Increased dose

[Catkins]

2 weeks and 4 days ago my dose of paroxetine was increased from 40mg per day to 50mg per day.

I still feel terrible. I don't think it's too early to feel the effects is it? Am I being too impatient?

I don't want to go down the road of thinking it isn't working. I am taking promethazine as well.

[panic_down_under]

2 weeks and 4 days ago my dose of paroxetine was increased from 40mg per day to 50mg per day.

Was the dose increased because paroxetine was losing effectiveness after being on it for years, or did you only begin taking it recently?

Is the promethazine for anxiety until paroxetine kicks-in, or for insomnia or are you taking it for something else?

[Catkins]

The dose was increased to help with anxiety. Long term user.

The promethazine was to help with sleep and daytime anxiety.

[panic_down_under]

It usually takes at least 3-4 weeks for a dose increase to begin taking effect and it will take even longer to get the maximum response. Antidepressants work indirectly by stimulating the growth of new brain cells. The cells provide the therapeutic response, not the meds, and they take time to bud, grow and mature. Unfortunately, there is no easy way of speeding up the process. If the promethazine isn't adequately controlling your daytime anxiety then ask your GP to either up the dose or prescribe something else.

[Catkins]

After I posted I also googled and it said 4-6 weeks. I think I expected them to work too quickly.

I haven't been using the promethazine regularly for the anxiety. I've only used it the last few days when my anxiety seems to have rocketed again. But I think I'm going to use it routinely for the mornings for a while. I think I resisted it for some unknown reason. I guess I didn't want to become reliant on it. But I think it's probably advisable at the moment.

[panic_down_under]

After I posted I also googled and it said 4-6 weeks.

That's the usual time frame. It takes about 7 weeks for neurons to fully mature, however, improvement of mood may begin earlier, but it can also sometimes take longer too. :sad: It all comes down to individual biology.


I think I resisted it for some unknown reason. I guess I didn't want to become reliant on it.

You are unlikely to become physically dependent on promethazine in the few weeks it will likely take the higher paroxetine dose to kick-in. Mild antihistamines have a low potential for tolerance and dependency anyway.


But I think it's probably advisable at the moment.

White-knuckling through anxiety is often counterproductive as it reinforces the fear.

[Catkins]

I think it seriously messed me up. I've been told the techniques a million times on how to float through anxiety. Accepting it and all that. But it was definitely at such a heightened level that wasn't working. I still feel anxious on the promethazine, but it does help a little so I'm definitely going to stick with it.

Thank you for your help, it was reassuring. I nearly didn't post for fear of the answer.

[panic_down_under]

I still feel anxious on the promethazine, but it does help a little so I'm definitely going to stick with it.

Talk to your GP about a dose increase. There is no point in suffering when a dose adjustment could alleviate most if not all of the anxiety.


I nearly didn't post for fear of the answer.

What answer were you dreading?

[Catkins]

I was dreading you saying that it would be working as well as it could right now, and this was as good as it's going to get.

[Catkins]

I didn't think I could have a dose increase on promethazine. I thought 25mg would be the standard dose.

[panic_down_under]

I was dreading you saying that it would be working as well as it could right now, and this was as good as it's going to get.

There are no guarantees. :sad: The increased dose may not work, but the odds are in your favour.


I didn't think I could have a dose increase on promethazine. I thought 25mg would be the standard dose.

The recommended dose range for insomnia is 25-50mg (https://bnf.nice.org.uk/drug/promethazine-hydrochloride.html). There isn't one for anxiety as this is an off-label use, but for most of its other indications the recommended daily doses are in the 6.75-75mg range and I don't see why this should be any different for anxiety. Promethazine has a fairly short half-life - 10-19 hours - so taking it once a day may not give adequate 24 hour relief.

[Catkins]

I'm allowed to take 3 per day. One to sleep and 2 during the day as required. I'm taking one in the morning routinely now and one before bed.

[Catkins]

I hate to tempt fate, but I think I'm feeling a little difference. This is at 3 weeks and 1 day.

[panic_down_under]

That's good news!! :)

Just don't get concerned if a bad day, or two follow. The one step forward, two+ back shuffle at around kick-in is usually a very good sign as it indicates the med is doing the work, not the placebo effect.

[Catkins]

I am taking it very tentatively. I am 100% holding back on getting cocky and thinking I'm cured. Been there and done that before. Continuing doing guided meditations, relaxation and deep breathing etc. It is a relief to feel a little better though.

[Catkins]

And here has been a bad day. All anxious and in a state again.

Fingers crossed for tomorrow.