More Questions About Ssris

[yogini]

I've now been on Paxil for about 2 months and things have been going well. I started out on 5mg (1/2pill). About 10 days later I went to 10 mg. I noticed improvement even on the 5mg - I felt a lot more energy and I didn't need compression hose anymore. A couple of weeks after increase to 10 mg, I started reducing my beta blocker. It took me a couple of weeks to get there, but I've been beta-blocker free now for the past three weeks. This is great news, as I took atenolol for 4 years. It took me a while to get the courage to try something new, but I see now that Paxil is a MUCH better drug for me. I have more energy, I've been able to be more active, my hand and feet have warmed up and I have more color in my face. I didn't realize how tired even the smallest dose of atenolol was making me, until I got off of it. The initial side effects of the Paxil were minor and have worn off ofr the most part, although I do see myself sweating more. All in al, this is great news.

Of course, despite the improvements, I'm still experiencing POTS symptoms. The worst was last week when I went ot the gym for the first time, and my HR stayed up for a whole day after that. I took some atenolol to bring it down. I still have to rest and be careful not to overexert myself. I'm wondering whether I should think about increasing my Paxil to 20 mg? I was wondering how those of you taking SSRIs got to the right dose? I don't want to overmedicate myself and I don't mind taking BBs sometimes as needed, but to the extent I can minimize my symptos on the Paxil, that would be great. I also read somewhere that SSRIs build up over time and that you need less as time goes on, so I am concerned about upping my dose.

Another question I have is what time of day to take the Paxil? Does it make a difference whether you take it in the am or the pm? Because I take it at night and I wonder whether it would be more effective if I took it during the day.

I'm going to call my dr on monday, but thought I would post about this to see if anyone had any thoughts. Thanks!

[flop]

Hi Rita,

I take Paroxetine (Paxil / Seroxat) too. I was initially prescribed 20mg and had to reduce the dose to 10mg for the first week because of side-effects. I have been taking the 20mg dose for about 18 months now. Paroxetine isn't licenced for dysautonomia but it is frequently prescribed off-lable for people in our situations. The usual dose for licenced indications is 20-40mg with a maximum dose of 60mg - increasing your dose might be a suitable decision but you should discuss it with your own doctor. I've not heard of levels building up and needing to be reduced over time, however I do know that if you want to come off Paroxetine that it needs to be done slowly and carefully gradually reducing the dosage over several months as there can be a nasty withdrawal syndrome if you stop taking it too rapidly.

I was advised by my pharmacist to always take Paroxetine in the morning, as it apparently interfears with sleep if taken later in the day (but on the odd occasion that I have forgotten my morning tablet I have taken it later on without too many problems).

Flop

[yogini]

Thanks, Flop. I have the go ahead from my doc to try the 20 mgs. I am switching to taking my Paxil in the am and then I will slowly up my dose starting later this week. My POTS symptoms are really acting up right now, so hopefully the changes will bring me back to "normal".

[Megan]

I was on Prozac before I was diagnosed with POTS, so my psychiatrist moderated that dose for me...I don't really remember how I got there. I'm thinking of switching to a different SSRI, though, that may help with the POTS more. I've always had a fear of Paxil...I'm not sure why. You've found it helps, though? I'm going to talk to my cardiologist and my psychiatrist, but it would be nice to have some other opinions from people about what helps them.

Meg

[yogini]

Paxil has been really good for me so far. Still get some POTS symptoms, but more manageable and a lot less fatigue than when I was on atenolol. I was really worried about side effects or having my POTS symptoms act up, but nothing major yet..fingers crossed! Good luck with your decision.