Worse before better on paroxetine?

[jonjon]

Hey PDU

Hope you have been well.

Amitriptyline has had no effect on headaches unfortunately. I am fighting the urge to take panadol as I find I am using it daily.

Teeth grinding has definitely gotten worse since starting the tricyclic. Sleep has actually gotten worse too except for that one great sleep on day two. I can feel it starting to activate me rather than sedate. Oh and the usual difficulty peeing and dizziness upon standing.

Basically I need a paroxetine type medication that does not cause insomnia or headaches and I would be fine. Is that too much to ask ;-)

Regards

John

[panic_down_under]

Hope you have been well.

I'm doing okay for an old fart. Had my second AZ vaccine yesterday which has me feeling very tired. I had no side-effects from the first one, didn't even feel it going in, but it is making up for that now.

Amitriptyline has had no effect on headaches unfortunately. I am fighting the urge to take panadol as I find I am using it daily.

Provided you're not exceeding the maximum daily paracetamol dose you should be okay, John. If you're concerned about the liver you could take n-acetylcysteine (NAC) supplements. It is given intravenously to protect the liver following paracetamol O.D..There is some evidence NAC eases anxiety too, especially OCD, though I can't say whether it has helped me because my PD was well controlled before I began taking it after lung surgery (it reduces fluid build up).

Teeth grinding has definitely gotten worse since starting the tricyclic. Sleep has actually gotten worse too except for that one great sleep on day two. I can feel it starting to activate me rather than sedate.

Which is the opposite of what it apparently did when you were on 30mg which begs the question is it the amitriptyline, or the combination.

Basically I need a paroxetine type medication that does not cause insomnia or headaches and I would be fine. Is that too much to ask ;-)

You apparently didn't have either side-effect while on escitalopram (Lexapro) at a high dose so maybe it is worth revisiting for longer than the 6 weeks you gave it before.

[jonjon]

Lol! I look forward to being an old fart myself someday ;-) I get my first covid shot later this month. I have two days left of home isolation and although it has been relaxing it has not been good for my exposure therapy.

I had smashing headaches all day yesterday but I am trying not to use pain medication for a while because I have read that you can experience rebound headaches.

I stopped the amitriptyline two days ago. Yes, the combination was activating me. Also the dizziness upon standing and difficulty peeing was not tolerable. (It is funny how we forget the side effects.)

Actually slept well last night without taking anything.

I think revisiting the lexapro is a good idea but I am VERY frightened about starting from scratch. I will wait till home isolation ends and work re opens and some normalcy returns to my life before I make any decisions. I was actually doing much better before this covid outbreak at work stuffed up my routine.

As always stay safe and thanks for the input mate.

John

[pulisa]

I take 5mg lexapro, John..I have a diagnosis of agitated depression and can't take high dose SSRIs. I find it helps me and I didn't have any side effects on start up. Sometimes less is more if you know what I mean?

[panic_down_under]

I think revisiting the lexapro is a good idea but I am VERY frightened about starting from scratch.

You won't be starting from scratch as you'll retain any accrued benefits from the paroxetine when you switch to escitalopram. Overnight switches between SSRIs at equivalent doses is usually straightforward. A potential issue may be that paroxetine has the shortest half-life of the SSRIs while escitalopram has the second longest so there might be a dip in plasma levels for a few days, but how much of a problem this will be given the low paroxetine dose is debatable.

[jonjon]

Hi folks,

I am having a telephone appointment with my psych next Thursday to discuss my progress. I usually do not do virtual meetings but considering the on going lockdowns in Sydney I have no choice.

I am currently in week 10 on the paroxetine 10mg.

Although not perfect my sleep has improved and I am no longer taking sleeping meds.
Headaches still persist randomly, sometimes they are intense and other times manageable.
Fatigue is still present but this might be due to lingering depression/anxiety.
Mood is ok but sometimes flat.

I come out of 14 days isolation tomorrow so hopefully things improve by the time I talk to my psych.

Will keep you posted.

[jonjon]

Hi all

Currently at the end of week 10.
Insomnia is no longer a problem and I am sleeping well. Headaches are still hanging around as is jaw clenching.

Worst thing is agitation has been steadily increasing the last few days. I think the amitriptyline that I only took for four days at a low dose might have screwed things up or perhaps as I get the full effect of the paroxetine my body is not agreeing with it.

I have not used benzos for weeks but now feel tempted to take one.

Still one week until I speak to my psych and hope this feeling goes away but if it does not I will be switching meds.

John

[pulisa]

I find that agitation is the worst symptom of all this. From my own experience I've found that lexapro helps to take the edge off.

Maybe it would be a good idea to take a benzo now and see if it makes a difference? Obviously benzos aren't for the long term but just to help you get through to Thursday? The jaw clenching will be causing the headaches.

[panic_down_under]

Headaches are still hanging around as is jaw clenching.

Is thew jaw clenching a recent thing, or something that's been occurring for a while, John?

Worst thing is agitation has been steadily increasing the last few days. I think the amitriptyline that I only took for four days at a low dose might have screwed things up or perhaps as I get the full effect of the paroxetine my body is not agreeing with it.

I can't see how amitriptyline could be having an ongoing effect, and agitation tends to begin very early on. I suspect it is more the disorder than the med.

[jonjon]

The jaw clenching has been going on for a while so I cannot really blame the medication. I always have chewing gum lying around for when it gets bad.

The agitation however has been ramping up for many days now and feels DIFFERENT to the anxiety/panic that I had to begin with. I had to take 0.25mg clonazepam yesterday. (Valium did nothing)

I am cutting down to 5mg paroxetine until I see my psych as I cannot tolerate agitation and it definitely feels medication induced. Headaches still ever present also. Maybe 5mg might be the dose for me considering how sensitive I am to drugs.


If not what is next? Lexapro? No medication? Do not want to do tricyclics again except as a last resort due to the orthostatic hypotension and difficulty going to the toilet.

Really feel stuck at the moment.