MED help needed!

[Loon-A-TiK]

Hi,

I am taking my last 10mg dose of Paxil today. That will leave me in a worse withdrawl mode than I'm in now, I'm sure.

ANYWAY

I now take only Lamictal and Abilify. The Abilify is still titrating up. I have 5mg currently.

My pdoc offered to call in some Wellbutrin for me if things get ultra bad. I'm anticipating ultra bad. What do you think? It is no SSRI to "bridge" and is not liquid Paxil to cut doses lower with, but does stuff. And would help with my current gym+Weight Watchers efforts

Seriously, I want to stem the tide of a worsening problem. Ideas? Should I go for the WB?

-----------loon-----------

[SerraGeorge]

I'm curious as to why you're anticipating ultra bad. Are you having additional symptoms because of tapering off, or are you afraid you will? (Notice I did not say "just afraid you will" because that fear can be as frightening as any physical withdrawl symptoms)

What's your support system look like? Is there someone around that can sort of help keep you grounded and give you a bit of a shoulder to lean on through this part? What about self soothing exercises? Do you regularly meditate, make use of affirmations, or have activities to distract yourself? Honestly, if your pdoc didn't explore this with you, I think he/ she ought to be smacked with a large fish. You don't just take someone off a med they've relied on for a long time without a "plan." *grumbles*

Okay... well, my grumbling aside, What does "ultra bad" look like? How will you know when/ if you get there? It might sound dumb, but I think it's important to define. I, and many others have gotten through hard things by being able to say, "Well, it's not like (insert ultra bad definition) yet. I can make it through this  part." It also seals an agreement with yourself. If it does get to ultra bad, you have a definition and an agreement that you will call the pdoc at that time.

In any case, we're all here to help and encourage you! *puts on cheerleader outfit*

2, 4, 6, 8! Who's going to dePaxilate? Loon-A-Tik Loon-A-Tik! Rah Rah Rah!

[LunaRufina]

My pdoc offered to call in some Wellbutrin for me if things get ultra bad. I'm anticipating ultra bad. What do you think? It is no SSRI to "bridge" and is not liquid Paxil to cut doses lower with, but does stuff. And would help with my current gym+Weight Watchers efforts

Seriously, I want to stem the tide of a worsening problem. Ideas? Should I go for the WB?

<{POST_SNAPBACK}>

To go off of what Serra said about defining... [sorry if I repeat]

What might be a good idea is to sit down and come up with a list of symptoms, even, that would be a time when you should 'do something' [whatever you decide that something should be].

From this you can also come up with a plan- if you feel a certain way, is it do to a med withdrawal symptom or because you are worried about med withdrawal symptoms? [like serra suggested the worry alone can really effect you]

Since you asked about the Wellbutrin-

I don't know how the abilify is effecting you specifically, and I have never taken it myself, so I can't speak from personal experience. But you are currently increasing your dosage of THAT. I have heard from several people that abilify can be somewhat activating, and if it is doing that to you, than Wellbutrin could create agitation and other side effects for you right now. But not necessarily.

I don't know if there was another med you were considering or if you had talked about adjusting when you take your Lamictal or klonopin.

Listen to SerraGeorge. She does a good cheer.

~navy~

[Velvet Elvis]

If you have trouble and have paxil left you can always use a pill cutter to go down as low as 2.5mgs a day.  Lower than that and you'll need the liquid.

Of the SSRIs I've been on, Paxil was by the worst one to come off of.  10mgs to zero might be kind of rough.  IMHO, you'd be better off asking your pdoc for some more paxil to cut up or for some of the liquid.  Tossing a new unrelated med into the mix might just complicate things and make it difficult to tell what is causing what symptom. 

I usually make it through SSRI discontinuation with benzos but rebound anxiety is often one of my worst problems.  They do seem to help a bit with the brain zaps too.

If you do have problems with anxiety and experience some rebound anxiety as a result of the Paxil discontinuation, Wellbutrin could be risky. 

If your mood bottoms out and you don't want to wait for a new AD to kick in, many bps are able to tolerate Provigil without much of a problem.  It acts like the stimulants and kicks in about an hour after you take it. 

I'm not real familiar with the ACs other than the ones I've been on.  Is increasing the Lamictal to help deal with depression an option?

[Squirlygrl]

For me, Wellbutrin with Lamictal would almost certainly override any antimanic effects of 5 mg Abilify, so I'll vote no.  But then, I'm not allowed to have Wellbutrin any more. 

sg

[Goddess]

I vote for getting some more Paxil and start cutting them to titrate down.  Why suffer if you don't have to?  And why add a new med into the mix at this point?  I'm a big believer in pill-cutting (see my doses). 

My dining table usually has 2-3 cards witih leftover pill remnants on them.  Pill cutters aren't necessary; I do better with a good sharp knife (non-serrated).  The backs of glossy Christmas cards work well, with a bit of cushion underneath, such as a tablecloth. 

Right now I'm taking 1/16 of a 100 mg pill of Trazodone at night.  I cut in half, then in half again, then slice it lengthwise, then in half.  That's one way to find out if you're really ready to go off a drug--go down really slowly.  If you can't handle those low doses, you for sure can't handle being off it entirely.

good luck!

Goddess

[LikeMinded]

Loon-A-TIK:

It's been said here at some time and I'll repeat it for your edification.  As you reach the lowest dose of Paxil, ask your pdoc for a low dose of fluoxetine (Prozac).  Co-dose for a while, remove the Paxil, and then very, very, very slowly titrate off the fluoxetine.  Many pdocs find this a good way of releasing their patients from the spell of SSRIs.  Fluoxetine is a mild SSRI that even has a very long half-life.  In fact, my own pdoc and I are planning something similar (once my Cymbalta gets to the target minimalist dose of 20 mg/every other day, we're going to start a minimal dose of fluoxetine, discontinue the Cymbalta soon after, and then slowly, slowly, slowly titrate away the fluoxetine.  If I notice severe problems very soon after discontinuing Cymbalta (while still on fluoxetine), I may be put on an NRI (such as Strattera), which may or may not be permanent.  Thank God I'm still on Neurontin (300-600mg QD) for the MS/neuropathy pain.

(Sorry for the extensive pharmacology geeking out there.  You've made the mistake of talking to a future neuropharmacologist.)

[AirMarshall]

I've been down the Paxil withdrawal road too. Not fun. Not.

If you are in agony now and have been at this 10mg level, then going to zilch is probably not going to make you feel better. Get on the horn to the Pdoc and get some more Paxil to stay at this level until the symptoms ease.

It would make more sense to stay at the present level for another week or two, until the withdrawal symptom ease to a tolerable level.  Why not?  Unless paxil is throwing you full blown manic or suicidal, then there isn't a good reason to slow things down. 

For the next step down work with your doc to get more paxil and split the tabs to go to 5mg. Take as long as it needs to reduce without blowing up your brain.

Wellbutrin?  I have no experience, must defer to others.

The most common way to bridge of Paxil is to use Prozac Weekly. A single pill provides a whole week dose. Paxil has an extermely long half life of about a week. It also is fairly 'soft' and doesn't have a lot of side effects.  My doc provided me with two weekly tabs to use for the week prior and week after my last paxil dose.    I think it helped tremendously.    Every doctor has their preferred way of doing things, and yours had decidedly different ideas. You might bring up the question of the Prozac bridging and what the advantages disadvantages are vs. Wellbutrin.

I may be repeating what others have written. This sort of thing steams me up.

Good Luck.

A.M.

[LikeMinded]

Actually, I forgot to add.  I transitioned from Paxil 25mg directly to Lexapro 10mg without any issues whatsoever.  As in direct transition with no crossover period, one day taking Paxil and the next Lexapro.  I don't know if your seratonin system is that robust, but it is something to consider.  Of course that's something I forgot since my current BAC probably allows vampires to get drunk off of preying on me.

[crazyethel]

I am overweight and was put on Paxil by a pdoc who obviously wasn't aware of the side effects.  I gained 60 pounds during the time I was taking it, when certainly another drug would have been acceptable.

At any rate, a different pdoc immediately withdrew me and put me on another SSRI at the same time.  I don't remember the dosage, but the switch caused me absolutely no problems.  I think it was to Celexa, but I'm not sure. It was one day Paxil and the next the other SSRI.

Anyway, I think weaning to something that is easy to remove when you're stable (Prozac would be a good one) may be the way to go.

I sure wouldn't throw Wellbutrin into the mix.  It's a different class and can really promote agitation and anxiety in some people....maybe not in you, but why bother? It will be confusing to figure out what's what.

[Loon-A-TiK]

Thanks for all the good input!

Serra and others- when I get anxious I either go exercise, call my mom (a unipolar manic) and we drive around the park together and just talk, or take Klonopin.

My boyfriend noticed that I seem less "drugged" since I've gone down on Paxil.

Physical Symptoms- my heart feels like it is skipping beats, and sometimes my heart hurts, like jabbing pain. I take Klonopin and go for a walk after that kicks in, and it usually makes my heart feel better. I have a strong heart and have been checked well, and no history of heart issues. I think I can take it.

Mental Symptoms- In the past- uncontrolled crying fits and psychosis. I haven't had those this time.

If I have to do it, I have refills on my Paxil script, and with my pill cutter could go down to 2.5mg. My pdocs haven't felt that it is necessary to bridge or go to liquid. Too bad pharmacists can't prescribe, because my uncle would do it and knows his stuff better than my pdoc 

Tonight is my first night Paxil-free. The very thought makes my heart jump into my neck and pound. I've got to just take some Klonopin and walk/meditate or something. Taking responsibility for getting through my withdrawl may be what I should ultimately do.

---------loon------------

[crazyethel]

Good luck tonight!  What a major accomplishment.  You've worked hard to make this happen.

[SerraGeorge]

I feel encouraged when you say things like "I think I can take it," and "I haven't had those this time." It means you are not panicking and you're remaining objective about this. That's VERY VERY good! I wonder if it might not be a good idea to go ahead and fill the Paxil scrip now. It might help some of the anxiety if you know you have it on hand.

You're doing all the right things Loon! You're keeping us active as support for you, remaining objective, and identifying your IRL supports and coping strategies. You're going to get through this!

Rah Rah Rah!

Serra

[synthetic]

My pdoc offered to call in some Wellbutrin for me if things get ultra bad. I'm anticipating ultra bad. What do you think? It is no SSRI to "bridge" and is not liquid Paxil to cut doses lower with, but does stuff. And would help with my current gym+Weight Watchers efforts

Seriously, I want to stem the tide of a worsening problem. Ideas? Should I go for the WB?

<{POST_SNAPBACK}>

First, small doses of Prozac might help with the Paxil withdraw, at least that's what I read someplace.  Might be worth asking your pdoc about.

Second, see my sig for my thoughts on Wellbutrin.  AD's in general are on my evil list though, so it might not be evil for you.  It would be worth giving it a shot at least, not like it is going to kill you.  Okay, there is a very small chance it might kill you.  It probably won't really suck though.  Okay, it might really suck, but chances are it would just plain suck and it might even help.  Don't know until you try.