GeoffD: intro

[GeoffD]

I was diagnosed with major depressive disorder about 10 years ago. GP decided to handle it himself, rather than refer me to psychiatrist. 

 

He recommended antidepressant - initially moclobemide, later prozac. 

 

He also recommended talk therapy. initially CBT, later a relationship oriented therapy. 

 

I've tried twice to reduce my prozac, of which I have been taking 70mg/day. Both times I failed. I now suspect I tapered off too fast. 

 

Now on my third attempt, tapering more slowly. Currently taking 27mg/day. I've been in touch with a psychiatrist, who recommended reducing by a modest amount every 6 weeks. He also recommended I sign up for this www site. My rate of reduction has been 40mg, 33mg, now 27mg, next target is 20mg. When I look at this www site, I may reduce my reductions. I've been aiming for less than 25% reduction each step. But psychiatrist says maybe 10%. He also says the last 10mg is the hardest to get off. 

 

I'd appreciate any thoughts on my current reduction regime. 

 

I don't know whether I'll get down to zero prozac, but that is my current goal. 

 

- GeoffD

[Gridley]

Welcome to SA, GeoffD.

 

Your psychiatrist is right:  You are tapering far too fast.  You are very lucky to have a knowledgable doctor.

 

We recommend tapering by no more than 10% of current dose every four weeks.  Some have to go more slowly.

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering Prozac.

 

Tips for tapering off Prozac (fluoxetine)

 

I suggest you hold where you are at 27mg for at least one month.  Withdrawal symptoms can be delayed, and you need to allow your system to get used to the lower dose it's now on.  If after a month you feel stable, you should continue with a 10% of current dose every four weeks taper.

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil)

 

Add in one at a time and at a low dose in case you do experience problems.

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

[Shep]

14 hours ago, GeoffD said:

Now on my third attempt, tapering more slowly. Currently taking 27mg/day. I've been in touch with a psychiatrist, who recommended reducing by a modest amount every 6 weeks. He also recommended I sign up for this www site. My rate of reduction has been 40mg, 33mg, now 27mg, next target is 20mg. When I look at this www site, I may reduce my reductions. I've been aiming for less than 25% reduction each step. But psychiatrist says maybe 10%. He also says the last 10mg is the hardest to get off. 

 

Gridley is right Geoff - you're very lucky to have such a knowledgeable psychiatrist. 

 

Do you mind posting the name of your psychiatrist? We have a list of Recommended Doctors and we could add him to the site for other members who are in Australia. It's a very rare find. 

[GeoffD]

Thanks Gridley and Shep for the welcome and your thoughts. It feels good to make contact! 

 

On reductions to my prozac dosage, I have settled on a slower plan - 10% every 4 to 6 weeks. I appreciate learning from your experience. My GPs were wrong on that one. But my psychiatrist is aligned with your thoughts. 

 

Perhaps confirming your 10% target, when I reduced from 27mg to 20mg I had a few weeks of feeling down quite often. That has now receded, and 20mg feels stable. Yippee! I am delighted to have got from 70mg to 20mg. 

 

I've noted some practical methods for making small dose reductions on this site. I haven't picked one yet, but all seem do-able. 

 

On my last call with the psychiatrist, he suggested taking a break from the reduction regime. So I've done so. It feels like 20mg is now my "regular" dose. In fact I think I'd be reasonably happy to stay on 20mg for the rest of my days (I'm 70 years old). However I'm fairly sure that at some time - a few months maybe  - I'll resume the reductions. I'd still love to get to zero! But if I don't succeed, I won't be shattered. 

 

One thing I've noticed over the time I've been reducing is that I have more energy. For both physical and mental tasks. Of course a sample size of 1 isn't conclusive. I wonder whether any other members of SA have noticed the same thing? Maybe it's widespread knowledge that I've missed? Or maybe it's not related to reducing dosage at all. 

 

I checked with my psychiatrist that it's OK to mention his name on this forum - he was fine with that. His name is Shaun Tampiyappa, and he works for Conduit Health, an organisation in Melbourne Australia which provides free psychiatric services to residents of regional (rural) Victoria. To get access to the service, I needed a referral from my GP. I've been very impressed by Shaun - he seems remarkably sane, intelligent, wise, and caring. And not particularly locked in to psychiatric orthodoxy. (If there is such a thing). 

 

Well, I think that's enough for now. It has been an eventful year so far, first the bushfire evacuations, now the virus lockdown.

 

Best wishes -- GeoffD

[Altostrata]

On 12/17/2019 at 1:04 PM, GeoffD said:

I've been in touch with a psychiatrist, who recommended reducing by a modest amount every 6 weeks. He also recommended I sign up for this www site. My rate of reduction has been 40mg, 33mg, now 27mg, next target is 20mg. When I look at this www site, I may reduce my reductions. I've been aiming for less than 25% reduction each step. But psychiatrist says maybe 10%. He also says the last 10mg is the hardest to get off. 

 

Welcome, Geoff. This is very amusing. We know a lot of doctors read this site, but his advice is right off our pages. Are you seeing him regularly?

 

70mg Prozac was a very high dose of Prozac. How do you feel now that you're taking 27mg? Have you felt any withdrawal symptoms as you've made your reductions?

 

After all these years, it's very unlikely you still have that "depression." You have a completely different nervous system now. However, depending on its effects, you may wish to continue on any amount of Prozac, your choice.

[GeoffD]

Hi Altostrata, thank you for the welcome! 

 

Your post appeared just minutes after I posted an update, which seems unlikely to be a coincidence. I believe my new post is subject to moderation, and so probably isn't yet published. 

 

Briefly, though, my psychiatrist seems to value SA highly. I don't think he would have recommended it without reasonable study, or without broadly agreeing with it. 

 

I meet with him (by skype) every 3 months. My initial inquiry was "Do I still need to take prozac?". Not surprisingly, he didn't give me an answer to that. Instead, he suggested I try a slow taper. We discussed my previous two (faster, unsuccessful) attempts to get off prozac. 

 

When we meet, we review my progress with the taper. Which leads to other topics of course. 

 

Some background. About 10 years ago I went through a phase of being always tired, and uninterested in life. My GP diagnosed depression. He recommended antidepressants and talk therapy. I understand this is the current normal approach to treating depression. 

 

My prozac dose for the last 10 years was 70mg/day. I understand 80mg is the recommended maximum. I tried that, but had some side-effects. However I seemed to tolerate 70mg. So there I stayed for about 10 years. 

 

I'm now aware that some people say to take prozac for at most 6 months. Clearly I've violated that idea. I don't think my GP mentioned any time limit. My GP was the only professional medical support I had, until I first met with my psychiatrist last year. 

 

Regarding talk therapy. I've had two counsellors. The first used the customary first-line approach of CBT, which didn't seem to suit me at all. But the second counsellor, a recovering catholic nun,  used what I believe is called a relationship-oriented approach, and she was immensely helpful to me. My work with her identified severe childhood trauma, and led to diagnoses of PTSD and also Asperger syndrome. I know these are only labels, but they have helped me understand some of my difficulties. We stopped meeting around 4 years ago. 

 

Back to prozac. I started reducing my dose last year. In monthly steps, I've reduced my dose from 70 to 60 to 50 to 40 to 33 to 27 to 20. I've been using 20mg capsules, and reducing the dosage by averaging over 2 days (e.g. 80 then 60, average 70) and later over 3 days (e.g. 40 then 20 then 20, average 27). 

 

My reduction from 27mg to 20mg was 3 months ago, in mid January. At first I had some down days after the reduction, but that faded after a couple of weeks. My guess is the reduction (27%) was too big for me. I note that SA suggests 10% reductions. My psychiatrist now suggests the same. 

 

I seem to be going well on 20mg. My psychiatrist suggested I take a break from the reductions, and I'm doing that, for a few months perhaps. So 20mg has become my new "normal" dose. I'm very pleased to have successfully reduced from 70mg to 20mg. 

 

I expect that soon I'll resume my dose reductions. I'll go with 10% a month. If successful, my goal is to get off prozac completely. But if not, 20mg feels OK. 

 

I'm very interested in your comment that the original depression has probably long gone. I suspect I've had phases of depression throughout my life. Maybe I'm currently between phases. So perhaps zero prozac will be fine, up until the next phase arrives. I guess I'll just have to wait and see! 

 

Well, I seem to have rambled on more than I planned. I'll end it here. Thank you for your post! 

 

GeoffD

 

 

[Shep]

12 hours ago, GeoffD said:

I checked with my psychiatrist that it's OK to mention his name on this forum - he was fine with that. His name is Shaun Tampiyappa, and he works for Conduit Health, an organisation in Melbourne Australia which provides free psychiatric services to residents of regional (rural) Victoria. To get access to the service, I needed a referral from my GP. I've been very impressed by Shaun - he seems remarkably sane, intelligent, wise, and caring. And not particularly locked in to psychiatric orthodoxy. (If there is such a thing). 

 

Thank you, Geoff. I've added his name and the Conduit Health website to our Recommended doctor list. 

[composter]

Hi @GeoffD how are you doing?

 

I am also pleasantly surprised to see there is an Australian psychiatrist who highly values this site and offers very similar recommendations. 
 

Hope your taper is going along well. 

[GeoffD]

Hi composter, 

 

I'm going well on my third attempt to reduce my prozac dose. 

 

I've recently reduced from 20mg/day to 15mg/day without problem, and have just reduced to 13.3mg/day. 

 

I've done these reductions by skipping days. First by skipping every 4th day, now by skipping every 3rd day. This way I don't have to cut up the 20mg pills. It seems to work OK. 

 

Next planned reduction, a month hence, will be to 10mg/day. Assuming of course that the move to 13.3mg/day goes well... That'll be a bigger % reduction, so I'll stay on it for 2 months. 

 

Thank you for checking up on me. It's good to know somebody cares. 

 

Hope you are going OK too - GeoffD

[Altostrata]

We do not recommend skipping doses to taper. See NEVER SKIP DOSES TO TAPER

 

You may have gotten away with it so far. If I were you, I'd hold at a measured 13.3mg/day -- that would be literally 13.3mg per day -- and taper more gradually. See Tips for tapering off fluoxetine (Prozac)

 

We know making the intermediary doseages is inconvenient. If skipping doses and tapering using the available commercial dosages worked, there would be no need for this site and we could all be enjoying the summer weather. The reason this site exists is because those simple methods cause a lot of withdrawal syndrome, which you may recall from your previous efforts.

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

 

[composter]

Right, going to echo Alto’s point here. A 10% taper rate per month is the safest approach to reduce harm and risk of withdrawal symptoms appearing. We strongly recommend this and the reductions you described are more like 15-20%. Better to hold now and taper slowly than to continue at this rate and risk a crash into withdrawal. 
 

If you read the Tapering Prozac linked above you will see that it’s quite easy to make a liquid solution of Prozac from tablets. Or, you might also be able to obtain a liquid Prozac solution with a doctor’s  prescription. 
 

If you’re wary about cutting the tablets, preparing a liquid solution is a good alternative and can be quite accurate with an oral syringe. That’s how I personally take my doses. I was intimidated at first to figure it out but I gave myself a few days after I got all the supplies together and tested the dissolving. The switch from tablet to liquid wasn’t too hard (we recommend a gradual crossover over 4 days or so of 1/4 dose liquid + 3/4 dose tablet...1/2 + 1/2...3/4 dose liquid + 1/4 dose tablet). And once I got used to taking the liquid in some juice it has become a routine. 

[GeoffD]

Thank you Altostrata & composter, 

 

I checked out the links you provided. I had already thought about the water dilution method, and have now adopted it. Not a big drama. 

 

Interestingly, I was going OK doing bigger reductions that 10%, and with the dose-skipping method. As far as I can tell. 

 

But now that I'm down to 13mg/day, compared to 70mg/day a year ago, I'm pretty happy, and I don't really care how long it takes to get to zero. 

 

I really appreciate this site, and all the effort you all put in to making it so good. 

 

Thank you, and much love - Geoff

 

[GeoffD]

A bit of an update. All is going well with tapering off my Prozac dosage. 

 

I've been making a reduction each month or so. My 13mg month went well. 

 

I've noticed that I seem to be able to cope with 20% reductions, and I've stayed with that, more or less. And it has been fine. 

 

I'm not saying others can do it. For some folks, 10%may be the limit. Or even too much. But I'm aware that there are large individual differences, and, so far, 20% has been OK for me. 

 

My later doses have been: 12, 10, 8, 7, 6, 5, 4, 3, and currently 2mg/day. All these reductions have felt OK. 

 

I'm using the water dilution method. I tip the powder from one 20mg capsule into 20ml of tap water. So it's easy to work out - if I want 3mg, I just put 3ml of the solution in the syringe, and drink it. These days, I empty any remaining drops from the syringe into the orange-flavoured vitamin C I drink to take the taste away. 

 

I've been on 2mg/day now for 2 weeks, it feels fine. I know that reducing from 3 to 2 is a 33% reduction, not 10% or even 20%. I'm guessing that when the does it this small, it's not so crucial. And any reduction to zero has to be a 100% reduction... So I'm currently thinking my next reduction will be to 1mg, then to zero. Any thoughts on this? 

 

Again, I'm hugely grateful for this www site. So much information, so much caring. 

 

Love to you all - Geoff