CaringHusband: Tapering from 20 mg Fluoxetine (Prozac)

June 22, 2023

Hello Everyone,

My wife will be weaning off of Fluoxetine. I, her loving husband, will be helping her with the process and asking any questions here to help in the process. I am helping because my wife has dementia.

I, her husband, have recently, after about five years, reached zero venlafaxine. I have learned a lot during this time.

It is my wife's turn. The anxiety and cause of anxiety, that got her onto the fluoxetine, no longer exists.

I do not want to miss anything about the process and likely side effects of tapering Fluoxetine. So even though I know how to navigate SurvingingAntidepressants.com, please moderator, do your introductory thing.

Thanks

June 22, 2023

The following is a copy/paste of a word document that I maintain for my wife. I utilize it to put her drugs and supplements into an am and pm seven-day pill container. She has a separate seven-day pill container for her first thing after arising Levothyroxine medication.

MEDICATIONS AM

Levothyroxine (Synthroid) 62.5 mcg= (½ 125 mcg) – Thyroid

½ hour before breakfast

Eliquis 5 mg - Blood thinner

Losartan Potassium 50 mg - Lower blood pressure

Metoprolol Succinate ER 12.5 mg (½ 25 mg) - A-Fib & Heart rate

Measure Blood Pressure: Hold if H.R.<60 bpm or S.B.P. <110 mmHg

Amlodipine Besylate 2.5 mg – Lower Blood Pressure

Fluoxetine HCL 15 mg (1.5 – 10 mg pills) weaning - Mood, Anxiety

Memantine HCL ER 21 mg - Slows Dementia

VITAMIN SUPPLEMENTS AM

Multi-Vitamin 1 tab

Magnesium Oxide 1 cap, 400 mg - Migraine Control (Carlson)

D-3 Vit. 1 cap, 50 mcg – Prevent deficiency in N.W. (Carlson)

Calcium 2 cap, 500 mg – Bone health (Pure)

Fish Oil Liquid 1 tsp 1,600 mg – Omega-3 Fatty Acids and Vitamin E 6.7 mg

---------------------------------------------------------------------------------------------------------------------------

MEDICATIONS PM

Eliquis 5 mg - Blood thinner

Losartan Potassium 50 mg - Lower blood pressure

Metoprolol Succinate ER 12.5 mg (½ 25 mg) - A-Fib & Heart rate

Atorvastatin Calcium 20 mg - Reduce Cholesterol

VITAMIN SUPPLEMENTS PM

Multi-Vitamin 1 tab

Magnesium Oxide 1 cap, 400 mg - Migraine Control

C Vitamin 1 cap, 1,000 mg (Vital Nutrients)

Cranberry 1 cap, Urinary tack yeast control (Nature’s Way)

We live in Washington State, USA. We are in Pacific Time Zone.

Levothyroxine as noted is taken at least one-half hour prior to eating breakfast.

7:00 AM Usual breakfast meal time.

6:00 PM Usual evening meal time.

MEDICATIONS AS NEEDED

Diclofenac Sodium Topical gel for pain

Tylenol 500 mg

Ubrelvy 100 mg for migraine

ALLERGIES

Ambien Ciprofloxacin HCL Naproxen/ sumatriptan

Flagyl Morphine Valium

Omeprazole Sulfadiazine

June 22, 2023

Hi, @CaringHusband. Thank you for helping your wife.

Hopefully reducing her drug burden will help with her dementia and give her a better quality of life.

I placed all your wife's drugs in a drug interaction check - including the "as needed" ones - and here's the report (note: you may need to sign up with that website, which is free to do so):

Drug Interaction Check Report

There's a MAJOR drug interaction between the "as needed" diclofenac and Eliquis, so it's important to space those two out by at least 2 hours, just to be safe.

There are a number of MODERATE drug interactions. Please carefully go through that list and make sure she's spacing any apart that may be causing problems. You may want to print out that list and work carefully with her doctor to see if spacing out the drugs may help with any side effects / adverse reactions.

I would work on spacing anything out as a separate change, meaning only one change at a time. So I would have her hold everything steady with the Prozac until she sees how she feels if any spacing changes need to happen. Then she can go back to tapering the Prozac.

8 hours ago, CaringHusband said:

ALLERGIES

Ambien                       Ciprofloxacin HCL       Naproxen/ sumatriptan

Flagyl                           Morphine                   Valium

Omeprazole                Sulfadiazine

Questions:

When was your wife on Ciprofloxacin HCL, Valium, and Ambien? Was she ever floxed by these drugs? (For information on "floxing," please see Hidden Dangers Of Fluoroquinolone Antibiotics In The Benzodiazepine-Dependent Population).
In your signature, you have that she stopped Lexapro in June of 2018 and that she began Prozac June 2, 2023. I think that may be a typo because she's currently tapering off Prozac. Do you remember when she first started Prozac? If so, please update your signature to reflect that date. Also, please update your signature to reflect her reduction from 18 mg to her current 15 mg that you have listed in your last post.

Please continue to use this thread to document your wife's taper and to ask questions. She's lucky to have you helping her with her taper, as you've been a member here yourself and know the path she's taking.

June 22, 2023

Signature revised today June 22, 2023. Wife's doctor initially gave her liquid fluoxetine and prescribed taking 18 mg in liquid form which is a 10% drop from 20 mg. I suggested to the doctor that wife would have to swallow less liquid if she were given Fluoxetine in a 10 mg pill form and remaining 8 mg could be taken in liquid form. The doctor agreed we could use pill form but switched dose to 15 mg, which is a pill and one-half. I replied that I would monitor wife carefully for common symptoms and if needed up-dose to 18 mg since we still have the liquid form available. I ask wife if she is feeling any symptoms such as anhedonia, extra fatigue, insomnia, unusual feelings in head and so far, no complaints. She has had fatigue for quite a while prior to starting taper, therefore this will be a difficult one to distinguish from prior status. Wife also experiences frequent migraines which she has had all of her life. Will continue to monitor her.

June 23, 2023

Quote

Oct. 2018 Start Prozac (Fluoxetine HCL) at 20 mg; June 2, 2023, Begin Fluoxetine HCL taper at 18 mg per Dr.; June 13, 2023 15 mg per Dr.;

@CaringHusband This is from your signature. The first reduction of 20 mg to 18 mg is a 10% reduction as you noted, but going from 18 mg to 15 mg is a 16.67% reduction, which likely is too fast. With Prozac's long half-life, the withdrawal effects may be delayed, so the decrease on June 2 may not have hit yet, but she's now reduced down another 16.67%.

In total, she's gone from 20 mg on June 1 to 15mg on June 13, which is a 25% reduction.

You may want to go ahead and ask her to updose. Although she's not currently feeling any different, because she's in such a fragile state, I would err on the side of extra caution, especially with Prozac's long half life. In a few weeks, she may feel the full effects of the withdrawal from these two recent reductions.

Because it's been 10 days since that last reduction, she may only want to go up partway to, say, 17 - 17.5 mg instead of the full 18 mg, as her system may have started to adapt to the lower dose.

June 23, 2023

@Shep I will bring wife up to 17 mg today. I was concerned about doctors change to 15 mg but was also trying to play nice with doctor. I will figure out an explanation for the doctor should she ask why I did not follow her recommendation. My response to the doctor could simply be that wife was starting to experience symptoms from the faster tapper drop and with advice from others who have tapered Fluoxetine, brought her back up to a less severe taper drop.

I will give her one 10 mg pill. I will also give her 7 mg in liquid form. The liquid solution is rated at 20 mg per 5 ml of solution.

I calculate the milliliters of liquid form to be: (7/20)*5 ml = 1.75 ml

Thanks Shep for you quick input.

June 25, 2023

@CaringHusband You may want to print this out for your doctor:

Stopping antidepressants

That was put out by the Royal College of Psychiatry in the UK, which is comparable to the APA (American Psychiatric Association) here in the U.S. It goes into the need for a slow taper with the patient being the one setting the rate.

How is she doing now? How is her sleep?

June 25, 2023

@Shep Appreciate all that you are presenting to me.

I was able to review the drug interactions lists you provided. I went to the drugs.com list that I have previously made for wife and updated it with the as needed drugs plus some other as needed drugs. Fortunately, the Diclofenac topical gel seems to be the only drug with major interactions. The easy solution is to simply stop using that drug.

I have come down with a really bad ear infection in both ears that has developed into liquid behind the ear drums. This has been getting worse over the last two or so weeks and I finally was able to see an urgent care doctor about it last Tuesday. I'm following their directions on medicating for it. I am exhausted today, napping and resting as much as possible. It may be a while before I feel well enough to get to all of your recommendations.

June 26, 2023

10 hours ago, CaringHusband said:

Fortunately, the Diclofenac topical gel seems to be the only drug with major interactions. The easy solution is to simply stop using that drug.

If this is a drug your wife periodically would benefit from, you could space it out at least two hours from any conflicting drug and see how she does, especially since her goal is not to be drug free but simply to reduce her drug burden. Or you may want to research to see if there's something that would help in the same way but not have the adverse drug conflict.

10 hours ago, CaringHusband said:

I have come down with a really bad ear infection in both ears that has developed into liquid behind the ear drums. This has been getting worse over the last two or so weeks and I finally was able to see an urgent care doctor about it last Tuesday. I'm following their directions on medicating for it. I am exhausted today, napping and resting as much as possible. It may be a while before I feel well enough to get to all of your recommendations.

No rush to post here. Please take care of yourself. You're taking on a lot to get through your own withdrawal, along with being a wonderful help to your wife.

July 1, 2023

@Shep My thought is to consider evaluation of wife's progress about four weeks from start of 17 mg level. This would be about seven weeks from start of initial tapper, or Friday, July 21, 2023. We see wife's primary doctor Thursday July 20. We will discuss the next tapper drop with this doctor. It will be a virtual visit, so will not be able to give the doctor the printout of Royal College of Psychiatrists "Stopping antidepressants" but would only give it out if doctor was interested in reading it. We live close to doctor's office and would be able to drop the information off easily at any time. I may read this document to wife even though she may not retain much of the information.

Tapering is going smooth so far with no new or unusual symptoms appearing.

I have recently read "A method for tapering antipsychotic treatment that may minimize the risk of relapse" by Mark Horowitz et. all.

I have a medical appointment lined up for myself July 6 to discuss my ear infection with a primary care physician.

That is all for now.

July 2, 2023

On 6/22/2023 at 3:33 AM, Shep said:

When was your wife on Ciprofloxacin HCL, Valium, and Ambien? Was she ever floxed by these drugs?

I read the article you provided a link to regarding "floxed". I appreciate being made aware of the dangers of these drug interactions. The more I learn of this multidrug type of warnings, the more wary I become of doctors and their quick decisions to provide a fix.

I have no way of knowing exactly when the wife took the Valium or Ambien drugs of concern. I can say that these three drugs have been on wife's allergy list since October 2019.

The October 2019 allergy list states: Ciprofloxacin HCL - Makes me sick to my stomach, last used 11/13/2016

I will assume that wife has not been "floxed" recently.

July 3, 2023

22 hours ago, CaringHusband said:

I will assume that wife has not been "floxed" recently.

This is good. You may want to put the entire class of fluoroquinolone antibiotics on the list of allergies.

On 7/1/2023 at 7:15 PM, CaringHusband said:

It will be a virtual visit, so will not be able to give the doctor the printout of Royal College of Psychiatrists "Stopping antidepressants" but would only give it out if doctor was interested in reading it. We live close to doctor's office and would be able to drop the information off easily at any time.

Are you able to email or use a chat feature during the virtual visit? Everything available on this site is linkable. Just mentioning this in case it's inconvenient to make an extra trip out to the doctor's office.

On 7/1/2023 at 7:15 PM, CaringHusband said:

I may read this document to wife even though she may not retain much of the information.

This would be nice for your wife to hear. She's very lucky to have you caring for her.

On 7/1/2023 at 7:15 PM, CaringHusband said:

Tapering is going smooth so far with no new or unusual symptoms appearing.

I have recently read "A method for tapering antipsychotic treatment that may minimize the risk of relapse" by Mark Horowitz et. all.

I have a medical appointment lined up for myself July 6 to discuss my ear infection with a primary care physician.

Very glad the taper is going well. Good luck on your own medical appointment.

Please update when you have a chance.

July 20, 2023

@Shep

Met with wife's doctor to discuss the next reduction in Fluoxetine today, July 20, 2023. The discussion was brief and congenial. I explained that due to coordination with mentor on SurvivingAntidepressants.org that in consultation I had chosen to bump wife up to 17 mg for the past four weeks. Doctor took this information well and suggested going to 15 mg which I readily agreed to.

Wife, even though I know she likely doesn't remember much about the past four weeks of tapering did answer questions very positively and expressed that she had not had any unusual symptoms over the previous period.

Will start new lower dose of 15 mg tomorrow morning.

July 21, 2023

16 hours ago, CaringHusband said:

I explained that due to coordination with mentor on SurvivingAntidepressants.org that in consultation I had chosen to bump wife up to 17 mg for the past four weeks. Doctor took this information well and suggested going to 15 mg which I readily agreed to.

Going from 17 mg to 15 mg is a 11.76% decrease. This is higher than we recommend.

Why taper by 10% of my dosage?

On 6/23/2023 at 9:41 AM, CaringHusband said:

I will bring wife up to 17 mg today. I was concerned about doctors change to 15 mg but was also trying to play nice with doctor.

She had an updose already a few weeks ago and I fear she's going to kindle her nervous system (if it's not already kindled) with anything more than the slowest of tapers. It will be very easy for her to confuse withdrawal issues with other medical issues, especially since cognitive problems can be caused by withdrawal, in addition to her already diagnosed dementia.

Hypersensitivity and Kindling

Please also note that as the dose continues to go down, it's important to pay attention to the SERT occupancy levels:

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

So the lower she goes, the slower she should go.

I wouldn't decrease the 17 mg dose more than 10%, which would be 15.3%. You may even want to do a micro-taper of 5% and perhaps consider the Brassmonkey Slide to make it even more gentle on her nervous system.

The Brassmonkey Slide Method of Micro-tapering

July 22, 2023

On 7/21/2023 at 1:49 AM, Shep said:

Going from 17 mg to 15 mg is a 11.76% decrease. This is higher than we recommend.

I did make the change to 15.3 mg on her first day of the new dose level. Thanks for your attention to this detail.

On 7/21/2023 at 1:49 AM, Shep said:

She had an updose already a few weeks ago and I fear she's going to kindle her nervous system (if it's not already kindled) with anything more than the slowest of tapers. It will be very easy for her to confuse withdrawal issues with other medical issues, especially since cognitive problems can be caused by withdrawal, in addition to her already diagnosed dementia.

I will read the topic Hypersensitivity and Kindling and get back to you later on this subject.

I am feeling the weight of responsibility for what I have taken on for my wife. I'm realizing more and more how difficult this will be for me to interpret from what she tells me is happening with her. Since she lacks a longer-term memory, this hampers her from giving me this perspective. All I can do is remember to ask her more than once a day how she is feeling. I do take daily written notes on what is happening with her.

I am quite familiar with the SERT transporter occupancy curves and their possible interpretations.

I have been following Brassmonkey for years now and have a high regard for his writings.

I do want to do the best I can with all this valuable information.

Thanks @Shep for your continuing help.

July 25, 2023

On 7/21/2023 at 1:49 AM, Shep said:

It will be very easy for her to confuse withdrawal issues with other medical issues, especially since cognitive problems can be caused by withdrawal, in addition to her already diagnosed dementia.

I agree with you that most of us who have gone through the tapering of an antidepressant drug have had difficulty distinguishing whether a symptom is caused by withdrawal or is caused by some other medical issue that our bodies are experiencing. That is why a lot of people here choose to pause their tapper for a while to see if the symptom will dissipate and go away or determine that it is an ongoing issue that may need medical attention. I will be trying my best in conjunction with my wife's feedback to determine when a pause is in order.

I also have the concern that my wife's ability to provide feedback may be limited due to the dementia. This process will not be easy, and I may be attempting to do something no one here has tried to do before. That is help someone with dementia get off their SSRI drug. Should this deter me from trying? No.

On 7/21/2023 at 1:49 AM, Shep said:

She had an up dose already a few weeks ago and I fear she's going to kindle her nervous system (if it's not already kindled) with anything more than the slowest of tapers.

I have finished reading the information provided about "kindle the nervous system". It is indeed something to be aware of and try to prevent. Based upon current feedback from wife, she is doing fine and has no symptoms to report out of the ordinary. This is good.

I also looked again at "Relationship Between Striatal Serotonin Transporter (5-HTT) Occupancy and Dose or Plasma Concentration of
Fluoxetine in 18 Healthy and Depressed Subjects." It shows we are in the therapeutic dose range near the top flatter part of the curve. The initial variation in dose that the wife has experienced are between 15 mg and 20 mg. In the range the occupancy ratio is fairly stable. Therefore, the disturbance to her central nervous system should be minimal. If these larger percentages variations had taken place in the steep part of the curve, there definitely would have been trouble. The lesson I have learned is that I must stick to no more than the 10% of the previous dose drop, even if the doctor is telling me otherwise. It will be imperative that I either get the doctor to understand the reason why I want to follow this plan, or perhaps I will have to move her to another doctor who will buy in with me.

If you can provide me with more detail regarding your concern about the wife already has "kindled", would appreciate the perspective.

Thanks @Shep

July 26, 2023

19 hours ago, CaringHusband said:

I also have the concern that my wife's ability to provide feedback may be limited due to the dementia. This process will not be easy, and I may be attempting to do something no one here has tried to do before. That is help someone with dementia get off their SSRI drug. Should this deter me from trying? No.

I applaud what you're doing and do understand that it's very difficult. At her age and diminished health, it should be viewed through the lens of "quality of life." It's possible that simply lowering the dose will be enough and she may wish to stay on a lower dose. Although there's still quite a bit of concentrated active ingredient in the lower doses (according to the SERT occupancy, as you've noted), a lower dose still can mean fewer side effects. We aren't just a site for coming off these drugs, but also for people who, for whatever reasons, simply wish to lower their drug burden. That's okay, too. Please let her know that.

19 hours ago, CaringHusband said:

It will be imperative that I either get the doctor to understand the reason why I want to follow this plan, or perhaps I will have to move her to another doctor who will buy in with me.

Some resources if it comes to that:

Recommended doctors, therapists, and clinics

MiA - Provider Directory

You may want to share some resources from the "how to talk to a doc" thread. The first post in this thread has some things you can print out for her doctor:

How do you talk to a doctor about tapering and withdrawal?

The concept of a slow taper is going mainstream. There's no reason doctors should be as ignorant as they are.

NY Times article about Lancet tapering study: How to Quit Antidepressants: Very Slowly, Doctors Say

If you go down the thread in that NY Times article, you'll see where Altostrata has listed even more information that may be helpful to share with your wife's doctors.

19 hours ago, CaringHusband said:

If you can provide me with more detail regarding your concern about the wife already has "kindled", would appreciate the perspective.

It's a general concern for anyone who's dealing with a lot of drug changes, whether it's adding in new or subtracting out old or upping or lowering the doses abruptly. Just something to be aware of as a way of encouraging very intentional and mindful changes.

19 hours ago, CaringHusband said:

I have finished reading the information provided about "kindle the nervous system". It is indeed something to be aware of and try to prevent. Based upon current feedback from wife, she is doing fine and has no symptoms to report out of the ordinary. This is good.

I think you answered your "kindling" question here. Yes, this is a good sign that the damage is minimal.

How is she doing? Is she sleeping well and enjoying life as best as she can? Does she have a good appetite most days?

July 26, 2023

@CaringHusband

Hi there.

I just wanted to say I thinks it's a wonderful thing you are doing for your wife. It must be very hard for you. All you can do is take it slowly and do it as gently as possible.

Sending healing thoughts to your wife

July 26, 2023

@Doctorsrcrap Thanks for stopping by. Yes, this in some ways will be harder on me stress wise to figure out the best moves to make for my wife. Not going faster than the 10% cuts every four weeks will be the best process to adhere to. If symptoms appear then may need to go slower.

I see you are now following this blog. Welcome to this tapering journey.

My best wishes to you on your recovery.

July 31, 2023

On 7/26/2023 at 4:20 AM, Shep said:

How is she doing? Is she sleeping well and enjoying life as best as she can? Does she have a good appetite most days?

@Shep

Based upon my observations and quarries made to my wife, I believe she is doing very well.

She reports a stuffy nose the last couple of days. I just gave her some fluticasone nasal spray this morning to help the stuffy nose. She said some head pressure was associated with the stuffy nose. I know that I and others here report head pressure as a symptom, and I will do my best to distinguish the source of the symptom.

She continues to have a good stable upbeat mood. I appreciate this about her.

She sleeps through the night generally logging between 7 to 9 hours of sleep on her CPAP machine.

She eats three meals a day, and the appetite is good even though often times when asked if she is hungry, she will tell me she doesn't feel hungry.

I feel she is generally doing well.

August 1, 2023

18 hours ago, CaringHusband said:

She reports a stuffy nose the last couple of days. I just gave her some fluticasone nasal spray this morning to help the stuffy nose. She said some head pressure was associated with the stuffy nose. I know that I and others here report head pressure as a symptom, and I will do my best to distinguish the source of the symptom.

Excellent detective work, CaringHusband. Yes, head pressure is quite common during withdrawal. Fluticasone is a steroid, and some people are sensitive to that during withdrawal, but if she's not having any upticks in symptoms, she may be fine.

18 hours ago, CaringHusband said:

She continues to have a good stable upbeat mood. I appreciate this about her.

She sleeps through the night generally logging between 7 to 9 hours of sleep on her CPAP machine.

She eats three meals a day, and the appetite is good even though often times when asked if she is hungry, she will tell me she doesn't feel hungry.

I feel she is generally doing well.

Thanks for the update. Very glad to read she's sleeping and eating well.

August 20, 2023

After four weeks of holding at 15.3 milligrams of Fluoxetine, made the next 10% cut to 13.8 milligrams on August 18, 2023. Using a combination of one 10 mg pill and 0.9 ml liquid.

Also visited her primary care doctor who is supporting us in this taper the very same day. After she had asked all her initial questions, I gave her a copy of "Serotonin Transporter Occupancy of Five Selective Serotonin Reuptake Inhibitors at Different Doses: An [11C]DASB Positron Emission Tomography Study". I showed her the hyperbolic curve for Fluoxetine and gave her a short explanation of it. I then gave her and showed her the excel spreadsheet which calculates each 10% drop to be made during the weaning process. I explained that each 10% drop from the previous dose was also a hyperbolic curve which best fit the transporter occupancy curve.

I also gave her "Stopping Antidepressants" by the Royal College of Psychiatrists and said that this paper supported tapering by 10% of the previous dose.

The doctor accepted the three documents and surprised me by say that this was her first time supporting someone to wean off fluoxetine.

I was very pleased at how well the visit went with the doctor. I know that she and my wife have developed a very good relationship.

The doctor also decided on her own to extend the time between visits to three months, which I was very pleased with. I think we are all getting more comfortable with this weaning process.

August 21, 2023

@CaringHusband Brilliant update, CaringHusband. And very well done on educating your wife's doctor.

How is your wife feeling? Is her sleep still good?

August 21, 2023

@Shep Thank you for the complement. Wife reports nothing unusual with her. She continues to sleep well with 8 to 9 hours of sleep recorded on her CPAP machine.

I'm thankful for your advice, and for not allowing me to get too far off the 10% reduction curve in the beginning. I think we are off to a good start.

October 14, 2023

After holding four weeks at 12.4 mg, made the next 10% drop to 11.2 mg on October 13.

Wife's overall health has been stable. She recently mentioned that she would like to get better sleep at night. Taking short naps in her chair has been a common observation of mine for a long time.

Wife's dementia has slowly deteriorated a little bit. She has been attending a class at the "Adult Day Health and Wellness Center" for over a year. The leader of that class made a decision that it was time to move wife into their "Adult Day Care" class where more support is available due to her deteriorating memory issues. This transition at the beginning of October has not been easy for wife to accept. This has also been an eye opener for me.

Recently visited her cardiologist, October 4, to discuss taking her off Metoprolol Succinate ER, 25 mg pill. I presented information about its potential for anticholinergic effects on cognition. A doctor in the neurological department had stated in her November 2019 report that she recommended not taking metoprolol because it "can affect cognition with mild and more significant anticholinergic effects." Her cardiologist agreed to take her off Metoprolol Succinate ER and I am to monitor wife's blood pressure to see if it rises. He said I should be able to observe a change in wife's dementia for the better in two weeks. I'm hoping that I will be able to see a change for the better.

Changes can be difficult and are for both of us.

October 15, 2023

@CaringHusband Thanks for the update on your wife. I hope that removing the metoprolol will help with her cognition. I'm concerned that the Fluoxetine reduction was just two days ago and she's also making a change by coming off the metoprolol. Please be careful that there aren't too many changes at one time.

Please let us know how she does.

October 25, 2023

As noted above, removed Metoprolol Succinate 25 mg after consultation with cardiology doctor on October 4, 2023. On October 14, 2023, wife had an atrial fibrillation event which required a visit to the emergency department. One shock to the heart brought her back into normal sinus rhythm. Restarted Metoprolol Succinate 25 mg on October 17.

Followed up with cardiology department on October 24. An EKG was taken, and it shows that wife now continues to be in a stable heart sinus rhythm. Physician's assistant stated that the removal of the metoprolol likely precipitated wife having the atrial fibrillation event. This statement does not make me feel good about my part in having this drug removed from her regimen.

I am glad that she is now stable. A future follow up visit in January is planned with her cardiologist.

Her next fluoxetine drop is planned for November 10. Any comments?

November 12, 2023

Continuing to follow the 28-day hold, then drop plan. As of November 10, 2023, have reduced to 10 mg of fluoxetine, which is half of the original dose.

I have not observed any unusual symptoms after implementing each drop, nor has wife given any feedback that would indicate not following the plan.

Due to limited feedback from wife, I do feel like I am performing this process more on faith than knowledge.

November 28, 2023

I hope your wife is doing OK.

I'm sorry about her heart problems too. I know how scary that can be

November 29, 2023

@Doctorsrcrap

Thanks for stopping by.

As best I can tell, wife's atrial fibrillation has not reappeared.

January 7

Continuing to follow the 28-day hold then drop plan, with ten percent reduction to 8.1 mg January 5, 2024.

I have not observed any unusual symptoms after each drop.

We saw her primary care physician January 4, 2024, and discussed fluoxetine weaning progress. The doctor believes my wife should be able to get to 1 mg of drug within a year and then stop. I agreed to stopping at 1 mg, but if we continue to follow the 10% drop plan, 1 mg will not be reached until July 2025.

The pharmacy has given me a 5 ml syringe to measure out the Fluoxetine. It has 0.2 ml gradations marked on the syringe and it is impossible to measure any more accurately than 0.1 ml. Beginning in November 2024 the drops will be less than 0.1 ml. I will need to modify the drop process somehow after that date.

January 27

Forgot to mention that wife did also follow up with her cardiologist January 4, 2024. The doctor notes she is stable on the current medication regimen.

January 31

DECISION TO BE MADE SOON

Due to my (husbands) extreme fatigue and input from others who are care givers in the care givers group I attend, I have come to the realization that I need to implement in-home care from paid care givers. This will involve talking to businesses that do this kind of work and implementing a visiting schedule with them. This will also involve implementing wife's long term care contract, which may not be easy or simple.

I have recently talked with my wife's neurologist who tells me his diagnosis has changed from vascular dementia to "progressive Alzheimer's". Doctor says wife may be ok at home from 6 months to 2 years. After that she will need the care that can be provided in a facility that specializes in care of people with Alzheimer's.

These facts also point to the fact that I will not be able to strictly follow SurvivingAntidepressants.org "10% of the previous dose" drug reduction plan and get her to zero before she could wind up in a care facility. The spreadsheet reduction plan that I am using indicates getting to 1.0 mg July 2025, that is if everything went perfectly, which cannot be counted upon.

According to the Royal College of Psychiatrists Fluoxetine has a "Low Risk" of withdrawal symptoms. Wifes neurologist recommends that I drop the Fluoxetine to 5 mg and hold for two weeks. Then the doctor recommends drop to zero. The neurologist says most people do fine with this method of getting off Fluoxetine.

I was just talking to my primary care doctor about Fluoxetine and this doctor also states Fluoxetine has been easy for his patients to get off of.

Given my wife's circumstances, I have two options. Option 1 would be to continue the current process until I know for sure that wife must go into a dementia care facility. Option 2 would be to take the action now, expecting low risk of symptoms occurring, and save some ongoing effort upon my part in doing the weaning process. I am seriously considering option 2 given the information that I have from three excellent sources.

But before I proceed, I will give anyone who wants to say something an opportunity to do so. I will wait two weeks for responses, which ends February 14, 2024.

February 1

If it were me I would continue to gently wean her until you have run out of time to do so. All the while you can do it that way, i would.

If you found that she isn't having any noticeable symptoms after each drop then maybe you could try 10 percent every three weeks.

The thing is with prozac is its long half life means that withdrawal just takes longer to show up.

I've heard of many people having awful withdrawal from prozac. It's a gamble. I'm sure a moderator will be able to give you more advise.

Did you ever get her vit b12 checked?

February 3

Yesterday I hired a professional in-home care service for my wife who now is diagnosed with progressive Alzheimer's.

To start, they will come into the home Monday, Wednesday and Friday, 16 hours per week.

This help will be good for both my wife and me.

I am hoping this will help reduce stress and improve quality of life for both of us. The hope for myself is better sleep.

It has been studied and documented that care giver burn out is most common with those caring for a loved one with dementia. I have burned out and just about gone over the edge into the pit of despair. Making a decision and implementing it has already relieved some of my stress. I'm going to get through this, again.

February 4

Making the next 10% drop in fluoxetine on February 2, 2024. Drop to 7.3 mg.

I have not observed any side effects in my wife from performing these slow and steady drops in fluoxetine.

CaringHusband: Tapering from 20 mg Fluoxetine (Prozac)

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