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Author Topic: Is it the right time to discontinue Seroxat (Paroxtine Hydrochloride)?  (Read 412 times)

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Offline LK89

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Iíll share my story later which is quite long (and interesting), right now I need some help.

Well, I started taking Xanax (Alprazolam) from 28th November 2013 after panic attacks and insomnia triggered by acute depression and chronic sadness. I did not visit any psychiatrist because I was unaware of ANXIETY DISORDER. I visited different doctors (health anxiety) and nearly all of them prescribed me Alprazolam at bedtime. Initially it was 0.25mg per day but later I had to take 0.75mg a day just for a week before I stabilized myself on 0.5mg once (bedtime).

Then a neuro physician also put me on Eszopiclone 2mg + 0.5mg Xanax. I took it for 10 days but sleep disorder worsened and then, finally I visited a psychiatrist on 29th December 2013, first time (in my life). He prescribed me the following medicines:

1) Seroxat CR 12.5mg in the morning after breakfast
2) Remeron (Mirtazapine) 15mg 2 hours before I sleep
3) Eszopiclone 2mg half an hour before I sleep
4) Xanax (Alprazolam) 0.5mg (same time as Eszopiclone)

Remeron proved like a magical pill but just for one night it let me sleep for 10 hours without any trouble. However, it ďstoppedĒ working the very next night and I had serous trouble staying asleep for more than 3 hours.

Then I made another visit on 03rd January 2014 to the same psychiatrist and following changes were made.

1) Seroxat increased to 25mg CR tab
2) Mirtazapine was also doubled i.e. 30mg 2 hours before I sleep
3) No changes with Eszopiclone and Alprazolam

The results were mixed; panic attacks and heartburn relieved but sleep disturbance was not completely resolved due to muscle spasms and joint pain during sleep.

On third visit on 14th January 2014, the doctor did the following things:

1) Eszopiclone was reduced to 1mg
2) Alprazlolam 0.5 mg was replaced by Clonazepam 1mg
3) No changes with Seroxat and Mirtazapine doses

I experienced severe sleep disturbance for 3-4 nights after switching to Clonazepam 1mg. Then my sleep started improving and I decided to tapper off the mirtazapine; from 30mg to 15mg but really bad sleep disturbance forced me to go for higher dose and I started taking 22.5mg (15mg x 1.5 tab). And after few days, I was able to reduce it to 15mg with reasonably good sleep. I also reduced the SEROXAT back to 12.5mg CR with no trouble!

A week after tapering off the Seroxat to 12.5mg, I decided to DISCONTINUE the medicine because I had regain the control over my mind. But thatís when I got chest infection with bad cough (I also suffer from chronic allergy which effects my throat) so I postponed it. I also stopped taking Eszopiclone 1mg (sleeping pill) 10 days ago!

Now I feel SUPER during the day, I feel confident and I can drive my car on busy roads safely! Yesterday night was one of the best nights in past few weeks, I slept peacefully for 4.5 hours before I was awaken, but still I was able to fall back to sleep after drinking a glass of water!

Now the QUESTION is; if I stop taking Seroxat (Paroxtine Hydrochloride) 12.5mg CR, will it disturb my sleep?

I donít want panic attacks back during my sleep. Remember that I donít want to reduce Mirtazapine and Clonazepam before my next visit to the psychiatrist.

Sincere advice needed!
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Offline insights

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Re: Is it the right time to discontinue Seroxat (Paroxtine Hydrochloride)?
« Reply #1 on: February 10, 2014, 04:33:54 PM »
Now the QUESTION is; if I stop taking Seroxat (Paroxtine Hydrochloride) 12.5mg CR, will it disturb my sleep?

Probably not given that the 12.5mg dose is sub therapeutic and that you were only on a therapeutic dose for too short a time for it to do you any good. Antidepressants work by encouraging the growth of new brain cells which takes 3-12 weeks at a therapeutic dose.

I suspect you've "regain the control over my mind" because of the 1mg Klonopin, and to some extent the Remeron. However, IMHO, benzodiazepines such as Klonopin are not good primary anti anxiety medications as doctors are becoming increasingly wary of prescribing them because of the dependency issue, though this varies from country to country and may not be the case in Pakistan.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline LK89

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It has been 7-8 weeks now
« Reply #2 on: February 11, 2014, 01:05:24 AM »

Probably not given that the 12.5mg dose is sub therapeutic and that you were only on a therapeutic dose for too short a time for it to do you any good. Antidepressants work by encouraging the growth of new brain cells which takes 3-12 weeks at a therapeutic dose. . . . .

. . . . However, IMHO, benzodiazepines such as Klonopin are not good primary anti anxiety medications as doctors are becoming increasingly wary of prescribing them because of the dependency issue, though this varies from country to country and may not be the case in Pakistan.


So your opinion is that it's okay to discontinue Seroxat & keep taking Remeron 15mg 1.5 hrs before bedtime and  Clonazepam 1mg right before I sleep, is it what you mean?
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Offline LK89

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Today's night was even better!
« Reply #3 on: February 11, 2014, 01:11:41 AM »
I got 8 hours sleep (again awaken midnight after 3 hours but able to got back to sleep & stayed asleep untill 9am). It was peaceful sleep :)  except for some stupid dreams I don't care because there wasn't any nightmare for a long time because I've stopped watching horror movies  :sprachlos020:
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Offline insights

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Re: It has been 7-8 weeks now
« Reply #4 on: February 11, 2014, 02:10:25 AM »
Quote from: LK89 link=topic=83168.msg467070#msg467070 date=1392098724
So your opinion is that it's okay to discontinue Seroxat & keep taking Remeron 15mg 1.5 hrs before bedtime and  Clonazepam 1mg right before I sleep, is it what you mean?

Okay, yes. Wise, maybe not. I think it better to treat anxiety disorders with an antidepressant like paroxetine (Seroxat, Paxil) than with benzodiazepines such as clonazepam.

However, I think citalopram (Celexa), or sertraline (Zoloft) are better choices than paroxetine which can be difficult to discontinue. You could continue to take Remeron to help you sleep, or switch to trazodone (Desyrel) and use clonazepam to control the anxiety until the antidepressant become effective. If the antidepressants works well you should then not need clonazepam except maybe for occasional breakthrough anxiety.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline LK89

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I'll discuss about Zoloft and Celexa with my doctor on next visit
« Reply #5 on: February 12, 2014, 02:00:44 AM »
Actually the problem is now all of my anxiety symptoms are (almost) gone, the only problem is SLEEP DISORDER. My quality of sleep is not so good. As I mentioned in earlier post that the yesterday (that day) night was very peaceful, however today's sleep wasn't that good. I spend (may be) 3 hours as "semi-sleep" condition before my brain shut down to rest.

As you say if anti-deps (Mirtazapine) is working fine then I should not take any other pill. My doctor told me to take Remeron (mirtazapine) at least 90 minutes before Clonazepam. And many times, it happened as I took Remeron, I fell asleep after few minutes and then awaken after some time which was different on different nights. Some nights I could stayed asleep for 5 hours without clonazepam but other nights I was awaken with some sweat (not too much, night time room temp is around 6-8 Celsius). Then I took the Clonazepam 1mg fearing that I might not get peaceful sleep after that interval.

So it means you're suggesting me to tapper off the clonazepam to 0.5mg and then discontinue it?

Anyway, I'll discuss my sleep disorder in detail in the right section as this one is only for medicines etc.

Thanks very much for your time  :happy0151:
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Offline insights

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Re: I'll discuss about Zoloft and Celexa with my doctor on next visit
« Reply #6 on: February 12, 2014, 06:18:10 AM »
Actually the problem is now all of my anxiety symptoms are (almost) gone, the only problem is SLEEP DISORDER.

Yes, but is the anxiety gone because you have recovered, or because of the clonazepam? I suggest it is the clonazepam.

Quote
As you say if anti-deps (Mirtazapine) is working fine then I should not take any other pill.

At the dose you are taking, 15mg/day, mirtazapine is unlikely to be having an antidepressant effect. It may be enough to sedate you, but not enough to initiate and sustain neurogenesis which is the mechanism that produces the positive results.

Quote
So it means you're suggesting me to tapper off the clonazepam to 0.5mg and then discontinue it?

No, I was not suggesting this. I believe clonazepam is the only medication that is reducing your anxiety and I predict that if you reduce the dose the anxiety will return within a few days.

IMHO, using clonazepam to control your anxiety is not a good long term choice and that antidepressants are better for this.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline LK89

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Update: 50 + hours without Seroxat and no pain!
« Reply #7 on: February 13, 2014, 02:13:03 AM »
Right now it has been around 55 hours since I took the last dose of Seroxat 12.5mg CR tab. I did not experience any serious withdrawal symptoms except minor cold flush in leg which lasted only for a minute or so, and somewhat strange sensation in stomach and chest when I'm hungry but it goes away as soon as I'm full. And most remarkable thing is, today's night was also much better. No sleep disturbance, as I took the 15mg mirtazapine, I started feeling sleepy and couldn't wait for 90 minutes for clonazepam and fell asleep and stayed asleep for around 4-5 hours. Then I took the clonazepam 1mg and went back to sleep for another 3-4 hours (almost 8-9 hours total).

I have 5 pills of Seroxat CR 12.5mg but I'm not going to take it unless something seriously goes wrong.


As you said clonazepam is controlling my anxiety, I'd say yes it could be true. I'll try to share my story as I think I don't have anything to do tonight. It'll let the other people know what might be the root causes of my anxiety related sleep disorder because it all depends on person's lifestyle and life history!

One more thing, if I do little physical exercise like walk, biking or hiking in the afternoon, I get better sleep after taking these pills . . .
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Offline insights

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Re: Update: 50 + hours without Seroxat and no pain!
« Reply #8 on: February 13, 2014, 05:54:03 AM »
I have 5 pills of Seroxat CR 12.5mg but I'm not going to take it unless something seriously goes wrong.

There is no point in taking them. Antidepressants do not work instantly, you must take them daily for 3-12 weeks at a therapeutic dose before they begin to work. For Seroxat CR the usual minimum therapeutic dose is 25mg/day.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

 

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