Dtox: Prozac - reinstate at what dosage after 2 week CT?

[Dtox]

Hello all, 

 

Firstly, a note to all SA readers & members who may be going through tough times right now & who are finding the path to recovery extremely difficult. My heart goes out to each of you. Please please hang in there. After years of turmoil I know from experience that it can & does get better. Trust that you have everything that you need within you to recover yet know that no man/woman is an island. Use the resources & support that SA offers here & tailor it to your needs to help guide your path. 

 

Secondly, thank you to Altostrata & the SA admin team for this invaluable resource for sufferers & carers alike & for keeping SA alive throughout all these years. I hope you realise the real & positive impact that you have & continue to make to peoples lives. 

 

Some background:

I came across SA many years ago, exactly at a time when I needed it most. Due to ongoing intollerable side-effects (extreme drowsyness, fatigue, dulling of the senses in every way etc) which were holding back my progress, self-development & enjoyment of life, I needed to improve my quality of life by finding a safe & proven path to reducing my medication (from Prozac 20mg downwards). I longed to re-experience, feel & know the 'real me' once again, flaws & all. The absence of literally ANY knowledge, understanding, guidance or support from my doctors as regards to how best to reduce my meds left me deflated, angry, frustrated & hopeless. Eventually I recognised that I needed to take responsibility for my own health & stop 'outsourcing' it to a medical profession that is to this day very ignorant (as regards how medications really work & affect patients & equally at a personal/relational level. Of all the professions I have encountered this is one that needs a full overhaul & oversight). This profession openly did not have my best interests at heart. Equally I knew I needed to be wise, to do things safely & slowly due to my high sensitivity to micro-changes & not fully disregard a profession & it's medication that, despite the years it robbed from me & despite its many many flaws & scarily strong side effects had in fact brought me back from what was at the time the brink all those years ago. I could only be grateful, despite the horror years.

 

So, i found SA, it's common-sense & well documented 10% taper approach & after applying that approach dilligently over a number of years with my doctor's knowledge (they never even heard the 10% approach or that an electronic scale weighing method could work) I ended up at the lowest level of Prozac I had been on in about 15 years. I felt so proud of myself & my quality of life overall was the best it had been for 2 decades. Career, relationship & life-goals were all tracking better than they ever had & for once I had hope & conviction in my abilities to turn anything around & progress. I still felt medication was holding me back though as I felt the side effects of the 10mg, especially after reinstating after missing a few days of daily dosages inadvertently (self-tapering requires self-organisation & preparation, something I still work on). 

 

My current predicament:

Recently Prozac has stopped being sold in capsule form where I live. Liquid form never agreed with my system (too sensitive). The first Fluoxetine (generic A I will call it) that I attempted to jump from Prozac to (at 10% less than I had been dosing) really didn't work for me (worryingly weird physical sensations in my head/skull that didn't alleviate much. Prozac reinstatement side-effects had always dissipated after a few days).

 

I then deliberated over the space of week while not taking anything at all with the choice whether to stick with Fluoxetine (generic A), see the switching side-effects through & continuing to taper over the next number of months/years or just going cold turkey on the basis that I was 'only' a about 8mg anyway. Deep down I knew that cold turkey was not wise but I partially outsourced the decision & didn't listen to my gut. So I cold turkeyed for about 2 weeks. I felt 'ok' during this time, pretty much as I had been before on Prozac 10mg, but I knew that Prozac had a long half-life so I didn't expect much or signifant changes one way or the other anyway. I did sense that some things were coming up for me that reminded me of my mental state when I first got 'sick'. At times I felt even more detached, less sociable & low & had a tangible drop in motivation for my work, my life goals. This worried me. During this time I had a niggling feeling in the back of my mind that cold turkey wasn't wise or the way to go. I rediscovered SA after all these years & read the repeated wise advice of not to cold turkey due to it's effect on the brain &  the higher probablitiy of worsened & protracted withdrawal syndrome & read from the scary experiences of other SA members who had CT'd & tapered. This helped me to decide to reinstate asap, hoping the window for reinstatement hadn't passed. 

 

Reviewing generic A's label showed it contained a lot more excipients than Prozac. I found an alternative Flouxeting brand (generic B ) with the exact same excipients as Prozac & yesterday I reinstated with Fluoxetine generic B at 7.2mg (10% less than I had been on on temporarily on generic A). It hit me hard after about 7 hours & knocked me out (very drowsy & wooly headed) but not like generic A had thankfully, so far anyway. Poor sleep hygiene last night hasn't helped today but I'm 'ok'.

 

My question (request for advice);

I realise I really don't know what dosage I should be reinstating. I read on SA since that reinstating at the original dosage can be counterproductive & to try at say 0.5mg to 1mg if previously on 20mg, however that example was for a different drug than Prozac/Fluoxetine. 

I know there is no strict rule of thumb & everyone & their CNS is different but I wonder which dose I should now continue reinstating at? Ultimately it is my responsibility & decision to make of course & I do note the SA advice of not to use reinstatement after CT-ing as means to taper quicker.

Of course whatever dosage I do decide to continue reinstating at must remain constant for about a month (too many dosage changes are too disruptive/destabilising). My gut & my ego is telling me that I should now take 2mg daily for 1 month, monitor it & if I hit lows in mood etc that I should slowly up it by a small amount (e.g. 3 or 4mg?) & monitor & if needs be continue doing so up to 8 or 10mg. 

This feels like a safe approach but equally I wonder if I should stick with 7.2mg & see through the jump/reinstatement side-effects. I would appreciate any advice or reassurance on either approach.

 

Thanks in advance & sorry for the long-winded post but it was good to get this out anyway & maybe some contents will be useful for others now or in the future. 

[Gridley]

Welcome to SA, Dtox.  Thanks for doing your drug signature.

 

If your last dose before CT was 8mg, then reinstating at 7.2mg was too much.  We recommend reinstating at a much smaller amount that your last dose. I'd suggest 1mg.

 

It takes 4 days for the reinstatement to reach full strength in your bloodstream and a few days

longer to register in the brain.  You need to give it time to work.  You will need to take the reinstated dose for longer than a month, more likely several months to stabilize before you can begin to taper.

 

Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.  You're still in the time period where reinstatement predictably works, up to 3 months after last dose.  It is best to reinstate as soon as possible after withdrawal symptoms occur. As I said, we usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, your system has become sensitized and If you take too much it may be too much for your brain and can cause you become more unstable.  Then, once you've stabilized on the reinstated dosage, which can take several months,  you can begin a 10% per month taper down to zero.  

 

Why taper by 10% of my dosage?

 

Please read:

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

This link is specifically about Prozac and gives you information on how to get the nonstandard small dose of 1mg, basically using a prescription liquid, making your own liquid or using the Gemini-20 digital scale to weigh doses.

 

Tips for tapering off fluoxetine (Prozac)

 

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.

 

 

 

 

 

 

Edited October 4, 2020 by Gridley