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Took Paroxetine for 13 years from 2002-2015. Then I decided I want to feel real emotions again like a real human being and went off of it cold turkey on September 1st 2015. After three weeks of brain zaps I was finally free! Or so I thought...

Felt good for two months before anxiety and desperate thoughts ruled my life. In February I realized I was in severe depression.

Decided to return to Paroxetine not knowing about the initial side effects (had none in 2002). Had three days of pure horror and was truly determined to end my life for the first time ever. Immediately stopped and tried St. John's Wort instead. Had a good week but then I couldn't sleep and thus not function at work so I tried to do without any medication again. That didn't work out well so on March 17th I began taking Citalopram (Celexa). First four days 10mg, then 20mg. To calm me down in order to be able to sleep I also took 1mg of Fluanxol every day at 4pm. Endured seven weeks including a few suicidal days. But the Citalopram didn't do squat for me!

Decided that I should give Paroxetine another try and stopped taking Citalopram+Fluanxol on May 3rd. Took nothing on May 4th and then immediately started with 20mg of Paroxetine on May 5th. In the past I had taken it in the evening but now I was afraid of insomnia and thus I currently take it in the morning at 6am. Side effects now have been anxiety, desperate thoughts and sweaty hands and feet. Only in the evening I always feel relaxed and normal.

Read about Paxil not working well for many people the 2nd time around which scared me to death because it seems to be the only med that worked for me.

Now today, it's day 17 back on Paroxetine, something happened: at 5pm I suddenly went into zombie mode for 3 hours. Zombie mode is the state I was in the 13 years of taking Paroxetine the first time. It's like there is a glass pane before my eyes shielding me. It's like there is a barrier in my head protecting me. It's like I'm not really here. But I can partake in anything without fear. I was happy that I finally got to be in this state again! There was no depression and no fear. I can't live unprotected like normal people. I tried and failed. I need my zombie mode back! Unfortunately after three hours it ended and anxiety returned.

Hope this experience today means that Paroxetine already starts working again! My life may depend on it.

I'll glady stay in zombie mode for the rest of my life if it means I don't have to suffer from depression and suicidal thoughts anymore. Better undead than dead.

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What other antidepressants have you tried? There are tons of other options, and they might not make you a "zombie". There's a whole world of them out there. 

I personally had the "pure hell" reaction to Paxil, but I have bipolar disorder. Paxil made me batshit for 2 weeks. Celexa did absolutely nothing. It was absolutely useless. If those are the only ones you've tried, maybe try others.

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Thanks for the advice, but I'm in really big trouble right now, can't afford to experiment with other options. Better the devil you know... I pray Paxil will kick in soon.

Well, if it hasn't worked after 2 months (today is day 20) I won't have a choice but to try others.

Celexa was completely useless for me, too.

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Sorry Paxil isn't working as well for you this time around.

SSRIs may decrease dopamine release when taken chronically due to stimulation of 5-HT2C receptors by increased serotonin (except fluoxetine (Prozac), which is a 5-HT2C antagonist, and therefore a NDDI (norepinephrine dopamine disinhibitor) as well, and sertraline (Zoloft), which has moderate dopamine reuptake inhibition). This dopamine inhibiting effect is possibly responsible for the emotional blunting effect ("zombie effect") felt by those taking SSRIs chronically. Agents that increase dopamine generally tend to resolve this emotional blunting. 

So a pdoc may may add one or more agents or switch their patient to another agent to either maximize dopamine stimulation (within safe limits) or minimize dopamine release inhibition. This includes adding bupropion (Wellbutrin), an NDRI (norepinephrine dopamine reuptake inhibitor) as an adjuvant agent (in addition to an SSRI or SNRI); adding a stimulant such as methylphenidate (Ritalin, Concerta, Metadate, Quillivant XR, etc.), dexmethylphenidate (Focalin), mixed amphetamine salts (Adderall), amphetamine (Evekeo), dextroamphetamine (Dexedrine), or Vyvanse (lisdexamfetamine); adding a eugeroic stimulant such as modafinil (Provigil) or Nuvigil (armodafinil); switching to fluoxetine (Prozac), which as aforementioned is a NDDI by means of its 5-HT2C antagonistic effects, or sertraline (Zoloft), which has moderate DRI; switching to an SNRI, such as venlafaxine (Effexor), which at high doses has slight DRI (weaker than that of bupropion, but bupropion is considerably weaker than stimulants in DRI), Pristiq (desvenlafaxine), which is also said to have weak affinity for DRI, duloxetine (Cymbalta), which some studies indicate that it too has slight affinity for the dopamine transporter (DAT), causing weak DRI, or Fetzima (levomilnacipran), which, while it doesn't have affinity for the DAT, is unique among the SNRIs in that its norepinephrine reuptake inhibition (NRI) is stronger than its serotonin reuptake inhibition (SRI) at a ratio of 2:1 (Effexor is 1:30, Pristiq is 1:14, and Cymbalta is 1:10), and NRI, by means of a cotransportational mechanism of action, increases dopamine neurotransmission as will as norepinephrine neurotransmission; adding the 5-HT1A agonist buspirone (Buspar) to augment the SSRI/SNRI, which increases dopamine by means of stimulating postsynaptic 5-HT1A receptors on pyramidal neurons in the cortex, which hypothetically stimulates downstream dopamine release in the striatum, as well as by blocking presynaptic dopamine receptors, or by switching to a SMS (serotonin modulator and stimulator) such as Viibryd (vilazodone) or Brintellix/Trintellix (vortioxetine), which are also 5-HT1A partial agonists; adding a 5-HT2A antagonist such as trazodone (Desyrel, Oleptro) (which can help sleep and anxiety), nefazodone (Serzone) (adding or switching to, can help anxiety but have to watch out for liver toxicity), or mirtazapine (Remeron) (which its main mechanism of action is α2 adrenergic antagonism, which enhances serotonin and norepinephrine release, but it also enhances neurotransmission at the 5-HT1A receptor, so may also enhance dopamine neurotransmission as well, in addition to its 5-HT2A and 5-HT2C antagonism—may help with sleep and anxiety, but have to watch out for weight gain with this one!); or by adding an atypical antipsychotic, most of which are 5-HT1A partial agonists, 5-HT2A and 5-HT2C antagonists (Latuda (lurasidone), Saphris (asenapine), ziprasidone (Geodon), clozapine (Clozaril, only for special cases as its distribution is restricted), quetiapine/Seroquel XR (quetiapine ER), Rexulti (brexpiprazole), Vraylar (cariprazine) (5-HT2A/5-HT2C inverse agonist)—aripiprazole (Abilify) is a 5-HT1A partial agonist/5-HT2A antagonist/5-HT2C partial agonist, Fanapt (iloperidone) is a 5-HT1A/5-HT2A antagonist, and olanzapine (Zyprexa), risperidone (Risperdal) and Invega (paliperidone) are 5-HT1A antagonists/5-HT2A antagonists/inverse agonists), but which are also dopamine antagonists, except for Abilify, Rexulti, and Vraylar, which are dopamine partial agonists (at the D2 and D3 receptors). Some of the atypical antipsychotics are particularly sedating, and some may be particularly troublesome with this side effect (Seroquel (Seroquel XR not as much as IR version), Zyprexa, Saphris (for me, it seemed to be sedating at 5 mg and stimulating at 10 mg), Clozaril), others may depend on the dosage (stimulating at lower doses, moderately sedating at higher doses—Latuda (stimulating generally at 20-40 mg, sedating at 60-120 mg) and Abilify (stimulating generally at 2-5 mg, may become more "relaxing" as one titrates up to 10-15 mg, and may become sedating as one approaches 20-30 mg, but for depression, generally the dose stays at or below 15 mg), while some are generally regarded as having low sedation (Invega, Risperdal, Geodon (stimulating in low doses, such as 20-40 mg twice a day, becomes less stimulating by 60-80 mg twice a day and beyond if if one needs it)). 

Some studies have been done with dopamine agonists in treatment resistant depression (both unipolar and bipolar), particularly pramipexole (Mirapex), but others such as ropinirole (Requip) and Neupro (rotigotine transdermal) may also have benefit too.

Some pdocs may even use a low dose of a first generation typical antipsychotic for treatment resistant depression, such as haloperidol (Haldol) or trifluoperazine (Stelazine) (which can also be beneficial for anxiety), sometimes even chlorpromazine (Thorazine) (very sedating and causes weight gain) or thiothixene (Navane).

Well, those are just some ideas for you to perhaps consider as augmentative or alternatives in case your Paxil ends up not working well for you this time around. I hope your response to Paxil continues to improve. Best of luck to you!

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Whoa thanks a lot for this very elaborate post! You've explained basically every possible option.

I'll try to get by with just one or at worst two meds.

Still hoping Paroxetine will work again. Today I'm 3 weeks on it. Zombie mode has yet to reappear. I'd be happy if it did because then I'd be stable again. Then maybe at some point I could consider getting an additional drug to counter the zombie effect.

Wonder if 20mg are enough. In the 13 years 20mg and even 15mg worked fine but maybe I should up the dose to 30mg.

Should Paroxetine not work at all I think I won't try another SSRI. Citalopram didn't work (so Escitalopram surely won't either) and with Fluoxetine and Sertraline I fear they won't do anything against my social anxiety disorder. They wouldn't help against insomnia either. Paroxetine seems to be the only SSRI with a slight sedative effect.
Sucks that I have to wait until August 1st for a pdoc appointment.

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I'd definitely consider trying a higher dose of Paxil if you aren't getting the response you need. Definitely that before trying an add on treatment. The max dose I believe is 60 mg, there are probably special cases in which one needs even higher doses than that.

5 minutes ago, christi4n said:

Citalopram didn't work (so Escitalopram surely won't either)

That depends on the dose of citalopram (Celexa). If you were at anything below 40 mg, then it's hard to gauge your reaction to Lexapro, however if you were at 40 mg Celexa, then that's said to be equivalent to 10 mg Lexapro but without the side effects (according to Stephen Stahl). So 40 mg Celexa may predict your reaction to 10 mg Lexapro. But know that the Lexapro can be taken to 20 mg (equivalent to 80 mg Celexa), and even 30 mg (120 mg Celexa) and 40 mg (160 mg Celexa). So maybe don't brush off Lexapro just yet.

Fluoxetine (Prozac) and Sertraline (Zoloft) may have robust actions for social anxiety disorder, but indeed they are stimulating, and as such may cause insomnia and initial startup anxiety. You're right about Paxil being one of the only SSRIs with a slight sedative effect. The only other one I think that has a sedative effect is fluvoxamine (Luvox), which for me was quite sedating. Perhaps fluvoxamine would be a good alternative for you, should you need to switch, that is?

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Okay, I'll increase my Paroxetine dose in two weeks if my depression doesn't get better until then.

And if it still doesn't work until August I'll discuss Fluvoxamine and Lexapro with my new pdoc. Though I think I might have lost hope in SSRIs by then and would prefer a different type of antidepressant.

Gotta say St. John's Wort had helped the best against my depression. But sadly not at all against my fears and it induced insomnia.

Thanks again!

Edited by christi4n

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Be sure to clear the dosage increase with your pdoc before going through with it.

What other kind of antidepressant were you thinking about?

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Dunno, maybe Bupropion or Cymbalta. Guess I'll let my pdoc decide after I have told him about my exact problems.

Can't clear the Paxil dosage increase with my pdoc because I don't have one before August 1st. Only have a GP now.

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I liked Cymbalta a lot. I'd definitely recommend a trial of it. The usual dose is 60 mg, but it can be rather stimulating for some when first starting it, so that can be mitigated by starting at 20 mg or 30 mg, and working up to either 40 mg (20 mg twice a day) or 60 mg (30 mg twice a day), then eventually switching to just the 60 mg capsule. For some though, it can be sedating, oddly enough. Good thing is there's virtually no weight gain for most people (I lost 10 lb on it the first week I started it).

I liked Wellbutrin too, I took it for years. It was the first antidepressant to have a favorable response for me. Definitely worth a trial either as an adjunct or by itself. Have to watch out for anxiety though, but for some people (like myself) it counterintuitively helped with anxiety (said to be more common in people with ADHD). Good thing about this med (unless you're underweight or have certain eating disorders) is that it causes weight loss for most people. I lost quite a lot of weight on Wellbutrin (can't remember exactly how much).

Sucks that you have to wait so long for your pdoc. Maybe you could clear the Paxil increase with your GP? And maybe if needed, discuss adding/switching to Wellbutrin or switching to Cymbalta with him/her too? GPs are usually pretty helpful with basic psychiatric needs when in a fix like yours, such as switching antidepressants.

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I'd actually welcome some weight gain (also like that about Paxil). I feel more secure if I'm not too thin. So because of that and because of anxiety I'd try Cymbalta before Bupropion.

Will wait until August though when I finally have a pdoc. I have such good memories of Paroxetine that I'm willing to give it three months to work.

On another note: Is it true that long term SSRI use (or serotonine reuptake inhibition in general) destroys the brain's ability to produce serotonine which leads to very bad things?

Edited by christi4n

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There are also the tricyclic antidepressants (such as amitriptyline (Elavil), imipramine (Tofranil), and nortriptyline (Pamelor) just to name a few), as well as the tetracyclics (amoxapine (Asendin) and maprotiline (Ludiomil) which are both primarily norepinephrine reuptake inhibitors, but amoxapine has some atypical antipsychotic properties "built in" as well (5-HT2A and D2 antagonism)). Some of these may help you to gain some weight (especially Elavil, doxepin (Sinequan), and Ludiomil; Pamelor has less of a chance of causing weight gain for most people, but some people gain weight, sometimes in substantial amounts).

I haven't heard this about SSRI's. Do you have a link to a source or something that explains it? I imagine this could be mitigated by adding something that antagonizes 5-HT1B and/or 5-HT1D receptors, which would increase serotonin release, as well as antagonizing 5-HT7 receptors, which would also stimulate serotonin release. The antidepressant Brintellix/Trintellix is a 5-HT1A partial agonist, 5-HT1B partial agonist (low intrinsic activity, so it's basically an antagonist), 5-HT1D antagonist, 5-HT3 antagonist, and 5-HT7 antagonist in addition to being an SSRI. The atypical antipsychotic Geodon has some meaningful 5-HT1B partial agonism and 5-HT1D antagonism, as well as 5-HT7 antagonism, Risperdal is an antagonist of 5-HT1B, 5-HT1D, and 5-HT7, as is Invega. Rexulti binds to 5-HT1B receptors (not sure if it's an antagonist or what though), and is a potent 5-HT7 antagonist. So there are some agents that could theoretically enhance serotonin release if this were true of SSRI's. Of course I don't know the mechanism of action behind this theory of destroyed ability to produce serotonin... so maybe these agents wouldn't be helpful at all if it were mediated by these receptors somehow.

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10 hours ago, mikrw33 said:

I haven't heard this about SSRI's. Do you have a link to a source or something that explains it?

It was in this forum I think, an old post from 2006 or 2005 where a female doctor told about her study from 2004 saying that SSRIs destroy serotonine metabolism which leads to depression and other really bad things. Couldn't find the post now and I'd rather stop thinking about this...

Thanks for the continued insight.

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Been taking the med on 1pm in the last days so I don't have to start my work days with side effects.

But today (day 22) I didn't get any side effects. Also there were zero depressive feelings! Just negative thoughts and worries. Maybe it's starting to get better. I also have substantially increased appetite.

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Day 23: felt protected today, I think it's starting to work! No anxiety, almost no depressive feelings, only negative thoughts and worries again (a lot though).

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Day 24: For the first time this year I woke up with a brightened mood today. Thought "am I reborn?".

Over the course of the day I felt protected again. In the afternoon felt a bit anxious inside, but still protected. I'm really hopeful now.

Zombie mode is back it seems. Btw., zombie mode is an exaggeration, it's more like a slight 'phase shift'. I'm here, but not completely.

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6 days ago, on Monday, I was suicidal walking at the railroads. Got lucky no train came by, my wife that I wanted to say my last words to talked me out of it on the phone.

Today, day 25 on Paroxetine, I have no death wish at all anymore, no depressive feelings and I feel safe. Zombie mode IS back. I still have depressive thoughts but my condition has changed extremely in the last days.

Looks like Paroxetine (and my wife) may have saved my life.

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1 year later now. Decided to give an update on this because I remember how desperate I was back then and was searching for paxil-success stories.

Three days after my last post I had my first (and only) real suicide attempt on June 1st 2016 around 5am (after I couldn't sleep again) so I was still far from being safe.
A couple of days later I luckily had vacation for three weeks. Felt terrible but at least I didn't have to work. After the vacation I broke down and gave up. Talked to my boss that I'm severely ill and won't be able to go to work. Got really lucky that he allowed me to work from home for a few months. With every month I felt better and better. Paroxetine finally fully worked again.
By December my depression was completely wiped away and I didn't feel any fear anymore. I don't feel anything anymore tbh. but that's okay.

If you're really desperate HANG IN THERE! The first two months unfortunately were terrible and it takes about half a year until it's working properly but it does work (unlike Citalopram). I now have ZERO depression and ZERO fears. I'm basically invincible. And happy.

Btw., since August 1st my dosage is 30mg. The increase from 20 to 30mg worked wonders. Instantly felt a lot better.

Edited by christi4n
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53 minutes ago, christi4n said:

1 year later now. Decided to give an update on this because I remember how desperate I was back then and was searching for paxil-success stories.

Three days after my last post I had my first (and only) real suicide attempt on June 1st 2016 around 5am (after I couldn't sleep again) so I was still far from being safe.
A couple of days later I luckily had vacation for three weeks. Felt terrible but at least I didn't have to work. After the vacation I broke down and gave up. Talked to my boss that I'm severely ill and won't be able to go to work. Got really lucky that he allowed me to work from home for a few months. With every month I felt better and better. Paroxetine finally fully worked again.
By December my depression was completely wiped away and I didn't feel any fear anymore. I don't feel anything anymore tbh. but that's okay.

If you're really desperate HANG IN THERE! The first two months unfortunately were terrible and it takes about half a year until it's working properly but it does work (unlike Citalopram). I now have ZERO depression and ZERO fears. I'm basically invincible. And happy.

Btw., since August 1st my dosage is 30mg. The increase from 20 to 30mg worked wonders. Instantly felt a lot better.

Wow..... Welcome back. What a story. Glad to hear you are doing better. I am surprised to hear that Paxil took 6 months to finally kick-in the 2nd time. That is a long time to wait when you are desperate & suicidal! I would've tried a different med probably.

I commend you on your strength to continue on. I bet you won't go off Paxil cold-turkey again. A lesson learned the hard way.

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Thank you for the supportive reply! :)

It already kicked in after 3 months when I increased the dosage, but it took 4 more months until I was completely free of any symptoms.

Definitely won't go off Paxil cold-turkey again. But I think I won't taper either. Too afraid of being without protection. I intend to take it for the rest of my life.

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