Rusdan: slow fluoxetine taper almost to zero

[Rusdan]

I have been in withdrawal with continuous symptoms of anxiety, distress, derealization, fatigue, and occasional crying since June 2019, when a psychiatrist took me off Effexor and Wellbutrin in rapid succession over a combined period of about 6 weeks. I substituted fluoxetine/Prozac for those to meds. It did not help with withdrawal symptoms much, and early in 2021 I started continuous taper (after false starts the previous year). The symptoms have varied from day to day. Big surges of physical anxiety (not panic attacks) have occurred much less in recent months, but feelings of distress, intense DR, frequent crying, and mental fatigue continue, making it very unpleasant to do almost anything except stay home (with wonderfully supportive wife). I started using liquid fluoxetine to slow the taper more. I'm now down to 6 drops of it per day, which is about 0.8 mg and 0.2 ml. I've been tapering drop by drop every 3 weeks, and the tapers don't make me feel worse, just not better, though some days worse than others. My question is now that I'm at such a tiny dose, should I continue to go drop by drop (another 15 weeks) or try going to 0 at this point? I'm happy to be on this site.

[Onmyway]

Hi @Rusdan, 

welcome to SA. Thank you for creating a signature. 

 

We recommend that you taper at no more than 10% of your previous dose every 4 weeks. In your case you would have to slow down your taper rather than increase it. The issue with fluoxetine is that it stays in your body for a long time (weeks) and so you will not feel any significant effects for a while after cutting. These drugs are incredibly powerful at the low doses. These graphs show that at the very low doses the receptor occupancy is very high, so even though you are dropping only 0.2mg that is a huge impact on the receptors and a lot of adjustments to be made. It would be advisable to go slower the lower you get. I know it is a lot of time and it is frustrating but better to do this than to destabilize your system even further and suffer more. Your symptoms seem to be still significant. 

To get smaller reductions you would need to dilute the fluoxetine. I can help you more with that if you would like. 

 

 

 

Why taper by 10% of my dosage? - Tapering - Surviving Antidepressants

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration - Tapering - Surviving Antidepressants

 

What are you doing to manage your symptoms? Some of these links may help to understand how things are developing and what you might do to help things along. 

 

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

 

Non-drug techniques to cope with emotional symptoms - Symptoms and self-care - Surviving Antidepressants

Important topics about symptoms, including sleep problems - Symptoms and self-care - Surviving Antidepressants

 

Wishing you more and bigger windows, 

OMW

[Rusdan]

Thank you so much for your response. 

 

Calculating just with liquid drops of fluoxetine, if I decrease from 6 to 5 drops after 4 weeks that's a decrease of about 17%. And thereafter of course the percentage drops get larger and larger. So I would appreciate your advice on diluting the fluoxetine.

 

I try to manage my symptoms of bearable but constant feelings of mental distress (not about anything in particular), intense DR, head pressure, and mental fatigue by working with my CBT therapist, going to Iyengar yoga classes, walking, eating well, keeping regular bedtime hours, and, just recently, doing at-home moderate strength training. I'm fortunate to have a loving and fully supportive family.

[Onmyway]

Hi @Rusdan

to be honest, if I were you, if I were having such significant symptoms, I would not change anything for a couple of months unless there is reason to believe that it is the medicine that is making you worse. That kind of rest from tapering would make you stabilize and possibly have an easier time when you start lowering your dose after. 

 

To do the dilution you would need to get yourself syringes. Drops are not reliable as a measure at these doses as a tiny change in the size of the drop would be a large percentage change. And in WD it is important to be as consistent as possible with your drug dosage - not jump up and down. 

 

I am going to explain this in as simple way as possible - it is not because I think you are not able to understand if I use shortcuts but because many people in WD have cognitive issues so it's better to be precise and as detailed as possible. 

 

Here is also a link to a thread that explains it well. 

https://www.survivingantidepressants.org/topic/759-tips-for-tapering-off-prozac-fluoxetine/

 

From an Internet search I can find that in the US the fluoxetine oral solution is 5ml=20mg, so 1 ml = 4 mg [If yours is a different concentration then the below calculations would not apply.]

 

You will need a 10ml syringe and a 1ml syringe but a 10ml one may be sufficient at these doses.

 

Option 1: You would get a 1ml fluoxetine and dilute it in 40ml of water. Each 1 ml of this solution would now be 0.1mg of fluoxetine. So to get 0.8mg you would get 8ml in the large syringe. You can store this covered in the fridge for a couple of days. Note that it is important to store it covered as otherwise some of the liquid would evaporate and the concentration of medicine would change. 

 

Option 2: Get 1 ml fluoxetine and dilute it in 80ml of water. Each 1 ml is now 0.5mg of fluoxetine. To get 8mg you would take 16 ml of the solution. 

For tapering you could go the following way: 

Taper plan 1: taper 10% every 4 weeks - your next dose would be 0.72mg (you could get 7.25ml by using the large syringe only) or do 7ml in the large and 0.2ml in the small syringe using Option 1 dilution. Remember to rinse the small syringe after you use it with the undiluted solution as that is more viscous and some will be left in it. Using Option 2 dilution you can do 14.5ml etc. 

 

Taper plan 2:

(Brassmonkey slide) you would lower by 2.5% of your previous dose every week (7 days) for four weeks and then would hold for 2 extra weeks to allow for things to settle. In this case you would go from 0.8mg to 0.78mg in week 1, then 0.76mg in week 2, then 0.74mg in week 3,  then 0.725mg in week 4, then hold for 2 weeks and repeat. 

https://www.survivingantidepressants.org/topic/17671-the-brassmonkey-slide-method-of-micro-tapering/

 

I would recommend Taper plan 2 personally, as it is gentler but in your case I'd recommend at least a few months hold so you stabilize. The point of getting off of these drugs is not just to get off of them but to do so in the least disruptive way and right now your life seems very disrupted. 

 

I would recommend reading this thread as well as it has useful links to other threads: 

https://www.survivingantidepressants.org/topic/300-important-topics-in-the-tapering-forum-and-faq/

 

Hope this helps and please take care of yourself. You need some respite and a long hold may help you stabilize and have an easier time after. 

 

OMW

 

Edited May 6, 2022 by Onmyway

[Rusdan]

Many thanks again to @Onmyway for detailed information about tapering liquid fluoxetine at very low doses. I would first like to take this moderator's advice to hold longer at my current dose of 6 drops of liquid, which I take from the bottle using a syringe. I think the drop amounts are pretty consistent.

 

In the past year I've carefully followed the 10% of previous dose per month taper. But what Onmyway says makes me think that I might have done better to hold doses longer than a month because my symptoms have never changed much from one month's taper to the next. And I've not had severe symptom spikes after a taper. I don't have sharp waves and windows. SA talks about stabilizing. Can you explain what that means? I don't think it means reaching a symptom-free state. Brassmonkey speaks of getting to "an average state of feeling bad." Is that a good way of describing a stabilized condition before moving to the next taper?

 

I've been in protracted withdrawal for three years this month. And what I've learned tells me that withdrawals of this length or longer are much more common than the psychiatric profession and pharmas have told us. I took ADs most of the the time for well over 3 decades, but of course I had no idea of what stopping these meds might require in recovery time.

[Rusdan]

Early last month @Onmyway gave me good advice on diluting liquid fluoxetine to reduce slowly at very low doses. Over the past many months I have reduced my dose to 0.8 mg (0.2 ml). Because anxiety symptoms have remained bearable but very uncomfortable, I have held at that dose for the past 53 days and will continue to hold until I feel more stabilized--again following @onmyway's advice. I have read if symptoms remain strong, one might consider updating just a little, say, up to 0.3 ml, which would be 1.2 mg, to see if that might alleviate the symptoms somewhat. Or a 0.4 ml updose? Then I would start down again very slowly using the diluted solution. Or should I cool my heels and just hold longer at the 0.8 mg?

 

I'm starting my 4th year of withdrawal from, first, Effexor and Wellbutrin, and then from fluoxetine.

[Onmyway]

@Rusdan.

If your symptoms are bearable I'd stay on this dose for at least a month or two longer. The brain (and body) likes stability. Are you seeing slow improvements in any of the symptoms? Do you see a windows and waves pattern? 

 

If you were to updose I'd suggest 0.81 (at these low doses that actually makes a difference) but preference would be to stay where you are.

 

In terms of the rest of withdrawal - are you taking good care of yourself?

We recommend no alcohol/pot/other psychoactive substances or supplements . Alcohol especially will set people back. You can try magnesium and Omega-3 (there are threads on them here). Most people find them useful but not all. So try a small amount, one at a time. Do you have additional support? Stressors? How is your sleep? What are your most significant symptoms? 

 

Given your long history on the drugs and multiple changes and cold turkey stops from which you didn't quite ever get a chance to stabilize it makes sense that it's taking longer. Your brain is working hard to repair the damage and if you leave it alone and support it as much as possible it will do an excellent job. 

 

For me withdrawal normal took about 8 months from when I  first went cold turkey 5 to 0 really, I reinstated quickly but continued tapering and in the meantime had over a month of benzo use that I also stopped cold turkey. 4 months after stopping tapering completely from the reinstatement I started seeing stability and normalcy (to an extent). For you it may be longer as you've had much bigger changes and never gotten to take a long break from what I gather. My symptoms ramp up as I lower but I know what to expect more or less. I still struggle with neuroemotions, sensitivities (usually sound), headache and nausea but it's much easier. I can lead a fairly normal though challenging life.

 

You will get there, no doubt. Just give yourself the opportunity to restart the taper from a place of strength.

 

Are you using syringes to measure the meds? The drops are not accurate and that can sensitize you further. 

 

OMW

[Rusdan]

@Onmywaythanks again for your helpful reply and your encouragement. I especially appreciate your sharing your experience with me. I will stay with my current dose of 0.8 liquid fluoxetine a while longer. I have not had much improvement in symptoms over the past several months. But the symptoms have changed; few strong surges of anxiety and more all-day nagging feelings of anxiety and distress, early morning anxiety, quite intense DR (which remains constant), and fatigue. I've never had extended waves or windows, rather little waves and windows from one day to the next!

I've followed SA off and on so I've taken advice on using omega 3 and magnesium. (See signature) No alcohol, no caffeine for more than 3 years. Wonderful family support--that could not be better. Very few environmental or psychological stressors. I'm retired, though work professionally from home when I feel up to it.

I do use a one mg syringe to measure my fluoxetine doses.

I've recently seen an integrative medicine physician. She is very savvy about what the general psychiatrists do and totally supportive of my withdrawal process. She wants to do a series of test, which may not produce any interesting results. But I will see what the tests, including genetic, turn up.
Thanks again. Any more advice is welcome.

[Rusdan]

@Onmywayhas been a big help with advice. I'm going into my 4th year of tapering from fluoxetine and experiencing continuous withdrawal symptoms. I don't have pronounced waves and windows, and lately I've been feeling as though I'm just getting worse: distressing anxiety most of the time and even more distressing deep derealization fog. As of today I've been holding at 0.8 mg liquid fluoxetine for 60 days. I thought I might start to feel more stabilized by now. But since signs of improvement are not happening (quite the opposite), I won't consider any further reduction for now.

[ChessieCat]

Lorazepam, max of 1 mg 2 times a week

 

Q:  Are you still taking this?

 

If yes, it might be "hurting" more than it is helping.

[Onmyway]

14 hours ago, Rusdan said:

@Onmywayhas been a big help with advice. I'm going into my 4th year of tapering from fluoxetine and experiencing continuous withdrawal symptoms. I don't have pronounced waves and windows, and lately I've been feeling as though I'm just getting worse: distressing anxiety most of the time and even more distressing deep derealization fog. As of today I've been holding at 0.8 mg liquid fluoxetine for 60 days. I thought I might start to feel more stabilized by now. But since signs of improvement are not happening (quite the opposite), I won't consider any further reduction for now.

Hi @Rusdan

that's a good idea. I find that if someone is very destabilized it usually takes more than 4 months (6-8) to get to stability. I think it's a good idea to keep holding.

 

I would avoid taking the benzo if at all possible though I understand it is providing some respite.

 

Why are you taking vitamin D? Are you deficient? I would avoid taking that as well since it can be activating and cause anxiety in withdrawal (it's a neurohormone).

 

Hope you Start seeing some windows soon.

 

PLease see the thread on managing the morning cortisol (I don't have the link handy) as it seems like your symptoms are worse in the morning.

 

Also, a few people have commented that they did not tolerate magnesium l-threonate well. I didn't like it either (I find mag citrate the best). Might be worth dropping it for a week to see if it makes a difference.

 

OMW

Edited June 19, 2022 by Onmyway

[Rusdan]

I'm responding to both @Onmyway and @ChessieCat. Your comments are much appreciated.

 

Both of you asked about my taking 1 mg or less of lorazepam not more than twice a week. I'm sure you are right that it would be better for me to avoid it altogether. The reason I have not stayed completed away from it is that when I've been in a family or other situation where I really wanted to have a reasonably good time, I've found that 0.5 or 1.0 mg of lorazepam is the one thing, the only thing, that represses my anxiety symptoms for several hours, though of course not more than that. I understand that taking no psychotropic drugs (other than the 0.8 mg of fluoxetine I'm holding at) would be the preferred course. I also understand the risk of physical dependence from taking a benzo regularly. But would you say that taking one occasionally is actively interfering with my withdrawal process, that is, slowing my recovery? I would appreciate any comment on that or reference to reading I should do.

Regarding vitamin D3, I started taking it several years ago after my GP told me I had a deficiency. I did labs a few months ago, and I have no deficiency now. I will experiment with staying off the D3 capsule (2000 units) and see what happens in connection with symptoms and my next labs check. There's also plenty of sun where I live!

The integrative psychiatrist I have seen recommended magnesium l-threonate. I can switch to magnesium citrate.

The same integrative psychiatrist has recommended that I take Hardy's Essential Daily Nutrients. The company recommends titraating up to 4 capsules 3 times a day. That's a lot! The capsules combine 26 different vitamins and other supplements, including manganese, copper, chromium, etc. I'm thinking SA would not recommend using this product. Would you comment? Thanks again.

I looked at the thread on morning cortisol and will apply. Yes, my symptoms are always more aggravated in the morning.

[Onmyway]

Hi @Rusdan our understanding of withdrawal (no one knows exactly what is happening with certainty) is that your brain/body is making changes to (reversing) the adaptations it made to the drug. Changes include upregulation of receptors, changing other brain chemicals (brain chemicals are interdependent), changing hormone levels, turning genes on and off etc. Every time you introduce a new psychoactive chemical into the mix, even if temporarily, you disrupt the process and potentially set yourself back. If it were me and I was struggling with akathisia and unbearable anxiety I might occasionally need the respite and take a benzo. I would not, personally, take them to be able to hang out with family. Having said that, you can choose to make other decisions, my role is to inform.

 

The reason why people recommend magnesium l-threonate is because it's supposed to be crossing the blood brain barrier. Whether that's good in withdrawal is not clear. Doesn't hurt to try stopping it for a week.

 

SA would recommend no supplements. Integrative medicine practitioners do not understand withdrawal any better than other doctors and so treat your body the same way they would treat a normal body. But in withdrawal we find that out bodies can be sensitive to things that don't impact other people. So I'd caution against trying supplements. b vitamins specifically and vit D are activating. 

 

What I would suggest is patience and stability - no changes for a while. In the meantime you can apply the morning cortisol management tools - blackout curtains etc. and non-drug management of symptoms - look up Claire Weekes - many here find her methods very helpful.

 

This will get better with sufficient time, we see it over and over again. Time is the healer if you leave the body alone.

 

omw

Edited June 20, 2022 by Onmyway

[Rusdan]

Thanks again @OnmywayI appreciate so much you careful and detailed explanations. I'll let you know how dropping D3 and Mag L-Threonate goes.

[Rusdan]

I haven't checked in in awhile because I was holding at 0.8 mg of liquid fluoxetine for more than 3 months. @Onmyway helped me get ready to taper again, which I did 12 days ago. And some weeks ago I stopped taking D3 and switched my magnesium from l-threonate to citrate with advice from @Onmyway. I decided to try tapering at 10% of previous dose, so I dropped to 0.72 mg (14.4 ml) with a dilution of 1 ml fluoxetine to 80 ml water. This change has gone reasonably well, though I've had somewhat rougher days on 3 of the past 4 (mainly aggravated head pressure, DR feeling, and fatigue). Might I attribute this to the fact that my brain on Prozac is noticing the taper in the second week?

 

I'm going into my fourth year of withdrawal with symptoms, after 34 years of taking, most of the time, one SSRI or another, plus an SNRI, Wellbutrin, and other pills. Sharp anxiety feelings have in the past several months been occurring much less often, and morning  cortisol surges have become quite mild. Seep is quite good, though I tend to wake up around 5:30. The head pressure, feelings of visual disconnect, and mental fatigue have not changed much, but I felt stable enough to start another taper. I can get discouraged and frustrated at such slow progress. Am I the only SA member to have said that? (Just kidding.)

[ChessieCat]

42 minutes ago, Rusdan said:

Might I attribute this to the fact that my brain on Prozac is noticing the taper in the second week?

 

Fluoxetine has a very long half life and it can take 3 weeks for the brain to register a change in the dose.

[ChessieCat]

43 minutes ago, Rusdan said:

I can get discouraged and frustrated at such slow progress. Am I the only SA member to have said that? (Just kidding.)

 

I haven't heard any other members complain about this in all the time I've been a member here.  I joined SA in October 2015.

 

However I have read their complaints!!!

 

I found it helpful to post about my discouragement and frustrations.  Other members supported and encouraged me through those times and I eventually got off my drug after a 6 year taper.

 

I think it helps to have a name for this feeling because then our brain doesn't keep trying to work out what is wrong which can add more stress.  When we have had to go through so much and know that we still have more to go through we can become "battle weary".

 

 

 

[ChessieCat]

49 minutes ago, Rusdan said:

I decided to try tapering at 10% of previous dose

 

You might consider doing a smaller reduction next time.  Remember to hold until you feel stable.

[Rusdan]

@ChessieCatThanks warmly for these helpful comments. Sometimes I’ve wondered what feeling stable might mean, perhaps feeling bad as usual but without symptoms swinging up and down and without new symptoms arising. 

[ChessieCat]

8 hours ago, Rusdan said:

Sometimes I’ve wondered what feeling stable might mean, perhaps feeling bad as usual but without symptoms swinging up and down and without new symptoms arising. 

 

It is important to listen to your body/symptoms and not reduce again until you are stable.

 

Non-drug techniques to cope

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

[Rusdan]

Thanks @ChessieCat, Brassmonkey’s Stability article was especially clarifying. 

[Rusdan]

I've been reporting what I hope will be the final months (many yet to go) of tapering off liquid fluoxetine/Prozac. Thanks to @Onmyway and @ChessieCat for good advice. I've been taking 0.72 mg/14.4ml of the 1 ml fluoxetine to 80 ml water for a little over one month (after more than 3 months holding at 0.8 mg liquid). In the past month anxiety and morning cortisol spikes have continued in remission, though the fogginess, DR, head pressure, strain visually processing the "world out there" have not changed much but have stabilized. I felt ready this morning to do another taper: 10% from 0.72 mg/14.4 ml to 0.648 mg/12.95 ml. Let's see how this goes.

[Rusdan]

I'm coming up on one month on a liquid fluoxetine doze of 0.648 mg/12.95 ml. My continuing symptoms--more than three years now--of fogginess (derealization), low level but continuous distress, fatigue, and some resistance to social interaction all continue, but these symptoms have been quite stable, and surges of anxiety and dread have slowly backed off over the past several months, a little at a time. I will probably try another taper soon but only 10% of 0.648 mg.

 

I have another question about my history that @Onmywayor @ChessieCator another member might be willing to comment on. I have a long history going back to 1961 of intermittent periods of derealization and anxiety, probably associated with complex trauma in childhood. I started taking ADs in 1987. I few years later I switched to Prozac, the hot new pill, but without much effect one way or the other. My psych put me on Prozac again in late 1996. Shortly thereafter my anxiety and disconnected feelings vanished completely, and I remained symptom free, except for one short period, for the following 17 years, when the symptoms started up again. During those 17 years my psychiatrists (a train of several) consistently told me, as you would expect, that my freedom from symptoms meant that I should stay on 20 mg of Prozac (later generic fluoxetine), not taper off it. Prozac was keeping me well, they said. I repeatedly asked these doctors if the drug might have longterm negative effects. And I was repeatedly told not to worry about that.

 

My reading of the critical literature in recent years, however, made me doubt that I was well all those years because of the Prozac rather than in spite of it. I learned that Prozac and other ADs were never intended for long term use and that there is no convincing evidence that longterm use is beneficial. I also knew that earlier in my life, before I took any medication at all, my symptoms would disappear for months or even years at a time. My question is this: Is it likely or even possible that I was symptom free for the 17 years BECAUSE I was taking Prozac the whole time? If the Prozac was "working" all those years, it stopped working suddenly in 2013. That happened amid an unusual though not devastating period of stress over a number of life issues. My history after that was one of more and different ADs until 2019, when I finally embarked on the long withdrawal adventure. I understand now that my very long term use of ADs--17 years times 2, whether they ever helped me or not, resulted in my multiyear and consistently discomforting withdrawal recovery.

 

I would be interested to know of other members who took an AD for a multiyear period, feeling well during that period, and concluding with their doctor's support, that the AD made them well--until it didn't! Thanks.

[Onmyway]

Hi Rusdan, 

I also took citalopram for 20 years. Initially it was prescribed for school related anxiety - I needed to make a decision that I thought had life changing consequences and was very anxious about it. The anxiety got much worse on the citalopram for the first weeks and then subsided as the issue was resolved - decision made. I ended up staying on the drug for a couple of years, then got off of it and had what I now know to be both acute and delayed withdrawal symptoms. Got through the acute ones which were more physical but the delayed ones which were anger and just general agitation (though not anxiety like before) I was told to be a return of my original condition and so I went onto the drug again for the next 14 years. During that time I was mostly ok but did have some intense rumination over important decisions - I am a bit of a perfectionist in that regard related to ways I have learned to be in childhood. Those were NOT prevented by the ADs and remitted on their own in a few months usually. Note that I had had episodes like that before ever going on the ADs as well.  So in effects can't say that ADs prevented those episodes or cured them either. I never planned to come off of them except that I wanted to get pregnant. And then when all hell broke loose I found that that ADs are indeed no better than placebo based on numerous scientific studies. Have a look at this article to realize the extent of regulatory and scientific negligence and outright deception. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172306/

 

You were likely symptom free because what we call depression/anxiety go away on their own most of the time. Placebos are incredibly effective for depression - have a look at the above article. What that means is that when you are off the ADs and the withdrawal symptoms are gone  you will likely feel good again. 

 

In the meantime you can learn some non-drug ways to manage your moods. I have done EMDR and IFS therapy and they have helped a lot. We don't usually recommend trauma therapy when in withdrawal but for me it was more like when you are walking through hell keep walking kind of thing, withdrawal brought up so many things that I needed to get through them rather than bottle them up further. 

 

If you need books to read on those topics do let me know. I like: 

The Body Keeps the Score by Bassel van der Kolk 

Complex PTSD by Pete Walker 

 

Getting Past Your Past on EMDR (this is the lay person version, I've only skimmed this, I have read the therapist one), trauma oriented

The Feeling Good Book (CBT) - useful skills, not trauma oriented 

Internal Family Systems Therapy (Richard Schwartz) - I like the first edition, trauma oriented 

 

OMW

 

[Rusdan]

Dear On my way! @Onmyway

 

Thanks so much for the long, thoughtful, and informative reply to my questions about my Prozac withdrawal. I've now read the article on ADs and placebos. I'm amazed by what they found. I may have seen this article or one on the same subject a few years ago, but it was well worth reading it again. Thanks for drawing it to my attention. And I hope you are doing well these days.

 

I've also read Van der Kolk's book much to my benefit. I may have suffered unknowingly as a child from complex trauma, meaning for me a home with an authoritarian mother who probably had deep psychological problems of her own.

 

I've done EMDR with a therapist some years ago now. I can't say that I received much benefit from it at the time. I really like my current therapist, but even though he does not live very far away, we have all of our session on FaceTime. I don't know if you can do EMDR that way.

 

Just a few days ago I started another taper. Uncomfortable and discouraging symptoms remain, but I have been quite stable. I dropped from 12.95 ml of diluted fluoxetine (1 ml to 80 water) to 11.65 ml. At this monthly rate, I will be ingesting this stuff for many more months! Assuming the tapers go well, do you have any advice about a total jump-off target? There's probably an article about this on the site, but I haven't found it.

 

 

 

 

[Onmyway]

Hi @Rusdan

EMDR can be done on Facetime. If that didn't work for you, my other suggestion would be IFS (internal family systems) therapy which I have done. It helps when you are stuck with EMDR. (This is a suggestion from me personally, no SA). The most important thing with therapy though is the relationship with the therapist and I'm so glad that you have found a good match. 

 

I think the lowest jumping point is a personal comfort issue. I am now at 0.55mg and can't imagine jumping off before 0.05 or 0.01 even. Others do differently. But these drugs are very potent at the lowest doses. Also remember that drug burden does go down significantly over time.

I think of the progress I'm making rather than the final outcome and that really helps.

 

If the withdrawal symptoms are significant I'd hold longer. The body does adapt and find homeostasis if you give it time.

 

OMW

[Rusdan]

Thanks again @Onmyway I will check out IFS therapy, which I had not heard of.

 

My symptoms have been so consistent and lasted so long that I'm quite convinced that protracted withdrawal is the cause and that the road to recovery is time and nothing else. The encouraging news has been that even though the current symptoms of low-level distress, grogginess, visual disconnection, and fatigue persist, worse anxiety symptoms have really eased up over the past year or more. It's not that I feel better. Rather the range of symptoms has narrowed.

 

My wife and I are planning a 9-day trip to the midwest later this month. I have some anticipatory anxiety about this (something I discuss with my therapist of course), but a year ago I would have felt unable to make a trip at all. It will be my first trip on an airplane since April 2019, thanks in part of course to COVID, which neither of us has had so far.

 

I do sometimes wish that I could consult with a medical professional who really knows something about AD withdrawal. My therapist is very supportive of my getting off the fluoxetine, but he does not have much experience with patients in AD withdrawal. The integrative and regular psychiatrists I've talked to (not recently) have sometimes been supportive, but none have shown much knowledge or understanding of AD withdrawal symptoms that go on for years. They just have more drugs to suggest. Among mental health practitioners who do understand, David Cohen, whose short YouTube videos on depression you have no doubt seen, is at UCLA just up the road from me. I haven't tried to see him. SA and moderators like you are my main source of interaction.

[Onmyway]

Hi @Rusdan, 

you may have a look at the videos by Derek Scott. This series provides a description of how it works in practice. But see if you can read up on the ideas first. To be honest, I am not convinced that you can get much from seeing a psychiatrist even if it is someone who understands withdrawal. They themselves don't have many tools to help. But if you do find someone, it would be amazing!

 

[Rusdan]

@OnmywayThanks much for the Derek Scott. I see his videos on line, and I will spend some time with them as soon as I can. I'm sure you are right about the psychiatrists. My therapist agrees!

 

 

[Rusdan]

I'm just reporting in to @Onmyway and anyone else who wants to read this. On Sept. 25 I tapered from 12.95 ml diluted fluoxetine (1 ml to 80 water) to 11.66 ml. So it has been 25 days since the taper, and for the past several days I've been feeling a wave of somewhat more intense distress, DR, fatigue, and morning tears. I've also had a new symptom in the past week and a half of a mild headache centered in the back of my head, as though there is muscle tension. The mild pain comes and goes. Most of my life Ive been free of headaches, including during withdrawal, so this is new. Are headaches of this type a common withdrawal symptom? 

 

I should always remember to express gratitude for the conditions of my life--loving supportive family, ability to work at least a few hours a day, secure home, and no serious financial problems (despite the market slide and the inflation!) My wife and I go off on a flying trip to visit family next week. My anticipatory anxiety is heightened when I think of going through airports, especially in a state of DR fog. But, who knows, it may not be so bad.

 

 

Edited October 22, 2022 by ChessieCat
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[Rusdan]

My headaches seem to have abated. That's good. But the DR and distress have been very difficult the past several days. It's hard to believe how tapering to barely a thimble full of liquid fluoxetine can cause such trouble. It has been 27 days now since I tapered from 12.95 to 11.66 ml. I felt pretty stable, if still far from well, when I did the taper. Clearly I won't do another one for some time. Is it fairly common to reach such a tiny dose of fluoxetine and yet have such a distressing reaction after a month from the last taper? I don't doubt the answer is yes. 

 

I've been in a continuous state of discomfort since June 2019, when I a psychiatrist had me go off Effexor in 3 weeks. I take heart, however, in the fact that the symptoms have continued to change very slowly, which suggests that they all might abate or disappear at some point. Thanks always to @Onmyway and @ChessieCat for staying in contact with me.

[Rusdan]

I'm continuing to hold at 0.58 mg liquid fluoxetine for 46 days.

 

Last week I returned with my wife from an eight-day trip to visit her relatives in the Midwest. This is the first air trip I've taken since August 2019. I continued to experience my chronic heavy DR, medium distress, and fatigue the whole time. Nevertheless, I managed the trip, which family really appreciated!

 

For the past few days I've noticed that the change to standard time has caused something of an upswing in anxiety, fogginess, and fatigue. But I see on the site that members in withdrawal/recovery may experience hypersensitivity to both time zone changes and seasonal clock changes. 

 

I appreciate @Onmyway seeing my posts.

[Rusdan]

I could sure use a word of encouragement. Since returning from a trip with my wife to the Midwest on Nov 2, the DR has been heavier than ever and the daily feeling of distress has been nearly constant. I've been holding at 0.58 mg diluted liquid fluoxetine for more than a month and a half and do not think I should go any lower yet.  Every day that I feel slightly better I think I'm on a trend toward wellness, but then the next day I can get so discouraged when the symptoms bare down hard again. I attended the recent Mad in America town hall, and I know symptoms can get worse at very low dosages. Some days are worse than others, but I have never had extended windows to break up the waves. The good news (if this is good news) is that over the past nearly three and a half years, my symptoms have changed from large surges of anxiety and tough early morning attacks of it to the very uncomfortable DR and just a gnawing daily distress that keeps me from wanting to go much of anywhere, especially not into stores or to movies. Is this a pattern of recovery I share with other members?

 

Also, I'm sure some members saw the article in the NY Times yesterday (Nov 15) about the effectiveness of ADs. It affirms that the chemical imbalance theory is way off the mark but that about 60% of AD users benefit from them. What struck me is that the article says NOTHING about two issues. There's not a word about people who want to STOP taking ADs and what can happen to them when they do. And there's no recognition at all about protracted withdrawals and the failure of so many medical professionals to even believe that people have them, instead of relapses. Did the pharmas get to the author of this article?

 

I wonder if other members had the same reaction to this piece? Any thoughts on that? @Onmyway and @ChessieCat

[Hanna72]

Hallo @Rusdan

Nice to meet you here, and congratulations on you taper and being at such low dose of fluoxetine. Well done💪
I haven’t read all your thread, but wanted nevertheless to drop by and tell you how proud you should be. Yes the lowest doses are the hardest, and you are clever to not rush  it and staying put while your body adjusts. I for one failed to be patient. So patience is a virtue here for sure in my opinion. 
Don’t get discouraged when things seem bumpy or distressing. Use and read up on your coping skills. Practice them, distract yourself, don’t overthink this, if you need a break, take one. Our minds are powerful, use it in a way to be positive and push your way through the storm.

You have come so far, there is victory in sight for you. BELIEVE !!

You can and are doing this.🙏

All my best to you.

 

[Rusdan]

Thank you @Hanna72 so much for your warm and heartening message.I will follow your advice. I hope that you are now a "success story" or close to it.

[Hanna72]

Dear @Rusdan

You are welcome. You are doing far better then I have…am, as I am still in the mitts of tapering. 

3 hours ago, Rusdan said:

hope that you are now a "success story" or close to it.

No I am not near to it😅 But I for sure hope I will be one day. 
Lets keep our faith and hope for the best. That always makes me feel better.

My best regards.