JohnsPrologueOneFive Tapering off 20mg Paroxetine and 15mg Mirtazapine after 7 years of mis-info's

[JohnsPrologueOneFive]

 Hi everyone 🙂
First of all I want to thank God for this site and the many (unpaid?) volunteers, admins, and regular posters, who help and inform so many struggling people (like me). Altostrata, Rhiannon, Mapleleafgirl, Brassmonkey... you are saving lives! Guys, you are good-willing, strong, confident and beautiful human beings, no matter where you are at in your life - Together, I believe, there is Hope that this whole ridiculous and inhumane situation around WD syndromes, ADs dependence, misinformed doctors and money-driven pharma's will stop one day... Actually, it is stopping, with each new study coming out, each post, each tapering success story.

 

So here's my story: (sorry if it's long! Its a huge step for me sharing it.)
I'm a 27 year old guy in Austria, I like sports, I'm blessed in having a loving, caring family, friends, and interesting studies at the university. Had a harsh break up in 2015. I felt very strange afterwards: no energy, constant flu-like, no sleep/appetite etc... but not "sad" or "depressed" (Ha! if it were only that simple!) Had no clue what it was, totally new, never felt that way. 2 months in that horrible state, I couldn't function! Doctor diagnosed depression, prescribed 20mg Paroxetine in the morning and 15mg Mirtazapine at night, saying these are not addictive, in two weeks I'll be better. (I maintained this schedule most of the time until 2023.) Yes, the pills really helped me to get back on my feet quickly! However, Jesus.... if I would have known -back then- about the horrible WD, the vicious side of big-pharma and the systematic lack of proper knowledge of doctors/GPs around ADs and the whole tapering thing...

 

Tried several attempts to get off the pills in the past 7 years -always in accordance with my doctor- never worked. Of course. Because I had no info or clue whatsoever on 10%taper, surviving ADs, Mark Horowitz & Taylor study etc... And neither does she - she's a very friendly, kind human, no prob... but misinformed old-school psychiatrist not ready to change her ADs-worldviews (sadly a common situation you guys might know well... )

 

"Just take 20mg Paroxetine one day, and 10mg the next day alternating for two weeks. After that, take 10mg one day, and 5mg the next day alternating for two weeks again. And after that, we'll tackle the mirtazapine". Or: "Try skipping doses, one day you take a dose, next day no dose, dose, no dose..." 

 

Always resulting in mild to severe withdrawal (not depression relapse as I now finally know!), frustration, loss of hope in my own body's autonomy, and in the usual doctor's: "Well-apparently-your-body-can't-handle-the decrease-so-you-may-just-take-them-for-the-rest-of-your-life-it's-nothing, just-a-pill-after-all".  I REFUSE to believe that. I feel deep down in my body & mind I don't need the pills. My body is OK. My brain is OK. Either I am missing out something, or she is, or idk what... but I am OK the way God created me.

 

In 2017 I started psychotherapy, did it for 3 years, it actually helped, learned a lot about myself and life, but at one point I didn't feel the need to continue since I didn't have anything more to say. So I stopped before going in circles. Plus: this sh*ts expensive haha.

Since 2022, one year ago, I decided to slowly taper kinda improvising (I didn't know about "surviving ADs" or 10% tapering). I made no record and don't remember exactly unfortunately, but I did something like this: (Mirtazapine allways the same 15mg every night until today)

 

day 1: 20mg Paroxetine

day 2: 20mg P.

day 3: 15mg P. 

Repeating this 3-day cycle: 20-20-15, 20-20-15 etc... and hold (for a month or two).

 

Then repeating 20-15-15 etc... and hold. Then repeating 15-15-15 etc... and hold. Then repeating 15-15-10 etc... and hold...
Alongside with coping mechanisms like jogging, Wim Hof breathing exercices and ice baths, cold water swimming, meditation, intermittent fasting, going to church praying... the WD symptoms (brain zaps, electric skin feeling, anxiety) were somehow manageable, I could somehow live life.

 

The last written record I have is:

October 2022: 10-10-5 etc... (mg Paroxetin, three-day-cycle)

November 2022: 10-10-5,  10-5-5  ;   10-10-5 , 10-5-5 ; etc... (alternating 2 distinct three-day-cycles) 

December 2022: 10-5-5 etc... 

At each step-down I had the usual symptoms: cryfullness, anxiety, diarrhea, irritable, fear, heart/chest pain... (you know the deal). But somehow manageable and lessening after some time (coping mechanisms? stupid "man-up" mindset? Maybe at one point our psyche just incorporates the actual WD symptoms into a "that's-normal-state"? or idk why?) Symptoms were creeping up through jan/feb, until all hell broke loose on 12.March 2023...

 

January, february, until early March 2023: 10-5-5-5-5-5 , 10-5-5-5-5-5 etc... (mg Paroxetin, six-day-cycle).

I repeated that 8 times, until 12.March 2023 where I had a complete, total crash: woke up in the middle of the night, fear/panic, heart racing, shaking, cold hands and feets (no blood flow, literally blue), extreme irritability... Hell on earth. The next morning I straight took 20mg Paroxetin out of fear, but then decided to stabilize at 10mg daily for at least a month.

 

When I discovered this forum the 13.March 2023 it was like the sun of justice has risen! Finally. I am OK. My doctor is wrong. I am not tapering correctly. These are severe WD symptoms. They will get better. I will successfully be off the pills in the future! Hallelujah 🙂 I wanna make this clear: Yes, I wish I would have known about this forum looong ago... But: I don't blame the doctor. I don't judge myself for not knowing all this stuff. These years actually were the worst and best experience in my life, very humbling, urging me to bring to the surface the very best version of myself, it helped me to value health, life & and especially: faith! Now my horizon is just: how can we, as a society, peacefully move forward out of this criminal systemic crisis designed by corrupted pharma lobbies and their misinformation about psychotropic WD and correct dosages for tapering.

 

Today, 03.April 2023, my daily schedule since 3 weeks is 10mg Paroxetin, 15mg Mirtazapin. WD symptoms have gradually disappeared, thank God! Some ups and downs in wave patterns over that time, but now I'm 99% good. I still have a very mild vertigo sensation sometimes when I walk outside (as if my brain doesn't process information to my feet quickly enough... very odd), and very mild morning anxiety (only some days).

Supplements occasionaly: Magnesium Chloride (MgCl2), cheap and works wonders for the CNS, sleep, infections... Vit D, Zinc...

 

My new taper plans

Conservative: 10% taper per month, starting dose: 10mg Paroxetine, jump off dose:  something below 1mg. Duration: 2 years (or 24 steps). Hopefully I can speed up things a bit because I'll need to taper the mirtaz. afterwards, but I'll see as I go, and anyway I don't care, my goal is to once and for all stop those pills.

 

Method 1: Digital mg scale ("CT-250 On balance 0.001g x 50g")

I've bought this scale for 80€, seems pretty stable and precise, it even has a level-bubble 🙂, kindof a "Gemini 20" equivalent.

Weight of one paroxetine 40mg pill: 0.495g. Therefore, when powdered, 1mg paroxetine should weigh: 0.495g / 10 = 0.049g

Weight of one mirtazapine 30mg pill: 0.303g. Therefore, when powdered, 1mg mirtazapine should weigh: 0.303g / 30 = 0.010g

So the scale method should help me going down through the end taper I guess...?

 

Method 2: Liquid

I read through Rhiannon's threads, that most pills actually are soluble in water. My main concern: is the small amount of white powdery residue of paroxetine at the bottom of the glass problematic? It should be only fillers, right? and the AI is evenly distributed in the water when shaking...

 

Method 3: Tapering strips     
Any experiences with this method? Does it work? Because it seems too good to be true! They ship worldwide personalized and customizable dosages of nearly all ADs, antipsychotics, anxiolytic pills etc... from "Cinderella Therapeutics" through "Regenboog Apotheek" in Netherlands. One strip is 28 days of pills. According to them, the most prescribed trajectory for 20mg Paroxetin daily intake is:

taper period 84 days // 3 strips (3 x 28days) // Strip 1: 20-10mg, Strip 2: 10-2.5mg, Strip 3: 2.5-0mg. (see tables, source: https://www.taperingstrip.com/) 

 

 

P.C. Groot and J. van Os advocate for a hyperbolic reduction similar to Horowitz & Taylor, but without the 1-month-holds in between. They have published several studies on successfull tapering with their tapering strips:

Groot, P. C., & van Os, J. (2021). Successful use of tapering strips for hyperbolic reduction of antidepressant dose: a cohort study. Therapeutic Advances in Psychopharmacology, 11, 20451253211039327.

Groot PC, van Os J. How user knowledge of psychotropic drug withdrawal resulted in the development of person-specific tapering medication. Therapeutic Advances in Psychopharmacology. 2020;10. doi:10.1177/2045125320932452  

Groot PC, van Os J. Outcome of antidepressant drug discontinuation with taperingstrips after 1-5 years. Ther Adv Psychopharmacol. 2020 Sep 2;10:2045125320954609. doi: 10.1177/2045125320954609 

 

Some results:

• "Most participants were long-time users, many of whom had tried to taper previously: 8% had used antidepressants less than 1 year (40% 1–5 years, 22% 5–10 years and 30% more than 10 years); 70% had tried to taper previously"

• "70% tapered completely using tapering strips"

• "Of participants who had tapered successfully using tapering strips, 72% was still without antidepressant 1–5 years later (follow-up data study 2)."

• "Patients rated tapering with tapering strips as occurring with much less withdrawal"

 

 Other Questions...

- Heart/chest pain WD symptom  - as if you are "heart-broken", thats a strange one...what is that? Is that due to serotonin receptors (5-HT?) in the heart? 

 

- Effect of different brands of the same AD molecule? (Mirtel, Mirtabene => Mirtazapin) Isn't it suposed to be the same chemical? I definately feel something going on in my body/WD symptoms after only 2 days switching to Mirtel when I ran out of mirtazapine abroad...

 

- Pre-crash high 2-3 days before a WD crash I have like a small "feel good, energy high". What is that? My hypothesis is that the body realises the drug level becomes critically low, tries to compensate/catch up, but cannot reach homeostasis and crashes. I experienced this maybe 2 times before a crash. Any thoughts?

 

- Psoriasis skin rash. The two times I had severe paroxetin WD I got those skin problems afterwards for few weeks, allthough not very problematic. I believe it is linked to stress hormone levels. Anyone else got that? 

 

Thanks for reading my post. I'll be happpy to answer questions! 🙂

Good luck on your journeys! 

 

"I am not a doctor and this is not medical advice. Just an informed opinion."

 

[Altostrata]

Welcome, @JohnsPrologueOneFive

 

On 4/3/2023 at 4:50 AM, JohnsPrologueOneFive said:

Today, 03.April 2023, my daily schedule since 3 weeks is 10mg Paroxetin, 15mg Mirtazapin. WD symptoms have gradually disappeared, thank God! Some ups and downs in wave patterns over that time, but now I'm 99% good. I still have a very mild vertigo sensation sometimes when I walk outside (as if my brain doesn't process information to my feet quickly enough... very odd), and very mild morning anxiety (only some days).

 

Good to hear you're doing better with this reinstatement. Paroxetine is a particularly difficult drug to go off. You may wish to stabilize for several months before attempting a very gradual taper.

 

Paroxetine (and mirtazapine) may be available in liquid form by prescription in your country. Compounding pharmacies can also make liquids. Tapering strips are quite reliable. You'll have to check that your insurance covers any of these.

 

We have many people here tapering with do-it-yourself paroxetine (or mirtazapine) suspensions made with water or pharmacy liquid. Tapering with liquid or tapering strips is very much easier than weighing doses.

 

FYI Tips for tapering off paroxetine (Paxil, Seroxat)

 

If I were you, I'd taper off paroxetine first, leave the mirtazapine to support your sleep. This is very important while tapering, because it's very common that dose reduction causes sleep disruption.

 

To answer your other questions:

 

On 4/3/2023 at 4:50 AM, JohnsPrologueOneFive said:

- Heart/chest pain WD symptom  - as if you are "heart-broken", thats a strange one...what is that? Is that due to serotonin receptors (5-HT?) in the heart? 

 

We do not know the physical cause of many withdrawal symptoms. The drugs affect everything in the body, not just serotonin receptors.

 

People sometimes notice differences among drug brands, sometimes significantly.

 

Mania or hypomania are among known psychiatric drug withdrawal symptoms. It sounds like you experience this for a couple of days before more severe withdrawal sets in.

 

People sometimes get skin rashes while tapering or as a withdrawal symptom. As I said, paroxetine is particularly difficult and generates many withdrawal symptoms.

 

[JohnsPrologueOneFive]

Dear Altostrata,

 

Happy Easter. Thank you so much for your detailed reply!

 

On 4/5/2023 at 9:49 PM, Altostrata said:

Good to hear you're doing better with this reinstatement. Paroxetine is a particularly difficult drug to go off. You may wish to stabilize for several months before attempting a very gradual taper.

Yes paroxetin indeed is a difficult drug... I'm doing better now but I decided yesterday to up the dose a bit: 15mg for 2-3weeks and see... and go up to 20mg (my original dose) if needed. I'm doing "ok" thank god, but not "good" (and life is supposed to be "good" not " well.. ok..."!)

 

After my first crash on 12.March 2023 I took 10mg paroxetin daily for 2 weeks and started monitoring and writing down my symptoms. Each day was getting better, with some little ups and downs along the way. The steady state of paroxetine is reached after 7-14 days (Horowitz & Taylor study 2018) and indeed around day 10 to 14 after a crash I noticed that an equilibrium state (drug intake and metabolization by the body) sets in.

 

HOWEVER: In those 2 weeks I did another mistake:

taking half a 20mg pill instead of a quarter of 40mg pill (splittable pills, same brand).  Logically, I thought that's 10mg either way. Well, guess what: no! I did that 3 to 4 times in those 2 weeks, which resulted in a second WD crash on 2.April; however this one was a lot shorter and less stronger: woke up in the middle of the night, fear, panic, cold hands, tinnitus... 6/10, and extreme shaking and trembling (9/10 this symptom was stronger than in first crash).

 

Lesson learned: no more switching pills whatsoever even if they are supposed to be same dosages: every day one quarter of a 40mg pill, PERIOD. Strictly writing it down in my notes.

 

Why 1/2 of 20mg is not equal to 1/4 of 40mg? I don't know for sure... but at such doses, 1mg of difference in Active ingredient may happen, and it can make a huge difference in the brain?  Maybe the pills are produced differently? Maybe the 20mg batch was not as "powerful" as the 40mg batch? This may be paranoid but: Maybe here and there they throw-in placebos in their pills? I doubt that, but who controls or inspects what they do? With every such arising questions I just trust big (p)harma less and less...

 

It has been 2 weeks of 10mg (one quarter of 40mg). I'm doing a lot better but still not 100% ok: dizziness, anxiety, vertigo, pressure in my head (up the nose) all like 2 or 3/10 severity. Yesterday i had to take 1/2 of 20mg because I had no more 40mg pills. Guess what?! 14h later at 2 o'clock in the morning, Boom! Anxiety, no sleep, cold hands. The short half life of paroxetin of 20h is really tricky... 

 

Today, looking at the past 2 weeks I am not 100% satisfied with my state of mind, so I decided to do the following: 

up the dose to 15mg daily for 2-3 weeks. Watch out for symptoms

If I'm still not 100% ok, up the dose to my original dose 20mg.   

 

Now I'll be gentle with myself, letting my nervous system relax a bit from the crashes, 3-4months... Then I'll taper with tapering strips, and select a conservative trajectory of 4-5months, from 15 or 20 to 0mg. If that doesn't work I will taper 10% per month as in this forum. 

 

On 4/5/2023 at 9:49 PM, Altostrata said:

If I were you, I'd taper off paroxetine first, leave the mirtazapine to support your sleep. This is very important while tapering, because it's very common that dose reduction causes sleep disruption.

True that! 👍

 

 I 'll write an email to prof. Peter Groot and Jim van Os to ask why "SurvivingADs" advocates for 10%per month taper (which for me means 3+years to stop 20mg paroxetin and then 2+years for 15mg mirtazapin...), when tapering strips studies show success in way faster tapers of 2- 4 months?

 

 

On 4/5/2023 at 9:49 PM, Altostrata said:

Paroxetine (and mirtazapine) may be available in liquid form by prescription in your country. Compounding pharmacies can also make liquids. Tapering strips are quite reliable. You'll have to check that your insurance covers any of these.

Unfortunately, Paroxetin liquid is not available in Austria. I've heard that in the Netherlands insurance doesnt cover the tapering strips (which is an absoltue scandal). But I'll see with my insurance... It isn't a huge deal for me anyway...

 

If anybody reading is interested: there are great infos on tapering etc.. on youtube on "World Taper day" and "Mad in Amercia" where Peter Groot and Jim van Os talk about their studies on tapering strips and ADs.

 

I'll be posting here how I go along the way!

 

Thanks a lot, have a nice day! :-)

 

[Altostrata]

Hello, @JohnsPrologueOneFive

 

How are you doing?

 

You can order tapering strips to support any rate of taper you wish. van Os and Groot found some people ordered shorter courses, some ordered longer courses to taper.

 

We advocate a 10% taper because we have found that it works for many people who had difficulty going off more quickly. If we had magic to enable people to go off faster, we would share it with everyone.

[JohnsPrologueOneFive]

On 4/28/2023 at 4:31 PM, Altostrata said:

Hello, @JohnsPrologueOneFive

 

How are you doing?

 

You can order tapering strips to support any rate of taper you wish. van Os and Groot found some people ordered shorter courses, some ordered longer courses to taper.

 

We advocate a 10% taper because we have found that it works for many people who had difficulty going off more quickly. If we had magic to enable people to go off faster, we would share it with everyone.

Hello @Altostrata,

 

Thank you for replying! 

 

Thanks, I am doing good finally! 🙂 I decided to go back up to my original dosage of 20mg Paroxetin daily, It's been more or less two weeks, and all symptoms such as vertigo, dizziness, fear etc... have gone away, thank God! I considered it more wise since I wasn't 100% happy with my state of mind at 15mg daily, I also had important work to do at university which necessitated that I'm the ''normal" functioning me. 

 

I plan to stay at 20mg P. and 15mg Mirt. daily for 3-4months, change my doctor (i already have a potentially good address!), and then order the tapering strips with a little bit longer trajectory than what Groot and van Os usually do. Something on those lines: 

 

First month: from 20mg Paroxetin to 15mg

Second month: 15 to 10mg

Third month: 10 to 5mg

Fourth month: 5 to 2.5mg

Fifth month: 2.5 to 0mg

 

The only thing I noticed is still the slight tinnitus. I tend to hear it when I try listening to it. When my mind is occupied with something else I don't really hear it, but I guess it is still there but not perceived as such. I'm not sure if it was caused by the pills, because I always had kind of a ringing noise in my ears before already I think... 

One also has to be careful not to get hypochondriac: if you get obsessed with looking for symptoms, you can always find something...

Anyways, it's not so annoying, I can live with that. 

 

I'll keep updates here and there.

Thank you again :-) 

God bless you

 

[Altostrata]

2 hours ago, JohnsPrologueOneFive said:

First month: from 20mg Paroxetin to 15mg

Second month: 15 to 10mg

Third month: 10 to 5mg

Fourth month: 5 to 2.5mg

Fifth month: 2.5 to 0mg

 

The speed of this taper is about twice that we recommend. Paroxetine is a particularly difficult drug to go off. You have prior episodes of withdrawal. This adds up to your situation being high risk for withdrawal. Good luck with your taper.