Shamair: tapering off 20mg Prozac

[Shamair]

Hello,

 

I just came across this website after having a session with my doctor that has put me into deep concern. I’ve been taking 20 mg of Prozac daily for the past 2 years (during a stressful phase I had to updose to 40mg and came back to 20mg again). Since 5 months I’m taking 20mg daily. I raised my concerns regarding family planning with my doctor and that I have to start tapering Prozac off since we’ve put a hold on planning a family since 3 years. She recommended going down to 10mg daily for a month and then 10mg every alternate day for 2 weeks. I’m finding this a bit too abrupt??! I tried going cold turkey from 20 mg last year and it brought horrible withdrawal symptoms. So I’m just so scared!! 

 

Also, is there anyone on this forum who has had a safe pregnancy being on any anti-depressant? I’ve cried my eyes out reading how much time the 10% per dose taper reduction technique takes. While obviously my main concern is to restore my health first it’s just difficult to accept some things.. 

[ChessieCat]

Hi Samair and welcome to SA,

 

Not many medical professionals understand about tapering and withdrawal from psychiatric drugs, which is why this site exists.  I am pleased that you realised that your doctor's suggested method of getting off Prozac is too quick.

 

SA recommends tapering by no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  This is a harm reduction method which is generally suitable for most people.  Some people need to go slower, whilst some are able to go more quickly.  However, there is no way to know which group of people you are in.  You could try tapering at a slightly quicker rate than SA suggests.  You will need to keep daily symptom notes so you can be objective and notice if withdrawal symptoms are worsening.  It's also important to note that because Prozac has a long half life, withdrawal symptoms can show up several weeks after making a reduction, or after you have made a few >10% reductions or reduced again too soon.  At the first sign of withdrawal symptoms increasing it is best to stop tapering and hold on that dose until you stabilise.  Depending on how bad the symptoms are you might need to increase your dose by a very tiny amount.

 

From:  Why taper by 10% of my dosage?

 

On 8/6/2011 at 6:43 AM, Altostrata said:

Can you taper faster?
If are not sensitive to a 10% drop, by listening to your body, you may be able to make 10% drops more often than every month.

Many people do fine with a faster taper. Are you one of them? You can't tell ahead of time.

 

Most people will stabilize (stop feeling the effect of a dosage change) after a reduction within a week. We recommend reductions at monthly intervals to give the nervous system a good 3 weeks to settle down between cuts.

 

If you feel withdrawal symptoms longer than a few days after a reduction, you are not a candidate for tapering faster.

It's best to go slowly at first to find out how you tolerate a reduction. Once you damage your nervous system with withdrawal symptoms, it can take a very long time to feel good again.

The 10% method protects everyone and you have the option of tapering faster if you can tolerate it.

If you think you can taper faster than 10% per month, follow this harm reduction approach to starting your taper:

• Initially, make a 10% reduction and hold there for a MONTH. It can take several weeks for withdrawal symptoms to emerge. Do that again the second month.
• If you have very minor or no symptoms from these 2 reductions, you can try reducing by 10% (calculated on the last dosage, the amount of decrease keeps getting smaller) every 3 weeks. Do that twice. If no problems, reduce by 10% every 2 weeks. Do that twice.
• If no problems after 4.5 months of very gradual reduction, you may be able to reduce by 10% every week.
• If significant withdrawal symptoms appear, STOP TAPERING. Hold at your current dosage for some months, stabilize, then make smaller cuts or go slower. Listen to your body.
• If you do not stabilize after some months, consider a slight updose and hold to stabilize. You will not be able to taper faster than 10% per month after that, and may need to go even slower.
• "Jump off" at the end when you are taking less than 98% of the original dose and reductions no longer cause any reaction at all.

Under this method, the fastest taper takes about 12 months.

 

 

I will also mention that many members find that the lower their dose gets the slower they need to go, by reducing less and/or holding for longer.  Why taper paper: dose-occupancy curves

 

It's also important to know that you may have to get to a low dose before you jump off:  When to end the taper and jump to zero?

 

When the drug is taken away too quickly we can get withdrawal symptoms:  Dr Joseph Glenmullen's Withdrawal Symptoms

 

Skipping days to taper is not recommended.  The brain likes consistency.  It is important to take the same dose at about the same time every day, even when taking a drug with a long half like Prozac.

 

Before you begin tapering what you need to know

 

This topic explains how to get the dose you need:  Tips for tapering off Prozac (fluoxetine)

 

Tapering Calculator - Online

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

 

We have a couple topics discussing pregnance and tapering/withdrawal:

 

antidepressants-withdrawal-during-pregnancy

 

wanting-a-baby-and-withdrawing

 

 

Please create your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

 

This is your own introductions topic where your can ask questions about your own situation and journal your progress.

[WiggleIt]

Dear Shamair,

Your gut instinct about your doctor's bad tapering advice is correct.  Skipping days is one of the WORST strategies to get off of a psych med.  It's right up there with cold turkey, which you already know is bad news.  Chessie's explanation was right on the money.  

The 10% rule is a harm reduction method.  I'm sorry that the news is difficult to accept, but if you skip days, then those consequences will be more difficult.

The following is my personal opinion.  It's a strong one, and I'm not going to beat around the bush saying it: After my own experience on and off these meds and witnessing what they did to my body, I feel it would be morally bankrupt to tell you to get pregnant while still on psych meds.  I'm not going to speculate about safe or unsafe pregnancies on meds, but, speaking as a woman who was on meds and who has lived through WD, I'd personally never get pregnant with psych meds in my body.

Please keep your chin up.  You've found safe tapering advice BEFORE getting ripped off of the meds, and that puts you already in a safer zone than so many people who've come off psych meds in unsafe ways.  You're already armed with knowledge, and that's a good, safe thing.  

[Shamair]

Thank you @ChessieCatand @WiggleIt for your help and opinion on this topic. This group support means so much to me. I will start tapering off in a few weeks and then share how it’s been going.