Switching from Effexor to Paxil

[tom_h]

My wife has been taking Effexor for 6 years.  I'm not sure of the strength, but let's call it a medium dose.  Pervious to Effexor, she had been on Paxil for many years to help with anxiety.  She found it very effective.  In 2007, a routine mammogram discovered Ductal Carcinoma In Situ in its very early stages.  She had a lumpectomy, followed by radiation therapy, and began 5 year drug treatment of Tamoxifen.  Shortly after starting the Tamoxifen, it was discovered that Paxil (and I guess any SSRI) greatly reduced the effectiveness of Tamoxifen.  Her oncologist placed on the SNRI Effexor.  Getting off Paxil and onto Effexor had some problems.  She slowly ramped down on the Paxil BEFORE starting the Effexor.  There were episodes of crying for no reason and several weeks of other slightly odd behavior before things smoothed out.  But my wife says she has never felt as good as being on Paxil.

So our physician has suggested that she return to Paxil.  He told her to just stop taking Effexor, and begin the prescribed dose of Paxil, which I think is 30mg., her old dose.  My wife is concerned about the withdrawal effects of the sudden stopping of Effexor, and has asked me to ask the group if anyone has done this switch on an immediate basis.  Any advice you can offer is appreciated.

[remar]

You sound like a wonderful and very caring husband. We forget that depression and med changes can effect the people we love, like our spouses, other family members and friends.
Your wife could be having the nausea and fatigue from both the withdrawal of Effexor and starting back on Paxil.
She sounds like she's doing great. I'm sure a lot of this has to do with you and your wonderful support. Her symptoms should get better the longer she's on the Effezor.

[tom_h]

Day 7 off of Effexor.  My wife reports the brain zaps completely disappeared on Day 6.  She has backed off the Paxil dose to 25mg.  She hope to continue reduce that to her prescribed daily dose of 20mg.  What remains currently in fatigue and occasional nausea.  I questions whether the nausea could be just an illness.  But upon taking her daily dose in the evening, the nausea goes away.  So within one week, she has successfully transitioned from 150mg. of Effexor to 25mg. of Paxil without too much of a problem except for a few initial days of brain zaps.

She claims to feel so much better on the Paxil than on the Effexor.  She said it was like living in an Effexor fog for the last 7 years, and now the fog has lifted.  The difference to me is remarkable.  I knew within 2 days off of it that she was feeling better.

It is times like these where my normally delicate and mild wife shows me how strong and determined she can be.  I'm extremely proud of her fierce determination when she set her sights on something to conquer.

[tom_h]

Day 4 off 150 mg daily dose of Effexor.  Yesterday my wife added 10 more milligrams of Paxil for a total dose of 30 milligrams per day.  The additional 10 taken latemin the afternoon great helped with the brain zaps and nausea until she could take her 20mg. dose late in the evening.

She reports feeling fantastic off the Venlafaxine, thinking clearer, and feeling more positive than she has in years.  The brain zaps have fallen off in frequency, she's sleeping better and I haven't gotten "beaten up" in the last two night while in bed with her.  I'll report again in the next few days.

[tom_h]

Thank you both for your input.  The crossover dose idea has been discussed with the physician, and it remains a backup plan.  For now, she want to continue this current course.    The vivid dreams and flailing about while asleep are not new symptoms.  She's been doing this a few years now while on the Effexor.  She was having a difficult time of it last night until she took the Paxil.  She was experiencing some nausea along with the zaps.  Interestingly she had not one zap earlier in the evening while talking to a friend we met while out at dinner.  She says it was almost like when her brain is active, the zaps go away.  So she took the Paxil around 10pm, and within minutes, the brain zaps stopped, and she had a restful night.  Today starts Day 3 off Effexor.  

[persephonedemeter]

The sleep behavior your wife is experiencing is part of Effexor withdrawal. I'm a little shocked her physician said to stop the Effexor completely and just get on the Paxil. My own psychiatrist told me that if I ever decide on my own to stop my Effexor, to let him know, because it needed to be tapered down, not stopped abruptly. I didn't listen to him, and on the very night I stopped, I had very vivid dreams that seemed very real to me and were very anxiety provoking. I reacted to them in my sleep and I threw a lamp against the wall. When I called him in the middle of the night because I wasn't sure if I was having a mental breakdown or what, and I was afraid to fall asleep again, he just sad, "You stop taking the Effexor, didn't you?"

What your wife is doing in her sleep is not safe to her and to you, just by what she is doing. That alone is worrisome. Well, if she wants to flirt with withdrawal symptoms, I guess that is her choice, but for your sake, I would sleep elsewhere, and I wouldn't have anything around her while she sleeps that can cause harm or mishaps.

[tom_h]

Day 2 without Effexor.  My wife says she feels good, but is beginning to experience "brain zaps" at intervals that are becoming closer together.  Otherwise, she says she's feeling upbeat and said that she never felt "right" on Effexor as compared to Paxil.

[tom_h]

I thought I'd resurrect this thread to let you know that my wife has begun the transition back to Paxil.  Despite my cautionary advice, she is determined to abruptly switch from Effexor to 20mg of Paxil, a 10mg lower dose than what she had been on.  Last night she stopped the Effexor and started Paxil.  We had an interesting night sleeping as I was awakened a number of times by her "loud" dreaming.  This is not unusual since she went on Effexor 7 years ago, but she was particularly active last night, jerking, sort of punching me, and yelling out loud.  This is challenging as we typically sleep wrapped up together in just a double bed.  My plan is check frequently on her to make sure everything is OK.  The last time she stopped Effexor was due to influenza.  However, we didn't know where the flu stopped and the Effexor withdrawal started.  She was extremely ill and asked to go to the ER until I discovered that she had stopped the Effexor.  Once started again, she made a miracle recovery within 24 hours.  She's on vacation this week, so though it would be a good time to do this.

[Paxiled]

No, and I wouldn't.  I tapered off Paxil and, unlike your wife, never recovered.  Be careful with stopping these meds -- we have enough problems.  No two drugs work the same, and Effexor is in a different class of meds than Paxil (Paxil probably worked better because Effexor is more stimulating, but  I gotta say, you do know how to choose the most difficult meds out there).  So what I would do is taper off the Effexor as slowly as need be until withdrawal is successfully overcome before starting the Paxil.  That way, she'll know if what she's feeling is the withdrawal or the new drug.  Also, keep in mind that once you stop Paxil it often doesn't work again or has to be at a higher dose -- it's just a strong and peculiar drug.  For all these reasons, I hope you do this with a psychiatrist who manifests a strong respect for the difficulty of doing this.  Good luck.