Paraxetine/Aropax increase

[rollergirl]

Hi All. So long story short I'm 41 years old and have suffered several lengthy episodes of anxiety usually lasting a few months with the last relapse starting at a xmas time after a really stressful year. After my last bad time a few years ago I stayed on 5mg of Paraxetine once I felt better and have been on that for a few years......but am now on my second day of upping to 10mg since the anxiety had returned. Was wondering what your thoughts are on whether I was managing basically drug free at 5mg (as in too little to do anything) and if you think going up to 10mg will help? After two days I'm just feeling a little spaced out and overthinking a bit much. I do lots of self help/meditation/acceptance exercises which also help. I would love to just stop taking medication and manage with self help alone. Has anyone done this successfully? Thanks

[BikerMatt]

An increase normally will raise your anxiety, but 5mg is a tiny dose and 10mg is also not much of a dose, so it shouldn't last to long.
If it was me taking 5mg I probably would have gone the other way to see if I could do without.

Good luck!

[rollergirl]

Thanks BikerMatt.

yeah i considered it but the latest relapse is quite strong and affecting me considerably so I thought I'd try the 10mg. I am in two minds though...so might go back down to 5mg then off...who knows. Feels risky either way

[panic_down_under]

After my last bad time a few years ago I stayed on 5mg of Paraxetine once I felt better and have been on that for a few years.

This may not have been wise. There is growing evidence antidepressants become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pubmed/27805299), 2016 and Amsterdam, 2009 (http://www.karger.com/Article/FullText/226611) found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007). Taking an antidepressant at low doses may produce essentially the same effect as stopping and restarting the med as plasma levels rise and fall below the therapeutic threshold.


Was wondering what your thoughts are on whether I was managing basically drug free at 5mg (as in too little to do anything) and if you think going up to 10mg will help?

I think you need to increase the dose to at least 20mg, the recommended minimum therapeutic dose for adults.


After two days I'm just feeling a little spaced out and overthinking a bit much.

It is not uncommon for anxiety levels to heighten after a dose increase due to the spike in serotonin activity. The brain will usually respond to this within a week or two by down-regulating serotonin synthesis and expression and brain levels then drop back to at least baseline and well below in some brain regions associated with anxiety (also depression).


I do lots of self help/meditation/acceptance exercises which also help. I would love to just stop taking medication and manage with self help alone. Has anyone done this successfully?

Formal CBT sessions would be a big help. Medicare pays for some session so ask your GP about them. BTW-both antidepressants and therapy seem to work by the same neurogenesis mechanism (http://www.americanscientist.org/issues/feature/depression-and-the-birth-and-death-of-brain-cells/99999). As far as your brain is concerned it probably matters little whether you treat your disorder with medication, or therapy. The important thing is that it is effectively treated.

[rollergirl]

So Panicdownunder..just curious, is it your opinion that once people feel back to normal on meds that they then ween off and stop completely? Wouldnt that result in another relapse being less responsive to medication that changing a current dose from 5mg to 10mg? Honestly just curious, not having a go as I have never used any other meds or gone over 10mg. tried 20mg once but it was too heavy on my head for working.

[panic_down_under]

So Panicdownunder..just curious, is it your opinion that once people feel back to normal on meds that they then ween off and stop completely?

That would depends on the person's history. Some people have the one bout of anxiety and/or depression, recover and get on with their lives. Others experience these disorders only at long intervals. For both groups using antidepressants only as needed is probably the best option.

However, quite a few of us have to deal with these disorders on a regular basis and remaining permanently medicated then seems the better option.

I developed panic disorder in January 1987 and began taking antidepressants in late February, so almost exactly 30 years ago. Over the next decade I tried living without meds 3 times. I relapsed about 9 months, 18 months and 6 months after stopping. Thereafter I decided to remain on antidepressants permanently, not because of the concerns I raised in my previous post as this wasn't known then, but because the hassle and trauma of weaning off and restarting meds just wasn't worth it.

So I've been medicated for about 27 of the last 30 years. And not on small doses either. Between 300-350mg of imipramine for most of the first decade, and 225mg dosulepin, aka dothiepin for the last 20 years straight. Both doses are well above the maximum. Despite this my brain hasn't turned to mush yet. Not that I'm expecting it to, just the opposite in fact as there is evidence antidepressants may reduce the risk of Alzheimer's (http://www.biosciencetechnology.com/article/2014/05/anti-depressant-reduces-alzheimers-plaque-growth-78-percent) and other dementias (https://www.ncbi.nlm.nih.gov/pubmed/21876440). Serotonergic antidepressants are also mild anticoagulants which may reduce the risk of heart attack and ischemic stroke (though they may increase the risk for the much less common hemorrhagic stroke) and may help the immune system fight some cancers (https://www.sciencedaily.com/releases/2008/09/080911142620.htm).


Wouldnt that result in another relapse being less responsive to medication that changing a current dose from 5mg to 10mg?

Probably not because the 5mg dose (and possibly the 10mg one too) will probably cause the same interruptions, albeit shorter-lived, but at a much higher frequency.


tried 20mg once but it was too heavy on my head for working.

One of the curious things about antidepressants is that any excess is just flushed down the toilet. Antidepressant have been shown to have significant affects on the brains of depressed mice, but none on the controls. For example during antidepressant treatment the amount of serotonin, noradrenaline/norepinephrine and dopamine in the brains of depressed mice drops significantly, but not in those of the controls (Zangen A (http://www.sciencedirect.com/science/article/pii/S0006899399012147), 1999; Zangen A (https://www.ncbi.nlm.nih.gov/pubmed/9375680), 1997). That said, it is possible you're a slow metabolizer in which case you might get away with taking a little less, although the dose recommendations do take this into account. There are blood tests available to measure plasma levels, but i don't know if GPs can order them.

[rollergirl]

Panic Down Under thankyou for your considered responses. I will try the 10mg for a month or so and see if that gives me relief in addition to the self help I do. Could I ask though at what point in a persons recovery would you suggest they consider going off the meds..ie 6 months after feeling in control on meds? (assuming I'm one who has an episode every few years and doesnt need/want permanent medication)? Also, why are you on such high doses? Did you start on less then over the years you now need more for the same effect? Has your meds 'poopep' out on you. This a term I see here often and is the main reason I dont want to stay permanently on meds.