Seaweedbrain: CT and reinstatement, help with Fluoxetine taper.

[Seaweedbrain]

Hi, I have been taking fluoxetine/prozac for the last 11 years and I recklessly tried stop it cold turkey earlier this May but was immediately hit with a barrage of withdrawal symptoms like diarrhea/gi tract malfunction, brain zaps, nausea, dizziness, fatigue, derealization and emotional blunting. After being bedridden for a week and searching up what to do I decided to reinstate the med at half dose and see from there. Since then I have been tapering down but at a pace not considered appropriately slow. Three months now and I’m down to 2.5mg per day. Symptoms that appear to has disappeared are the brain zaps, nausea, and diarrhea. But I seem to have gained new symptoms like heart palpitations and skin numbness. The anhedonia/emotional blunting is still as bad as ever and the fatigue is still affecting my daily life. Imsomnia seems to be improving to the point I’m able to at least sleep 5 or 6 hours now as opposed to the beginning where I would have whole nights of no sleep at all. The slow rate of improvement is really making me concerned about recovery. Did I make mistakes that are preventing me from healing? I fear that my disastrous attempt at cold turkey may have done damage to my central nervous system. Is there hope for a full recovery?

Edited August 18, 2023 by manymoretodays
name to title

[Altostrata]

Welcome, @Seaweedbrain

 

It appears you got severe withdrawal symptoms after abruptly quitting 40mg fluoxetine, and you now have withdrawal syndrome now from going off 20mg too fast. 

 

Please stop tapering, allow your nervous system to settle down. When was your last reduction?

[Seaweedbrain]

Thanks for the advice. 
I believe the last reduction I made was two weeks ago from 3.5mg. Unfortunately I actually ended up missing my dose for two days when I was visiting a friend in another town and forgot to bring the med. This caused my heart palpitations and tinnitus to get worse to the point where I felt like jumping out of my own skin.

Since yesterday I have been hooked up to a cardiac holter monitor after I told my doctor about this. She doesn’t think withdrawal from antidepressants should take any more than 2 weeks but I hope these physical symptoms would show that isn’t true at all.

I don’t know how much help doctors are in this, mine suggested I should go on abilify, but I fear that will only give me more frightening symptoms. I’ll hold on like you said, just hope it’ll help my sleep recover soon

[Seaweedbrain]

I’m taking 2mg of melatonin for sleep every night and it seems to be helping. But I have no idea what to do about all the other symptoms.
The anhedonia is particularly distressing, it had set in very rapidly post ct and I have not seen any improvement. It felt like having a cord to my consciousness yanked out, turning me into a zombie. It and the fatigue is making it very difficult to motivate me to do even basic tasks like showering. I used to be a very active person and involved with several sport programs, now I can barely get through the day

[Altostrata]

How long have you been taking 2.5mg? How do you feel before and after each dose?

 

It's very important that you take your dose at the same times each day. Skipping doses can indeed make a bad situation much worse.

 

Your doctor doesn't know anything about withdrawal. Most do not.

 

 

[Seaweedbrain]

I have been on 2.5mg for only two weeks so far.
Things seem to settling down from the chaos caused by the two day skip. Nowadays in the mornings I would wake up with anxiety and a pounding heart, often with brain fog as well. After I take my dose around 9 or 10am I try to take a daily 1 hour walk to maintain some physical health. I don’t have the energy or motivation to play sports nowadays which sucks. There often seems to be a period around 2pm where I would feel very groggy and listless. By 6pm or so the morning anxiety usually fades away for the evening. Then I would try to accomplish some sort of task, showering or watering the plants. I don’t always succeed because of how bad the fatigue is still. On the upside melatonin has definitely made going to sleep easier.

[Seaweedbrain]

Also, I noticed I might be having a reaction to an antihistamine pill I took last night. Woke up with even worse emotional blunting and extremely slowed thought processing. Worst of all my vision seems to be disturbed? Is this a known effect of allergy meds on withdrawal?  Should I stay away from them?
Thank you for the support.

[Altostrata]

2 hours ago, Seaweedbrain said:

I have been on 2.5mg for only two weeks so far.
Things seem to settling down from the chaos caused by the two day skip. Nowadays in the mornings I would wake up with anxiety and a pounding heart, often with brain fog as well. After I take my dose around 9 or 10am I try to take a daily 1 hour walk to maintain some physical health. I don’t have the energy or motivation to play sports nowadays which sucks. There often seems to be a period around 2pm where I would feel very groggy and listless. By 6pm or so the morning anxiety usually fades away for the evening. Then I would try to accomplish some sort of task, showering or watering the plants. I don’t always succeed because of how bad the fatigue is still. On the upside melatonin has definitely made going to sleep easier.

 

This sounds like a typical stabilization process. Please be patient.

 

Is your allergy pill the type that people use to sleep?

[Seaweedbrain]

The allergy pill I took was 10mg of reactine(cetirizine). It says the possible side effects are drowsiness, dry mouth, and stomach pain. However I’m getting the feeling that during withdrawal, my nervous system seems to find lots of substances to be aggravating. The nausea is now back with a vengeance. I hope this isn’t going to screw up recovery too badly

[Altostrata]

You might want to take half a tablet, see if that helps.

[Seaweedbrain]

In the past few days, I have taken up jogging as I heard more frequent exercise will increase BDNF and help with neuroregeneration. It seems to be giving me some relief from anxiety/restlessness. Then my leg muscles would start twitching and this would last around half an hour. Don’t know if this is a sign that my peripheral nervous system needs to heal, but I’m going to continue and hope it goes away.
My sleep is still fragmented and disruption during 4 to 6 am is still a major issue. Not sure if I should risk trying herbal supplements yet or not

[Altostrata]

15 hours ago, Seaweedbrain said:

Then my leg muscles would start twitching and this would last around half an hour.

 

This could mean your leg muscles are not yet conditioned to the jogging.

 

15 hours ago, Seaweedbrain said:

My sleep is still fragmented and disruption during 4 to 6 am is still a major issue.

 

What is your usual sleep pattern?

[Seaweedbrain]

In the past I was a very physically active person, I would go long distance jogging and play sports for hours with no issues. Maybe my muscles have atrophied? The muscle twitching/spasms occur at other times too, even when lying down. I think this might be a withdrawal symptom as it often happens at around the same time as body temperature swings. 
My sleep schedule used to be from 11:30pm to 8/9am, I would rarely have issues like waking up constantly in the very early morning. Now I would wake multiple times from 3am onwards, and this would always be accompanied by heart palpitations. I checked my rate this morning and it was 115, way higher than normal. Checked again 5 minutes later and it dropped to 78. I think it was beating irregularly as well, which is worrying me a lot

[Altostrata]

Yours does sound like a withdrawal syndrome pattern.

 

Twitches and jerks in leg muscles tend to occur in the evening. Magnesium can help, as can staying well hydrated and leg stretches.

[Seaweedbrain]

Managed to find some magnesium threonate a fee days ago, I’m now taking two 140mg capsules a day. Still too soon to tell if it’s having any effects. I’m continuing to walk and jog everyday, even though I no longer experience the runner’s high. The anhedonia is as bad as ever, and from what I recall, it’s actually worse now than the previous month. I used to be able to enjoy food but that’s gone too, I’m getting very worried that this decline is a bad sign. Ruminating on this is making my anxiety worse but I don’t know what could distract myself sufficiently. Should I continue to hold the taper?

[Altostrata]

Magnesium is best taken in small doses throughout the day.

 

Have you had health anxiety before?

[Seaweedbrain]

These past few days are becoming a nightmare. My heart palpitations and insomnia only seem to be getting worse by happening earlier in the morning (around 4am now). Anxiety spikes are very frequent, and the deep breathing self soothing doesn’t seem to make any impact. Continuing to exercise even though I feel no joy or other emotions anymore, but finding the motivation is getting harder and harder. I don’t want to sound like a quitter but things feel very hopeless right now. I’m going to talk to my doctor again next week, but don’t have any optimism, nothing is working

[Seaweedbrain]

I realized my anxiety/autonomic dysfunction/panic is definitely much worse in the mornings. I think I’m going to try a bit of l theanine to help me stay asleep for longer, I’ve read it’s a calming agent. Maybe with better sleep, I could finally see some improvement.

[Altostrata]

On 8/23/2023 at 11:22 AM, Seaweedbrain said:

I have been on 2.5mg for only two weeks so far.
Things seem to settling down from the chaos caused by the two day skip. Nowadays in the mornings I would wake up with anxiety and a pounding heart, often with brain fog as well.

 

It seems that after this settled out, your withdrawal syndrome became apparent.

 

On 8/22/2023 at 12:22 AM, Altostrata said:

It appears you got severe withdrawal symptoms after abruptly quitting 40mg fluoxetine, and you now have withdrawal syndrome now from going off 20mg too fast. 

 

Since you're now taking 2.5mg, you may wish to updose to 3mg and see if that helps.

[Seaweedbrain]

Thanks, I’ll go back to 3mg for a few days and see if anything improves. My sleep is still extremely fragmented and now I’m down to just 4 hours a night. If I didn’t have health anxiety before I certainly do now. I’m worried my dysautonomia is going to create new symptoms. Constant obsession is making my anxiety worse but I can’t seem to take my mind off it. These past few months have already been hell, and it keeps telling me I’ll never recover.

[Altostrata]

3 hours ago, Seaweedbrain said:

Thanks, I’ll go back to 3mg for a few days and see if anything improves.

 

You might want to give it at least a week or 10 days.

 

Skipping doses when you're already unstable can cause a lot of problems.

[Seaweedbrain]

My doctor announced that the results from the cardiac holter monitor were within the normal range. I guess since the dysfunction is based in the nervous system there probably wasn’t a standard treatment for it. Unfortunately she is still skeptical that my symptoms are protracted withdrawal and not a “relapse atypical depression” and insists I should try mirtazapine for my sleep issues. I’m getting very nervous as this might crash me and take me somewhere even worse than before, but I’m not sure she would be willing to continue these appointments if I don’t try anything

[Altostrata]

Very few doctors will grasp the concept of protracted withdrawal syndrome.

 

If you want to stick with this doctor, recommend that you stop asking her to fix you, because trying other drugs is all she knows.

[Seaweedbrain]

Thanks for the advice, I’ll tell her that I don’t want to use psych meds to fix this. Hopefully I could stabilize my sleep problems and that could help with the others. My emotional numbness and apathy is definitely the most distressing of my symptoms but beyond some basic cbt I don’t have anything to tackle it with. My brain feels emptied and my personality stolen away. How long does anhedonia generally last? Are there people who will have this for the rest of their lives?

[Altostrata]

Please read 

 

[Addax]

Hi @Seaweedbrain. 
 

I am sorry to read you are experiencing significant withdrawal symptoms. I know they are horrible, scary and so hard to make sense of.  The emotional numbness and looping thoughts/ ruminating on potential catastrophic outcomes, are some of the cruelest symptoms of withdrawal. 

One thing I think is worth trying for sleep is a sleep mask. It’s not a cure, but it can be helpful with sleep and dampen down morning surges of anxiety by keeping ambient light and especially morning sunshine off your eyelids - which can signal your body to start making cortisol. We need cortisol, no doubt, however, when our nervous system is dysregulated so is cortisol production.  (Cortisol is responsible for and or influences a number of systems, including circadian rhythm and waking us up in the morning).  
 

Also, anything you can do to pull your mind away from your thoughts and focus on your symptoms is a good idea. Whether it’s walking, running, puzzles, grounding exercises, attentional training, coloring in mandalas. I would avoid rigorous exercise in the evening because it can increase cortisol and you don’t want that close to when you plan to go to bed.

 

Hopefully, you will find some relief with the increase.  

You will be okay again, Seaweedbrain. You will. It just takes time. 

 

 

[Seaweedbrain]

@Addax Hey, thank you for the advice and earnest encouragement.
Just knowing that others have dealt with the same horrible hell I’m in and climbed out has given me some new hope. I need to remind myself that my mind is playing tricks on me because it’s unwell. Just need to keep focused on healthy activities even when I don’t feel like it’s doing anything. I think I’ll hold at this dose and hope it helps settle some of the symptoms. 
The sleep mask idea definitely sounds promising, I recently started using ear plugs and reducing the ambient noise seems to have lowered the amount of times I wake up from unknown causes in the middle of the night
 

[Seaweedbrain]

My sleep issues seem to have gotten worse, I now have difficulty falling asleep as well as staying asleep.
Don’t have a good idea on what’s causing it. It might be due to the updose but it could also be the higher dose of vitamin d or the gingko I started to try and mitigate brain fog. I would spend many hours just tossing in bed because I can’t seem to maintain sleep more than 3 hours at a time. 

I know that my doctor wants me to use the mirtazapine for sleep but I really don’t need another drug to wreck havok on my already fragile brain. Melatonin doesn’t seem to be helping anymore. I’m going to try some camomile tea in the meantime

[Altostrata]

You easily could reduce your vitamin D dose and ginkgo and see if that resolves the problem.

[Altostrata]

On 9/24/2023 at 7:10 AM, Seaweedbrain said:

it could also be the higher dose of vitamin d or the gingko I started

 

How about stopping this to see if it helps?

[Seaweedbrain]

Sorry for the late reply, I haven’t been online very much the past week.
I stopped the gingko and increased the melatonin to 5mg and sleep improved slightly the past couple of nights, so hopeful I caught the culprit. Going to lay off the experiments with herbals for the moment, I think they’re giving me too many side effects. With the amount of daylight decreasing I don’t want to stop the vit D because I’ve been prone to seasonal depression in the past.

I’m getting tested for iron and vit B levels but I already have doubts that there’s going to be a noticeable deficiency. Nothing has ever showed any physical indications of my withdrawal. Other than continuing to exercise I can’t think of anything else to do for my health. Trying not to become hopeless is going to be a constant fight sadly, but I might as well chug along.
 

[Altostrata]

3 hours ago, Seaweedbrain said:

Going to lay off the experiments with herbals for the moment

 

Good idea.

[Seaweedbrain]

I think I experienced a window last a few days ago where I felt unblocked and was able to feel bouts of sadness and fear when thinking about all that withdrawal has cost me. Wasn’t the greatest feeling but it felt so much better than the void I’ve been stuck in since May. Then when I went to watch tv I was finally actually able to focus and distract myself for a while. I wasn’t feeling 100% like before withdrawal but it felt significant enough to be considered noticeable improvements. Then after 6 days I’m now back to complete numbness and brain fog confusion. Trying not to be discouraged but having everything yanked away again feels crippling and I’m worried it will make me lose any will to continue to take care of my wellbeing. Almost 6 months now since withdrawal started, and I’m back to square one

[Altostrata]

The pattern of recovery goes up and down, if not interrupted by another adverse drug reaction or other event, in The Windows and Waves Pattern of Stabilization  This can take a long time. Gradually, you should see more windows. 

 

[Seaweedbrain]

Another month, still extremely slow progress.
Recently I’ve joined a gym and gone into weightlifting and aerobic exercises. I noticed definitely lost muscle during my early withdrawal period spent bedridden. Still don’t expressing any of the post exercise euphoria but it’s a healthy way to spend my time, unlike pacing around at home. It has restored some of my appetite and I’m hoping that’s a good sign.

However the sleep trouble has recently gotten worse again, with wake ups always around 4 and not being able to return to sleep. I can imagine I might have some serious endocrine issues so I sent in a request for a sleep study. My doctor is still stubbornly refusing to believe that withdrawal can last longer than a week and wants me to return to an ssri (lexapro). I searched it up and sure enough, it scores high in sleep disturbances and sexual dysfunction. Don’t know how to convince her otherwise or if it’s even worth trying. If I switch providers it would be very long wait as the Canadian healthcare system is very overwhelmed currently 

[Addax]

2 AM and/or 4 AM wake-ups/ anxiety surges and sleep problems in general are not uncommon. I’m sorry you’re having to deal with that.  Did the 4 AM wake ups coincide with when you started lifting weights?

 

Have you provided you doc with any of the research articles listed here: Journals and scientific sources ?