ArthurDaly: Fluoxetine, jumped from 10mg in Sept 2023, still bad waves

November 13, 2023

Hi all,

I have come to this website fairly late (I hope) in my journey with psych meds. I no longer take anything, but 9 weeks from my last dose of Fluoxetine I am still suffering bad waves/windows.

Until May of this year, I was still suffering badly with waves/windows from Diazepam withdrawal, which began properly in June 2022. I have been off work pretty much since then. Things got a good bit better between May and August, more like a higher baseline of anxiety/vulnerability to stress, rather than the waves/windows pattern. During this time, I was doing Neurofeedback and the ketogenic diet (thanks to Dr Chris Palmer's excellent book). I was able to do a speech at a family gathering, which feels unthinkable now.

In June, I started tapering from Fluoxetine, 20mg (my history with which you can see in my signature), using the liquid solution, reducing by 2mg every 3 weeks. I now realise that was too fast.

In mid-August I started getting waves again. I had not done nearly as much reading into SSRI withdrawals as I had with benzos, so I assumed it was the Diazepam waves coming back (which Ashton says can happen), but then at the end of August I got one of my worst waves ever for about 4 days: suicidal depression, 0hr sleep (even during worst of benzo withdrawal I could get 2-3 hours a night), tremors, agitation. At the time, I believed that was because I was given a different brand of the liquid solution - I thought maybe more of the active ingredient was getting into my system somehow, causing serotonin syndrome (because of the tremors). But now having read about the dangers of linear tapering I am guessing that it was withdrawal from Fluoxetine, and my cliff edge was around 10mg, made worse as I was/am not yet fully recovered from the Diazepam withdrawal. However, at that stage I decided to just to jump from 10mg, partly influenced by doctors who said that would be fine.

I have now read about the need to do hyperbolic tapering, but I am where I am - 9 weeks off and I do not really wish to reinstate. I am having waves/windows every 3 days, which is very different from Diazepam - that was more like 3 week waves, 1 week windows - but they do seem to be just as severe, particularly the depression.

I realise that I am perhaps lucky that I was on Fluoxetine rather than another SSRI (I am well over a year out from stopping Mirtazapine, so I don't think that is likely to be playing a role still). I am interested to hear any indications/opinions from folks on here as to how long it may be before the waves disappear and I return to my previous level of function. I am encouraged by the fact that although they are regular/severe, the waves do seem to have identifiable triggers rather than totally random.

This is embarrassing, but I have found that one definite trigger is orgasm/ejaculation. In that process, there is a huge release of dopamine, followed by a decrease but also an increase of a hormone called prolactin which at a high enough level can cause psychosis. I am thinking my dopamine levels/receptors are just too low, because dopamine restrains prolactin production. You may ask, why not abstain? But another clear symptom of my withdrawal is uncontrollable nocturnal emissions, which I didn't even have in my teenage years - roughly once a week, followed by a 3-day wave. I did not have obvious sexual dysfunction while on Fluoxetine, but I am thinking that this symptom is some kind of rebound hypersexuality.

Finally, the other clear triggers for symptoms are sweet foods and stress.

Thanks for reading - I wish you all continued, and quick, healing.

November 13, 2023

Hi @ArthurDaly and welcome to SA,

Unfortunately, no one can tell you how long your WD symptoms will last, but this site offers a lot of resources for coping with them.

Here are some links to get you going:

How psychiatric drugs remodel your brain

What is Withdrawal Syndrome?

Are We There Yet?

Non-drug techniques to cope with emotional symptoms

Keep it simple, slow and stable

Let us know if you have any questions. You might find it helpful to reach out to other members as well.

And again, welcome

Lotus Rising

December 19, 2023

TL;DR - do I reinstate Fluoxetine after stopping 3 months + 10 days ago at 10mg?

Hi all, looking for advice and the wisdom that comes from experience - about reinstating.

Been off Fluoxetine for 3 months + 10 days. I tapered down from 20mg using the liquid, starting in May/June 2023. At that time I already had significant improvement from Diazepam withdrawal (last dose November 2022) and a reduction in Fluoxetine from 40mg to 20mg (Jan 2023).

I started experiencing bad symptoms again from mid-August when I was at 12mg. At the time I put this down to a change in the brand in the liquid solution, but I now know that was wrong - it would have been from the reductions. Not knowing that was wrong, however, I decided to just stop Fluoxetine completely on 10 September - the worst possible decision I could have made. I realise the symptoms I was getting from mid-August would likely have been from reductions made in July, possibly even June; and I made things a lot worse by stopping cold turkey. It may be that I am only now experiencing the symptoms from the Fluoxetine leaving my system completely.

My symptoms are severe depression, insomnia, occasional panic attacks, headaches, head pressure, heart pounding, occasional nausea/vomiting. Though my symptoms vary in intensity, I don't have any windows when I feel better (like I did with Diazepam withdrawal). My symptoms are made worse by certain stimuli: orgasm, sugar, exercise and stress.

I am thinking about reinstating to go slower. I would try a low dose (eg 1mg) at first. I would like to hear people's advice and experience of reinstatement and a slow taper thereafter.

I am concerned about an adverse reaction if I reinstate, and how long it may last. I am also concerned about how long it would take to reach the dose that would alleviate my symptoms, eg if I increase by 1mg per week. Finally, I am concerned about how long and slow my taper would have to be thereafter - I would rather not live my life for possibly years worrying about whether the latest reduction is going to turn my life upside down. On the other hand, I want to alleviate my symptoms as quickly as possible: I concerned about how long my current withdrawal symptoms will last, both because they are horrible to experience and they are keeping me off work, making life very difficult financially. I am aiming to be functional by February.

So my decision is whether to reinstate Fluoxetine after 3 months + 10 days after what was in effect a cold turkey withdrawal at 10mg, when I was already experiencing bad symptoms from previous reductions.

Grateful for all wisdom, experience and outcomes from this difficult decision.

December 19, 2023

12 hours ago, ArthurDaly said:

It may be that I am only now experiencing the symptoms from the Fluoxetine leaving my system completely.

Please go back to the post and read the link that Lotus Rising gave you called "How Psych Drugs Remodel the Brain". This is very important to understand this. It's not a matter of the fluoxetine leaving your system completely, it's the fact that these drugs have literally changed your brain, and your nervous system cannot function properly in the absence of the drug, because you tapered too fast. That is what causes the symptoms. That is why we suggest a 10% every 4-6 week exponential reduction, to allow the brain time to change as we very slowly come off the drug.

12 hours ago, ArthurDaly said:

I am thinking about reinstating to go slower. I would try a low dose (eg 1mg) at first. I would like to hear people's advice and experience of reinstatement and a slow taper thereafter.

Yes, I would also suggest a reinstatement of 1 mg. I suggest getting a liquid fluoxetine, and using a syringe to take it. Be sure and find out how many mg of the drug are in one ml of the liquid. Your chemist/pharmacist will know this.

12 hours ago, ArthurDaly said:

I am concerned about an adverse reaction if I reinstate, and how long it may last.

It's good you are concerned about this. If you reinstate at a very low dose, like 1 mg, this significantly reduces the chance of this adverse reaction happening.

12 hours ago, ArthurDaly said:

if I increase by 1mg per week.

I would not suggest increasing it this fast. It will take about a week for a reinstatement to fully register with your system, and a few more weeks for it to really take effect. I would suggest waiting about 2 weeks between dosage increases or even better, listening to your body, and just taking this one step at a time. Often, only a very small reinstatement is necessary to alleviate symptoms. And, it will be that much less to taper off of in the future. These drugs are very powerful, especially at the lower doses. Also, reinstatement may not take away all your symptoms completely, but it should make them less severe and bearable. You may still have some windows and waves. I would suggest that you let us walk you through this reinstatement. Here is our thread about reinstating:

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

Please let us know what you decide to do.

Edited December 19, 2023 by getofflex

January 3

Dear @getofflex, thank you for response.

I decided to wait to see if I would see improvement over the festive period before reinstating. Unfortunately, there was no such improvement. Since cold turkeying in early September (when I was already experiencing waves/windows from what I now know were the prior reduction), my good spells have become shorter and shorter, and by the end of December they disappeared altogether. Essentially, I have a baseline which is quite bad, then certain triggers (stress, food, exercise, ejaculation (which is of course embarrassing)) can then make things even worse.

Therefore, I reinstated 1mg of Fluoxetine yesterday, when my symptoms were very bad. I am keeping a note of symptoms. I have perhaps noticed a small improvement, but I am 99% sure this is just part of the normal pattern of fluctuation rather than an immediate effect of the Fluoxetine, particularly as it is a long-acting SSRI. I suppose it is encouraging that I have had no immediate adverse reaction. If this happens, I will either cease or reduce to 0.5mg.

My "rules" for reinstatement, which will remain flexible and responsive to my symptoms & comments here, are as follows:

1. If I have no improvement 7-10 days after a dose increase, I will increase the dose by 0.5-1mg. I appreciate this is faster than @getofflex has recommended above, but for employment/financial reasons it is imperative that I get functional again as soon as possible. A longer taper after is a price I am willing to pay.

2. If there is improvement after a dose increase, I will see if it is sustained for 7 days before deciding whether to make the next increase. In assessing whether the improvement is sustained, I will take account of the fact I may still get windows and waves during reinstatement.

3. If I get an adverse reaction from any dose increase, I will immediately drop back to the previous, wait 7 days and if the reaction disappears but there is still no improvement, try the increase again.

I will post updates here through my reinstatement journey.

January 4

I am tentatively encouraged by how I am feeling 2.5 days after reinstating. I was feeling about a 2/10, now I am a 4/10.

Am I out of the woods in terms of an adverse reaction?

January 4

@ArthurDaly

It will take at least 4 days for your CNS to start adjusting to the reinstatement and with the longer half-life of fluoxetine, it will likely take even longer.

I do however think it's a good sign that you haven't had any reactions. For me, I knew right away that reinstatement wasn't working because I had an almost immediate increase in symptoms.

You can always refer back to the above post on reinstating as well. Lots of good info there.

January 7

Thank you @LotusRising.

Today was the 5th day at 1mg. On days 4 and 5 of reinstatement I have maybe felt a little worse than days 1-3, but still better than pre-reinstatement. A little extra stress may be responsible, however.

January 8

After reinstating at 1mg, Day 7 has been quite bad, back to the pre-reinstatement baseline. I think it is just part of the normal fluctuation in my withdrawal symptoms rather than an adverse reaction. The only differences in my symptoms from pre-reinstatement are hot ears at night when I go to bed and perhaps just a feeling of being a bit hotter in general (around my face and neck).

I plan on going up to 2mg Fluoxetine tomorrow.

I should say I also take Omega 3 fish oil - good quality and high EPA.

January 9

Dear @getofflex & @LotusRising,

I am having second thoughts about increasing today, which is day 8 of my reinstatement. I have been at 1mg so far.

On days 2-4 and part of day 5 of reinstatement, I definitely had an improvement which I am 99% sure was attributable to reinstatement. However, beginning on day 5, and continuing now into days 6-8, I have had been in an increasingly bad wave of symptoms, putting me back to my pre-reinstatement baseline of severe depression, rapid heartbeat, insomnia etc. It is obviously very difficult to tell whether this is an adverse reaction. The timing may suggest that it is given what @LotusRising said about it taking at least 4 days for my CNS to adjust to the reinstatement, but the only difference in my pattern of symptoms from pre-reinstatement is the addition of hot/red ears, which come on in flashes when I lie down. There is maybe a feeling of hotness around my neck/shoulders too, perhaps mild paresthesia. Otherwise, it feels identical to my symptoms pre-reinstatement, so just a wave.

I am also concerned that I will have simply left reinstatement too late, and it will not be effective. If this is the case, does it mean I've just gone back to square one of withdrawal by reinstating?

What would you recommend doing?

January 21

Hi again,

I've ruined it. I went up to 4mg Fluoxetine because I was impatient. Now having serious adverse reaction - panic attacks, insomnia, suicidal ideation. My family need to be with me 24/7 to stop me doing the deed.

I really need guidance.

My plan is to not take any today, but then what should I do? Back to 1mg, 2mg, 3mg?

January 21

Hi ArthurDaly

Everything you said I went through for a long time. My family watched me in shifts.
I know you are in a place of desperation right now and looking for answers.

Updosing and reinstating can be unpredictable. When your central nervous system adjusts to a lower dosage, you might become more susceptible to specific side effects like insomnia and anxiety, particularly with more stimulating antidepressants. Seeing as it was Fluoxetine the side effects would make sense. For this reason we can't rush or get impatient.

It may be helpful to give more insight, how long where you on 4mg? How fast did you go up and from what dose? Did you take one pill or had this been going for days?

How did the schedule for reinstatement look like? Meaning how long were you at the previous dose (what was the previous dose?) and then how long have you been on the current dose?

If you have been taking it regularly usually it is not advised to skip. But that is the general guidelines as far as I know. What makes you think you should skip?
What was the last dose you felt bearable at? It might be best not to drop any more than needed.

If you provide more information that may give more insight to someone who has experience on this.

Edit: I can't offer tapering advice. But these maybe some things to consider.

January 21

Hi @ThatOneGirlStitch, thanks so much for responding.

I should have mentioned the reaction symptoms include akathisia.

To answer your questions, here is my reinstatement schedule (clearly I got impatient and departed from my original plan):

2-8 Jan (7 days): 1mg

9-12 Jan (4 days): 2mg

13-17 Jan (5 days): 3mg

18-20 Jan (3 days): 4mg

I first noticed the reaction on the evening of 20 Jan, but that was before I dosed that night (each dose caused fatigue, so decided to dose at night). Given how quickly I increased, it could well have been 3mg that caused the reaction, however, and it's then just been compounded by going to 4mg too early.

The last dose I felt bearable at was 2mg. My thinking for skipping just to minimise the amount of Fluoxetine in my system as quickly as possible, so as to alleviate the symptoms of the reaction. By that, I do not mean minimise to 0mg, but to get it down as quickly as possible from the level causing the reaction symptoms.

Finally, I should say I did experience hot/red ears a couple of evenings on 1mg (while I was still dosing in the morning), suggesting some kind of reaction to that low dose. I also got a bad wave on the last 2 days of 1mg, but I didn't think that was caused by reinstatement as the symptoms were the same as withdrawal (and had the same trigger, ie ejaculation).

January 22

@ArthurDaly

Got it. It is a hard call to make because you up faster than anticipated.

Getting Fluoxetine out of your system as quickly as possible might be too much of a change.

I would personally move down a dose. I can't recommend how fast or slow to go. The idea is to try to keep your system as stable as possible. Emptying your system fast may farther destabilize you. This is the general rule. All bodies have exceptions.

I'm saying this based on my experience with Remeron/Mirtazapine. The gave me a drug while I was in withdrawals before we figured out what was happening. I started to lose my hearing on the drug so in a panicked I did a fast taper. I don’t know if it was the jump or if it caught up with me, but I was thrown into an acute so much worse than the first time. I took it for about 2-3weeks before I decided to fast taper.

But we are all different. So I can’t guarantee anything. But seeing as you have been on higher than 2mg for about a week, you might want to slowly drop.
If it weren’t for the side effects, treating it like a normal taper would be best I would think. But because of the adverse effects that puts you in a tough spot. You risk worsening if you drop faster than your body can manage. But you could get better.

It is a stimulating drug so in *theory* the anxiety, insomnia, and panic will go down as it gets out of your system. It isn’t going to be instant fix in my opinion. So symptom management will be best in the meantime. Akathisa depending on how bad it is can be helped by having weight in you such as a weighted blanket or a hot bath. These are temporary in the moment aids. I remember crying in the hot bath being on watch by my family. Do whatever you can to get by in the meantime.

Best advice I have is be wary of fast changes. Some people might say hold and see if you stabilize. In your case maybe quitting fast would help but I don't see that trend. When I was on Mirtazapine that wasn’t an option.

Most you can do is gather as much information as you can, try to look at you situation objectively (Which is hard in withdrawal) and make decision based on that.

I don’t know if a mod would having any more to add or change. They've seen more than I have, but they also know this is not an exact science. I know some people where reinstatement went wrong but I don’t know how they handled it.

This doesn’t give you the answer to your question. But I hope you find something useful in it.

January 22

@ArthurDaly I contacted a friend who also has no medical qualifications for her opinion.

Quote

Me:
Is it a common theme was that if reinstatement fails don’t quiet, but taper?

Her answer:

No. I think just in general if your system is unstable, any change could set it off, so you should keep changes as gradual as possible.

If it’s all stimulant related and has nothing to do with system stability issues, then yeah, getting off cold turkey *might* stop those symptoms. But whether it works or not, the sudden change could destabilize his system again.

Reinstated.
Symptoms began.

- If symptoms are purely a reaction to the stimulant and this also might have happened to a normal person who had an adverse reaction:
- You suddenly stop the stimulant, the stimulant symptoms go away and you might go back into acute because your system is unstable again.
- If you taper gradually, your stimulant symptoms will last longer but you are less likely to destabilize your system.
- If you do not change anything, the symptoms remain the same.

- If the symptoms are because the stimulant destabilized your system:
- If you stop suddenly, you further destabilize your system and everything gets significantly worse.
- If you taper gradually, you will be adding more change to your system when it’s still unstable, which might make it worse.
- If you do nothing, your system will slowly restabilize and you might eventually be stable enough to taper.

Simplified

Reinstated.
Symptoms began.

- If symptoms are purely a reaction to the stimulant and this also could have happened to a normal person as an adverse reaction:

[cold turkey]
You suddenly stop the stimulant, the stimulant symptoms go away and you might go back into acute because your system is unstable again.

[Taper]
Your stimulant symptoms will last longer but you are less likely to destabilize your system.

[No change]
If you do not change anything, the symptoms remain the same.

- If the symptoms are because the stimulant destabilized your system:

[cold turkey]
You further destabilize your system and everything gets significantly worse.

[taper]
You will be adding more change to your system when it’s still unstable, which might make it worse.

[no change]
If you do nothing, your system will slowly restabilize and you might eventually be stable enough to taper.

Bottom line try not to destabilize the nervous system as much as possible.

I do disagree with her on
- If symptoms are purely a reaction to the stimulant and this also could have happened to a normal person as an adverse reaction
Because I think we are susceptible to that in withdrawal in general now.

This is just another view point. She started trying figuring things out same time I did. 3? years ago.

January 23

Hello again @ThatOneGirlStitch, thanks so much for the trouble you have gone to in advising me.

Sunday, only 48 hours ago somehow, was truly terrible - akathisia, definite suicidal intentions, depersonalisation etc. I am still very poorly, but ultimately stable and even did some cognitively challenging tasks earlier.

Regarding my plan of action, I will be dropping to 1mg, which I will stay on for at least 3 weeks before reevaluating. My mistake was increasing the dose far too quickly in my hypersensitive state. I'm not giving up on reinstatement yet - I just did it wrong first time round.

January 24

@ArthurDaly

I'm am so sorry you went through that. Those symptoms where the most difficult time in my life. If you have seen steady improvement you might want to hold it there.

I'm not sure if 1mg is a small enough drop. But I am very sensitive and plan to micro taper my drugs when stable. So that is where I am getting my opinion from.
If a jump up was too much of a change a jump down might be too.

These are just things to consider as you know your situation better than I do. If I find any more information I will post it here. Hang in there.

February 16

An update on my reinstatement journey - and a request for advice.

I started reinstatement on 2 January at 1mg. After a severe adverse reaction when I increased to 4mg around 20 January, I dropped back down to 1mg.

The adverse reaction resolved, but I was essentially back to where I was before, which was pretty bad. However, then something interesting happened.

I had been taking high EPA fish oil since late October, over 2 months before reinstating, as I read that it was good for depression. Things just got continually worse from then until I decided to reinstate. I attributed this to more and more of long half-life Fluoxetine leaving my system, and withdrawals just getting worse and worse for that reason.

However, about 2 weeks ago, I ran out of the fish oil. I slept beyond 5am for the first time since September and my anxiety was lower. I got a new bottle of fish oil and my sleep/anxiety/racing heart got worse again. I did some research, and found this article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664844/

So I trialled stopping the fish oil - and again I slept and felt a lot better for a couple of days. I do wonder whether my symptoms got a lot worse from October to January because of the fish oil, and so I don't know if I was so bad that I actually did need to reinstate.

Anyway, at that point, having been back down to 1mg for 3 weeks, I increased to 2mg, which I have now been on for 6 days. Things have gotten bad again. I get increasingly anxious, depressed and a bit suicidal for the rest of the day, and then sleep very badly.

I think I am just too sensitive still, so I plan on dropping back to 1mg again and sticking with that again for at least 3 weeks. I really should have given myself more time at 1mg and without fish oil to see how things went. If I do increase again, it will be to 1.5mg next, rather than 2mg.

However - and this is where I am looking for advice - if things are not too bad at 1mg, i.e. like for that couple of days before I increased to 2mg, should I just stick with 1mg indefinitely and hope that I heal at that dose?

February 16

Hi Arthur,

I'm really sorry that you are feeling that way. If things are bearable at 1mg then I think it might make sense to hold at that dose for the time being rather than risk destabilizing your CNS further.

BTW what is your long term plan? Are you trying to reinstate a higher dose in the hope of easing your symptoms, or are you trying to get down to zero? Reading your signature, I think what might have happened when you tapered down to 12mg last year was that you were following a linear rather than a hyperbolic taper. Basically the 2mg drop from 14 mg reduced the availability of the drug in your brain much more than the 2mg drop at 20 mg. There's a good explanation of this in the following interview with Mark Horowitz.

February 16

1 hour ago, ArthurDaly said:

An update on my reinstatement journey - and a request for advice.

I started reinstatement on 2 January at 1mg. After a severe adverse reaction when I increased to 4mg around 20 January, I dropped back down to 1mg.

The adverse reaction resolved, but I was essentially back to where I was before, which was pretty bad. However, then something interesting happened.

I had been taking high EPA fish oil since late October, over 2 months before reinstating, as I read that it was good for depression. Things just got continually worse from then until I decided to reinstate. I attributed this to more and more of long half-life Fluoxetine leaving my system, and withdrawals just getting worse and worse for that reason.

However, about 2 weeks ago, I ran out of the fish oil. I slept beyond 5am for the first time since September and my anxiety was lower. I got a new bottle of fish oil and my sleep/anxiety/racing heart got worse again. I did some research, and found this article:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4664844/

So I trialled stopping the fish oil - and again I slept and felt a lot better for a couple of days. I do wonder whether my symptoms got a lot worse from October to January because of the fish oil, and so I don't know if I was so bad that I actually did need to reinstate.

Anyway, at that point, having been back down to 1mg for 3 weeks, I increased to 2mg, which I have now been on for 6 days. Things have gotten bad again. I get increasingly anxious, depressed and a bit suicidal for the rest of the day, and then sleep very badly.

I think I am just too sensitive still, so I plan on dropping back to 1mg again and sticking with that again for at least 3 weeks. I really should have given myself more time at 1mg and without fish oil to see how things went. If I do increase again, it will be to 1.5mg next, rather than 2mg.

However - and this is where I am looking for advice - if things are not too bad at 1mg, i.e. like for that couple of days before I increased to 2mg, should I just stick with 1mg indefinitely and hope that I heal at that dose?

You need to stop chopping and changing the dose in response to every change in symptoms. If I were you I would stick at 1mg for a minimum of 3 months. Stay off the fish oil for now and don’t change anything else.

You are going to experience windows and waves, the important thing is not to act every time you feel bad.

February 16

Quote

54 minutes ago, Alpha23 said:

BTW what is your long term plan? Are you trying to reinstate a higher dose in the hope of easing your symptoms, or are you trying to get down to zero? Reading your signature, I think what might have happened when you tapered down to 12mg last year was that you were following a linear rather than a hyperbolic taper. Basically the 2mg drop from 14 mg reduced the availability of the drug in your brain much more than the 2mg drop at 20 mg. There's a good explanation of this in the following interview with Mark Horowitz.

Thanks for your reply @Alpha23.

The linear taper was definitely the cause of my problems. I only discovered hyperbolic tapering, receptor occupancy etc too late - in October '23. I have now read/listened to basically all of Horowitz's stuff, but my ignorance in August '23 meant that because I had been managing 2mg reductions until that point, I wrongly attributed the symptoms that arose then to a change in the brand of the liquid Fluoxetine I was using. Because I could not get the old brand, I decided to hell with it and just stopped the Fluoxetine at around 10mg. Big mistake, obviously.

As to my plan, it had been, in accordance with the SA guidance, to reinstate at higher dose in the hope of easing my symptoms, and then once stabilised do a slow taper to 0mg. My decision to reinstate, however, was because things had been so bad over November and December. I was 3.5 months out, and only getting worse - and I realised the window for reinstatement would be closing. Now that I strongly suspect that I was as bad as I was because of the fish oil, in retrospect I may have not reinstated. But that is a counterfactual and I just don't know how things would have been had it not been for the fish oil.

I am where I am, so I think my plan now will be to see how I am on 1mg and no fish oil. The best case scenario is that that goes well, and again in accordance with the SA guidance, all I needed was a low dose to stabilise and ease my symptoms, and then do a slow taper from 1mg.

February 17

15 hours ago, ArthurDaly said:

Thanks for your reply @Alpha23.

The linear taper was definitely the cause of my problems. I only discovered hyperbolic tapering, receptor occupancy etc too late - in October '23. I have now read/listened to basically all of Horowitz's stuff, but my ignorance in August '23 meant that because I had been managing 2mg reductions until that point, I wrongly attributed the symptoms that arose then to a change in the brand of the liquid Fluoxetine I was using. Because I could not get the old brand, I decided to hell with it and just stopped the Fluoxetine at around 10mg. Big mistake, obviously.

As to my plan, it had been, in accordance with the SA guidance, to reinstate at higher dose in the hope of easing my symptoms, and then once stabilised do a slow taper to 0mg. My decision to reinstate, however, was because things had been so bad over November and December. I was 3.5 months out, and only getting worse - and I realised the window for reinstatement would be closing. Now that I strongly suspect that I was as bad as I was because of the fish oil, in retrospect I may have not reinstated. But that is a counterfactual and I just don't know how things would have been had it not been for the fish oil.

I am where I am, so I think my plan now will be to see how I am on 1mg and no fish oil. The best case scenario is that that goes well, and again in accordance with the SA guidance, all I needed was a low dose to stabilise and ease my symptoms, and then do a slow taper from 1mg.

@ArthurDaly I wish you the best of luck. Are you still on the ketogenic diet you mentioned in your signature? I have been intermittently fasting for over a year and am now gradually switching to a ketogenic diet. Have you seen many benefits from the diet and if so, how long did it take for these benefits to show up?

February 17

Quote

12 hours ago, Alpha23 said:

Are you still on the ketogenic diet you mentioned in your signature? I have been intermittently fasting for over a year and am now gradually switching to a ketogenic diet. Have you seen many benefits from the diet and if so, how long did it take for these benefits to show up?

I am still on the ketogenic diet, yes, but I had a recent departure from it which took me out of ketosis. That was because it was causing me bad constipation (lack of fibre) - so I ate a lot of bran flakes (i.e. carbs) over a 3 day period. It hasn't helped noticeably with withdrawal from the Fluoxetine since September '23, but I think may have been counter-acting any benefits with the fish oil. However, back in May '23, when I was enduring withdrawal from Diazepam and possibly the effect of reducing the Fluoxetine from 40mg to 20mg, I noticed a significant improvement in my symptoms after starting keto - although at the same time I also started something called Neurofeedback, so that could also have been the reason for the improvement; or both, of course. The improvement happened about 2 weeks after starting keto.

March 7

Hi all,

A further update. I have now been back down to 1mg for almost 3 weeks. I am having a consistent adverse reaction every day in the hours after I dose. I know this because last week I had a three-day work engagement that I could not avoid (I have otherwise been off work entirely). On the first day, the reaction came on at the same time but much more severe - extreme sense of heat/anxiety, and like my organs were bursting out of my chest. I simply could not have managed the second and third days if the reaction happened again, so on those days I skipped my dose and managed a lot better. When I started dosing again, the same adverse reaction has come back.

My symptoms are consistent with what is described here: https://antidepressantsfacts.com/2000-05-06-prozac-experience.htm. That is a post by a person who, similarly to me, has stopped and restarted Fluoxetine several times. I am also having severe problems with memory, cognition etc.

For the above reasons, I am seriously considering discontinuing my reinstatement, which I started just over 2 months ago. I am only at 1mg now. Do I need to taper? Based on the adverse reaction I am continuing to get, my thinking is that I have not adjusted to being back on the Fluoxetine yet.

March 7

35 minutes ago, ArthurDaly said:

For the above reasons, I am seriously considering discontinuing my reinstatement, which I started just over 2 months ago. I am only at 1mg now. Do I need to taper? Based on the adverse reaction I am continuing to get, my thinking is that I have not adjusted to being back on the Fluoxetine yet.

I would still taper. The SERT occupancy changes at 1mg and below will be significant, so your brain has a lot of adjustments it needs to make. If you stopped taking it you would probably feel alright for a few weeks, due to fluoxetine's half-life, but then withdrawal would hit and nobody can predict how intense it would be.

You've been making a lot of changes to try and prevent symptoms from happening. What you need to do is formulate a plan and stick to it. Either you stay on 1mg for 6 months or you taper off, and stay off. When you're experimenting with doses of fluoxetine it can take up to a month and beyond to notice any changes.

March 7

Thanks @Erimus.

I agree I need to decide on a plan and stick to it.

My dilemma is this. I did get bad withdrawal symptoms after CTing at 10mg in mid-September. However, I was getting windows until late October. The waves had obvious triggers, such as caffeine/orgasm, which can be managed. The windows stopped when I began taking high EPA fish oil in late October. I didn't realise that was the cause until after reinstatement. I am 99% sure it was.

Obviously, I cannot rule out, and can perhaps expect, some WD symptoms if I stop now, but I am hopeful that may not be the case if my receptors have not yet adapted to Fluoxetine again after 3.5 months off and only 2 months back on, during which I am still getting the adverse reaction. Further, if I do get WD symptoms, then they ought not to be as bad as when I went from 10mg to 0mg. Even if I was to get WD symptoms that are as bad as they were in September/October, they did not bring the kind of suicidal ideation and distress I am suffering now, so ultimately it may be safer. Further, it seems adverse drug reactions can cause longer lasting damage. I would more inclined to stick it out at 1mg if I thought the adverse reaction was something just to be waited out. However, the story at the link in my post above seems to be about someone in my position having an adverse reaction lasting 4 years after reinstating at 20mg of Fluoxetine. The advice on surviving antidepressants is also to the effect that if one experiences an adverse reaction, then one should stop/reduce dose immediately.

March 7

5 minutes ago, ArthurDaly said:

Thanks @Erimus.

I agree I need to decide on a plan and stick to it.

My dilemma is this. I did get bad withdrawal symptoms after CTing at 10mg in mid-September. However, I was getting windows until late October. The waves had obvious triggers, such as caffeine/orgasm, which can be managed. The windows stopped when I began taking high EPA fish oil in late October. I didn't realise that was the cause until after reinstatement. I am 99% sure it was.

Obviously, I cannot rule out, and can perhaps expect, some WD symptoms if I stop now, but I am hopeful that may not be the case if my receptors have not yet adapted to Fluoxetine again after 3.5 months off and only 2 months back on, during which I am still getting the adverse reaction. Further, if I do get WD symptoms, then they ought not to be as bad as when I went from 10mg to 0mg. Even if I was to get WD symptoms that are as bad as they were in September/October, they did not bring the kind of suicidal ideation and distress I am suffering now, so ultimately it may be safer. Further, it seems adverse drug reactions can cause longer lasting damage. I would more inclined to stick it out at 1mg if I thought the adverse reaction was something just to be waited out. However, the story at the link in my post above seems to be about someone in my position having an adverse reaction lasting 4 years after reinstating at 20mg of Fluoxetine. The advice on surviving antidepressants is also to the effect that if one experiences an adverse reaction, then one should stop/reduce dose immediately.

At the end of the day you must decide what is best for your health. We can only offer advice, and point to the information we have at our disposal. The truth is none of us know what is happening inside our brains due to these drugs, and only you can feel the results of the actions you take. My concern for you is that you have taken SSRIs for much of the last 15 years, and have tapered off much quicker than your brain can keep up with.

Regarding the fish oil, I've also struggled to tolerate it in high doses. I would avoid supplements completely until you can better separate withdrawal symptoms from supplement reactions.

March 8

Thank you @Erimus. I really appreciate your input.

This is really all my fault. I think I was doing reasonably well at 1mg or 2mg until I stupidly decided to increase to 3mg then 4mg in mid-January. I think since then I have been suffering from hypersensitivity caused by the adverse reaction of going up to 4mg, because now I can't even cope with 1mg.

My impatience was as a result of trying to get myself ready for the 3-day work commitment I had last week. I don't think reinstating helped me get through that at all, but I did manage it - it was the hardest thing I've ever done, and was only possible because on the 2nd and 3rd days I didn't dose. I am self-employed so that has at least given me financial breathing space for the next 6 months.

March 14

I am in hospital for severe suicidal ideation and agitation. They want to give me chlorpromazine (thorazine). Thoughts?

March 14

15 minutes ago, ArthurDaly said:

I am in hospital for severe suicidal ideation and agitation. They want to give me chlorpromazine (thorazine). Thoughts?

We can't assist you with that. We offer peer support for tapering off psychiatric medication.

ArthurDaly: Fluoxetine, jumped from 10mg in Sept 2023, still bad waves

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