Freeing myself from paxil; suggestions welcome!
August 21, 2012 9:40 PM Subscribe
On paxil for 10 years and want to go through life med-free. Please share specific tips or knowledge about managing my experience. Snowflake inside...
I'm a 26 year old female, originally prescribed paxil for anxiety/depression/eating disorder symptoms, but at 15, it was coded as general adjustment disorder. I am at a place in my life where I finally have the confidence and stability of location to commit to tapering off of paxil, with the help of a psychiatrist and therapist. I've been taking 60 mg, once a day, and have just tapered down to 40mg.
While I still have minor symptoms of anxiety and eating disorder that I continue to manage, I am a generally well adjusted person and I don't want to be on medication for the rest of my life. It means a lot to me to do this for myself, but I am also very scared of what the process will be like and how I will handle it emotionally. I have read other information, including this post about what to expect.
I have a demanding job that is relatively high stress and involves a lot of interacting with people, so managing my reaction to this is important.
Any specific suggestions about how others dealt with the process would be much appreciated. For example, are there certain vitamins that would be helpful? Journal exercises? Cognitive tricks?
Finally, for anyone with some science knowledge, is it possible that, after 10 years of being on paxil, my brain will not be able to produce serotonin effectively?
I should include that it's been about 4 days since I've lowered the dose and I've noticed the following symptoms: skin sensitivity, especially nipples; heightened propensity for tears over nothing, slightly less desire to interact with other people.
I apologize if there is already another question about this that I missed, but I'd really appreciate any advice people have to share!
I'm a 26 year old female, originally prescribed paxil for anxiety/depression/eating disorder symptoms, but at 15, it was coded as general adjustment disorder. I am at a place in my life where I finally have the confidence and stability of location to commit to tapering off of paxil, with the help of a psychiatrist and therapist. I've been taking 60 mg, once a day, and have just tapered down to 40mg.
While I still have minor symptoms of anxiety and eating disorder that I continue to manage, I am a generally well adjusted person and I don't want to be on medication for the rest of my life. It means a lot to me to do this for myself, but I am also very scared of what the process will be like and how I will handle it emotionally. I have read other information, including this post about what to expect.
I have a demanding job that is relatively high stress and involves a lot of interacting with people, so managing my reaction to this is important.
Any specific suggestions about how others dealt with the process would be much appreciated. For example, are there certain vitamins that would be helpful? Journal exercises? Cognitive tricks?
Finally, for anyone with some science knowledge, is it possible that, after 10 years of being on paxil, my brain will not be able to produce serotonin effectively?
I should include that it's been about 4 days since I've lowered the dose and I've noticed the following symptoms: skin sensitivity, especially nipples; heightened propensity for tears over nothing, slightly less desire to interact with other people.
I apologize if there is already another question about this that I missed, but I'd really appreciate any advice people have to share!
Really high grade marijuana in really, really small amounts (get a vaporizer). I'm serious.
As you really start to cut back, start a 5-HTP + Vitamin D regimen, with a real emphasis on the Vitamin D.
posted by lobbyist at 9:50 PM on August 21, 2012 [1 favorite]
As you really start to cut back, start a 5-HTP + Vitamin D regimen, with a real emphasis on the Vitamin D.
posted by lobbyist at 9:50 PM on August 21, 2012 [1 favorite]
Any specific suggestions about how others dealt with the process would be much appreciated
Others can speak to the specifics of tapering off; my comment is to please listen to warning signs from yourself and your doctors if tapering off turns out to not be the right thing at this time. A couple of people in my family have had to learn the hard way that they need their medications, even though they wanted to be off of them. I'll spare you the details (because your situation is your own, etc), but don't get so fixated on the goal of living medication-free as to lose the real goal of living a good life.
posted by Forktine at 10:22 PM on August 21, 2012 [8 favorites]
Others can speak to the specifics of tapering off; my comment is to please listen to warning signs from yourself and your doctors if tapering off turns out to not be the right thing at this time. A couple of people in my family have had to learn the hard way that they need their medications, even though they wanted to be off of them. I'll spare you the details (because your situation is your own, etc), but don't get so fixated on the goal of living medication-free as to lose the real goal of living a good life.
posted by Forktine at 10:22 PM on August 21, 2012 [8 favorites]
It may not be as overwhelming as you think. I think it's important not to substitute over the counter meds or alcohol/marijuana for you Paxil, of course, as that could lead to a downward spiral. However, being able to rest well and actually look forward to bed time is important (to me anyway). Being anxious at night and having insomnia can also lead to a downward spiral, so develop a relaxing bed time routine and perhaps take something to help you sleep, like daily melatonin. I take one advil PM (more than one gives me terrible restless leg syndrome and I can't sleep at all, so be careful with that type of med), and I sleep very well and wake up at 5, at which point I have some great me time before work. Good luck!
posted by waving at 3:48 AM on August 22, 2012 [1 favorite]
posted by waving at 3:48 AM on August 22, 2012 [1 favorite]
Paxil is brutal to come off of - I had symptoms for weeks. If you have tapering symptoms your doc may suggest supplementing with Prozac to help. I know that sounds insanely counterintuitive, but Paxil has a really short half life - which is what makes the tapering period so hellish - and Prozac has a really long half life, so it really does help.
posted by 8dot3 at 5:16 AM on August 22, 2012 [3 favorites]
posted by 8dot3 at 5:16 AM on August 22, 2012 [3 favorites]
I agree with the advice that Forktine and waving's advice.
Its true that people have a tendency not to want to be on a medication for the rest of their lives, especially to treat something like anxiety or depression. While this is understandable, your goal should ultimately be what is going to give you the most healthy and fulfilling life. Getting mental health help, either from therapy or medication, are still greatly stigmatized. But the way I try to think of it is this: if I got cancer, I would explore every medical option available to fight it.
Finally, I want to mention that you should start developing new resources, outlets, and strategies for dealing with anxiety. What healthy things do you like to do that help you feel less anxious? Start incorporating those into your life now.
posted by emilynoa at 5:58 AM on August 22, 2012
Its true that people have a tendency not to want to be on a medication for the rest of their lives, especially to treat something like anxiety or depression. While this is understandable, your goal should ultimately be what is going to give you the most healthy and fulfilling life. Getting mental health help, either from therapy or medication, are still greatly stigmatized. But the way I try to think of it is this: if I got cancer, I would explore every medical option available to fight it.
Finally, I want to mention that you should start developing new resources, outlets, and strategies for dealing with anxiety. What healthy things do you like to do that help you feel less anxious? Start incorporating those into your life now.
posted by emilynoa at 5:58 AM on August 22, 2012
I wrote this question a while back, and I am now successfully down to the lowest possible dose I can be on, and am ready to stop taking it altogether in the next few days.
I tried unsuccessfully to get two different doctors to prescribe me some Prozac (fluoxetine) to help coming off, since what I read about half life and withdrawal really made sense, but since there are no clinical trials documenting this, neither doctor was willing to prescribe the off label usage.
One doctor did endorse me taking Benadryl to deal with brain zaps, dizziness, nausea, and that has helped.
Teeny tiny amounts of marijuana have helped. I'm saving up for a vaporizer.
Knowing that it will be uncomfortable, and that my anxiety will resurface, has helped. I do get more anxiety now, but try to recognize it for what it is, and then take steps to deal with it.
The thing that has helped the most is mindfulness meditation. Helps in recognizing anxiety, and in gaining distance from and perspective about my worries, emotions, and thoughts. Also helps to cultivate a more approach oriented response to discomfort and sadness...I've been more tolerant and accepting of withdrawal symptoms, both physical and mental, and less inclined to fear them, suppress them, or try to escape them. I recommend The Mindful Way Through Depression.
Good luck! Feel free to memail me if you'd like any more information or support! Oh and if you find that this is not the best time to come off of them, or that you want to stay on them after all, be gentle with yourself and know that you gave it a try and you can always try again, and that you'll be more prepared each time to deal with what it feels like and brings up for you.
posted by whalebreath at 6:37 AM on August 22, 2012 [2 favorites]
I tried unsuccessfully to get two different doctors to prescribe me some Prozac (fluoxetine) to help coming off, since what I read about half life and withdrawal really made sense, but since there are no clinical trials documenting this, neither doctor was willing to prescribe the off label usage.
One doctor did endorse me taking Benadryl to deal with brain zaps, dizziness, nausea, and that has helped.
Teeny tiny amounts of marijuana have helped. I'm saving up for a vaporizer.
Knowing that it will be uncomfortable, and that my anxiety will resurface, has helped. I do get more anxiety now, but try to recognize it for what it is, and then take steps to deal with it.
The thing that has helped the most is mindfulness meditation. Helps in recognizing anxiety, and in gaining distance from and perspective about my worries, emotions, and thoughts. Also helps to cultivate a more approach oriented response to discomfort and sadness...I've been more tolerant and accepting of withdrawal symptoms, both physical and mental, and less inclined to fear them, suppress them, or try to escape them. I recommend The Mindful Way Through Depression.
Good luck! Feel free to memail me if you'd like any more information or support! Oh and if you find that this is not the best time to come off of them, or that you want to stay on them after all, be gentle with yourself and know that you gave it a try and you can always try again, and that you'll be more prepared each time to deal with what it feels like and brings up for you.
posted by whalebreath at 6:37 AM on August 22, 2012 [2 favorites]
The best way to deal with going med-free is to have good coping skills in place and use them actively, on a daily basis. You'll also want to be diligent about taking care of yourself. Some of the things that keep me feeling good:
Walks through nature and meditation are both fantastic for reducing stress.
This was mentioned in the other thread: you might keep a record of your mood levels to track how you're doing. It may sound silly, but you'd be surprised at how much you can ignore without being aware of it. Definitely work with your therapist to address any issues that pop up.
When I came off of meds, I had some killer withdrawal symptoms and was pretty emotionally raw for a while. If I could do it again, I'd taper off waaaaay more slowly.
(I wouldn't personally consider 5-HTP medication-free, and I'd be cautious about using it.)
posted by moira at 7:35 AM on August 22, 2012 [2 favorites]
- Sleep. OMG sleep. Regular schedule, good quality and quantity.It sounds like stress is going to be a key point for you, so you might want to look into ways of reducing it. Maybe take deep breaths and relax your muscles several times a day. Maybe rearrange your environment a little, or do some problem-solving to help things go a little more smoothly. You could carve out a serene bit of quiet time alone midday to help you feel refreshed. Remember to let some things go. Pick a mantra that calms you and keeps you focused on the big picture.
- Daily mental health maintenance. I try to keep this small and approachable, no more than 15 minutes/day. Right now, it includes listing 5 things I'm grateful for each day. I also try to have moments of relaxed appreciation (mindfulness) throughout the day. Beyond that, I might spend a few minutes problem-solving in my journal, working through a CBT workbook, etc.
- Related, if something difficult comes up, I try to use healthy coping skills to deal with it. That might mean CBT techniques, gradual approach, stress reduction, etc.
- Eating all my meals.
- Exercise.
- Meaningful or enjoyable activities, done mindfully.
- A relatively clean environment. I feel crappy and overwhelmed, otherwise.
- Social connection and support.
Walks through nature and meditation are both fantastic for reducing stress.
This was mentioned in the other thread: you might keep a record of your mood levels to track how you're doing. It may sound silly, but you'd be surprised at how much you can ignore without being aware of it. Definitely work with your therapist to address any issues that pop up.
When I came off of meds, I had some killer withdrawal symptoms and was pretty emotionally raw for a while. If I could do it again, I'd taper off waaaaay more slowly.
(I wouldn't personally consider 5-HTP medication-free, and I'd be cautious about using it.)
posted by moira at 7:35 AM on August 22, 2012 [2 favorites]
I really support your choice to move from managing your issues with medications to managing them with other modalities.
As a general rule, substituting non-prescription drugs for prescription drugs is something you want to talk about carefully with your doctor(s). Non-prescription drugs may be equally or more effective and/or have fewer side effects, but they are also drugs and have chemical effects and interactions with prescription drugs that your doctor(s) need to know about. Doctors aren't going to narc on you if you use weed to help manage your anxiety or ED, I promise, but they 100% need to know that's happening while they monitor how the Paxil tapering is going.
posted by Sidhedevil at 2:16 PM on August 22, 2012 [1 favorite]
As a general rule, substituting non-prescription drugs for prescription drugs is something you want to talk about carefully with your doctor(s). Non-prescription drugs may be equally or more effective and/or have fewer side effects, but they are also drugs and have chemical effects and interactions with prescription drugs that your doctor(s) need to know about. Doctors aren't going to narc on you if you use weed to help manage your anxiety or ED, I promise, but they 100% need to know that's happening while they monitor how the Paxil tapering is going.
posted by Sidhedevil at 2:16 PM on August 22, 2012 [1 favorite]
In case it helps you (or anyone), I have avoided any noticeable side effects from Paxil tapering by doing it over an insanely long period of time.
My daily dose is 20mg for OCD and depression, and has been for maybe 15 years. Three different times I have tapered it down with the help of a pill chopper. Something like:
Week 1: alternate (roughly) 3/4 of a pill with full pill
Week 2: maybe 5 days of 3/4 pill mixed with 2 of full pill
Week 3: 3/4 pill all days
Week 4: a couple days of 2/3 pill, and 3/4 pill on the rest
Week 5: most days 2/3 pill, some with 3/4
etc
The good outcome is that I haven't noticed any of the common Paxil withdrawal symptoms.
The not-so-good outcome is that I have eventually noticed I was less pleasant to be around than when I was taking the full dose. So, I have abandoned the reduction and gone back to the full dose. The last time I tapered off, I held constant for several weeks at a half dose. I thought I was doing fine, and planned to resume further tapering. Until my wife said she thought we needed to go into counseling. That was my reality check! I resumed taking the full dose and things have been much better since then.
So I'd echo the advice of Forktine and others: as much as we'd prefer to be drug-free, there are worse things. I wish you the best with whatever you find works for you.
posted by Snerd at 4:05 PM on August 22, 2012 [3 favorites]
My daily dose is 20mg for OCD and depression, and has been for maybe 15 years. Three different times I have tapered it down with the help of a pill chopper. Something like:
Week 1: alternate (roughly) 3/4 of a pill with full pill
Week 2: maybe 5 days of 3/4 pill mixed with 2 of full pill
Week 3: 3/4 pill all days
Week 4: a couple days of 2/3 pill, and 3/4 pill on the rest
Week 5: most days 2/3 pill, some with 3/4
etc
The good outcome is that I haven't noticed any of the common Paxil withdrawal symptoms.
The not-so-good outcome is that I have eventually noticed I was less pleasant to be around than when I was taking the full dose. So, I have abandoned the reduction and gone back to the full dose. The last time I tapered off, I held constant for several weeks at a half dose. I thought I was doing fine, and planned to resume further tapering. Until my wife said she thought we needed to go into counseling. That was my reality check! I resumed taking the full dose and things have been much better since then.
So I'd echo the advice of Forktine and others: as much as we'd prefer to be drug-free, there are worse things. I wish you the best with whatever you find works for you.
posted by Snerd at 4:05 PM on August 22, 2012 [3 favorites]
Response by poster: Thank you all so much for your thoughtful responses. It really does help me to think about the options I have. And I take seriously the reality that I may end up choosing being medicated as a necessary evil of sorts. I worry that, as our body is a system, putting something in on one end is bound to have consequences (positive/negative) and that the longitudinal studies on SSRI long-term effects just don't have the time under their belt to really capture these consequences. Also, there is the (remote) possibility that I might one day want to have children, and I know that Paxil isn't ideal for pregnancy. But I do take seriously the reality that I may need to consider another kind of medicine rather than go sans medication.
At this early point, I'm having some emotional imbalance, among other symptoms but still want to continue treatment, so the tips on managing withdrawal symptoms are appreciated.
posted by sb3 at 9:11 PM on August 23, 2012
At this early point, I'm having some emotional imbalance, among other symptoms but still want to continue treatment, so the tips on managing withdrawal symptoms are appreciated.
posted by sb3 at 9:11 PM on August 23, 2012
The very best tip I know to give about decreasing withdrawal symptoms is to bump dosage back up a bit and taper off much more slowly. I totally get the desire to be done with it, already, but it's worth taking a little extra time.
posted by moira at 6:45 PM on August 24, 2012 [1 favorite]
posted by moira at 6:45 PM on August 24, 2012 [1 favorite]
This thread is closed to new comments.
posted by sb3 at 9:42 PM on August 21, 2012