Edmunds: prolonged Wellbutrin withdrawal

[Altostrata]

I'm going to guess this is a wave and not indicative of anything. Do what you can to surf it. Please let us know how you're doing.

[Edmunds]

Thanks for recent messages from @Altostrata and @manymoretodays. Anxiety, fear, feelings of hopelessness really came roaring back today, about 11 months since my too-short taper from Effexor and 9 months since going off Wellbutrin. My taper from Prozac is down from 20  to 10 mgs for the past two and a half weeks. Anxiety is today as bad as it has been for several months. And it occurs to me that I've been on a downhill slope for the past month or more. I'm hoping this is just a long wave. It's also possible that the lockdown and the continuous stream of bad news has something to do with my current state. Are SA members struggling more these past couple of months with the the strain of living through this pandemic?

[Altostrata]

You reduced 20mg Prozac by 50% 2.5 weeks ago? You've been taking it a year. We advise a much more gradual taper.

 

Do you have any other symptoms that might be withdrawal symptoms? How's your sleep?

[Edmunds]

Thanks for the reply @Altostrata I did not explain my taper at all clearly in my message of 17 hours ago. The fact is I started the taper from 20 mgs Prozac this past January at 10% decrease per 4 weeks or so. I reached 10 mgs about two and a half weeks ago and have been holding there.

 

The anxiety surges eased up greatly as of last November, so the heavy anxiety yesterday triggered much discouragement, even though I know that this sort of regress can happen. But since the anxiety remitted, now nearly six months ago, the continuing symptoms, which have not changed much, are 1) heavy derealization in the form of perceptual fogginess and disconnect from the world "out there;" 2) blurry vision [though my ophthalmologist examined me recently and reported nothing wrong with my eyes] that may be linked, I imagine, to both WD and continuing taper of Prozac; 3) sore, dry eyes, which is worse toward the end of the day; 4) fatigue and sleepiness much of the time; 5) Not diarrhea but multiple BMs every day, which carry no troublesome symptoms and appear healthy.

 

Of course I"m wondering if the anxiety the past few days is a signal that my brain doesn't like having the Prozac reduced to 10 mg.

 

Sleeping quite normally has, through all of this recovery, been my consistent experience, though coupled with dreams always involving conflict and trouble of some sort. (Last night a long dream about trying to pack and close up our house under great stress in time to get to an airport to make a flight. That was followed by a surreal plane crash, though I survived unhurt, thanks!😬)

 

My consolation through the lockdown is knowing that friends around the world and I are sharing this experience as a species, all of us with nearly the same genome.

 

[Altostrata]

When did you start to get withdrawal symptoms as you were tapering?

 

What times of day do you take your drugs? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

This will help determine if the drugs are causing your symptoms.

[Edmunds]

Thanks @Altostrata. My history of WD symptoms started in May 2019 when I taper way too fast off Effexor and same 2 months later from Wellbutrin. By November the strong anxiety symptoms were receding. Since then I've been on a plateau the symptoms quoted below:

On 5/3/2020 at 10:19 AM, Edmunds said:

1) heavy derealization in the form of perceptual fogginess and disconnect from the world "out there;" 2) blurry vision [though my ophthalmologist examined me recently and reported nothing wrong with my eyes] that may be linked, I imagine, to both WD and continuing taper of Prozac; 3) sore, dry eyes, which is worse toward the end of the day; 4) fatigue and sleepiness much of the time; 5) Not diarrhea but multiple BMs every day, which carry no troublesome symptoms and appear healthy.

 So I can't say that the taper from Prozac has caused any different or worse symptoms, though I became concerned 3 days ago when I had a nearly day-long anxiety upswing. That has not happened in subsequent days, however.

 

I take my 10 mg of liquid Prozac almost invariably around 8 a.m. along with Omega 3, D3, and B12. The general pattern of remaining symptoms is very consistent. Derealization (DP/DR)fog feels a bit less stressful inside our house and more so out in the sun and where there is more color, sound, and action around me. Later evenings tend to be slightly more relaxed than earlier in the day. My eyes feel sorer and drier in the later afternoon than earlier. Blurry vision is constant throughout the day.

 

I stopped taking magnesium chellate for awhile to see if it might reduce the number of BMs I have every day. It had no discernible effect, so I bought more to take every other day (every day dose has in the past caused diarrhea.) Any advice about magnesium? A bad idea to resume it?

[Altostrata]

How long have you been taking vitamin B12?

 

Do you spend a lot of time at the computer?

 

How's your sleep? What is your sleep schedule?

 

If magnesium gives you diarrhea, I would stop taking it. Small doses throughout the day are more tolerable and effective than one large dose.

[Edmunds]

 Thanks @Altostrata I've been taking B12 for several years (Methylcobalamin, 1000mcg). A neurologist recommended it to help prevent or reduce ocular migraines, though I continue to have them once in a while. They usually last 15-20 minutes, sometimes followed by minor headache.

 

I do spend a lot of time at my computers, though certainly not all day. Mostly, I'm grateful that I can continue to put in working hours every day. (I have worked from home for several years now.)

 

My sleep schedule is quite consistent, averaging from about 10:30 pm to 7:00 am. No sign of insomnia, and throughout all my troubles with anxiety/dissociative disorder, that has never been a problem.

 

The magnesium I resumed taking every other day (chelated 250 mg) has not caused diarrhea, though as I have written before I have been having more than the usual number of BMs every day. They seem normal in all respects except in number. Stopping the magnesium for a few weeks had no effect on that condition. I haven't seen multiple BMs  listed as a symptom of WD, though it's the only cause I can think of.

 

I had increased anxiety for awhile yesterday but not during 8 days before that and not today.

 

I'm coming up on 1 year since my psych and I switched from Effexor to Prozac, with a fleeting 3-week taper off the Effexor, and off Wellbutrin about 2 months later. Last July the WD started setting in: anxiety surges every day, crying spells, cortisol spikes on waking, heavier derealization, blurry vision. These all lasted until November (2019), when the anxiety, crying spells, and cortisol mornings began to receded and, except for occasional anxiety, disappeared. I assume, however,  that the continuing derealization and blurry vision, plus chronic fatigue, mean that the WD process continues. Do my moderators agree?

[Altostrata]

The withdrawal process is not continuing, you are stabilizing.

 

How about cutting the magnesium tablet in half? It's more effective in small doses taken more frequently. Have you tried fish oil?

 

When you have a chance, could you put your signature in chronological order?

 

 

[Edmunds]

Thanks for the reminder @Altostrata I fixed my signature.

 You mentioned that I'm no longer in wd but still stabilizing. That's helpful. I'm now heading into year 2 following the start of my initial taper from Effexor, completed on my psychiatrist's advice in 3 weeks.

I'm at 8 mg of Prozac having started the taper from 20 mg in January. I don't feel that the taper is giving me trouble, though days very in how much derealization and low-level anxiety bother me. My blurred vision has not changed for the better.

I can understand this long stabilization considering that I have been on one or another AD most of the time since 1987.

[Altostrata]

What is your taper schedule? Are anxiety and derealization worse at any particular times of day?

[Edmunds]

@Altostrata I'm impressed with your fast reply!

 

My taper schedule from liquid Prozac has been about 4 weeks per 10 percent reduction. I'm at the end of the second week at 8 mg.

 

At present the anxiety is quite consistently more troublesome in the morning hours and least noticeable in later evening. But I don't want to overstate the anxiety symptoms, which are far less than they were during the first 4 months of withdrawal in 2019.

 

The derealization is highly consistent and predictable. It doesn't really change at all from day to day. For me, it takes the form of a perception of two symptoms in the diagnostic list of symptoms: "unreal surroundings" and "looking into a fog". For me these symptoms are heightened these days by two other problems. One is the blurry vision, which glasses do not correct. The other is esophoria (double vision), which my special glasses with prisms partially correct. I need new glasses now, but the HMO center I go to (to get insurance coverage) is currently closed . In short, my visual experience is a bit anxiety producing. Then there is the pandemic!

[Altostrata]

It seems your derealization symptom is related to your vision problems, which may not be due to psychiatric drug withdrawal.

 

If you feel your symptoms have gotten worse with your last reduction, you may want to hold on tapering for more than a month, then try a smaller reduction or The Brassmonkey Slide Method of Micro-tapering

 

The taper should be calculated on the last dosage. The amount of the reduction keeps getting smaller.

 

For example:

First 10% reduction on 10mg - 1mg = 9mg

Second 10% reduction on 9mg - 0.9mg = 8.1mg

Third 10% reduction on 8.1mg - .81mg = 7.3mg

 

and so forth.

[Edmunds]

Thanks for that @Altostrata

 

I'm sure my DR symptoms are not directly related to my vision problems. I have had the same DR symptoms off and on since I was 19. They have in fact gone away for years at a time. I was having DR for a few years when I went off Effexor and since then the DR has been worse.

[Altostrata]

If the symptoms you call DR are pre-existing, we might not be able to do anything about them, they are part of your neurology or have other causes. It is possible withdrawal-induced hypersensitivity has made them worse or more noticeable.

 

Does adjusting your taper make sense to you?

[Edmunds]

@Altostrata I think you are right that the WD that began a year ago has made the derealization systems more aggravating.

 

My ongoing taper from Prozac may be causing a moderate regression at this point--dull anxiety symptoms some days. Slowing the taper as you suggest makes perfect sense. Frankly, I'm impatient. I'm eager to get off it completely because accomplishing that might lead to improvement in my vision. As you know, Prozac has been exposed as a notorious AD for causing vision problems. But I will hold at my current 8 mg of Prozac until these anxiety spells let up, then proceed on the taper as you recommend.

[Edmunds]

@Altostrata A few weeks ago Altostrata suggested a micro taper from fluoxetine/Prozac. I can't say that current symptoms are receding consistently, but since starting the taper back in January, I have been on a plateau but not getting worse or feeling a sustained reaction from the taper. Consequently, I have continued a straight 10% reduction, starting from 20 mg last January, rather than the micro taper. I'm at 8 mg right now and will go to six in two weeks, barring significant setback.

I also found a new therapist who is experienced with the weird dissociative symptoms I have (derealization), which long precede my withdrawal from Effexor and Wellbutrin. The WD, however, made the derealization worse. My other main continuing symptom in blurry vision, plus low-level anxiety some days.

[Altostrata]

Your own body is the best guide for your tapering speed, Edmunds. Good to hear it's going well.

[ChessieCat]

1 hour ago, Edmunds said:

Consequently, I have continued a straight 10% reduction, starting from 20 mg last January, rather than the micro taper. I'm at 8 mg right now and will go to six in two weeks

 

Looks like you might be calculating your 10% on the original dose of 20mg.  SA recommends tapering no more than 10% of the current dose followed by a hold of about 4 weeks.

 

This would mean that your next reduction from 8mg would be 7.2mg not 6mg.

 

From your drug signature:  Magnesium Chelate, 250 mg

 

Do you take this in one dose?  It is better to take magnesium throughout the day rather than all at one time.  I take mine twice a day and have proven (by stopping and starting it several times) that it reduces my anxiety.

 

Edited June 22, 2020 by ChessieCat

[Edmunds]

@ChessieCat Thanks for writing more than a week ago. Because I have not had any clear negative reaction to the speedier Prozac taper that I adopted, I will continue with the full 10% at 3-4-week intervals. I just went down from 6 to 4 mg. I will hold or go back up a bit if I think I should.

 

I said no clear negative reaction, though I have been on a plateau of recovery for a few months, dealing mainly with heavy derealization fog, blurry vision, and mental fatigue. Because I was on ADs and other meds (even one antipsychotic briefly) for most of more than 30 years, I can see why I'm going into Year Two of slow stabilization. I now have a new therapist who has some experience with dissociative disorders and complex trauma. A lot of therapists don't.

[ChessieCat]

7 hours ago, Edmunds said:

Because I have not had any clear negative reaction to the speedier Prozac taper that I adopted, I will continue with the full 10% at 3-4-week intervals. I just went down from 6 to 4 mg. I will hold or go back up a bit if I think I should.

 

It is better to slow down your taper than to go too fast and rely on updosing, which may not work or could possibly make things worse.  We have members who have ended up taking longer to get off their drug because they tried to go too quickly and ended up having to hold for long period/s of time to stabilise, and because withdrawal sensitises the nervous system some don't go back to their previous level of stabilisation, and so they end up having to make smaller reductions so they can get off the drug but also aren't at their previous WD normal state.

 

The big issue with Prozac is that because of it's long half life it can take some time before you get the signs that the taper rate has been too fast which means that the brain has more work to do to stabilise.

 

From the Tips for Tapering Prozac topic:

  

On 7/3/2011 at 4:11 AM, Altostrata said:

Is Prozac "self-tapering"?
Because of its very long half-life, Prozac has the reputation of being "self-tapering," meaning it requires only a short taper. However, some people do suffer withdrawal from Prozac, just as severe as other SSRIs. Because of the long half-life, withdrawal symptoms simply take longer to appear.

We suggest starting out with a slow taper of 10% per month for a couple of months; if no withdrawal symptoms appear, rate of taper may be increased -- but slow down if withdrawal symptoms arise.

 

 

It could be that you are one of the people who are able to do a fast taper.  However, there is no way to know if this is the case.  That is why it is better to go slower in order to avoid the withdrawal and destabilisation, than to go quicker, become destabilised and possibly end up in a worse condition for a much longer time.  The idea of tapering slowly is so that the brain can adapt to not getting as much of the drug and keep withdrawal symptoms to a minimum during the process.

 

  

On 8/31/2011 at 5:28 AM, Rhiannon said:

This is something I posted somewhere else and then saved. I know it's all stuff I've said before, but it bears repeating and further discussion. A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

 

That's not what happens with medications that alter neurotransmitter function, we are learning. What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain. So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along).

 

It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

 

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

 

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected.

 

 

 

 

 

Edited July 2, 2020 by ChessieCat

[Altostrata]

In a linear reduction such as the one you have adopted, each decrease is a larger and larger proportion of the prior dosage. This means increasingly larger step for nervous system accommodation. As Chessie said, don't count on updosing to fix errors. Your nervous system will appreciate fewer rather than more drug adjustments.

[Edmunds]

Thanks to @ChessieCat and @Altostrata for good advice. The last thing I want to do is an updose of the Prozac, so I appreciate the reminder. I've been doing the taper from 20 mg for about 6 months, but I won't try to rush it now that I'm at 6 mg.

[ChessieCat]

On 7/3/2020 at 4:29 AM, Edmunds said:

but I won't try to rush it now that I'm at 6 mg.

 

I'm very pleased to read this.

 

When I got down to 1.125mg Pristiq I was having difficulties working out how I was going to taper further after the compounder told me, after he had said many times when asked that he could make any dose I needed, that the smallest dose you could make was 0.125mg.  I was very tempted to jump at 1mg.  Thankfully after several attempts at working out a taper plan I came up with something and now have all my capsules made up for the remainder of my taper.  It ended up being a relief once I had the capsules because I now have no excuse.  There have been several times during my taper that I have become impatient.  Now I'm so close I've decided that it's not worth risking messing it up now when I have put in so much money and effort to get to where I am.

[Edmunds]

• Thanks @ChessieCat I'm holding at 6 mg of Prozac and using liquid. 6 mg is equivalent to 1.5 ml in my syringe. It's getting harder to pull a precisely accurate amount into the syringe. I may have to buy one that measures relatively tiny amounts. I''ll see what's available.
• My blurred vision seems a little worse the past several days. I know that Prozac can cause this. I wonder if this symptom could be related to my taper getting close to zero dose? Or is it just part of a wave in the stabilizing process?

[brassmonkey]

If you add equal amounts of liquid and water and mix it up well you will have a solution with half the strength. To get the same dose you are now taking you would have to measure out twice as much.  This might make it easier to measure your dose.  The diluted liquid can only be kept for a day or two before it spoils so don't make up a lot all at once.

 

What is the strength of the liquid as listed on the bottle?

[Miyan]

@brassmonkey Sorry for asking from others forum 

6 minutes ago, brassmonkey said:

The diluted liquid can only be kept for a day or two before it spoils so don't make up a lot all at once.

I makes 80ml solution with distillated water. I uses Syringe for oral. Normally I takes 4ml everyday means 20days I keeps the solution. Will the solution expire in One or two days.

[Edmunds]

Thanks to @brassmonkey @ChessieCat  @Altostrata and @Miyan for advice on liquid Prozac/fluoxetine dosage.

On 7/2/2020 at 9:47 AM, Altostrata said:

In a linear reduction such as the one you have adopted, each decrease is a larger and larger proportion of the prior dosage.

This is a point I had not considered, but I understand the math!

I am though a bit confused about the discussion of making solutions and their strength. I'm taking a generic fluoxetine hydrochloride. The solution contains 0.23% alcohol but nothing else is listed. I think, though, that there's some sucrose in the bottle as well. The bottle says to store at approximate room temperature. The expiration date on the bottle (120 ml full) that I started using about a month ago is October 2021. When I started the liquid form at my request to help with the taper, my psych just said to take the tapering dose you want and squeeze it into a little water or juice. That's what I do. I don't see how the amount of the water makes a difference in the strength of the dose. Am I missing something?

[Altostrata]

18 hours ago, Edmunds said:

It's getting harder to pull a precisely accurate amount into the syringe. I may have to buy one that measures relatively tiny amounts. I''ll see what's available.

 

Are you using a 5mL oral syringe now?

 

We suggest dilution because a greater volume might be easier for you to measure with the syringe you have. But you can get a 2mL, 1mL, or 0.5mL syringe instead, if you wish. They have smaller graduations than the 5mL syringe.

 

Google for your liqud drug manufacturer to see full ingredients of the liquid. Most likely, it has water and flavoring in it as well as alcohol.

 

Good of your psychiatrist to leave tapering up to you. They usually don't have a clue.

[Edmunds]

Thanks again to  @Altostrata I'm at 4 mg Prozac/fluoxetine and holding there (tapering Prozac since January after Effexor and/or Wellbutrin WD symptoms eased up last December.) My symptoms have been a bit worse: heavy derealization, blurry vision, and feelings of anxiety/distress many days though not all. I think I read this on the site, but is it fairly common for people to find tapering from and finally getting off of the last mg drops (or beads) of Prozac especially uncomfortable? Also once I'm off the last of my AD meds (more than 30 years of one or another), is it common for one's brain to continue the rebuilding and restabilizing process for awhile? I'm just trying to look forward with hope.

[Altostrata]

When was the last time you made a drug change? What was it? What is your taper schedule? How old is your liquid?

[Edmunds]

My last AD change was to Prozac in May 2019. I did that when my psych had me do a fast taper off Effexor, and, about two months after that, Wellbutrin. No drug changes at all since July 2019.

 

Owing at first to misunderstanding and then contrary to some advice, I have done a linear 10% taper off Prozac at about 4 week intervals since January 2020. I'm down to 4 mg per day of liquid.

 

The scripts for the recent two 120 ml bottles of liquid fluoxetine were filled about 2 months ago, i.e. May. I using the second bottle now.

 

Thanks for the questions @Altostrata

 

 

[ChessieCat]

2 hours ago, Edmunds said:

is it common for one's brain to continue the rebuilding and restabilizing process for awhile? I'm just trying to look forward with hope.

 

This is an excellent topic and was recently updated:

 

are-we-there-yet-how-long-is-withdrawal-going-to-take

 

[Altostrata]

Please look at your bottle of liquid and review the expiration date.

[Edmunds]

The expiration date on the bottle of liquid Prozac is October 2021. 

[Edmunds]

@ChessieCat and @Altostrata The updated article on recovery time was a good reminder.