gfretter: Paxil too fast taper - returned to full dose and experiencing bad withdrawals

[gfretter]

Hi everyone, 

 

I have been on Paxil 40mg for around 15 years for OCD. I have never tried to taper or cut out but I do regularly forget to take my dosage once or twice a week as I'm forgetful and it has never caused much harm (I thought). 

 

I have been in a very good place for many years and have often spoken to Drs about tapering, with not a lot of advice received. A long time ago I received the advice to take 'one pill instead of two on tuesdays and thursdays' or something like that - the Dr didn't think I could cut pills. 

 

Disclaimer: I am aware that everything i have done was a very bad idea after doing research on it - now I am trying to deal with the consequences. 

 

I thought that as I often forget to take a dosage that it would be foolish to go up to the 'full' dosage of my meds and then taper from that (how wrong I was) so I calculated what I thought my regular dosage may be - about 28mg per day average. I decided to start a 'regular' taper of this - taking a full dosage 4 days a week, half dosage 2 days and skipping a dosage once. (Again - foolish, I'm so upset thinking about this now I know what I know). Everything was going fine for the first two weeks.

 

2.5-3 weeks I noticed that I was starting to develop panic attacks over things I could normally process well. I also developed a lot of nausea and dizziness one morning, 3 weeks after starting the 'taper'. I immediately returned to my full dose realising that I had made a mistake, and the dizziness and nausea went away that day. The mild panic attacks lasted one more day. About 5 days after returning to my full dose I had another small panic attack. Then something external to spike my anxiety happened and I had 2 days of experiencing full on panic attacks. I was overwhelmed - I had never felt feelings of panic like this so constantly, usually I would have bad mornings and feel better at night but these days I was constantly anxious and racing heart. Today is a week since I resumed the full dose and I am feeling a little better, but am struggling to concentrate on my work, fighting off panic attacks, having hot flushes and then chills, feeling spacey and like I am almost drifting out of my body. The panic is mostly in the form of ruminating which I have struggled with in the past. 

 

On the weekend I was ruminating about the external stressors, but today I am ruminating about what a terrible mistake I have made with my medication and if I have ruined my life and my central nervous system and will be feeling this way for years. I am feeling intense despair as well as panic, and as a result of the ruminating have been combing websites like this looking for re-assurance but leading to more panic. I realise I am seeking re-assurance here by posting, but I have also learnt that there are so many things I didn't know about withdrawal like kindling and updosing and a destabilised nervous system and am afraid that I need to do research to know what to do - even though it is giving me panic attacks. I have read that updosing less than a month after beginning withdrawals can be effective and am hoping I just need to continue to regularly take my meds and let my central nervous system re-stabilize. I am so afraid when I hear stories about people suffering for years that I am going to experience that, even though I was only tapering for 3 weeks before I updosed to normal. I'm also afraid that my doctor won't be able to help me.

 

Looking for any advice (that won't send me into an anxiety spiral) or tips from anyone who has experienced similar to me. At this point I am not thinking about how I can get off this medication - I am only thinking about how I can return to a stable state and re-assess later when I am in a better place.

 

Apologies for the trauma dump and hopefully this post is approved!

 

Thank you in advance

[gfretter]

Hi all, 

I'm looking for some help and support. I have been on Paxil 40mg for 15 years for OCD. I have had many discussions with Drs about tapering but never tried until recently. A Dr some time ago told me to have 1 pill instead of 2 every few days to taper as she didn't think I could cut pills. I have been in a really good place for at least five years and I recently decided I wanted to finally try tapering to try to better manage my weight. The issue I have is that I very regularly forget to take my paxil (at least once or twice a week, sometimes taking 1 pill when I'm running low etc etc). I had never noticed any adverse reactions other than brain zaps and dizziness that went away as soon as I took a dose. 

 

Disclaimer: I now know that everything I have done was a very bad idea and I am paying for it. At this point I am just trying to return to a stable state on my full dose and hold that, I'm not thinking about how I might taper off these meds in the future - I need to return to a regulated central nervous system first and consider the rest later. 

 

Due to regularly missing doses, I decided that I wouldn't want to start a taper based off 40mg because I didn't believe that I took that much on average. I calculated that on average I probably only have 28mg a day with missed and half doses. I decided to just try to replicate that regularly by taking a full dose 4 days a week, missing a dose 1 day and having a half dose on two days (all very bad choices I now know). I did this for 3-4 weeks (starting 16/7) before I started noticing I was experiencing some mild panic attacks. On 6/8 I realised the panic attacks were to do with withdrawals and I also was experiencing a lot of nausea and dizziness. I resumed my full dose immediately and have been taking it regularly since 6/8 (8 days). 

 

I the nausea and light headedness went away almost immediately and the panic attacks subsided until 9/8 when I had another moderate panic attack. On 10/8 some external circumstances (a sick pet) occurred and I started experiencing the worst panic attacks I have ever had, they lasted most of the day on 10/8 and all day on 11/8. I was experiencing heart racing, tremors, hot flushes and chills, feelings over hopelessness and despair and anxiety spirals.

 

I have been ruminating a lot. The external circumstances are easing a bit but I am still finding anything I can to ruminate on - at the moment it is that I have ruined my central nervous system and completely lost all the hard work I have put in for years because of the stupid decision I made to start tapering. This has led me to sites like this where I am reading a lot and seeking reassurance but it's usually just leading to my panic getting worse when I read anything negative. I realise I'm seeking re-assurance by posting here but I also feel that I want information that might help me through this period. I'm terrified that a doctor can't help me as they don't know enough about SSRI withdrawals, and that my case is complicated as I returned to my full dose as well. I read that updosing back to your full dose can be effective if done within a month - I resumed my dose after a month of tapering and am hoping eventually the full dose will kick in and start having an effect? 

 

Yesterday 12/8 was a slightly better day than the weekend - I felt panicky and hopeless in the day but had quite a good night feeling too tired to still panic. I took fish oil and melatonin and magnesium at night and had a quite good sleep but woke up at about 7am with racing heart and feeling panicked and it hasn't gone away yet. 

 

I would love to hear any success stories of others who have returned to full dose after failed tapering, or any coping tips for the panic attacks and withdrawal symptoms. I have read some say that holding on a lower dose after they tried and failed to taper was more successful, but I think that is risky as I have been on this full dose for 15 years and only attempted to taper for 1 month.

 

Thank you for your help in advance.

[Catwoman73]

Hi @gfretter, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes. 

 

Thank you for completing your drug signature.  And I'm so sorry for what you are experiencing.  Unfortunately, you did receive some terrible advice from your doctor, as it really isn't advisable to skip doses as a method of tapering.  Don't worry- I think many of us have been there.  I know that's my doctor's best advice too!

 

Here at SA, we recommend tapering by no more than 10% of your current dose, no more often than every 4 weeks.  This is called hyperbolic tapering, and is designed to release the receptors in the brain more slowly and gently from the drug, thereby reducing acute withdrawal symptoms and reducing the risk of protracted withdrawal.  I would absolutely recommend using this method, or even a microtapering method when you are ready to try again.  You can read more about hyperbolic tapering here:

 

Why taper by 10% of my dosage?

 

And an awesome method of micro tapering here (I'm using this one, and coping extremely well!):

 

The Brassmonkey Slide Method of Micro-tapering

 

I'm sure you have already done some reading here, and have likely figured out that we typically recommend very slow updosing to try to help mitigate withdrawal symptoms rather than an immediate return to a previously tolerated dose, as overshooting your dose can cause you to feel activated, making things significantly worse.  The good news in your case is that, based on the symptoms you are currently describing, it does not look like this has happened to you.  It seems that you are experiencing very normal symptoms of your nervous system being destabilized.  Activation typically looks like more constant high level anxiety, akathisia, and outright non-stop terror.  

 

And even further good news- you WILL stabilize.  You have absolutely NOT ruined anything.  This is just a little speed bump in the journey.  It's going to take time and patience, but you will find stability.  The nervous system heals quite slowly, so when it has been destabilized, you can expect to spend many weeks to months experiencing lots of ups and downs with your symptoms.  In fact, it's a good sign if you are having good days and bad days- this is known as the windows and waves pattern of stabilization, and is an excellent sign that healing is occurring.  You can read more about windows and waves here:

 

Windows and waves pattern of stabilization

 

While you wait to stabilize, there are certainly a few things you can do to aid your body in healing.  Eat a healthy, whole foods diet, stay adequately hydrated, gentle movement/exercise, adequate rest, and avoiding neurologically active substances, such as caffeine, nicotine, alcohol and recreational drugs.  And we absolutely do not recommend using other psychiatric drugs to attempt to deal with symptoms.  This is for two reasons.  First of all, when the nervous system is destabilized, the effects can be unpredictable, and you stand the chance of making things worse rather than better.  Secondly, you will only create a situation where you have to taper off of something again in the future, thereby prolonging your withdrawal/tapering journey.  

 

So the question becomes- how to cope with the emotional symptoms right now.  This is the tough part.  We have many threads on how to cope with emotional symptoms here at SA, and I will link them below.  Personally, intense daily mindfulness and meditation practices are absolutely the cornerstone of my coping mechanisms.  I also enjoy spending time in nature, swimming (I feel almost normal in the water!), and distraction with art projects.  No, I am not artistic- I do paint by numbers lol!  It's a wonderful distraction.  Many of these things don't work immediately.  They take consistency and practice.  But while you are practicing, your brain is slowly learning to respond to stressful situations in a different way.  And over time, your brain will eventually learn to respond automatically with calm.  I'm a great example of this- I have found great peace with these practices by being consistent, and by believing deep in my heart that I can heal. 

 

Non-drug techniques to cope with emotional symptoms

 Easing your way into meditation for a stressed-out nervous system

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

Ways to cope with daily anxiety

"Change the channel" - dealing with cognitive symptoms

Dealing With Emotional Spirals 

Shame, guilt, regret, and self-criticism

 

OCD can be particularly difficult to deal with while in this state.  There are MANY members here who are coping with OCD while tapering or while destabilized- to read more, type OCD into the search bar at the top right hand side of the page, ensure that 'everywhere' is highlighted in the drop down menu on the right side of that search bar, and click the magnifying glass.  Lots of threads will come up.  Like LOTS.  You are most definitely NOT alone. 

 

You might consider starting a journal of your symptoms.  Rate them every day on a scale of 1-10.  This can help you identify your windows and waves, and also potential triggers for your waves.  It is common to become hypersensitive to many things while your nervous system is in this condition, including medications, supplements, and even foods.  So tracking your dietary intake, activities, etc can help identify triggers.  Here is a good list of typical symptoms that you could use as a template for a symptom journal, if you wish:

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

We only recommend two supplements here at SA- magnesium and omega-3 fatty acids.  Do be advised, however, that because of this potential for odd reactions to things while unstable, it is best to start at very low doses of anything that you take to see how you fare, and increase slowly over time.  This even applies to the supplements we recommend here! 

 

In summary, it sounds like you are ok to hold where you are right now, and wait for your body and brain to stabilize.  We can revisit this if you start to become more anxious and agitated.  Start keeping a symptom journal, and watch for windows and waves.  And triggers for your waves.  Take good care of your body and your brain with healthy diet, gentle exericise, etc, and start using the non-drug coping mechanisms recommended here.  You may find some of your own, too!  Give your body what it needs, and you will find stability.  None of this means you need to be stuck on these meds forever- you can taper again once you are stabilized.  You can do this in a much slower, more controlled manner to minimize the impact it has on your life.  

 

Most of all, don't lose hope!  The human body is designed to heal.  We have to work pretty hard to NOT heal.  With time, patience, and a bit of work from you to treat your body and mind right, and you will get there.  And we're here to support you along the way!

 

This is your introduction topic.  Each member gets one intro topic- please post questions, concerns and updates here on this thread.  But don't hesitate to explore the rest of the forum- there is lots of good information here.  And if you're up to it, engaging with other members by reading and commenting on their threads is a great way to feel less alone.  I truly believe it takes a village to get through this, and you have that with the members here.

 

Thinking of you! ❤️‍🩹

[gfretter]

Thank you so much for your thoughtful reply. I had worried I was experiencing some sort of activation because the symptoms got worse after I stopped skipping doses. But I also thought it may have just been something that was on the way either way from withdrawals. I will definitely be taking your advice on many things. Having a hard time at the moment identifying the windows and the waves especially with external stresses added to the mix. Can they be quite short? At the moment I am tend to have the same symptoms everyday: racing heart and high anxiety in the morning from about 7am, stretching throughout the day with varying severity, then around 5 I often feel quite depressed and like nothing can cheer me up, then by about 7 or 8 I feel a sense of calm and clarity and can usually get to sleep with some magnesium and melatonin and sleep relatively well. I’m hoping the sense of calm and clarity starts to get longer - I’m terrified of it shorter.

[Catwoman73]

3 minutes ago, gfretter said:

Having a hard time at the moment identifying the windows and the waves especially with external stresses added to the mix. Can they be quite short? 

 

Yes, windows can absolutely be quite short, particularly in the acute phase of withdrawal/destabilization.  It will get better with time and patience!

 

4 minutes ago, gfretter said:

At the moment I am tend to have the same symptoms everyday: racing heart and high anxiety in the morning from about 7am, stretching throughout the day with varying severity, then around 5 I often feel quite depressed and like nothing can cheer me up, then by about 7 or 8 I feel a sense of calm and clarity and can usually get to sleep with some magnesium and melatonin and sleep relatively well. I’m hoping the sense of calm and clarity starts to get longer - I’m terrified of it shorter.

 

This is a very standard pattern for withdrawal.  In the morning, it is a normal part of our biology to have a cortisol surge.  This is designed to wake us up and get us moving for the day.  While in withdrawal, our confused brains interpret this cortisol surge with a danger signal, sending our brain and body into fight or flight mode.  Hence your morning anxiety, racing heart, etc.  As the cortisol surge loses traction through the day, the anxiety tends to ease, which is why you get a sense of calm in the evening.  Depression is absolutely part of the withdrawal experience as well, and the cyclical nature of yours makes me think that dealing with the anxiety all day, in the context of having to live your life while feeling this way, must be absolutely exhausting for you, so when the day ends, you just crash, leaving you feeling helpless and hopeless.  

 

The good news about this pattern is that you can count on having some period of relief each day.  That gives you something to look forward to.  It also allows you to plan around your usual pattern.  If you are working, be sure to be kind to yourself during your work day- take your breaks, eat well, stay hydrated.  Spend some time on your lunch hour listening to a calming guided meditation.  When you get home- you are clearly DONE, and need a break.  So take one- take a nap, watch a favourite TV show, or develop some ritual that make you feel good (for me- a cup of tea on my porch with a good book or a snuggle with my cat often helps).  When you feel the sense of calm coming on, that's a good time to make yourself something to eat, and tackle one or two small tasks that need to be done (like, throw in that load of laundry, or pay some bills).  Or, if what you need is to just rest and enjoy feeling a bit better, that's totally ok too!  Right now, the most important thing you can do is be kind to yourself.  ❤️

[Schmeg82]

Hey there! 
I’m a fellow Paxil user that started off with the same story as you but I unfortunately started to taper all the way down to 5mg entirely to fast and went into bad acute and then protracted withdrawals.  I also updosed back to 10mg from the 5mg unfortunately without much luck on stabilizing however I have windows throughout the day where I get stuff done on a somewhat normal level.  Throughout this journey it’s very important to not ruminate (I know that’s so hard, I find myself still doing it) and find ways to help cope & distract rather then try and find constant reassurance.
 

 There’s many free videos on YouTube, I love Angie peacock’s the most.  I also find the meditating videos very helpful, especially the before bedtime ones.  Being outside in nature is the biggest help for me, even just sitting in the fresh air and sun in my backyard or going for short walks when I can.  I like to read a lot also, non fiction, which keeps my mind off of withdrawal & symptoms.  
 

Paxil is definitely a hard one to come off of but when you stabilize you can start your very very slow taper.  I’m starting my taper now again since it’s been 6 months since updosing and I believe I’m in poop out (tolerance) I’ve been on the drug almost 22 years. 
 

I keep a daily journal of symptoms also, which I find helpful to recognize patterns or triggers.

I’m  also here if you have any questions or need suggestions! Good luck and I hope you see some better days soon! 

[gfretter]

Hi there, thanks for your reply and I hope you’re doing well. What do you mean by poop out/tolerance?

I’m terrified I won’t stabilise from going back to my full dose, it’s been two weeks and I don’t know how much I can go on with the intense anxiety in the daytime 😭 I’m hoping things will start to improve as I only did the tapering for a month before updosing back to regular dosage very soon after withdrawals started. But I thought I would be feeling better by now and I’m not ☹️ I find it very hard to be alone with my thoughts!

thank you again

[Willy]

14 minutes ago, gfretter said:

Hi there, thanks for your reply and I hope you’re doing well. What do you mean by poop out/tolerance?

I’m terrified I won’t stabilise from going back to my full dose, it’s been two weeks and I don’t know how much I can go on with the intense anxiety in the daytime 😭 I’m hoping things will start to improve as I only did the tapering for a month before updosing back to regular dosage very soon after withdrawals started. But I thought I would be feeling better by now and I’m not ☹️ I find it very hard to be alone with my thoughts!

thank you again

I’m sorry you’re going through this. For me poop out means  I would go into wd without changing the dose. I was forced to start my Paxil taper while in wd because my body became tolerant of the drug. I was basically forced into the taper. I’ve been suffering for a month with no let up. Please follow the taper guidelines on this forum. Take care and you will be fine

[gfretter]

Hi all,

I’m experiencing withdrawal symptoms after too fast tapering and skipping doses leading to panic attacks and anxiety. Worst thing for me is the cortisol spike in the morning - I’m so anxious with a racing heart from about 7:30am (I take my meds at 8:30am) and it doesn’t start easing until late afternoon. 
the one thing that has really helped me to distract from my ruminating and calm me is talking to others.

My mum was staying with me for a week when the symptoms started but when she left I felt so alone and full of despair, and the idea of having no one to just check in with and have a quick chat with to break me out of my cycle has been awful. My sister came to visit me and I had quite a good day just chatting with her constantly to keep my mind occupied.

i can call people but I can’t call people for like 10 hours of the day! 
I have been trying to listen to podcasts while doing things to keep my mind occupied but I find them quite easy to ignore.

any tips would be greatly appreciated

[Catwoman73]

16 hours ago, gfretter said:

 

I’m terrified I won’t stabilise from going back to my full dose, it’s been two weeks and I don’t know how much I can go on with the intense anxiety in the daytime 😭 I’m hoping things will start to improve as I only did the tapering for a month before updosing back to regular dosage very soon after withdrawals started. But I thought I would be feeling better by now and I’m not ☹️ I find it very hard to be alone with my thoughts!

thank you again

 

Poop out/tolerance is when the dose of the drug you are taking is no longer effective.  This can often result in withdrawal symptoms starting, even if you haven't changed a thing.  

 

Stabilization can take a long time!  With the inconsistent dosing that you have experienced, your nervous system is likely in quite a state right now- it's going to take many weeks to months.  I know the anxiety is just brutal- I find that to be the hardest symptom of all to cope with.  It's really important while you are waiting for stability to start working on those non-drug coping mechanisms.  Start with some guided meditations or yoga Nidra, as @Schmeg82 suggested.  That's a great place to start, because someone else does the work for you- you just have to follow along, and keep bringing your mind back when it wanders.  Distraction can be a really wonderful tool as well- I enjoy doing art projects (paint by numbers... I am soooo not artistic lol), or going for walks, while focussing on my surroundings (listen to the birds and the insects, feel the wind on my face... if my mind wanders, that's ok- just bring it back to focussing on what is immediately around you).  Simple deep breathing is well known to calm the nervous system... I swear, there are days where I feel like all I do all day long is breathe!  And that's ok- whatever it takes to get you through the days. 

 

I know it's quite shocking that a drug so casually prescribed by doctors can cause this much pain.  It is really very normal to go through a grieving process when you encounter these symptoms.  Be gentle with yourself- allow your feelings to come and wash over you.  It's healthy and normal.  Acceptance is the key to getting through this, but it's not easy.  We're here for you every step of the way!❤️

[Willy]

51 minutes ago, Catwoman73 said:

Acceptance is the key to getting through this, but it's not easy

This is very true and critical to the process. I’m still trying to accept my situation and settle in to it. Patience is the other critical piece which is still something I’m working on. 
 

You will be fine. A lot of people on here will help you with a plan of action and support you through the process. Take care!

[gfretter]

Hi all,

I thought I would update you on how I have been going. I last posted on August 18 almost two weeks ago.

I continued to wake up with panic/racing heart in the morning, but a friend came to stay with me for support, and one of the causes of my external stresses was resolved. With my friend and work to distract me I had a few good days where I would feel relatively calm after about 11am. I wasn’t sure if this was a window or stabilisation or greatly helped by the distractions.

I then had an external stress trigger me into quite an anxious night and following day. I went to visit my parents and had a bit of a wave over the weekend but still an improvement from prior waves.

In addition to the early morning anxiety, I was experiencing depression around the time the sun set for an hour or two.

This week on Tuesday about 4 weeks after

I updosed back to 40mg I woke up and waited for the anxiety and racing heart and it never came! The last three days I have felt quite close to normal emotionally. I have still experienced some difficulties sleeping, waking up early and some strong heart beat in the evening. But the difference from two weeks ago is huge. I may be in another window but I’m hoping the waves will be shorter and milder.

 

thank you to everyone who posted for your support. I think I’m still dealing with the shockwaves of such a terrible time, as well as the worry about if/how I will ever get off this drug. But at the moment I’m just focusing on healing and stabilising.

[Sebas]

Good to hear the CNS stability is making progress. Give it some more time to fully stabilise. 

 

I would, if i may, challenge you to think about restarting a proper taper after you have fully stabilised. Search this website for brassmonkey slide method.

 

On this website we see lot of people whose ssri poops out (looses efficacy) after 15-20 years. Cat referred to it above. Most of those people have been on them for so long pretty unwillingly and/or unnecessarily. In my opinion and experience it would be a wise consideration to anticipate. Suppose you would manage at 20mg then you would be taking 50% less of this poison. 

 

Like you already acknowledged taking your drug regularly is very important for accurate blood levels. Especially during tapering that is where cns will be challenged for stability! Make it part of your daily routine.

 

Bye Sebas

 

 

[Lenyams]

I had the 3rd attempt to taper Zoloft 50mg.

2 times quick taper which never worked and 3rd time slow taper with liquid and reduced to 46mg during 3 months after which pws hit me hard!

became sensitive to heat and almost faint, went to hospital with high heart rate and panic, nausea, diarrhea, anxiety, insomnia, akathesia, tinnitus, burning nerves in my feet and palm/fingers.

 I don’t know why this happened to me? Why even during very slow taper with liquid! Then the specialist told me to go up but now I’m worse and not stabilizing!

having so many symptoms and cannot function or go to

work! I cry every day and pray to heal. ! I do have some good days with Les symptoms but than I get hit again hard and seems to become worse!

am I kindled????? I tried some vit b12 , omega 3 , valerian, chocolate, decaf coffee but it seems that my body cannot have it!

I took some benzo 1/2 pil sometimes to calm down but I’m afraid to take anything and prefer just to

suffer!

some days I have some hope and I can manage to do some stuff in my house like cooking, karaoke.

 

i also have sensitivity to sound and busy places , going with noise canceling plugs in the supermarket and still get that anxiety and claustrophobia which I never had!

I feel my CnS hyperactive and feel depressed, crying all time!

It’s now 5 weeks since I went back to full dose but still feeling crap!

I don’t understand why I feel like this as I didn’t even taper so much! Just 4mg in 3 months and why did this hit me so hard?

is this kindling and why am I reacting so bad to everything including magnesium and omega 3!

 

I had yesterday horrible back pain due to bad sudden movement and took 1 paracetamol and one ibuprofen 600 and today I felt really bad, with anxiety and burning nerves!

this is beeing tortured alive 😢😢😢😢😢

does someone recognize this?

when will I be again stable ?