Skipped dose, breakthrough anxiety?

[Piano]

I skipped a dose a few days ago, and now I’ve had three days of breakthrough anxiety. Anyone else experienced this? I had some major stress lately too, especially when visiting my borderline mother [emoji22]


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[panic_down_under]

I skipped a dose a few days ago, and now I’ve had three days of breakthrough anxiety. Anyone else experienced this? I had some major stress lately too, especially when visiting my borderline mother [emoji22]

Paroxetine has a very short half-life so the missed dose may have had an impact, but it could equally be the heightened stress is overpowering the med at your current dose, perhaps even a combination of both. What dose are you on?

[Piano]

Hi, it must have been just breakthrough anxiety, it got better after a few days. Hugs to anyone who needs it [emoji8]


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[Piano]

Hi, it must have been just breakthrough anxiety, it got better after a few days. Hugs to anyone who needs it [emoji8]


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And now I’m having breakthrough anxiety again [emoji26] this time I didn’t miss a dose [emoji50] please give me hugs [emoji22]


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[panic_down_under]

And now I’m having breakthrough anxiety again [emoji26] this time I didn’t miss a dose

Probably a silly question given the times we live in, but are you under greater than usual stress at the moment, or has something changed in your life? Also how much paroxetine are you taking and how long have you been on this dose?

[Piano]

I am on 30 mg paroxetine, I have been on it for about 4 years. I have a cold at the moment, and I feel very frustrated about it.


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[panic_down_under]

I am on 30 mg paroxetine, I have been on it for about 4 years. I have a cold at the moment, and I feel very frustrated about it.

The cold may be a factor both emotionally and physically. An immune system in overdrive can trigger or worsen anxiety (https://www.medicalnewstoday.com/articles/immune-system-may-trigger-anxiety-in-response-to-infection) and depression (https://www.popsci.com/depression-infectious-disease/). These are arguably symptoms of an immune system disorder (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002174/) (see also (https://www.mqmentalhealth.org/posts/could-depression-be-caused-by-our-immune-system)). Patients taking immune system boosting meds such as interferon (http://www.hepmag.com/articles/hepatitis_interferon_depression_2501_22378.shtml) to treat viral diseases and cancers are now often also routinely prescribed an AD because of this. Immune system proteins may also reduce the effectiveness (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337012/) of antidepressants.

The breakthrough anxiety may ease once you get over the cold. If it doesn't then discuss increasing the dose to 40mg with your GP/psychiatrist. It might not be a bad idea to up it anyway as 30mg seems to be only just enough to keep anxiety at bay when everything is going well. Paroxetine has only a short half-life and no active metabolite to extend its effectiveness so if you're taking immediate-release paroxetine consider splitting the dose to 1x20mg morning and night if the dose is raised to 40mg. Personally, I'd do this even with the slow-release formulations, however, many doctors discourage split dosing because the more often a med needs to be taken daily the more likely patients are to stop taking it altogether. We can be a fickle bunch.

[Piano]

Thank you so much for your thorough and caring answer. I will definitely consider increasing the dose if the anxiety doesn’t stop when I am over the cold. Thank you thank you so much [emoji3059]


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[Piano]

I upped my dose on Friday, and it already seems to be helping for the anxiety. I really really hope this will help [emoji50]


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[panic_down_under]

It will likely take a little longer to fully kick-in, but it sounds promising. :emot-nod:

[Piano]

Thank you so much [emoji7] how long do you think it will take?


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[panic_down_under]

Thank you so much [emoji7] how long do you think it will take?

Weeks rather than days. How many I can't say as it comes down to individual biology. It takes about 5 days just for paroxetine plasma levels to stabilize again after a dose increase. But you might get the benefit of the placebo effect, so...

[Piano]

I spoke too soon [emoji24] I’m having horrible side effects [emoji24] please send me some comforting words [emoji22] I am on two weeks and five days


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[panic_down_under]

I spoke too soon [emoji24] I’m having horrible side effects [emoji24] please send me some comforting words [emoji22] I am on two weeks and five days

What side-effects are you having?

[Piano]

Anxiety, diarrhea, low apetite, sweating


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[panic_down_under]

Anxiety, diarrhea, low apetite, sweating

Unfortunately, these are common initial side-effects of most ADs. In most cases they resolve in a week, or two. Over-the-counter preparations containing loperamide (Imodium) are usually effective for diarrhoea. If the anxiety levels get too severe contact your GP as it can be eased with short-term meds such as diazepam, or mirtazapine.

[Piano]

Thank you so much! I feel much better now. Weeks 2-3 were horrible!


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[panic_down_under]

I feel much better now.!

Thanks for the update. Long may that continue! :emot-nod:


Weeks 2-3 were horrible

Unfortunately, ADs can sometimes make things worse at the beginning, but usually the results are worth the unpleasantness.

[Piano]

I am so grateful for your input [emoji3059]


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[panic_down_under]

I am so grateful for your input [emoji3059]


Vær så god :)

[Piano]

Vær så god :)

[emoji3059]


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