Medication problem

[tom1984]

Hello, I got burnout with beginning depression in Oktober 2019.
After a weird disturbing intrusive tought with regard to suicide I developed this obsession about it.

I contantly asked myself if I would do it or not, so compulsions. It got a lot better but wasn't completely gone.

My doc and psychologist advised me to up paroxetine from 5 to 10 mg.
I was on 5mg for years after struggling with anxiety (used to take 20mg 10 years back).

3 weeks ago I increased from 5 to 10mg and it made everything worse. The anxiety over my thoughts ar full blown, sometimes I start thinking they become real because I feel this bad. But I am so sad because I don't want to die or become suicidal. It is my worst nightmare. Also I seem to feel more depressed like not feeling like doing things or not interested in things I think about.

Can this anxiety and low mood spike still be from the 5mg increase after 3 weeks or should I go back down to 5mg? My docter thinks it is a strange reaction but suggests to try 4 weeks.

I am realy struggling with myself now when I did so much work to releave my burnout. It has been a 1,5 year recovery and now it feels like 5 steps back.

Can anyone give me advice if this is normal after 3 weeks or if I respond bad to my medication.

Thanks for helping me out here.

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[Carys]

HI Tom, I'm afraid I know nothing about this medication, but you might have better chance of a reply in the 'Seroxat/paroxetine' section of the forum.

[panic_down_under]

My doc and psychologist advised me to up paroxetine from 5 to 10 mg.
I was on 5mg for years after struggling with anxiety (used to take 20mg 10 years back).

Prolonged sub-clinical dosing may increase the risk of ADs pooping-out (https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants/faq-20057938).


3 weeks ago I increased from 5 to 10mg and it made everything worse. The anxiety over my thoughts ar full blown, sometimes I start thinking they become real because I feel this bad.

...Can this anxiety and low mood spike still be from the 5mg increase after 3 weeks or should I go back down to 5mg? My docter thinks it is a strange reaction but suggests to try 4 weeks.

It is most likely from the dose increase caused by the resulting increase in serotonin activity. The body usually responds after a while by down-regulating serotonin synthesis and expression which diminishes most of the side-effects, including the anxiety and/or depression spike. 10mg is still a sub-therapeutic dose for most. Increasing paroxetine doses at weekly intervals shouldn't cause any side-effects to become more severe, however, waiting longer won't significantly reduce them no matter how long the delay as you've discovered.

[tom1984]

Prolonged sub-clinical dosing may increase the risk of ADs pooping-out (https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants/faq-20057938).



It is most likely from the dose increase caused by the resulting increase in serotonin activity. The body usually responds after a while by down-regulating serotonin synthesis and expression which diminishes most of the side-effects, including the anxiety and/or depression spike. 10mg is still a sub-therapeutic dose for most. Increasing paroxetine doses at weekly intervals shouldn't cause any side-effects to become more severe, however, waiting longer won't significantly reduce them no matter how long the delay as you've discovered.Thanks for helping out.

So as I understand it is best to push trough somehow?

I feel so nervous and anxious, it sucks.
After 2 weeks I was tinking it would subside, but now I am 3 weeks in and no relief yet.



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[panic_down_under]

So as I understand it is best to push trough somehow?

I think what has happened is the dose you were on wasn't high enough to sustain the brain changes paroxetine made leaving you unprotected when remission ended and you are now essentially starting from scratch. It will likely take more than 10mg and some time to regain control.


I feel so nervous and anxious, it sucks.

You shouldn't have to suffer while waiting for paroxetine to kick-in, Tom. White-knuckling through anxiety is counterproductive. Ask your doctor to prescribe either a small dose of one of the *benzodiazepines (BZDs), or better still of **hydroxyzine, a antihistamine with pretty good anti anxiety properties. It's not quite as potent as the BZDs, but often potent enough. Other alternatives are beta-blockers and mirtazapine. If s/he won't prescribe anything then you could try over-the-counter ***Benadryl (diphenhydramine).


* BZDs inhibit the mechanism by which ADs (and therapy) work so should only be taken when required, not routinely just in case.

** Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.

*** Benadryl's active ingredient differs from country to country. The one you want is diphenhydramine. If the Canadian Benadryl doesn't contain it there will probably be another antihistamine brand that does. Please discuss its suitability with your pharmacist if on medications other than paroxetine, or you have other health issues. Diphenhydramine can cause drowsiness, as may BZDs, beta-blockers, mirtazapine and hydroxyzine so caution is needed if performing potentially hazardous tasks, including driving.

[tom1984]

My psychiatrist told me to go back to 5mg.
Can I expect withdrawal symptoms after just 3 weeks?

I think he wants to try some different med.

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[panic_down_under]

My psychiatrist told me to go back to 5mg.
Can I expect withdrawal symptoms after just 3 weeks?

Hard to say, but any symptoms are likely to be mild and short lived. Try not to get hung up on this as not all withdrawal symptoms are necessarily down to the med. Psychology is at least as important. Convince yourself that you should suffer and an anxious mind is quite capable of delivering the whole catastrophe.


I think he wants to try some different med.

In most cases ADs can be switched overnight, especially at the low dose you're on.

[tom1984]

It is just I feel so nervous my stomach hurts. I just want to walk end keep moving. My anxiety towards my anxious thoughts spirals. I barely sleep and I don't feel like doing anything. On top of that it is hard to see past this in the future.

This for 3 weeks.

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[tom1984]

Today after going back to 5mg paroxetine I feel a little human again!

My psychiatrist advises me to take a small dose of sulpiride/dogmatil for a while to lower my anxious thoughts.

My mom likes dogmatil very much lol!

Paroxetine has an energy part, an anxiety relieve part and a anti depressant part.

It seems that the energy part kicked in first and settled on my anxiety. It might have to do with how different people digest medication.

Yesterday we did a depression test at my psychologist and I came out 17 points on the BDR scale. Mainly because I said I don't have so much fun doing things as I used to. That made me lightly depressed.

There is hope!
Thanks for helping me out in the midst of a bad time. Very much appreciated!

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[panic_down_under]

Today after going back to 5mg paroxetine I feel a little human again!

That's good, though I suspect it was more mind over matter than the dose reduction as plasma levels take a while to drop. But whatever works.


My psychiatrist advises me to take a small dose of sulpiride/dogmatil for a while to lower my anxious thoughts.

Not a fan of antipsychotics for anxiety, but they can be very useful in the short term.


Paroxetine has an energy part, an anxiety relieve part and a anti depressant part.

ADs don't actually have a direct chemical effect in that way. They work by stimulating the growth of new brain cells which provide the therapeutic response, not the meds.


It seems that the energy part kicked in first and settled on my anxiety. It might have to do with how different people digest medication.

The immediate increase in serotonin activity when first taking SSRIs, or increasing their dose can heighten anxiety within hours to days, sometimes weeks to which the brain (and other organs) usually responds by down-regulating serotonin synthesis and expression dropping levels in many of the brain regions associated with anxiety and depression to well below baseline.


Yesterday we did a depression test at my psychologist and I came out 17 points on the BDR scale. Mainly because I said I don't have so much fun doing things as I used to. That made me lightly depressed.

Looks like your depression is mostly centred on anxiety and once it is bought under control the depression will dissipate.