Why the last little bit of taper is so hard

[altostrata]

Just thought I would throw this tidbit out for those who are having trouble tapering down from a ridiculously small dose of this accursed drug.

Paxil is both a substrate and powerful inhibitor of the liver enzyme controlled by the P450 cyp 2d6 genetic structure.

This means that Paxil needs the cyp 2d6 enzyme to be metabolized out of your body, but it also blocks cyp 2d6 from working. Diabolical, eh?

When you reduce your dosage of Paxil, at a certain point, which may be around 5 or 10mg, Paxil's inhibition of cyp 2d6 is reduced. This means that at low doses, it is leaving your body faster.

As you go lower in dosage, the impact of withdrawal on your body increases. This suggests that if you are getting discontinuation symptoms as you lower your dosage to, say, 5mg, you need to lower in smaller and smaller increments the closer you get to zero. If you have been weaning by 1mg, you need to wean by .5mg or even .25mg.

It may take your body longer to stabilize at each step when weaning from low doses.

[babs]

Good research, Alto! I only wish I was aware of it when doing my taper.

[Iksfreundin]

Where can I get a shot of cyp 2d6?

[scotty]

Alto, couldn't agree more with the physiology of this! One other factor that has to come into play is the psychological component of that last dose!

[Iksfreundin]

Originally Posted by altostrata

When you reduce your dosage of Paxil, at a certain point, which may be around 5mg, Paxil's inhibition of cyp 2d6 is reduced. This means that at low doses, it is leaving your body faster.

As you go lower in dosage, the impact of withdrawal on your body increases. This suggests that if you are getting discontinuation symptoms as you lower your dosage to, say, 5mg, you need to lower in smaller and smaller increments the closer you get to zero. If you have been weaning by 1mg, you need to wean by .5mg or even .25mg.

It may take your body longer to stabilize at each step when weaning from low doses.

Okay, so, the "increase of the impact of withdrawal" is due to the faster processing of the paxil out of the system?
What about us that DON'T stabilize? I'm already a bit fearful of the last few drops. Will we have it easier? (please say yes, please say yes, please say yes )

[RR]

The reason it is so hard to, not discontinue, but rather withdraw from Paxil is simple: because it is a dependency-inducing drug. Kinda like heroin I would guess, without the high, but a whole hell of a lot harder to get off of. Like trying to coax the "drug" equivalent of a bale of concertina wire from the recesses of your brain.

And how "hooked" you can get prior to starting Paxil ... no one knows. It's kinda like your beneficient but ill-advised doctor playing Russian roulette with a prescription pad, and your friendly but unwitting local pharmacy pulling the trigger. (Just as GlaxoSmithKline planned it back in the late 1990's.)

On my final withdrawal attempt from Paxil wherein I "succeeded" (i.e. survived Paxil ) I was, if you will, "dynamited" out of the Paxilian waters after dropping only a single milligram -- down from 10 milligrams to just 9 milligrams (using liquid Paxil). At the time I did not understand what was happening: I thought I had possibly come down with severe food poisoning. This point marked the beginning of a protracted and unimaginable "Hell on earth" that only those of us who have survived a severe Paxil withdrawal -- hell, let's call it what it really is, a poisoning -- can remotely comprehend.

To this day I will not discuss (although I continue to write about) the particulars of what happened to me with anyone except another Paxil survivor. Unless, of course, it's in due course of being deposed, or on the witness stand in front of a jury.

[Chrysalis]

This suggests that if you are getting discontinuation symptoms as you lower your dosage to, say, 5mg, you need to lower in smaller and smaller increments the closer you get to zero. If you have been weaning by 1mg, you need to wean by .5mg or even .25mg.

I can attest to this. I'm at 2.25 ml of liquid = 4.5 mg of Paxil, and measuring with an eye dropper. The past two days, I have measured the 2.25 ml, and then squeezed one extra little drop out, to lower my dose by ever so little. And guess what, I can feel that minute drop. Getting some eye swooshs today and have been on the verge of crying suddenly a couple of times for absolutely no reason. Ugh.

Margaret

[LCrawford67]

I'm soaking up all of this new information for my wean. You think, 1 mg at a time is a really slow taper. I guess I'll be going slower than that, once I get to 5 mgs.

[velveteengreen]

Science is fascinating... I wish I would have known more before going CT.

[LCrawford67]

It's amazing what we've learned, isn't it?

[Kristin]

Well, that helps explain why I couldn't hold with my last 1 mg drop. Thanks for the info! And Laurie, that psychological factor is a big one for me, akin to jumping off a building. Can you imagine if I told a therapist I needed help letting go of 0.25 mg. They would surely think it was ALL psychological and not even consider physical effects possible from such a tiny amount.

[Delynbetter]

Fear cannot be allowed during those last few drops or after that final dose. At the same time, we can't keep ourselves from fearing the unknown. For me, it was all in the timing. Drop on a Friday or some day where I would have plenty of time to rest during the days for the next few. Also flinging the bird at the medication showing it that I was beating it.

Truly, my anger at the medication is what got me over it. Add to that the knowledge of what "could" be and armed with how I'm going to deal with it if it did happen. Even after that last does it took another 4 months before I didn't feel like the Tazmanian Devil, but seeing the windows and still knowing that I would eventually win back the control from the drug kept me going...and then the window got stuck...open...and one final huge bird was flown to that bottle.

"Turn anger and frustration into motivation." Truly what I did, even though I saw this quote after the fact. Doesn't explain the physiological aspect of difficulty - but helped get through it.

[LCrawford67]

Delyn, theres certainly something to that! You HAVE to be angry at the drug, you have to have patience while tapering, of course, but you have to say, "NO MORE!" I think that's what keeps me going. Of course, I'm nervous about my next taper. But, I hold on to the stories of the long term users, who, by tapering very slowly, had minimal discomfort. That, and the fact that I'm a determined little bugger!

[hope]

Originally Posted by altostrata

Just thought I would throw this tidbit out for those who are having trouble tapering down from a ridiculously small dose of this accursed drug.

Paxil is both a substrate and powerful inhibitor of the liver enzyme controlled by the P450 cyp 2d6 genetic structure.

This means that Paxil needs the cyp 2d6 enzyme to be metabolized out of your body, but it also blocks cyp 2d6 from working. Diabolical, eh?

When you reduce your dosage of Paxil, at a certain point, which may be around 5 or 10mg, Paxil's inhibition of cyp 2d6 is reduced. This means that at low doses, it is leaving your body faster.

I weaned off the last few mg.s pretty fast. That would explain why once totally off, the sh*t really hit the fan and I was such a frieken mess. Thanks for the information.

What I don't understand yet, is why it didn't work after restarting it. And also, why was I having such horrendous reactions to everything including vitamins.

[altostrata]

Originally Posted by hope

What I don't understand yet, is why it didn't work after restarting it. And also, why was I having such horrendous reactions to everything including vitamins.

A lot of people don't get a repeat round of Paxil. It's the poop-out effect.

I envision it as blistered serotonin receptors. After being pounded on for a while, they just don't respond any more.

Some of us, me included, are hypersensitive to drugs and some supplements. The hypersensitivity is most likely due to an HPA (hypothalamic-pituitary-adrenal) axis dysregulation caused by withdrawal. The dysregulation makes your HPA axis hyper-reactive -- a little bit of something that never bothered you before causes a big reaction. Examples of HPA axis hyper-reactivity are cortisol surges aka pseudo-anxiety attacks and blood pressure spikes.