Paxil withdrawal or serotonin syndrome?

[chacha]

Need help making a decision. I am all alone on this so I will take your advice. If you have any information, please post so I can make the most informed decision possible.

Last Friday, I was set to drop from 25 mg to 12.5 mg. My pharmacist forgot to put the prescription in the bag so I actually had to go cold turkey for 3 days. When I got the medicine, I took 25 mg because of the advice on here that I was dropping too fast (which I agree with). I started feeling better and better over the next 2 days.. then boom.. last night.. zero to sixty.. bad symptoms.. worse than the withdrawal.

Here are the symptoms:

Nausea
Diarrhea
Extreme mental confusion
Chills
Feeling flushed (maybe fever)
Brain zaps.. not just in 2 or 3 every 2-5 seconds.. but non-stop
Extreme sensitivity to lights
Agitation/Irritation
Extreme leg aches (I have Fibromyalgia, but this is worse)

When it started it was about 2-3 hours after I had taken my 25 mg for the day. I am positive that I took the pill.. and only took one pill.

Currently I'm taking Pepto and Zantac for the stomach aches, covered the windows in the house for the light sensitivity, covered myself with blankets even though that makes me sweat, Vicodin for leg pain (only 1/3 of a 5 mg tablet), Robaxin to relax muscles, Lyrica for Fibromyalgia, and a 5mg Valium this morning.

I tried going to the E.R. last night, but husband was yelling at me for wanting to go to the doctors so close to his bedtime. This morning I got up and called my psych.. she has yet to call me back.. it's now 5pm.. her closing time. My only options left are to take Paxil, go to the E.R., or wait this out.

If I take a Paxil and I'm having serotonin syndrome, then I could die. If I resist and go cold turkey.. well.. then I might wish I died. If I decide to take the Paxil, do I take 25 mg or 12.5?

PLEASE HELP!
cha cha

[scotty]

Serotonin syndrome occurs when one is taking more than one serotonin enhancing drugs. Missing paxil for 3 days and restarting would not cause serotonin syndrome. This is more likely withdrawal from the 3 missed days and will pass. If you were on 25, then take 25.

[chacha]

I'm too scared to take it. Withdrawal is kicking in again which is better (and different) than how I was feeling the past 24 hours. To go through that advanced of withdrawal 2 hours after taking a pill is just too odd for me. Perhaps I lack your knowledge. Thank you for the advice. I will think about it for the next couple of hours. I do know my area of expertise on half-lifes is limited.

I wish my shrink would have called me back today. It would be nice to be monitored by someone.

Not to be warned of this withdrawal affect is criminal. I was in such a fragile state of mind when I first went to seek help. They (the doctor and the pharmaceutical company) took advantage. I pray one day I will be well again.

*hugs*

[Samalabear]

In the latter days of my being on Paxil my memory was so bad that I would forget my refills and then, oops, we have a problem. I went into withdrawal. I've three days without Paxil at least a couple of times in those last couple of years. It was miserable, but I would stabilize within a couple of days of being back on.

I have to admit, though, it's nothing compared to true CT withdrawal, which is what I eventually happened to me, and I had reached the point where I had to keep going because I was many months after my last dose and didn't want to risk having a severe adverse reaction and ending up in the psych ward.

The three days you'll recover from. If you want to taper off Paxil, though, you'll have to taper off very slowly, as most here are. You've already had the taste of what CT withdrawal will be like and it only gets worse, believe me. That first drop that you were going to take from 25 mg. to 12.5 was already way too big.

I'm really sorry you've got all these problems. There's a lot of valuable information here and support, so you're not alone.

[scotty]

Originally Posted by chacha

I'm too scared to take it. Withdrawal is kicking in again which is better (and different) than how I was feeling the past 24 hours. To go through that advanced of withdrawal 2 hours after taking a pill is just too odd for me.

Chacha...it may take a few doses to get back on track again after missing doses. Your paxil level with those missed doses was down to nothing, so it will take at least a few days to stabilize again. Not taking it is going to make things worse, as cold turkey withdrawal sets in. Take the 25 and know that this is withdrawal and will pass quickly.

[scotty]

Originally Posted by chacha

I do know my area of expertise on half-lifes is limited.

Half life is pretty simple

You take 25mg of paxil
24 hours later, if you take no additional paxil you're down to 12.5mg
24 hours later, if you take no additional paxil you're down to 6.25mg
24 hours later(which is your three days) you're down to 3.125mg

So you can see how it will effect you.

Now, restarting:
You take 25mg
24 hours later you're down to 12.5, but you take another 25
24 hours later you've got 6.25 from the first dose and 12.5 from the second dose....you take another 25mg
24 hours later you've got 3.125+6.25+12.5= 21.875 So at this point you're starting to get back to where you were when you missed the doses.

I hope this helps explain how it can take time to recover from missed doses.

[texgirl]

Sorry if I'm missing something, but it seems to me that it makes a lot more sense to take one 25 mg Paxil than six other drugs to deal with the side effects of skipping the Paxil.

Going back on 25 mg Paxil is the most sensible course of action here. You will get stable, within hours or days, and need to stay stable for a little while before you consider tapering again. And when you are ready to taper again, stick to the 10% rule. Don't even think about going from 25 to 12.5. That's a 50% dose cut and will quickly put you right back where you are now.

[elisa]

Originally Posted by Gnuoy

the max does of paxil is 60mg's. 20-25mg is a low dose and you wont get serotonin syndrome from that dose. serotonin syndrome happens when the ssri is at a very high dose or 2 ssri's taken at once. 20-25mg's is such a low dose some people cant even tell the difference on the drug or off the drug.

20-25 mg of Paxil is NOT a low dose, it's a REGULAR dose. MOST people are on this dose. It's even disputed whether a 60 mg dose is more "effective" than a regular 25 mg dose.

Serotonin syndrome can be caused by taking 2 SSRI's or one SSR with St John's Wort, SAMe, L-tryptophan or any other supplement that's serotonin enhancing.

Here is a link that explains what serotonin syndrome is about: http://members.aol.com/atracyphd/syndrome.htm

Please, don't confuse antidepressant withdrawal with serotonin syndrome!!

[chacha]

Hi hi everyone. Thanks for all the input. With your help I think I figured out the problem. According to Wikipedia

"A large number of drugs and drug combinations have been associated with the serotonin syndrome."

They list opioid and stimulants as contributors. I've been prescribed Provigil to help give me a boost in energy. For a long time, I haven't been taking it because my energy has been up ever since I started the Atkins diet. Yesterday, I took 2 (spread out throughout the day) because I was feeling better.. getting things done.. and I thought stabilized on Paxil again. I really was feeling great until it hit rapidly. In addition, I took hydrocodone for my Fibromyalgia pain (an opioid) and I took this new Sudagest (a knockoff of sudofed) which has pseduoephedrine (a stimulant as well). I take that for my TMJd since that is the only thing that clears the fluid out of my jaw. But I hadn't taken it lately either because I had felt weird after taking it. In addition, according to the half life schedule above, I had gone down to zero Paxil and then gone all the way up to 25 mg in a short amount of time. My body is really extra sensitive to medicines so.. ya.. this is really starting to suck.

All of those combined and I'm sure I was in some sort of serotonin toxicity. So crap.. laaa.. I just took 12.5 mg of Paxil because I was feeling guilt about being irresponsible and cold quitting when yall are providing such great information. ((sorry, thinking aloud)) I shouldn't cold quit. Maybe.. hmmm.. I didn't take the sudogest today or the provigil. I can give those up temporarily. I can't give up the hydrocodone because of physical pain. I can try to cut down on it while all this is going on.

I read that when serotonin toxicity occurs, you are supposed to give up all serotonin immediately? What should I do? Laaa.... Anyone else feel like a walking medicine cabinet?

The best situation would be to get back up to 25 mg, stabilize, and then taper off a lot slower. Is that possible now?

Thanks again for all the help!
*hugs*

[chacha]

25 mg of Paxil was the second step of three upgrades in my dose. My psychiatrist does not go higher than 37.5. Maybe different doctors/states/countries do different things? At this point, no one can say if it was serotonin toxicity or not since there are no medical tests. I respect your opinion. Thank you for sharing.

For now, I'm looking for answers on how to proceed from here. At this point, I do not feel comfortable taking 25 mg again. I took the 12.5 mg tonight. If I do 'okay' then I may go back up to 25 mg to completely stabilize.

Thanks everyone for your kind words and support. Nice to be among people others who are going through the same thing.

*hugs*

[elisa]

Originally Posted by Gnuoy

20-25mg of Paxil to me is a low dose. I was as high as 60mg's now that's a HIGH dose. If you take 60mg's and divide it in half it would be 30mg's and that is a MEDIUM dose. 20mg Paxil is a LOW dose.

As I said, 25 mg of Paxil is the NORMAL/AVERAGE dose. If you received the "benefits" of 60 mg of Paxil then you're out of the "norm". Please don't confuse the NORMAL/AVERAGE and most prescribed dose with YOUR PERSONAL EXPERIENCE. Additionally, some prescribers just go way overboard and raise the dose unnecessarily.

I was on 225 mg Effexor XR and that is considered the maximum dose. I certainly would not be saying that this would be a normal dose for everyone else.

As far as I know, most people here on paxilprogress are/were on 25 mg of Paxil or on equivalent doses of another brand.

[anxiety247]

Actually, I'm currently on 50mg Paxil. In my mind, 50mg is a high dose and I saw 25mg as a small dose. I also know that 25mg worked great for my anxiety/worry but now that we're adding OCD and Depression to my brain mix, 25mg wasn't doing the job anymore, so my dose was increased. I know everyone's different but that's kinda how I saw it too - similar to what Gnuoy said.

[LCrawford67]

Originally Posted by Gnuoy

20-25mg's is nothing, and most people get off it with ease with a slow taper. some people got off 20mg's even on cold turkey with not much problems its a very low dose. be careful weaning at the high dose you are on now. if you are trying to wean drop a milligram a month don't even drop 2mg's. good luck!

That couldn't be farther from the truth! Most people here, myself included, tapered from doses of 20-30 mgs. That is not a "very low dose" that's just the most common dose prescribed.

I went through pure hell trying to cold turkey and then taper too fast. My taper lasted over a year and with 10% drops.

To say someone can stop CT or taper quickly from 20 mgs, or to say it's "nothing" is ridiculous.

[scotty]

Exactly...20-25mg of paxil is the "effective dose", not a low dose. The majority of paxil users are on this dose and cold turkey withdrawal is no less dangerous at that dose than at 50mg.

Please be careful of making generalizations.

[texgirl]

The size of the dose of Paxil has little or no effect on the severity of withdrawal a person might experience. I know it seems logical that withdrawal should work that way, but in fact nothing about Paxil withdrawal is logical. We've had people here taper off big doses like 40 mg with relative ease, and others (many more, actually) suffer every side effect in the book while tapering off 10 or 20 mg.

[Jax]

I think that no matter what your dose, no matter how long you have been on it, and no matter which med you are taking, you have to be careful. I am tapering faster than many can, but I have to take my stuff EVERYDAY or suffer teh consequences...and Prozac is "easy" to get off...we all have challenges and all have to do what works for us, but the point of being on this board is to help each other through, and to give support, even when we have no idea what the other person is dealing with...just knowing someone is out there who can tell us we are strong enough and help us move forward with our lives as we get off this crap. We should never say that something is easy if we haven't been through it ourselves...you can say it was easy for you, but making that into a generalized statement is hard on those of us who find it harder, and it make us feel like failures for not being that strong. Dose doesn't determine ease of WD and tapering...moral of this whole thing, NEVER ASSUME...it makes an A** out of you and me.

[elisa]

It is estimated that around 68-70% of people getting off of Paxil get withdrawal symptoms. For Effexor it's even higher - 78%.

The odds are stacked against the vast majority of users regardless of the dosage. That's one of the main reasons why we need to taper very slow, regardless of dosage.