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GentleSteps

GentleSteps: Introduction

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GentleSteps

This site has been a sanctuary for several months and I would like to thank AltoStrata, her fellow Admins and all posting members for the invaluable information shared in the various forums.  In this most confusing and isolating phase of my life so far, you have all helped me to feel less alone, less confused, and important teachers.

 

I believe I may have created a meds signature line in my sign-up form, but if not I will correct that shortly.

 

Briefly, I realized I was in a polypharmacy rut in February of this year.  Prozac 10 or 20 mg (?) from early 1997 to early 1998.  Newly sober, the Paxil caused "speediness" and I was switched to Paxil - Paxil 20mg/day (depression/anxiety) from 1998 to approximately Spring 2007.  I simply stopped taking it after running out, was in long-term therapy and did not think twice about leaving such a "small thing" behind.  Even though there were large stressors at work.  The state of lability, extreme depression, dysphoria, DP, DR (terms I did not know then) were horrendous.  I returned to the original psychiatrist who tried me on various other meds for a hellish 2 months, never once mentioning I might be in withdrawal from stopping the Paxil.  The last straw was an Effexor trial, which put me in a state of agitation, physical heat, and inability to leave bed beyond imagination.  It took months to find a new Psychiatrist, which happened about February 2008.  He felt I had simply been on too small a Paxil dose - I had heard about "poop out" by that time but he dismissed it - I had not heard about withdrawal on Paxil cessation and he did not mention it.  He put me back on Paxil and built up slowly from 10 to eventually 60mg.  Unfortunately I don't remember the timeline for that buildup.  However, 60mg became the maintenance dose at which I remained until Feb. 2017 of this year - nearly 10 years.  He also became my psychotherapist and had a wonderfully humane aspect to him to which I attribute most of the great healing that happened over the first 3-4 years.  My life became strong and rich and fulfilling again - in all areas.  In 2010 there was a collision of traumatic stressors in work and family.  As well, somatic experience of panic, high anxiety and heart palpitations such as I'd never experienced since childhood episodes of severe abuse became frequent.  I made certain decisions in my life.  We continued the meds and the therapy.  In June (?) 2012 - after months of persistent inner agitation, weepiness, anxiety (following death of family member), he added Ativan 0.5 at night.  A year later he added another 0.5 in the am.  A year after that he added another 0.5 at noon.  I can not know with any certainty but based on everything that I have read about tolerance and withdrawal with Paxil and Ativan, I believe that I experienced pre-taper withdrawal-like symptoms for several years.

 

I wish I had known then - when he began adding the benzo to the Paxil - what I know now.  I had trusted him so completely as a person and a professional.

 

Fast forward to February 2017.  He announced abruptly that he was closing his practice - in 3 months.  We had been working together for about 9 years.  The anxiety caused by the announcement led him to increase my RXs for Paxil to 80 and to double Ativan to 1mg 3 times a day.  He acknowledged that the 2 drugs did not appear to be "working" or "ideal" anymore.  Sadly I think his priority at that point was to get to the end of the three months without liability - so it was easier to simply up the meds and "explore referral options."   Two months on the upped prescriptions saw me living like an outpatient in a chemical straightjacket - as a full on zombie.   I found my way to Mad in America and the literature on iatrogenic psychotropic drug injuries, the psychiatric profession's blind faith in the hypothesis of the "chemical imbalance", and the frightening stories about withdrawing from SSRIs and benzodiazepines - especially the 2 I was prescribed.  This was all quite frightening and overwhelming.  I was able to find a wonderful and sympathetic therapist. 

 

The zombie straightjacket was too much.  I decided to taper myself back to my "baseline" though no-longer-working (even according to the Psychiatrist) polypharmacy of Paxil 60mg and Ativan .05 3 times a day.  I did that from April to August.  Symptoms ranging from extreme loss of appetite, acute DP/DR, extreme and sudden heart palpitations and anxiety, and a slow-motion hyper depressive grey movie in the background looping "this is the end of the road for me" movies - but always behind a screen.  The gestalt  in terms of doing anything is a 1000 mile distance between a flourishing idea or thought and any action to carry it out.  Including washing dishes!

 

The search for a meds doctor who is sympathetic to a patient wishing to taper off psychotropic drugs that no longer work and are causing is still on.  I will be meeting one next week, and I believe his name does appear on a list of potentially knowledgeable providers somewhere on this site.  I will report back.   He appears to be familiar with tapering patients off psychotropic drugs and he is also a holistic treater with experience in acupuncture, something called "functional psychology" (?), and other holistic practices.   Thanks to SA I shall have with me a lot of information to discuss - very calmly - with him, including the formula of tapering 10% (vs. last dose), listening to the body even within a tapering protocol, and the question as to whether the Paxil or the Ativan should be tapered first.  (I saw a psychiatrist one month ago who wrote out a taper schedule for Ativan that was very aggressive -  I modified it and have "held" at an early stage after feeling my body rebelling and reading here about the 10% recommendation.  Same psychiatrist was ready to have me start tapering Paxil simultaneously until I mentioned perhaps it was not a great idea and he very quickly agreed.  Those fancy degrees, Research Hospital affiliations, decades of experience .... That's another story.)

 

I wish to thank you all from the bottom of my heart - for being here.

 

 

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Altostrata

Thank you, GentleSteps, and welcome.

 

Thanks also for writing such a complete signature. (After a bit, you may wish to just keep this year's information, to enable faster loading and scrolling in your Intro topic.)

 

How are you feeling now?

 

Please do let us know about your meeting with the new doctor.

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ChessieCat

Hi GentleSteps and welcome from me too.

 

You might find these topic provide some helpful information about talking with medical professionals:

 

How do you talk to a doctor about tapering and withdrawal?


What should I expect from my doctor about withdrawal symptoms?

 

Your signature contains a comprehensive history which would be excellent to refer back to.  What I would suggest that you do is copy and paste it  into a post.  You could then create a link in your signature which goes to that post.  To get the link right click over the share icon at the top right of the post and copy link location.  This way you could simplify it with the most recent information which is what is most helpful for the mods but still have the rest of the information easily accessible if the mods or members want to check out the older history.

 

And just in case you haven't seen these topics:

 

Why taper by 10% of my dosage?


Dr Joseph Glenmullen's WD Symptoms Checklist

 

Brain Remodelling


Video:  Healing From Antidepressants - Patterns of Recovery

 

Windows and Waves Pattern of Stabilization

 

Taking multiple psych drugs? Which drug to taper first?

 

Acupuncture - Posts #6 & #8 (not detox or stimulation)

 

Tips for tapering off Paxil (paroxetine)

 

This is your own Intro topic where you can ask questions and journal your progress.

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ChessieCat

I've added drug tags which are under the heading of this topic.  If you click on them you will find other members with the same tag.

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GentleSteps
13 hours ago, Altostrata said:

Thank you, GentleSteps, and welcome.

 

Thanks also for writing such a complete signature. (After a bit, you may wish to just keep this year's information, to enable faster loading and scrolling in your Intro topic.)

 

How are you feeling now?

 

Please do let us know about your meeting with the new doctor.

Good Afternoon Alto,

 

Thank you for the welcome.  I will follow instructions on condensing the signature, thanks.

 

I am stable in the daily instability at the moment.  Mentally, I do travel to that place where I wonder if I am in WD or just losing my mind.  I am very grateful that I've had full-time, challenging, work that I can do mostly from home, which helps to re-establish some perspective on that plane.

 

The non-work energy I've been focusing on nutrition over the past months, partly with the help of this forum.   The biggest challenge is the logistics of having to shlep to shop for food, etc.  I have cut back caffeine to very minimal amounts in the a.m. as over the past year the hyper-sensitivity to it became suddenly very obvious.   Same with refined sugar - which is down to near zero after I noticed (again in the past 10 months or so), began to severely trigger my cardio-vascular reactivity..  There's no alcohol or non-RX drugs in the picture at all (for many years now). Because of the extreme weightloss since Jan. (I went from an 8 to a 6) I direct energy towards ensuring eating - I'm now on a pattern of mornings (greek yogurt, granola, melon, berries, banana) - lunch (avocado plus cheese or meat sandwich) - dinner (as much as I can afford - red meat or chicken - bitter greens (kale) and mashed potatoes).  I hope I don't have terminal wasting disease ... but that's probably a neuro-anxious catasrophisation.

 

There is some trepidation around meeting (yet another) doctor, due to anxiety-based "forecasts" as to reactions, interpretations, etc.  I have read the posts on how to speak to doctors.  I found them extremely helpful and am using them as guides to write up a little statement so I can make as clear and neutral a pitch as I can.

 

I read with interest, also, the posts on others like myself who are contending with an SSRI/Benzo combination (long-term) and now wish I had not rushed to start tapering the lorazepam/Ativan in tandem withe paroxetine/Paxil.  That said, it was quite clear that the full dosage was not doing much to quiet anxiety-type symptoms, though your comment that the med could still be a "trellis" of sorts for the GABA system made me wonder.  So, one of the "bullet points" I am trying to craft for my discussion with the new Dr. is whether we should stop tapering the Ativan (and/or step back up a bit), and concentrate on the SSRI/paxil/paroxetine since that is the more activating med.  I have no idea what the depth of his knowledge is in this arena, so this may just confuse him and/or invite him to see me as a "fringe reader of the internet" (ha!).

 

Will let you know how the appointment goes.  Is there a way to PM you privately on this subject for the time being?

 

 

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GentleSteps
13 hours ago, ChessieCat said:

Hi GentleSteps and welcome from me too.

 

You might find these topic provide some helpful information about talking with medical professionals:

 

How do you talk to a doctor about tapering and withdrawal?


What should I expect from my doctor about withdrawal symptoms?

 

Your signature contains a comprehensive history which would be excellent to refer back to.  What I would suggest that you do is copy and paste it  into a post.  You could then create a link in your signature which goes to that post.  To get the link right click over the share icon at the top right of the post and copy link location.  This way you could simplify it with the most recent information which is what is most helpful for the mods but still have the rest of the information easily accessible if the mods or members want to check out the older history.

 

And just in case you haven't seen these topics:

 

Why taper by 10% of my dosage?


Dr Joseph Glenmullen's WD Symptoms Checklist

 

Brain Remodelling


Video:  Healing From Antidepressants - Patterns of Recovery

 

Windows and Waves Pattern of Stabilization

 

Taking multiple psych drugs? Which drug to taper first?

 

Acupuncture - Posts #6 & #8 (not detox or stimulation)

 

Tips for tapering off Paxil (paroxetine)

 

This is your own Intro topic where you can ask questions and journal your progress.

Thank you Chessie, for the welcome and the great links. 

I have read several of them, several times, and will continue to do so.  They have a stabilising effect on free-roaming dreads and anxieties!

 

On the neuroplasticity.  One of my the biggest dreads is wondering whether plasticity is likely to work in my case, given thelength of my tenure on SSRI & benzo.   It's funny but I've noticed that when I drink fresh pressed ginger and/or fresh squeezed OJ I feel life energy and balance and the tiniest feather-tip of wholeness.  I suppose in the Sci-Fi version of the WD recovery sanctuary that I imagine in fragments on some days there would be a beautiful room with views of trees and a part of the day reserved for imbibing (or IV'ing?!) these amazing natural sources of prana and strength! :)

 

I need to re-read the Tips for tapering off Paxil (paroxetine) but also have to thread that through the fact of my dual-status with the damned Ativan/lorazepam/benzo.  The thread on how to approach the order of tapering in an SSRI/benzo scenario had very intersting points.

 

Thanks again for chiming in to say hello and for all of your work on this forum.

 

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Altostrata

We appreciate your posting in your Intro topic, to share information with the mods and the community as a whole.

 

Vitamin C can be calming. You might concentrate on bringing more of it into your diet, even adding supplements to take with meals.

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ChessieCat

It's important to learNon-drug techniques.  There are a lot of suggestions which I suggest you check out.

 

The brain is an incredible thing.  I have been taking ADs for 25+ years and have managed to get my current drug dose down from 100mg to 19mg.  I am feeling more like my old (or should I say younger) self as my dose gets lower.  I didn't realise how numb I had been for so many years.  Back in May this year (I was on 25mg at the time) I bought a brand new car and I was excited, more than I had been in a long time, but it was a dulled excitement compared to this last week when I have experienced excitement which is different from back in May.  Real excitement.

 

It's going to take time and patience and most likely some discomfort but it will be worth it.

Edited by ChessieCat

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GentleSteps

Hi All,

 

Chessie - thank you for your story about excitement returning albeit "dulled" at first.  I've been reading "success stories" and "best of SA" and I'm finding them very nourishing, especially the accounts of how peeps have been using the self-care techniques in their own individual recoveries and the great metaphors around those techniques, like "thoughts are visitors - I am not a hotel"!  Lots of talismans to collect and refer to a day and minutes at a time!

 

I do have a question for the expert mods.  The new Pdoc I saw dismissed tapering out of hand, saying he'd rather first "build up" my body with supplements to support the symp and para symp nervous systems.   I've been holding at Paxil (generic version) 42mg since July.  After that I tapered the Ativan (benzo) from 1.5 per day to .75 per day and have been holding that since late August.   I know it would have been better to hold the Ativan where I was and just work on tapering one med - the SSRI Paxil. 

The WD symptoms have "stabilized" in that they have not gotten worse or better in about 2 weeks. 

 

I am wondering whether to ask the Pdoc to give me an Rx for the liquid Paxil so I can begin doing very micro tapers - starting at 10% of current but going less % if my body tells me.  He will be sure to challenge me on why I want the liquid formula. 

 

Any insights as to my plan to hold the Ativan firm but start planning for a 10% or micro tapering of the Paxil?  And any suggestions as to how I can address the Pdoc?  Unfortunately I seem to live in an area that is a "desert" when it comes to Pdocs and my next option would likely be either a GP or a nurse practicioner - and finding either of those who would be willing to oversee a taper (and recognize w/drawal) will be an enormous challenge.

 

Thank you!

 

Now going to stream a guided meditation before sleeping.

 

 

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GentleSteps

Yesterday went to see a Pdoc referred because he works with getting people of psych meds.

I was hopeful that he could become a partner in helping me with tapering off Pazil.  Unfortunately he did not recognize any of the WD symptoms I have been experiencing since I started a taper on my own (60mg April to 42 (ish) end of July).  His emphasis seems to be on using supplements and vitamins to strengthen the nervous system first.

It may be sound advice - but it is hard for me to gauge, especially since he sells the supplements to his patients.

 

I would appreciate advice from those on this board with Paxil taper experience on whether I should simply hold at the current 42 or whether I can start tapering on my own, starting with a 10% cut, as recommended here on SA.

 

Thank you.

 

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sungirl

I received some Paxil taper support and help via email from Dr. Stuart Shipko on the website "Mad in America"  He recommended a very slow taper of only 1mg/month to me and if I started with anxiety symptoms to go back to the last comfortable dose and stay there before tapering again. At 5mg he recommended tapering by only .5 mg/month.  My MD is aware of and supporting me through this taper.  It's more complicated since you are tapering from two meds at once.  Maybe it would be good to start with only one of the two?  Best wishes to you!

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GentleSteps

Thanks for the reply Sungirl.

 

Congratulations on reaching the 5mg mark with dual support from Dr. Shipko and your MD -  you created a strong support system for this leg of the journey: Brava!

 

I agree re the dual tapering - I will be holding off on the Ativan taper whilst approaching the Paxil taper;  postings here on SA have been very helpful in making this decision.  

 

You've given me the idea of contacting a P-doc outside my immediate area who may be able to help remotely.  Thanks for that. 

 

Though, after reading  Dr. Shipko's paper in MIA from a few years ago I may have to reach acceptance as to whether I am even a candidate for tapering ... this could be neuro-anxiety talking though!

 

 

 

 

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Altostrata
22 hours ago, sungirl said:

I received some Paxil taper support and help via email from Dr. Stuart Shipko on the website "Mad in America"  He recommended a very slow taper of only 1mg/month to me and if I started with anxiety symptoms to go back to the last comfortable dose and stay there before tapering again. At 5mg he recommended tapering by only .5 mg/month.  My MD is aware of and supporting me through this taper.  It's more complicated since you are tapering from two meds at once.  Maybe it would be good to start with only one of the two?  Best wishes to you!

 

Hi, sungirl. Please start a Introductions topic for yourself so we can get to know you.

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GentleSteps

Hi Everyone,

Stopping by to say hello.  Since last Friday I tapered Pax from 42 to 40.  I started taking Vit. C and a Multi V. as well (morning and night).

This past week, and still now, I've been overwhelmed by total emotional numbness and lethargy.  When I'm not working, which has been brain-foggy, I'm sleeping or just huddled in bed.  I even slipped on eating properly a few days - that may not have helped.  This is a new state for me where I am so flat I can't even bring myself to listen to meditations or podcasts. 

Is this WD? It's really hard.

GS

 

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ChessieCat
2 hours ago, GentleSteps said:

Since last Friday I tapered Pax from 42 to 40.  I started taking Vit. C and a Multi V

 

SA recommends only making one change at a time, otherwise if you experience issues you will not know what is causing the problem.

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GentleSteps

ChessieCat, thank you for the note and apologies for the late reply. 

 

Advice welcome on next steps.  I plan to hold the Paxil at 40mg for 4 weeks and then to taper 10% to 36.  Because I only have 40mg pills I will be dry cutting and will try to be as precise as possible.  Until then and through the next 4 weeks, I will not change anything else - i.e., holding Ativan .75 (.25 am, .25 pm, .5 night), and the Vitamin C, Multi and Magnesium (morning and evening).   The only Pdoc I've been able to find here was unwilling to support me in tapering so I will be doing this on my own and I do not have access, yet, to a doctor who is willing to prescribe the liquid Paxil that would help with a more precise taper.

 

Thank you.

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GentleSteps

Hello.  A brief update.  I have been holding Paxil at 40 and Ativan at 1.0 (.75 was a typo in previous email) since the last post.  The insomnia for me means being unable to fall asleep after going to bed around 8:30 or 9:00, being up with a low-level of agitation until about 1am.  Last night was first trial of melatonin - it is in liquid form and I took one 1/4 of a dropper in tea.  I felt the effect within 30 minutes, and went to sleep within an hour.  I slept soundly for a good 12 hours.  Unfortunately I awoke with a feeling of a heavy haze in my head which persisted most of the day.  I may try again at a lower dose - perhaps just a drop to start - in the next day or two.

 

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GentleSteps

Symptoms have modified somewhat.  Episodes of acute anxiety (rapid heartbeats and emotional feelings of high panic) have lessened, including in the morning, when they were particularly strong.  Falling asleep faster after I go to bed - a lessening of the insomnia.  I am dreaming again as of about 3 weeks ago - these are pleasant dreams except on waking and realizing the contrast to my reality.  The anhedonia, agoraphobia, weight loss (tied to inability to maintain regular healthy eating pattern), and dark feelings (depression, doom, despair) are very present and persistent through each day.

 

In reflecting back, I am regretting two aspects of the tapers I began on my own.  First, tapering the Ativan and Paxil in tandem up to my current hold. Second, tapering the Paxil from 80 to 40 in 6 months.  It's becoming clear why I'm experiencing as much suffering and discomfort but nearly impossible to sort out which drug taper is causing the WD symptoms.  This is causing me great fear that I have put myself into a tapering journey with no hope of being able to plan timings (for each drug, separately) in a way that will allow me to remain somewhat functional in the next phases of the tapers.  So this is a moment for summoning self-forgiveness towards myself for having done the best I could with the knowledge I had when I started down this difficult path to healing. 

 

Yet I am stuck in the double trap of taking an SSRI and a benzo that have been non-therapeutic (in fact, counter-therapeutic) for years already and are now just toxins I take to avoid the known extreme dangers of a cold turkey cessation.   I am using breathing and meditation techniques every day to disarm the waves of rage against the doctor who placed me in this trap without ever uttering a word about the truths on long-term SSRI use and any use of benzo polypharmacy.  Given Fava's published studies on the effects of long-term SSRI use - causal agents in creating chronic depression - it seems unforgivable that any psychiatrist who had patients on these drugs for years failed to take note of Fava's findings and to speak to his/her patients about them as a prelude to weaning them off.  I truly cannot wrap my head around this at the moment.

 

 

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GentleSteps

Hello all,

 

As I re-read the SA link on Why Taper by 10% it's pretty clear to me that the taper(s) I did on my own without the benefit of having first read SA's 10% taper protocol has put me in a very symptomatic withdrawal.  

 

Since I am nowhere near tapering either the Ativan or the Paxil, would there be any merit to updosing either drug at this point to see if I can find a less symptomatic plateau?  Or should I be focusing more intensively on non-drug techniques to try to reach a better baseline?

 

(This said, even at the baseline doses I was on at the start of the year - 60 Paxil, 1.5 Ativan - the drugs were no longer working and I was already experiencing symptoms consistent with SSRI and benzo withdrawal, especially the extreme and confusing depression, terror, intrusive random memories from my whole life and the anxiety accompanied by heart palpitations and stiff neck/shoulders.

 

I would be grateful for advice from the collective wisdom here at SA.

 

 

 

 

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baroquep

Hi Gentlesteps, I would suggest that you start an introduction topic in the members only benzo forum where you can get specific advice with respect to your Ativan use.  It would be next to impossible to determine whether the withdrawal symptoms are from Paxil or Ativan at this point.  It is probably a good idea to ensure that you are first stabilized on Ativan and you will be able to find help in the benzo forum to determine whether or not you are stable on that drug first before continuing to taper Paxil.  In the meantime, I would probably not make any changes to your dose of Paxil at this time.  Once we hear back regarding your situation with Ativan, we will be better able to determine whether this is a good idea for you to continue to taper Paxil at this time.  

Personally, I have never up-dosed, and instead chose to ride out the symptoms until I could return to "withdrawal normal".  For me anyway, I felt that keeping my dose steady was more important as difficult to manage as some of the symptoms could be.  ChessieCat determines whether or not to up-dose based on her current symptom profile, if the symptoms are unbearable, she will up-dose slightly, say 0.25-0.5mg or less, and see if that provides any relief.  It is always a gamble tapering or up-dosing and you face the risk of either of these options making your situation worse by causing further disruption to your central nervous system.  The only one that can determine whether or not you can ride out the symptoms at your present dose or if you feel it is necessary to up-dose slightly is you.    But as I said, I think it would be best for you to introduce yourself in the benzo forum and ensure that you are stabilized on Ativan and then we can take things from there, here in the antidepressant tapering forum.    

Here is the link where you can start an introduction thread in the benzo forum Members Only Benzo Forum

 

Withdrawal Normal Description

Rate Symptoms Daily to Check Patterns and Progress

 

I've also attached a few links that you might find helpful with respect to the symptoms that you are currently dealing with.

 

Intrusive Thoughts and Increased Panic

Fear, terror, panic, and anxiety

Tension / Pain / Twitches / Spasms in Muscles and Joints

 

Memories from Pre-Drugged Years Surfacing  And from the Ashton Manual on Benzodiazepine withdrawal:

 

Intrusive memories. A fascinating symptom in patients undergoing benzodiazepine withdrawal is that they often mention the occurrence of what seem to be intrusive memories. Their minds will suddenly conjure up a vivid memory of someone they have not thought about or seen for years. Sometimes the other person's face will appear when looking in the mirror. The memory seems uncalled for and may recur, intruding on other thoughts. The interesting thing about these memories is that they often start to occur at the same time that vivid dreams appear; these may be delayed until one or more weeks after the dosage tapering has started. Since recent sleep research indicates that certain stages of sleep (REMS and SWS) are important for memory functions, it is likely that the dreams and the memories are connected. In both cases the phenomena may herald the beginning of a return in normal memory functions and, although sometimes disturbing, can be welcomed as a sign of a step towards recovery.

 

Poor memory and concentration are also features of benzodiazepine withdrawal, and are probably due to continued effects of the drug. Mentors should be prepared to repeat encouragements again and again, week after week, as their words are soon forgotten.

 

https://www.benzo.org.uk/manual/bzcha03.htm#6

Edited by baroquep

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GentleSteps

Dear Baroquepep,

 

Thank you so much for your response and all of your suggestions.  I am especially grateful, and quite awed, knowing from your posts what you are going through yourself as you do such wonderful, attentive and articulate service to others.  Bowing in deep gratitude and thanks.

 

 

 

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