joseantonio: I need some advice

[joseantonio]

Hello everybody!! I'm new to this forum. I stopped diazepam one year ago. Still on seroquel 50 and tapering fluoxetine. I'm on 5mg of fluoxetine every other day, since it's not possible to split the pills further to 2,5mg. I've read in this forum it's not a good idea to take fluoxetine every other day. Water tritation seems very complicated to me. I don't know if gelatin capsules may be a better idea? Whic dose is the final dose before totally stop fluoxetine ? I haven't read anything about the final doses before jumping.

[joseantonio]

2nd Intro topic title:  I need some advice

 

I stopped diazepan one year ago. Still on seroquel 50, and now tapering fluoxetine. I'm on 5mg every other day since two months ago, but not doing well. I've read on this forum it is not a good idea to take fluoxetine every other day, even having long half-life. The point is I don't know how to split the pill further to 2'5 mg, and I'm not convinced that water tritation gives a precise dose. I'd like hearing some advice. I've also read you need to wait for your symptoms to resolve to keep tapering, but I Wonder if at the end of the taper It's not better just to complete the proccess in order to allow your brain to really heal. From my experience of taper dizepam I got stuck at the end of my taper and I needed to resume my taper to finally get rid off the drug and finally heal. 

 

Edited September 21, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[Altostrata]

Welcome, @joseantonio

 

Please stop taking fluoxetine every other day. It would be better for you to take 2.5mg every day, probably by making your own suspension with water. This tells you how Tips for tapering off fluoxetine (Prozac)

 

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

 

Please let us know if you have any questions.

[joseantonio]

Thanks for answering. I'm going to try to get fluoxetine oral solution in order to follow your recomendation. 

[ChessieCat]

It is very easy to make your own liquid.  There are some benefits to making your own liquid.  You don't have to worry about the dispose x amount of time after opening (I think it might discard 1 month after opening).  And even though you are able to dilute the prescription liquid, I think it would be easier to do that with a liquid you make yourself from tablets/capsules.  Also, the prescription liquid might be more expensive depending on where you live, if it is available at all.

 

A homemade liquid generally will keep in a sealed container in the refrigerator for 3-4 days.

 

See Post #1 of the Tips for Tapering Prozac topic which Alto provided.

 

And:

 

how-to-make-a-liquid-from-tablets-or-capsules

 

[joseantonio]

I guess this question may have been already anwered. Anyway, I'd like to hear some thougts or experiences about if someone feels better as he or she goes further with their tapering. I'm at 2,8 mg of fluoxetine,and I'm thinking of going down to 2mg. 

[getofflex]

8 hours ago, joseantonio said:

I'd like to hear some thougts or experiences about if someone feels better as he or she goes further with their tapering

It all depends upon how they go about tapering.  If they taper according to our harm reduction approach of only reducing by 10% or less every 4 weeks, then yes, they may feel better as they go further with their tapering.  If they taper faster than this, chances are they will feel worse and worse as they taper.  We see this a lot, especially when people first come in here.  

 

8 hours ago, joseantonio said:

I'm at 2,8 mg of fluoxetine,and I'm thinking of going down to 2mg. 

I would not suggest you do this.  That is about a 30% reduction, and it puts you at risk of destabilizing your nervous system, and having withdrawal symptoms, which can take a very long time to resolve.  I would suggest you only reduce down by 10%, which in your case would be 2.5 mg.  Please read this links to understand why we suggest the 10% taper.  We generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

It is because these drugs make significant and profound changes to our brains, and the brain must reverse those changes to go back to its prodrug state as we taper.  Read this: 

 

How Psychiatric Drugs Remodel Your Brain

 

Can you please give more details about your fluoxetine taper?  Please list dates, and dosage amount of each reduction.  See my signature for an example.  Thank you.   

 

Previous post moved to your intro topic to keep your history all in one place.  Please post questions and discussion about your situation in this one thread, to avoid confusion and duplication of efforts.  Thank you.  

 

 

Edited January 5, 2023 by getofflex

[joseantonio]

Thanks for answering. I guess you're right about 10% reduction. The problem is that as you get further down im your reduction you have to reduce more than 10% at some point. Otherway, you'll never finish tapering. 

 

 

 

[Altostrata]

On 1/6/2023 at 8:18 AM, joseantonio said:

The problem is that as you get further down im your reduction you have to reduce more than 10% at some point. Otherway, you'll never finish tapering. 

 

Actually, you never do have to taper at less than a 10% rate. But you're correct, it's an exponential curve and never reaches zero.

 

2.5mg fluoxetine is still a sizable dose of fluoxetine with significant receptor occupancy. We've been answering your question for going on 12 years. You risk withdrawal by jumping off at 2.5mg or tapering faster at lower receptor occupancy. See 
Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration and
Discussion of a scientific journal article with data supporting a very gradual taper. 

 

If at this point you decide to risk withdrawal by tapering too fast, we may not be able to get you back to stability.

 

 

[joseantonio]

Thanks for answering again! I though that 10% reduction regards to receptor occupancy and not the current dose. If I'm right you can jump off in a dose that occupies 10% receptor, Am I? 

 

There's an article written by Mark Horowitz, where it says you can reduce by 30% with regards to fluoxetine due to its long-half life. 

 

[Altostrata]

5 hours ago, joseantonio said:

I though that 10% reduction regards to receptor occupancy and not the current dose.

 

This is incorrect. A 10% reduction refers to an exponential taper at the rate of 10% of the last dose.

 

Mark Horowitz's work refers to a hyperbolic taper based on receptor occupancy. The two methods are similar but not the same. Nowhere does the Horowitz method say to quit at 10% occupancy.

 

At 2.5mg fluoxetine, you are still at substantial receptor occupancy, perhaps around 50%. Maybe someone can look this up for you.

[RayGirl]

On 1/9/2023 at 5:45 PM, Altostrata said:

 

This is incorrect. A 10% reduction refers to an exponential taper at the rate of 10% of the last dose.

 

Mark Horowitz's work refers to a hyperbolic taper based on receptor occupancy. The two methods are similar but not the same. Nowhere does the Horowitz method say to quit at 10% occupancy.

 

At 2.5mg fluoxetine, you are still at substantial receptor occupancy, perhaps around 50%. Maybe someone can look this up for you.

 

Hi Alto, has anyone here actually tried the hyperbolic taper based on receptor occupancy instead of based on dose? 

[Altostrata]

Yes, we have a few mathematicians here who calculated their reductions by examining the hyperbolic curve of SERT occupancy for their drug.