Increased Paroxetine dose from 10mg to 20mg

[Panic sufferer]

Hello all, first post here!

I have been on Paroxetine 10mg for 3 and a half years. After a stressful recent episode with my eyes and work worries my panic attacks returned so I went to see my GP about upping the dose to 20mg. I've been on 20mg for a little over 2 weeks now.

I have gone from 10mg to 20 twice before (once ten years ago and also 5 years ago), with no side effects. This time the side effects have been vicious! Insomnia, shaking, increased anxiety, palpitations.

Has anyone else had this happen when moving up a dose? Does anyone have any good coping advice?!

[panic_down_under]

I have gone from 10mg to 20 twice before (once ten years ago and also 5 years ago), with no side effects. This time the side effects have been vicious! Insomnia, shaking, increased anxiety, palpitations.

Has anyone else had this happen when moving up a dose? Does anyone have any good coping advice?!

I suspect that 10mg was doing nothing for some time and the increase to 20mg has put you into effectively the same position as starting the med from scratch hence the severe side-effects.

Antidepressants do not have a direct affect on anxiety (or depression) in the way, say aspirin has on a headache. They work indirectly by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells, not the meds directly.

However, neurogenesis requires a minimal amount of the drug to initiate and sustain the process and for most taking paroxetine this is at least 20mg. Some may get away with a bit less but the problem with borderline dosing is that many factors can reduce antidepressant effectiveness from time to time, interactions with other medications, including supplements, menstrual cycles, common infectious diseases such as colds and flu, etc, which activate the immune system. At these times neurogenesis may be interrupted.

Interrupting neurogenesis can have ongoing consequences for a meds effectiveness as 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. Anecdotally, they may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD, 2016 and Amsterdam, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Amsterdam JD, 2009; Leykin Y, 2007).

While those studies tested complete med discontinuation, frequent interruptions of neurogenesis due to low med doses may trigger the same consequences so I think you should seriously consider staying on at least 20mg in future.

As for the symptoms, all you can do is treat them. Small doses, 25-75mg, of immediate-release trazodone (Desyrel) has become the standard treatment for SSRI induced insomnia. A benzodiazepine (BZD) for the first couple of weeks would help with the heightened anxiety triggered by the initial increase in serotonin activity, or alternatively try small doses of the prescription antihistamine hydroxyzine (Vistaril). While not as potent as the BZDs, it has fairly strong antianxiety properties and is often potent enough. It also tends to be mildly sedating which may also help with the insomnia.

[Panic sufferer]

thanks panicdownunder,

My sleeplessness improved a bit since Friday (then had a bad night last night but hopefully it's a one off). I was prescribed two weeks of Zopiclone for it, but haven't taken more than 4 pills as I know how powerful and addictive it can be, plus I might need to drive the following day.

I, also, suspect now that the 10mg was doing little and the side effects have thus been made worse by (effectively) going from nothing to 20mg. I wish I'd understood that when I saw the GP & upped the dosage in January, as having not had side effects previously, I naively assumed there wouldn't be any this time...

some of the other side effects such as supressed appetite, heightened anxiety & tremor have either faded or gone.