Ask1: Prozac Withdrawal and Tics

[Ask1]

My 16 year old son has had ADHD and Anxiety since he was 8.  
 

2014 guanfacine 3mg and Ritalin 5mg.  2020OCD symptoms post COVID His dr discontinued above drugs

9/2020 started him on Pristiq 50mg.  

11/2020 added gabapentin 300mg.

1/21increased Pristiq to 100mg. Added Prozac 10mg.

2/21 He started ERP therapy.  Increased Prozac to 20mg.  Tics started minimally

4/21 Increased gabapentin ultimately to 1800mg

before we changed to another dr bc that dr wouldn’t listen to us.  
 

8/21 The second dr discontinued everything except Prozac and increased it to 60mg.

8/21 started ruminating thoughts and panic attacks

9/21 increased Prozac to 80 mg

10/21 Prozac decreased to 40mg

10/21 Prozac decreased to 20mg. Tics increased

11/21 added Buspar for 4 days. Tics exploded 

11/21/21 prozac discontinued 

12/1/21 rage began. Tics exploded. confusion began. Panic attacks and ruminations continued. 
 

he has been genetic tested recently and was found to be a poor metabolizer of SSRIs so it is taking twice as long to clear his system. 
 

my son is a shell of a person. He has had to homeschool until the tics and the rage abate. 
 

any encouragement or insight would be appreciated. We are so very scared. 

 

 

 

 

[Shep]

Hi, Ask1.

 

Welcome to Surviving Antidepressants.

 

I'm sorry your son is going through this, but I'm glad you're here getting informed about these drugs and being an advocate for your son. The good news is he's young and resilient and with time, he will heal and go onto have a great drug-free life. 

 

On 12/29/2021 at 7:55 PM, Ask1 said:

11/21/21 prozac discontinued 

12/1/21 rage began. Tics exploded. confusion began. Panic attacks and ruminations continued. 
 

he has been genetic tested recently and was found to be a poor metabolizer of SSRIs so it is taking twice as long to clear his system. 

 

This is a case where he will need to weigh the pros and cons of reinstating a small amount of the drug in order to ward off withdrawal symptoms. It looks like stopping Prozac may have created more symptoms than he was having from side effects. Please discuss this with your son and let us know if this is true. If so, a small reinstatement may help. Please see: 

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

Here is some more information to get you started. Please share this information with your son. He is the best judge of what is happening in his body and mind. It's best if the person doing the tapering is fully informed and involved in all aspects. He is welcome to post questions here. 

 

Tips for tapering off fluoxetine (Prozac)

 

Why taper by 10% of my dosage?

 

How psychiatric drugs remodel your brain

 

Healing from antidepressants. Patterns of recovery video (4 minutes)

 

The Windows and Waves Pattern of Stabilization

 

 

We also recommend the website Mad in America for scientific research and other information on these drugs and alternative ways of managing the stresses of life that are often  pathologized as an "illness." This website has a Family Resource page you may want to check out:

 

Family Resources

 

And an online moderated Parents Support Group:

 

Online Parents Support Group

 

Thanks for giving such detailed notes on your sons drugs and symptoms. Please add this information to your signature. You may need to reformat it so it will fit. Here is information to do this:

 

How to Summarize Your Drug History in Your Signature

 

A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

Please keep using this thread to document your son's taper and post questions you and he may have. 

 

[Ask1]

Thank you but the panic attacks and ruminating thoughts that he experienced at the onset of increasing his dose to 60mg have been torture for him. Complete torture. I asked him and he just won’t go back on Prozac.  Is there anything else we can do?

[Shep]

Adverse reactions are dose-dependent. If it was the massive increase to 60 mg that caused those symptoms, he may do quite well with a reinstatement at a much, much lower dose. He would get the benefit of the reinstatement without the side effects of panic attacks and ruminating thoughts. 

 

Please see:

 

About reinstating and stabilizing to reduce withdrawal symptoms

He might want to try 0.5 mg - 1 mg Prozac and see how he feels. Withdrawal is about the body's dependency on a drug. As written in the first post in that thread, "According to what medicine knows about psychiatric drug withdrawal syndrome, reinstatement is the only way to alleviate withdrawal symptoms. All the papers about withdrawal symptoms allude to how symptoms usually resolve after reinstatement. This is considered a hallmark of withdrawal syndrome."

 

Please discuss with your son and let us know what you decide. At a dose that low, he could quickly discontinue if there were any problems. 

 

Also, please add a signature. Instructions are in my previous post. 

[Ask1]

How long after reinstatement should we see relief?  Started yesterday. It felt same/worse.  We were 5 weeks out from 0 dosing. Could we have been thru the worst?

[Shep]

9 hours ago, Ask1 said:

How long after reinstatement should we see relief?  Started yesterday. It felt same/worse.  

 

It takes about 4 days the drug to build up to full effect and then it can some weeks for your brain/body to adjust and stabilize. 

 

How much did he reinstate? How did it the symptoms appear after he took a dose? 

 

 

9 hours ago, Ask1 said:

We were 5 weeks out from 0 dosing. Could we have been thru the worst?

 

Antidepressants are notorious for a delayed withdrawal, sometimes not for several months after coming off. This is another reason fo reinstating so if there is a worse withdrawal period later on, the reinstatement will help mitigate the damage. 

 

He also is dealing with a nervous system destabilized from other drugs, their side effects, and their withdrawals. This may take awhile to sort itself out. 

 

He may find some helpful information to handle to handle his symptoms here: 

 

Non-drug techniques to cope with emotional symptoms

 

We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them. However, magnesium and fish oil tend to be calming to the nervous system and many people report they do help. Please only add in one supplement at a time and at a small dose. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

Please add a signature. Here is information to do this:

 

How to Summarize Your Drug History in Your Signature

 

A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

[Ask1]

We reinstated in a small dose, 5mg about 4weeks ago.  The tics diminished. The rage attacks cycle in and out.  He is back in school but only attending a few classes face to face, his ADHD is off the chain.  We tried adding in Ritalin but it aggravated his rage attacks. Now it just feels like a waiting game. 

[Ask1]

I know I should be stronger and at my best for him.   It I am completely worn down and just busted. Depressed really. I wake up every day almost sad that I am waking up. I walk through the whole day with a lump in my throat. I don’t want to take anything for the very obvious depression/anxiety that I feel but I know my feelings are hurting his recovery. 

[Shep]

On 12/31/2021 at 6:53 AM, Shep said:

And an online moderated Parents Support Group:

 

Online Parents Support Group

 

@Ask1Have you been able to touch base with this group? You may find it helpful to connect with other parents going through this process with their children. 

 

On 2/17/2022 at 5:39 PM, Ask1 said:

I don’t want to take anything for the very obvious depression/anxiety that I feel but I know my feelings are hurting his recovery. 

 

What you're doing is saving your child from a lifetime of pain on these drug cocktails. Please cut yourself some slack. Make sure you're finding ways of non-drug coping that are helpful. 

 

Non-drug techniques to cope with emotional symptoms

 

If your son sees you finding ways of feeling better, he may also want to explore more of these kinds of things. 

 

On 2/17/2022 at 5:37 PM, Ask1 said:

We reinstated in a small dose, 5mg about 4weeks ago.  The tics diminished. The rage attacks cycle in and out.  He is back in school but only attending a few classes face to face, his ADHD is off the chain.  We tried adding in Ritalin but it aggravated his rage attacks. Now it just feels like a waiting game. 

 

We don't know of any drugs that treat withdrawal. Stimulants such as Ritalin are likely to cause more harm than good, so it's best to avoid them. 

 

Please read this and share it with your son:

 

Neuro emotions

 

The neuro-emotions, especially rage, can be overwhelming and powerful, even for fully gown adults to handle. Make sure he always has a way of getting away from people and going some place where he can calm down and gather himself. Going outside near nature can help, if that's possible. If not, being able to excuse himself quickly and go to a bathroom may be helpful for him. There's no way to explain a neuro-emotion and many of us going through withdrawal have been profoundly embarrassed by our over reactions. Make sure he's not internalizing what is clearly a withdrawal over reaction. Make sure YOU'RE not internalizing this, too. 

 

The neuro-emotions are very common during withdrawal but they do pass in time. Keep messaging this to your son. You may also want to drop the "ADHD" label, which reinforces a permanent defect in his brain. Messaging recovery and healing is really important for him right now. 

[Ask1]

Thank you!  I will definitely join the parent group. It will be helpful to have a group going through the same thing. We added in Omega 3 to the magnesium/L Tryptophan BID combo and that seems to be helping. That and a lot of therapy: we switched his math class to a self-paced online class to help reduce the stress and are trying to change our parenting style to be more results oriented instead of “hey, Why didn’t you get this chore done?” The consequence is still there, just minus the feeling of judgement. 
 

In all, we are trying to frame the narrative to be positive-this is hard but like all hard things it gives us the opportunity to grow in unique manner. 
 

Prozac is driving us nuts! It’s half-life is forever and the active metabolite, even worse. We know it will be summer/fall before probably see the light at the end of the tunnel because of the CYP2D6 enzyme issue. 
 

thank you for the support!

[Ask1]

My 16yo son who used to be normal just bit me

 

We are three months out. How much longer will this madness last?

 

 

Edited March 1, 2022 by ChessieCat
added topic title before merging with intro topic

[Shep]

@Ask1It's not madness and your son IS normal. He's going through something that many people on this forum find to be the hardest thing they've ever been through. Imagine doing that at such a young age. He's having to try to regulate his emotions which are being bounced around horrifically due to the chemical storm of withdrawal. 

 

This will pass. Please be patient with him. He may not be able to handle all of the stress of school and other responsibilities that are placed on him right now. 

 

Has your son been able to read any of the articles on this website? 

[Ask1]

Thank you, it is just incredibly hard when he is violent. Minutes later he is apologetic. It is just all too much though. He has not read the site, I’ve shared but he just doesn’t. He is so focused on “he is fine”.  But he is not and that is part of the problem. If he would just acknowledge that he is in a challenge, I think it would help.  He is seeing a therapist and working on it all. 

[Ask1]

@Shep, things are getting better but the anger/violence is still there. He gets over it more quickly but I am left shaking afterwards no matter the length of time that it lasts. We are now almost 4 months out from when we hit 0 dosing and almost 7 months out from when we started tapering off. I don’t know if we should add more Prozac, maybe add L Tryptophan or just leave it alone. Most days are pretty good. It just gets bad about once or twice a week and just for a few minutes. But it leaves me shaken for the day and I am now completely depressed but really can’t do anything for it except talk to a therapist and that doesn’t really help. I appreciate that what he is going through is difficult but I think I will be dead or hospitalized before it is done. I just can’t take being yelled at and hit anymore. Especially when it is my son.  

[Shep]

@Ask1If your son is only having waves one or twice a week, than he's doing amazing and I wouldn't make any changes to his drugs or supplements. He's stabilizing. 

 

If you don't feel you can handle your son without ending up "dead or hospitalized," please work with his doctor or therapist so you're safe. 

 

You may also want to touch base with the Mad in America family group for help getting support for caretaker burnout, which is what it sounds like you're dealing with. 

 

[Ask1]

Thank you.  It’s good to hear your take on things, we have no perspective because we have never really been through this. 
 

And yes, I feel completely burned out. I am trying Mad in America but still feel pretty burned out and depressed myself.  
 

It just feels so so bad.  

[Ask1]

The reality is my sweet boy has broken my ribs on 4 different occasions. Feeling devastated beyond measure may be caregiver burnout.  But I just don’t know how to move forward to a place where I don’t feel vulnerable and sad. Mad in America doesn’t really help.  I mean you commiserate and learn but it doesn’t change the fact that someone I love attacked me several times. And I know that it is the withdrawal but that doesn’t my make me feel less vulnerable and less scared. My kid is a completely different person, he never lost his temper before let alone attacked anyone. He may go back to being the same person he was before all of this but I will never truly feel safe and at ease around him ever again. 

[Ask1]

What is the average length of recovery? I’ve seen the graph of the window/wave model.  Does it say that at a year you are only 25% better, alluding to there being 3 more years?  Trying to get an expectation set.  Actually, starting to think about college, or not college.  Have a sophomore who is 4 months out from zero dose and 7 months out from when we started tapering. We took it a little fast but had to because he was ticking so hard when he was out on Prozac 60mg that he was sent to homebound school and completely suicidal from starting to tick 24/7.

 

now he does not tick thanks to Abilify. But he is raging still. ADHD is off the chain. OCD is off the chain.  Hypersensitivity to sensory stimulus. In short, barely functional
 

there is NO way he can leave home in this state but we have to start visiting colleges soon and we all have no idea what is even possible. He always wanted to go out of state but that is impossible currently. He can't even go anywhere not in the city we live much less live somewhere other than with us until he stops raging.  What can we expect?  College is 2.3 years away. I don’t want to squash his dreams but definitely will if it means saving him from going to jail because his rage attacks would completely land him in jail if anyone other than his family witnessed them. 

[ChessieCat]

Unfortunately there is no way of predicting anything when it comes to psychiatric drugs.  Basically we are each an experiment where N=1.

[Onmyway]

@Ask1,

I moved your post to your intro because it relates to your case and we like to keep all of the information on your case in one place. Can you please update your signature? You mention Abilify above. Why is he taking Abilify? Abilify is an antipsychotic and not a benign drug esp at an age where his brain is developing. Did you reinstate prozac and is he still taking it? If not, when did he stop it? Did he taper? That will impact the timing of recovery. He seems to be getting better already which is great. 

 

Your son has experienced immense medical trauma - he was drugged at a young age with drugs that are contraindicated for him - SSRIs actually harm kids and increase suicides and violence (there is an FDA warning for this you can sue this doctor!). He was prescribed Prozac at outrageous doses for his age - the max dose for adults is 80mg. That on top of him being a poor metabolizer. Then he was put on and taken off of multiple drugs without giving his nervous system a chance to recover and without proper tapering. No kid deserves to go through that and have random drugs thrown at him at that very fragile age.

 

Your son is a victim here. 

 

His nervous system has been under attack by multiple drugs at a time when it is just developing. What he is feeling and exhibiting as behavior are consequences of all of the assaults on his nervous system. He doesn't have a choice. When all this is over, he will likely be your old well-behaved person again though the trauma of the whole experience will need to be dealt with for both you and him. It can't be easy for him to lose control of himself. It is hard for adults to go through that. It also can't be easy for a parent to go through this. I am hoping you both recover well but he needs time and patience for healing. I think you need to throw the college plans out the window for now - the focus should be your son not some imagined ideal future for him. He may go to college when he heals and he may achieve wonderful things in life but right now he needs to heal. He needs love, gentle care. As an adult who has gone through withdrawal (much milder than what you are describing your son going through), there is no way to adequately describe the hell that withdrawal is. Imagine your worst experience in life and multiple it by x1000. That is how horrible withdrawal is. Your feelings are hurt. His whole world is upside down and he has no control over anything, least of all his own body and emotions. If he is hypersensitive, then the whole world hurts him. It is wildly unpleasant to be in his own body and in this world. That is what he is going through. 

 

OMW

Edited April 10, 2022 by Onmyway

[Ask1]

We did reinstate Prozac, he did taper. Tics started when he was on Prozac and increased when he was tapering off. The tics were 24/7. He couldn’t go to school because of them, he couldn’t typed or write and he couldn’t sit in a desk because he would rock so hard he would fall out. Being homebound was creating more problems, he was becoming very very OCD and the rage attacks were almost every day. Abilify helped minimize/not eliminate the tics so he could at least go back to school. We will be tapering him off Abilify as soon as we can.

[Onmyway]

Hi @Ask1,

I understand the difficulty that Prozac has caused your son and how you are in a bind. But you needed to reinstate the prozac at a very very low dose 0.5mg or less to see if they would lessen the tics and then after stabilization you would taper him at a very slow rate (no more than 10% a month)- this information is all in the first post that @Shep gave you. 

 

Your son's nervous system is basically destabilized from all of the drugs and starts and sudden stops. It needs recovery and healing which will happen very slowly. Ruminating/rage/OCD symptoms are all part of withdrawal - most of us go through that. Were the tics more like akathisia (which is usually caused by psychiatric drugs)? Please read the Abilify side effect profile carefully. 

 

Our brains undergo huge changes in adolescence (synaptic pruning). It is not good to mess with that. It can have lifelong effects. You can think of the brain as a finely tuned incredibly complex interdependent system which is also very adaptable to its environment. When you change one thing - add a drug, or stop a drug - you are not changing just one thing, you are changing all the dependent parts which are then causing other changes and adaptation. Read the first post below for some explanation. 

What is happening in your brain? - Symptoms and self-care - Surviving Antidepressants

How psychiatric drugs remodel your brain - Symptoms and self-care - Surviving Antidepressants

 

Is he also still taking the ADHD medication? Can you please update the signature with everything he is taking now incl. supplements? 

 

 

 

[Ask1]

Updated signature. Limited to 12 lines. He isn’t taking adhd meds

[Ask1]

And HE is wanting to go visit colleges, not us.  I want to get him on his feet first but as I said before he is aggressively optimistic and rages if you even suggest to slow things down 

[Shep]

I'm locking this thread and will follow up with Ask1 about seeking support on the ground for her and her son.