Page 1 of 13 12311 ... LastLast
Results 1 to 10 of 127

Thread: Worse before better on paroxetine?

  1. #1
    Join Date
    Jun 2021
    Posts
    89

    Worse before better on paroxetine?

    Hi Iíve suffered from anxiety with panic attacks and depression for a few years now and have tried many many different medications.

    The first one I tried was pristiq because it had worked for me about 10 years ago during a previous depressive/insomnia episode. I was on it for three years and came off it without any problems. This time around it just made me more anxious. ☹️

    After this I tried lexapro, atypicals, anti psychotics, tricyclics, and even an MAOI which felt like I was on speed. 😬

    Amitriptyline and lexapro were probably the best of a bad bunch.

    Now Dr has started me on paroxetine 10mg daily. She thinks itís the best fitting SSRI for my condition .

    I started this dose 2 weeks ago and she wants me to go up to 20mg. Since starting paroxetine I found myself taking 2mg Valium daily! Not a lot but I donít want to go down the benzo path.

    The thing is I actually feel more anxious and depressed. Iíve only had one brief happy period since being on it. So Iím naturally fearful of increasing my dose.

    I canít see my psych as she is on holidays but have booked in to see my GP for advice.

    Has anyone had luck on 10mg paroxetine? And did you feel worse before getting better?
    I mean how long am I supposed wait? I know literature says 4-6 weeks but that seems like a really long time right nowÖ

    Thank you in advance people.

    John.

  2. #2
    Join Date
    Jan 2017
    Posts
    2,985

    Re: Worse before better on paroxetine?

    Quote Originally Posted by jonjon View Post
    Hi Iíve suffered from anxiety with panic attacks and depression for a few years now and have tried many many different medications.
    to NMP, John,

    The first one I tried was pristiq because it had worked for me about 10 years ago during a previous depressive/insomnia episode. I was on it for three years and came off it without any problems. This time around it just made me more anxious.
    Antidepressants (ADs) can be less effective the second time requiring a higher dose to achieve the same level of control and the initial side-effects may be more severe and/or different too. How long did you take desvenlafaxine (Pristiq) this time and what was the highest dose?

    After this I tried lexapro, atypicals, anti psychotics, tricyclics, and even an MAOI which felt like I was on speed. 😬

    Amitriptyline and lexapro were probably the best of a bad bunch.
    Which of the tricyclics and MAOIs did you try, what was the maximum dose taken and how long were you on that dose? Did you stop because it wasn't working, or for other reasons?

    Now Dr has started me on paroxetine 10mg daily. She thinks itís the best fitting SSRI for my condition
    With the possible exception of clomipramine (Anafranil) and fluvoxamine (Luvox) for OCD, no AD is intrinsically more effective than the others for specific disorders, or generally, but one or two will usually be better than the others for an individual both in effectiveness and tolerability. It all comes down to how they mesh with individual biology. Unfortunately, there is still no reliable way of determining the best med/s except by trial and error.

    I started this dose 2 weeks ago and she wants me to go up to 20mg. Since starting paroxetine I found myself taking 2mg Valium daily! Not a lot but I donít want to go down the benzo path.
    Definitely take diazepam if you need to as white-knuckling through anxiety/panic is counterproductive, however, the biggest problem with benzodiazepines (BZDs) isn't the dependency issue as many think, some of the ADs can be harder to quit, but that BZDs inhibit neurogenesis, the mechanism by which ADs (also therapy) work (see: Boldrini M, 2014; Nochi R, 2013; Sun Y, 2013; Song J, 2012; Wu X, 2009; Stefovska VG, 2008).

    The thing is I actually feel more anxious and depressed. Iíve only had one brief happy period since being on it.
    No AD will work within 2 weeks, except by a usually short-live placebo response, and they very often make anxiety and/or depression worse at the beginning by increasing serotonin activity before biofeedback kicks-in to reduce serotonin synthesis and release. Both disorders are caused by high brain stress hormone levels *killing brain cells in the two hippocampal regions of the brain and inhibiting the growth of new ones which causes the hippocampi to atrophy. ADs work by stimulating the growth of new hippocampal cells. These cells and the connections they form produce the therapeutic response, not the ADs directly. It takes about 7 weeks for neurons to grow and mature, however, improvements in mood may begin a few weeks earlier with kick-in usually occurring in the 4-12 week range.

    *See: Depression, antidepressants, and the shrinking hippocampus; Depression and the Birth and Death of Brain Cells (PDF) and How antidepressant drugs act: A primer.... As per above, therapy works through hippocampal neurogenesis too, as do Omega-3 fatty acids/fish oil and exercise to lesser degrees though they can make a significant difference in mild cases.

    So Iím naturally fearful of increasing my dose.
    Most serotonergic ADs, including paroxetine, need to be taken at doses high enough to saturate about 80% of the serotonin transporters (5-HTT) to initiate and sustain neurogenesis. Unfortunately, there is no readily available test to determine the dose needed to achieve this for individuals. The minimum recommended dose has been shown to achieve this. Taking less may not be enough, and even worse, may increase the odds of the med pooping-out by inhibiting neurogenesis every time plasma levels drop below that required to sustain it.

    The rule of thumb on this is the increase the dose no earlier than 5 times the half-life of the med, which for paroxetine is 21 hours x 5, so 5 days. Upping it earlier may increase the severity of any initial side-effects, but delaying and increase won't significantly reduce their severity no matter how long the delay.

    I mean how long am I supposed wait? I know literature says 4-6 weeks but that seems like a really long time right nowÖ
    Unfortunately, there is no way of speeding up the process. It is what it is.

    Ian
    __________________
    .

    - - DIY Covid-19 test: Wake up and smell the coffee - -

    - - What to know about: Telepsychiatry | Teletherapy - -



    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  3. #3
    Join Date
    Jun 2021
    Posts
    89

    Re: Worse before better on paroxetine?

    Hi Ian

    Thanks for the response.

    I was on pristiq for 6 weeks at 100mg but it just made anxiety much worse. Was a bit better for depression.

    Was on lexapro for 6 weeks also starting at 10mg and working up to 20mg but had the same results as the pristiq.

    The MAOI was parnate for 7 days. I felt really hyped up and there was no way I could continue.

    I was on nortriptyline for about 2 months at low dose 10mg but didnít do much and amitriptyline couldnít go past 30mg because of sedation. Again I wasnít on this medication very long. Also tried deptran for about a week but stopped due to abnormal aggression. Very strange for me as Iím pretty peaceful.

    Regarding paroxetine dose I can only guess that the 10mg is upping my serotonin because of all the increase anxiety/depression (side effects?).

    Might try to go to 20mg after talking to my GP.

    On another note Iíve seen online that there is a slow release version of paroxetine that might help reduce the start up anxiety. I wonder if anyone has had luck with that vs immediate release?

    I really hate the fact that anxiety is a side effect for an anti anxiety medication. Grrr

    I will try and stick it out the best I can.

    Thanks

    John

    Ps thanks for the links will check them out tomorrow. 👍

  4. #4
    Join Date
    Jun 2021
    Posts
    89

    Re: Worse before better on paroxetine?

    Ok so I just saw my GP and her suggestion was to stick with medication for another 2 weeks till I see my psych. Apparently feeling a little bit worse when starting a med is normal.

    I must say that on other medications I would be crawling out of skin by this stage and that is not happening.��

    She said I could try and up my dose but could lead to more side effects. In her own words my condition “is above her pay grade” lol.

    Not really sure what to do but looks like I’ll be sticking to 10mg as I’m frightened of heightening my anxiety and depression. Thanks

    Wish me luck ��

  5. #5
    Join Date
    Jan 2017
    Posts
    2,985

    Re: Worse before better on paroxetine?

    Quote Originally Posted by jonjon View Post
    I was on pristiq for 6 weeks at 100mg but it just made anxiety much worse. Was a bit better for depression.

    Was on lexapro for 6 weeks also starting at 10mg and working up to 20mg but had the same results as the pristiq.

    The MAOI was parnate for 7 days. I felt really hyped up and there was no way I could continue.

    I was on nortriptyline for about 2 months at low dose 10mg but didnít do much and amitriptyline couldnít go past 30mg because of sedation. Again I wasnít on this medication very long.
    As I suspected you were never on any of these either long enough, or at a high enough dose of some to get a therapeutic response.

    I find it 'interesting' that you were prescribed 3 TCAs, but not imipramine (Tofranil) which was the 'gold standard' panic disorder AD for decades before the SSRIs hit the market and bewitched psychiatrists and GPs with promises not all could keep.

    Also tried deptran for about a week but stopped due to abnormal aggression. Very strange for me as Iím pretty peaceful.
    Very strange indeed as despite the claims doxepin (Deptran) is only a powerful antihistamine, not an antidepressant. If 30mg amitriptyline was too sedating then doxepin should have rendered you comatose. But all these meds can be very unpredictable. It all comes down to how they mesh with individual biology

    Regarding paroxetine dose I can only guess that the 10mg is upping my serotonin because of all the increase anxiety/depression (side effects?)
    Serotonergic ADs increase serotonin activity within the first hour of the first dose. The fact that this often makes anxiety worse is one of the clues that anxiety and depression aren't caused by too little serotonin as popular mythology claims. Fortunately, after a few weeks bio-feedback mechanisms kick-in to significantly down-regulate its synthesis and expression in areas of the brain that manifest anxiety and the heightened anxiety and other side-effects then usually diminish.

    On another note Iíve seen online that there is a slow release version of paroxetine that might help reduce the start up anxiety. I wonder if anyone has had luck with that vs immediate release?
    Give it a try if you can get it prescribed, but there's no guarantee that it will reduce the severity of the initial side-effects. If paroxetine proves successful then you should take a slow/extended-release formulation to avoid any potential yo-yo effect as the med enters and drops out of your system.

    I really hate the fact that anxiety is a side effect for an anti anxiety medication. Grrr
    Who said the gods don't have a sense of humour?!

    Not really sure what to do but looks like Iíll be sticking to 10mg as Iím frightened of heightening my anxiety and depression. Thanks
    Unfortunately, you need to break eggs to make an omelet. I urge you not to remain on 10mg indefinitely as it will likely cause the med to poop-out.
    __________________
    .

    - - DIY Covid-19 test: Wake up and smell the coffee - -

    - - What to know about: Telepsychiatry | Teletherapy - -



    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  6. #6
    Join Date
    Jun 2021
    Posts
    89

    Re: Worse before better on paroxetine?

    I really hate the fact that anxiety is a side effect for an anti anxiety medication. Grrr


    Who said the gods don't have a sense of humour?!


    The gods must be crazy ��


    Not really sure what to do but looks like I’ll be sticking to 10mg as I’m frightened of heightening my anxiety and depression. Thanks


    Unfortunately, you need to break eggs to make an omelet. I urge you not to remain on 10mg indefinitely as it will likely cause the med to poop-out.

    Might try the 20mgs when I have no commitments the next day.
    Ive had a horrid run on meds and don’t want to rush this one.

    Regards

    John


  7. #7
    Join Date
    Jun 2021
    Posts
    89

    Re: Worse before better on paroxetine?

    Sorry but I’m still getting the hang of the quote features Ian

  8. #8
    Join Date
    Jun 2021
    Posts
    89

    Re: Worse before better on paroxetine?

    On a side note the GP said they don’t prescribe extended release first off because if you have a bad reaction it will be in your system longer? Kind of makes sense I guess.

  9. #9
    Join Date
    Jan 2017
    Posts
    2,985

    Re: Worse before better on paroxetine?

    Quote Originally Posted by jonjon View Post
    Ive had a horrid run on meds and donít want to rush this one.
    Unfortunately, having to endure the initial side-effects is something some of us can't avoid. All you can do is treat the side-effects and hunker down until they pass.

    Ime, distraction helps. I have a collection of books I was given while in hospital when first prescribed an AD. Reading them got me through some very dark days (mostly my own fault for upping the dose quickly because I wanted to get back to work asap to save my career). When I say 'reading' I don't mean in the way you're, hopefully, reading this. It was more looking at each word in turn without really grasping what the story was about, but it helped divert my attention from the misery. They've served the same purpose a couple of times since when going back onto ADs. Thirty four years later I still can't tell you what most are about. I did promise myself I'd read them when I retired, but 22 years later I still haven't found the time.
    __________________
    .

    - - DIY Covid-19 test: Wake up and smell the coffee - -

    - - What to know about: Telepsychiatry | Teletherapy - -



    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  10. #10
    Join Date
    Jun 2021
    Posts
    89

    Re: Worse before better on paroxetine?

    Ok so I decided to go to 20mgs last night as everything says that is the minimum therapeutic dose and it’s the weekend and most of Sydney is in a COVID-19 lockdown so should be an easy weekend.


    -Side effects to report are nausea after taking pill. I take it with dinner so that helps reduce the nausea.
    -Dry mouth for which I use biotene mouth spray.
    -Jaw stiffness.
    -Sleep disturbance but not quite insomnia so I think that will pass.
    -Headaches are worse and have taken paracetamol.
    -Increased anxiety which I think is the cause of the headaches. Really don’t want to be reaching for Valium as I’ve been on 2mg for a couple of weeks now and it is by no means a panacea.

    Interestingly it hasn’t increased depression so far…(it’s not really better either) Depression and anxiety are a real chicken and the egg situation.

    My main concerns are the increasing anxiety and related headaches as I need to show my face at work for a couple of hours on Monday and driving sends my anxiety/panic into the stratosphere! Even just thinking of it.

    Distraction techniques I use are couch time and TV but I know I can’t do that forever. Watching Mare of Easttown with the wife at the moment. I also force myself to do a 10 minute walk in the afternoons. And of course reading this forum!

    Hope you get around to reading those books Ian. Lol

    I wish I get some relief soon but I have remember that this is marathon and not a sprint.

    God bless

    John

Page 1 of 13 12311 ... LastLast

Thread Information

Users Browsing this Thread

There are currently 6 users browsing this thread. (0 members and 6 guests)

Similar Threads

  1. Mirtazapine and Paroxetine? OTC Sleep Meds affecting Paroxetine?
    By WackoSirJacko in forum Mirtazapine /Zispin
    Replies: 3
    Last Post: 06-04-17, 23:18
  2. Paroxetine making me feel worse
    By Nikkidiff in forum Symptoms
    Replies: 3
    Last Post: 01-08-16, 13:49
  3. External hemorrhoids fear growing worse and worse
    By Hats in forum Health Anxiety
    Replies: 2
    Last Post: 13-04-16, 07:15
  4. paroxetine making me worse urgent
    By little kyle in forum Panic / Panic Attacks
    Replies: 2
    Last Post: 03-05-12, 01:20
  5. Paroxetine
    By Cico in forum Medication
    Replies: 1
    Last Post: 27-02-09, 17:35

Tags for this Thread

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •