the Paxil will lead to withdrawal once the Prozac is out of my system. I haven't taken a benzo in the last couple of days and will avoid them if at all possible. I think you are right and I should go back up to at least 9mg of the Paxil-where I was before the Prozac mess, and stabalize for a while. I appreciate your input.

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moess87

Hello Hazel

 

I am also new to this forum, but have tried to cut my dosage by 50 % a couple of times in the past. To begin with it feels amazing - like life flowing in to ones body again - but as day become weeks I start feeling more and more insane. As I understand your post you have been on an antidepressant dose equivalent to 50 mg sertraline (Zoloft) most of your life. This roughly means that you've had a reuptake inhibition of 80%. Going down to 25 mg lowers this to 70% and 5 mg of paroxetine (Paxil) gives you approximately 50 % of reuptake inhibition. With this in mind of course there is a big risk, that you soon will start feeling the withdrawal.

 

As I see it, there is no shame in increasing the dosage again, if you now make a good and reasonable taper plan now. 

 

Link for information on reuptake inhibition

http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.161.5.826

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JanCarol

Hey Hazel - 

 

I like Petunia & Chessie's idea of sticking with the Paxil.

 

Don't worry about withdrawals - you've done enough bouncing of your doses to keep your brain going for awhile now.

 

If it were me, I'd start at 5 mg, and increase towards the 10, every 4-7 days.  Do not go over 10.  You may find that you find a "sweet spot" somewhere under what you were on before.

 

However, with all the fast tapers, changes and switches that you've made - it may be hard to "feel" that sweet spot.

 

Please Keep notes on paper

 

I'm sorry you've been put in this situation.  It does get better, though it may take  time,  patience, and self-care.

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Hazel

Thanks for the advice. I do think it would be good to slowly go up in dose on the Paxil. Today has been good except for feeling dizzy. I am fine with going up as long as I can avoid feeling intense withdrawal. I wouldn't think I'd have to go up to more than10 mg, hopefully even 9. Then I'll hold for a while and maybe only taper 5% to start.

I reallly do appreciate all the feedback and am so thankful to have found this site. I'd hate to think where I'd be if I hadn't found it.

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nz11

Hazel any update?

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grandmaD

I wish you success in your journey.  My only advice is take it slow.  I was impatient as I had already wasted 10 years trying to get off it the doctors way and always back to full dose.  The switching I did caused further damage and so when I began tapering I was not stable.  It is important to be stable and feel pretty good before tapering. 

 

Take care of yourself and realise you are not the same person any more and have to treat yourself kindly and that not everyone, including family will understand your problem.

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Hazel

I was doing pretty good when I first stopped the Prozac and went to just the Paxil. Last week started having trouble with sleep, waking at around 2:00 am and then around 5:00 am. Now the last couple of nights I've had trouble falling asleep as well. I even took a lorazepam last night around midnight to finally get some sleep. I don't know if this is to be expected yet from trying to make the switch to Prozac and then going back to Paxil? It's been about 2 and a half weeks now since I've been at 9mg of Paxil. Should I give it more time? Reduce? Go up to 10? I don't have a lot of patience with this either, so it's hard to just wait and see how I'll feel. Right now I would just love to be able to get a decent nights sleep. Fortunately, I feel pretty good during the day thus far. Any input would be greatly appreciated.

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grandmaD

I think most of us felt pretty good when we first stop Paxil, that is the nasty aspect of it.  You get false security and hope.  It sneaks up on you after about 3-6 months and suddenly, you are hit with w/d and thats when most of us panic and go back on a full dose, etc.

 

What is lorazepam?   A sleeping pill? 

 

Did you say you went back to 9mg about 2 weeks ago?  You did a way too fast drop from Jan to March, so your w/d symptoms are likely from that.  All you can do is wait it out until you stabilise at 9mg but you can expect some discomfit until then.

 

All the best!

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nz11

Thanks for the update.

 

If i were you i would not take lorazepam (a benzo) for a sleep aid. If you take this for 1-2 weeks then it will also need tapering and get this, the withdrawal effects can include 'severe insomnia'.

"The aftermath of benzo withdrawal can be very protracted with many symptoms persisting for months and years" (Breggin). Sounds much like ssri wdl really. 

Did the doctor prescribe that with the prozac ? Have you taken it before? I cant see it in your drug sig.

 

If sleep is the only issue at the moment then count yourself lucky.

Many of us including myself struggle with not sleeping with any regularity.

Do you think you can do this without adding more drugs?

 

I also like grandma think this is a time to hunker down and sit tight, it could take a while to settle ...think in months.

 

 I don't have a lot of patience

Well wdl from these drugs is very good at teaching patience.

We are all learning patience in this process.

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Hazel

I was prescribed the lorazepam when I was trying to adjust to the Lexapro and having a lot of anxiety. I only take it very infrequently. The last time I took a tablet before the other night was a couple of weeks ago when struggling with the switch to Prozac. I am very careful to not take it regularly and never have. I will definitely try to not take any drugs if I can help it. I prefer to use more natural ways of healing anyhow. I will wait it out and hope to feel better in time. I slept better last night, so that was good????

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Hazel

Hi all,

it has been a while since I've written anything here.  I was doing pretty well tapering off paroxetine up until a few days ago.  I've been doing the Brass Monkey slide method and got down to about 7.9 mg.  I make up my own liquid.  I've had some ups and downs over the past couple of months, but mostly feeling pretty good and able to live my life normally.  

 

I started feeling funny a few days ago-more anxious and just a general sense of unease.  It's increased over the last couple of days where I had trouble falling asleep the last few nights and last night I was able to fall asleep, but woke up around 3:30 with high anxiety and couldn't fall back asleep.  

 

Not sure why I am feeling like this now?  I had a couple of drinks over the weekend, so maybe that's why?  I've been able to have a couple of drinks here and there without issue, but this being a holiday weekend I did over more days than usual, but only a couple of drinks each day.  I am staying away from alcohol now and caffeine as well.  

 

I did lower my dose again on Tuesday from about 8.1 to 7.9 mg.  I know I should have probably waited till I was feeling better, but things weren't too bad at that time.  Yesterday and last night have been pretty bad.

 

Not sure what to do.  Should I just wait this out and hope it passes?  Is it normal to have waves like this while tapering?  It's so frustrating since I thought things were going pretty well for a while there and haven't felt this bad in months.  

Edited by scallywag
merged topics, added paragraph breaks for readability

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scallywag

Hazel, I've merged your recent post in a new topic into the introduction topic you started in April so that all your information, questions and answers are in one place.

 

Your deduction about the cause of your wave is a good one. You may want to hold at your current dose for extra weeks before doing the next part of the slide.

 

Waves occur during slow tapering, not just after a fast taper or cold-turkey stop. Going slowly minimizes the risk that they occur and likely decreases the intensity and frequency of waves but doesn't eliminate the possibility of them.

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Hazel

Thanks Scallywag for your response.  I'm sure the alcohol this past weekend is a big part of why I'm having a hard time now.  I guess I learned the hard way that it's not worth it.  I took 8mg today and will hold here till I am feeling much better.  I guess I took for granted that things were going well and didn't expect to feel this bad again as long as I was tapering slowly.

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grandmaD

I am sure we have all done this!  Thought things were going fine and made a bad decision to try go faster, etc.  It is a learning process, to keep on plan, trudging on slowly, unfortunately. 

 

It is not unusual to not be able to fall asleep or stay asleep.  At first, I would get up, very angry and stomp through the house!  Then I decided to just accept it and got myself a jig saw puzzle to do when I got up.  Now, I just accept it as part and parcel of it all.

 

I have not touched alcohol for 6 years now and after a while, you don't miss it, or the coffee.  I have a very weak late made on whole milk once a week, and seem to be able to handle that.

 

You might find that despite doing a slow taper (I also did a 5% taper which I couldn't handle and am now doing 2.5%) and found that things like anxiety and insomnia continued to get worse.  Your only hope is that it is not as bad as it would be if you weren't doing a slow taper,.  I have learnt now not to say "it can't get any worse" because it can!

 

I wish you all the best, and will try and keep up with your posts.

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Hazel

Thanks grandmaD :)

This weekend was filled with ups and downs.  Had a very difficult time trying to fall asleep on Friday as I was up with high anxiety due to intrusive thoughts.  Felt better during the day Saturday and was able to sleep pretty well since I was exhausted from not sleeping much the previous night.  Sunday morning woke up feeling anxious but got better as the day went on.  Last night had trouble falling asleep again and have had anxiety all morning.  Feeling frustrated and losing hope.  I haven't had alcohol in 2 weeks and have cut back on caffeine.  Really thought I'd start feeling better by now.  

I was wondering if the ionic detox foot bath I had last Wednesday could be contributing to this wave?  I had one 2 weeks prior to that as well, so maybe that is partly why I have been struggling lately?  I am cancelling my next session and planning to hold at 8 mg for as long as it takes.  I just want to feel good and sleep well again!

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Hazel

Still struggling with sleep.  I've been able to fall asleep fine, but wake up early-last night it was around 2:45 am, with anxiety and can't fall back to sleep.  The anxiety typically sticks around till late morning and then I feel pretty good for the rest of the day.  I have gotten pretty desperate for sleep a couple of times now and took a lorazepam, which worked wonderfully.  I know I shouldn't take any, but I am careful not to take it often-the last time was early May.  I just need my sleep to function, so I've taken one two times now.  Not sure what else I can do.  I take magnesium, fish oils and melatonin.  No alcohol or caffeine.  Should I consider going back up to 9mg paroxetine, I'm currently at 8mg.  I just want to feel good again and be able to sleep.  Any feedback would be greatly appreciated.

 

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scallywag

How much magnesium are you taking? When are you taking it?

 

Are you still taking 5-HTP?  If so what dose and when are you taking it?

 

Are you still taking a B-Complex?  If so, when are you taking it? Some people find B vitamins overly stimulating. 

 

Waking up in the middle of the night is a form of insomnia and can be a withdrawal symptom. Other members post about their experiences and what's worked for them in this topic: Waking with panic or anxiety - Managing cortisol surges. Please don't be discouraged by the first part of the title; the information is valuable even if you're not experiencing anxiety or other types of "alerting."

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Hazel

I have a question I am hoping someone can help me with.  I've been holding at 8 mg of paroxetine since July 6 to try and stabilize before resuming tapering.  I realized I hadn't really given myself enough time to recover after all the changes and it caught up with me.  I am starting to feel better, but I still wake up early morning with anxiety, which dissipates after a couple hours.  Daytime I feel mostly normal, which is good.  I'm wondering if I should continue to hold until the morning anxiety goes away or resume tapering?  Is it normal to still experience withdrawal symptoms while tapering?  Is it even possible to have no symptoms while tapering?  I would love to have a symptom-free taper and will hold as long as it takes, but worry about holding too long as well.  Any thoughts?

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baroquep

Hi Hazel, in my experience, it is better to hold longer rather than rush things.  If you are feeling relatively well with anxiety still being a concern, I would hold for at least another month and see if your anxiety settles.  After running into trouble back in March, I did a good long hold and most, if not all, of my symptoms resolved, including the anxiety.  I do get very mild symptoms now and again after a taper that remind me that I am withdrawing but they are manageable and for the most part very mild.  I too want to have a symptom-free taper and decided to switch to 5% decreases with longer holds so that it doesn't feel like I'm perpetually dealing with withdrawal symptoms.  The 5% reductions have been much easier on my CNS and I've come to accept that if I want to have the fewest number of symptoms, I have to go very slow.  I also had to limit the use of supplements and now take only Omega 3 and magnesium and was able to add in iron after about six months.  After introducing a few different supplements that I thought would help with symptoms, they caused a reaction and I stopped taking them immediately.  B-vitamins tend to be activating and for me and I discontinued them back in March.         

 

It sounds like you are on the right track. 

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Hazel

Thank you for your response Baroquep.  I think I will continue to hold.  It's nice to hear that a nice long hold worked for you. I know it will take me a long time to get off this medication as well, but if I can feel like myself I am fine with however long that takes.  I don't seem to have problems with the supplements I take.  I have been taking most of them for a long while now. I think I will also try tapering 5% or less once I am ready to start tapering again.

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baroquep

Good to hear that none of your supplements are causing any difficulty, just be mindful that you may run into difficulty as you get lower on your dose of Paxil and is something that you can tweak as necessary.  I was also on most of the supplements I was taking for many years only to have them go paradoxical on me and ended up having to discontinue them to re-stabilize.  If you are looking to stay as symptom free as possible, a 5% taper sounds like a good plan.  It made a huge difference for me as what withdrawal symptoms I do experience now are much less intense and far easier to manage.  

 

Hoping that the anxiety settles sooner rather than later, so that you can continue to have a fairly uneventful journey off of Paxil.

 

Best,

BaroqueP

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Hazel

Thanks BaroqueP😊

May I ask how far down you are now on your meds?  I've read that some people struggle the further down they go, so I plan to go slowly to avoid that as much as possible.  I was also wondering if once you've really stabilized you can drink alcohol on occasion or have some caffeine.  I do miss an occasional glass of wine and my coffee drinks!

 

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