Worse before better on paroxetine?

[panic_down_under]

I decided to take the day off work considering I am changing medication timing.

I skipped my nighttime dose of paroxetine and took it this morning instead.

How did that go, John? Any increase in side-effects severity?

I will give this new regime another week or two but if it does not improve I will have to give up/switch antidepressants.

Citalopram is one of the two SSRIs considered to be least likely to trigger insomnia, but the other is paroxetine, so there are no guarantees. It comes down to how well a med meshes with individual biology. One of the TCAs may be a better bet.

How is the slow dose increase going?

[jonjon]

How did that go, John? Any increase in side-effects severity?

Hi Ian. To be honest it doesn’t seem any better or worse.

Citalopram is one of the two SSRIs considered to be least likely to trigger insomnia, but the other is paroxetine, so there are no guarantees. It comes down to how well a med meshes with individual biology. One of the TCAs may be a better bet.

I took 2mg melatonin last night and slept well. But that might also be because I do not work Wednesdays.

How is the slow dose increase going?

Due to the insomnia and crushing headaches I have gone back to 10mg. I know 20mg is meant to be the therapeutic level but have read of people being on lower doses successfully for years.

I am really angry that all I seem to have gotten from this medication are side effects. Namely headaches and insomnia. I will admit I had a couple of good days but that was about it.

Soon I will have been on it for 6 weeks. Do I continue with it for a bit longer or am I flogging a dead horse? I mean will there be some magical moment at the 2 month mark were I will say that this has all been worth it?

[jonjon]

Still getting the hang of the reply with quote thing sorry.

[panic_down_under]

Due to the insomnia and crushing headaches I have gone back to 10mg.

I doubt the tiny dose increases would be causing this.

I know 20mg is meant to be the therapeutic level but have read of people being on lower doses successfully for years.

There are always a few exceptions that prove the rule, but a lot of the time they are folk who have gone into remission and all too often when their disorder returns fail to get a response from the med even at its maximum dose.

I am really angry that all I seem to have gotten from this medication are side effects. Namely headaches and insomnia. I will admit I had a couple of good days but that was about it.

It is still early days and you are on a dose that may be unable to initiate the therapeutic response. For most ADs the dose needs to be high enough to block 80% of the serotonin transporters (SERT) to initiate neurogenesis.

Soon I will have been on it for 6 weeks. Do I continue with it for a bit longer or am I flogging a dead horse? I mean will there be some magical moment at the 2 month mark were I will say that this has all been worth it?

I can't say, John. Only time will tell.

[jonjon]

Thanks Ian

Striatal Serotonin Transporter (5-HTT) Occupancy at my dose looks like 70 percent going off the chart. (Hopefully in my case it is higher)

Also the blood plasma level difference from 10mg to 20mg are negligible but for me personally the side effects going from 10mg to 20mg are unbearable.

So it looks like I have no choice but to tolerate what I can for now and pray for the best.

Regards

John

[panic_down_under]

So it looks like I have no choice but to tolerate what I can for now and pray for the best.

Is therapy an option, John?

[jonjon]

Is therapy an option, John?

I have a psychologist I see every month or two.

She helped me at the start but lately I am not getting much help out of her. We seem to be talking about the same things a lot.

I feel the CBT only gets me treading water but nowhere close to remission. That is why I am pinning hope on medication.

[Catkins]

To be honest I think a combination of counselling, CBT and medication is what works best for me. But sometimes you do need to go over things time and time again before you feel the benefit. 14 years of managing my anxiety and it came to kick me up the arse this year again. So back into counselling and there are still things that were lurking in my brain that negatively impact on me. I would stay stick with the counselling as well as trying medication.

[panic_down_under]

I have a psychologist I see every month or two.

She helped me at the start but lately I am not getting much help out of her. We seem to be talking about the same things a lot.

I feel the CBT only gets me treading water but nowhere close to remission

Are you actually doing CBT? It, and the related REBT and mindfulness therapies, isn't just dropping in for a chat with the therapist every once in a while about problems, but a time limited (typically <=12 sessions), goal oriented approach involving learning how to reframe anxiety (also depression), challenging the thought patterns and habits that encourage it and devising coping strategies for when it flares. See: All About Cognitive Behavioral Therapy (CBT)

[jonjon]

Thanks Catkins,

Sorry to hear your anxiety stirred up again. I really hope you are feeling better.

Recovery is multi faceted although we all wish for that elusive silver bullet.

I am at six weeks with the meds. Sleep has improved since I changed to morning dose. Anxiety and headaches which go hand in hand still ever present.

Go Australia in Tokyo 2020/2021 :-)