Hello,
Thanks for posting your query at DoctorSpring.com
I have gone through your question in detail and I can understand what you are going through.
Clomipramine and paroxetine are good medicines for OCD and are almost equally effective. Some patients respond well with paroxetine and some respond well with clomipramine. We cannot say if any of these two drugs is superior.
Coming to the cross tapering, what your psychiatrist is said is not wrong but there are couple of things which i would like to suggest which you can discuss with your doctor:
1) Stopping paroxetine at 20mg abruptly may be avoided. Instead one more step of reducing the paroxetine to 10mg and then stopping it after 1 week is a better idea.
2) When in between you are on both clomipramine and paroxetine, you need to look out for the possibility of serotonin syndrome which is a side-effect of combining the TCA and SSRI.
3) Sedation can be more.
4) Paroxetine will stay in the system for 24-48 hours after stopping the medicine totally.
Hope this helps,
In case if you have any further query, do let me know.
Kind regards
Dr. Srikanth Reddy
Patient replied :
Thank you for your reply.
What are some of the signs of serotonin syndrome? Is it likely to occur or unlikely? I've been taking the 25mg of clomipramine for 3 days and cut down to 20mg of paroxetine 3 or 4 days ago. Should I suggest to my GP to cut down to 20mg after one month and then 10mg for a week or so? Will the effectiveness of the clomipramine be inhibited because I'm taking it in conjunction with paroxetine? Will I have to be off the paroxetine completely before I notice any beneficial effects of the clomipramine?
Also, what is the difference between tricyclic anti-depressants and SSRIs? Why do doctors rarely prescribe tricyclics and prefer to prescribe SSRIs?
Thank you.
Hello
Here are the answers that you want:
What are some of the signs of serotonin syndrome? Is it likely to occur or unlikely?
ANS: Its not likely but one needs to be careful and cautious. The symptoms of serotonin syndrome are
- Agitation or restlessness.
- Confusion.
- Rapid heart rate and high blood pressure.
- Dilated pupils.
- Loss of muscle coordination or twitching muscles.
- Muscle rigidity.
- Heavy sweating.
- Diarrhea.
I've been taking the 25mg of clomipramine for 3 days and cut down to 20mg of paroxetine 3 or 4 days ago. Should I suggest to my GP to cut down to 20mg after one month and then 10mg for a week or so?
ANS: You may ask your GP to cut down to 20mg over next week and then to 10mg over the next week and then to 5 mg after 1 more week and then stop.
Will the effectiveness of the clomipramine be inhibited because I'm taking it in conjunction with paroxetine? Will I have to be off the paroxetine completely before I notice any beneficial effects of the clomipramine?
ANS: No. Clomipramine may act even in presence of paroxetine.
Also, what is the difference between tricyclic anti-depressants and SSRIs? Why do doctors rarely prescribe tricyclics and prefer to prescribe SSRIs?
ANS: SSRIs are newer drugs with lesser side-effect profile and hence doctor prefer SSRIs. Both are the groups of antidepressants and structure of SSRI and TCA are different and SSRIs are relatively more safer.
Hope these answers help you.