Currently I am taking 25mgs Quetiapine, 150mg bupropion xl, 15 mg mirtazapine and just started lamotrigine 37.5mgs. The plan is to get off of the first 3 medications and add Paxil 10mg. So I'm just on lamotrigine and Paxil. I do have a diagnosis of bipolar 1. However I believe I have been misdiagnosed. How would I go about tapering each medication and in what order? Also can Paxil be taken with lamotrigine? Is there any cognitive side effects?
Tapering off multiple medications?
Question posted by 2025091971 on 2 days ago
Last updated on 17 August 2025
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Answers
WildcatVet
1 day 12 hours ago
Hi again!
The combination of lamotrigine and Paxil (paroxetine - generic equivalent) or Paxil alone can rarely cause hyponatremia which is a low sodium level:
https://www.drugs.com/interactions-check.php?drug_list=1430-0,1800-0
Don't be alarmed when you see the word seizure... lamotrigine was originally used as an anticonvulsant but it was also found to be a good mood stabilizer. Make sure that you eat the usual recommended amount of salt and you may need an occasional blood test to monitor your level.
Paxil has also been reported to potentially cause mildly impaired concentration as a temporary initial side effect.
You should never stop or decrease a psychotropic medication except under medical supervision! My non-professional opinion would be to ditch the quetiapine first but don't stop your antidepressant!
Also remember that Paxil is an SSRI and has the potential to cause a manic reaction.
Take care! WC
WildcatVet
1 day 12 hours ago
PS, Paxil is not only a good antidepressant it's also very effective for treating anxiety disorders. It has good user reviews for both depression and anxiety.
2025091971
1 hour 36 minutes ago
This would explain why I got pneumonia so many times on paxil when I previously took it. Why does it not state this possible side effect in the leaflet and why are doctors not concerned about interactions? Such as paxil affecting the Lamictal level. Or that you shouldn't take paxil and seroquel? My doctors are useless. Every time I get a prescription filled I learn everything from the pharmacist.
I'm not adjusting anything that my doctor doesn't know about. I'm hoping Lamictal will be enough for the depression and anxiety and I won't have to start paxil. Do you know if Lamictal will enhance the effects of bupropion xl?
I'm worried about stopping the seroquel with being on bupropion. Since one increases dopamine and seroquel takes it away. I don't want to be thrown into mania by stopping seroquel. I've asked 2 doctors about this and they both say that won't happen since I'm only on 25mgs of seroquel.
Are you say not to stop bupropion xl or the mirtazapine?
WildcatVet
28 minutes ago
They can be hundreds of potential side effects that could affect any given user or none at all and most only affect a small number of people. For instance, pneumonia has only been reported in 0.1 - 1.0% of Paxil users. A doctor may be aware of thousands of potential interactions but has to judge the risk against the benefit to you. Even a Patient Information sheet can only address the most common side effects. That's where a pharmacist comes in - they have studied pharmacology for years and that is their job - but even they can't address every side effect that could occur.
I only suggested stopping the quetiapine because it causes somnolence in about 57% of users and mirtazapine 54%. Why take both especially if it doesn't seem to be working well. The fact of quetiapine being an antipsychotic and mirtazapine an antidepressant would make me want to stop the quetiapine because of the risk of more serious side effects.
But that's just me.
Wildcat
Related topics
paxil, depression, bipolar disorder, obsessive compulsive disorder, social anxiety disorder, generalized anxiety disorder, bupropion, lamotrigine, mirtazapine, quetiapine, medication, tapering
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