reverse: Would it be better to restart?

[reverse]

Hello

 

After a decade on fluoxetine, it stopped working and I gradually stopped taking it.

 

Unfortunately my tapering was not very slow and I moved from 60mg to zero in about a month or so.

 

Some withdrawal symptoms have got better but some still persist.

 

Would it be advisable to re-introduce a small dose so that I can do a slower tapering off?

 

Thanks! 

Edited April 28 by Emonda
Name to title

[Carmie]

Welcome @reverse, 

 

I’m sorry to hear you’ve got persistent withdrawal symptoms, everyone on this site can certainly relate to withdrawals. We will need a bit more information first as to when you started and stopped the medication. Also the doses and dates, and any other medication you may on. Can you please go to the top of this Introduction and Updates page and you’ll see a thread telling us to start a topic about ourselves. In the first paragraph there’s a link showing you how to do a drug signature. Thanks. 
 

Going from 60mg to 0mg is definitely way too quick. It’s recommended to taper by no more than 10% of the last dose every month. 
 

Sending hugs🤗

[reverse]

Hi

 

I do not appreciate that you don't allow me to post in the Symptoms forum, this is really not nice at all. What are you afraid of? spammers?

 

Anyway, I wanted to ask if anyone had SSRI discontinuation vasomotor symptoms.

Apparently SSRI are prescribed for vasomotor symptoms like in menopause. Also, it seems quite established that migraines are vasomotor headaches.

 

However, not SSRIs but TCAs are prescribed for migraine prevention and relief. Personally had great migraine prevention and relief with Fluoxetine though the "experts" have not found lots of "evidence" for that.

 

Now during discontinuation, not only migraines are back but it seems the particular artery implicated in my migraines is quite sensitive.

 

Has anyone had similar experience? 

 

Thanks! 

[Emonda]

Hi Reverse,

I've moved your new post back to your own thread. Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

3 hours ago, reverse said:

I do not appreciate that you don't allow me to post in the Symptoms forum, this is really not nice at all.

 

The policy of this site is that the 1st two posts of a new member must be approved by a moderator. After that, you are able to post more widely.

 

3 hours ago, reverse said:

What are you afraid of? spammers?

 

We are trying to ensure new members are not missed. We want to make sure everyone is welcomed and given introductory information.

 

3 hours ago, reverse said:

Anyway, I wanted to ask if anyone had SSRI discontinuation vasomotor symptoms.

 

I am not familiar with this, but you can use the search function in the top right corner of the page and details will come up.

 

3 hours ago, reverse said:

Now during discontinuation, not only migraines are back but it seems the particular artery implicated in my migraines is quite sensitive.

 

The list of potential WD symptoms is quite lengthy. It's worth keeping a copy handy on your computer for reference: Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

Some helpful links for you to read are as follows:

 

About Reinstating and Stabilizing to Reduce Withdrawal Symptoms

 

Kindling

 

And

 

Windows and waves pattern of stabilization

 

Emotional Spirals

 

Non-drug coping strategies

 

Melatonin for sleep

 

We don't suggest many supplements, but two that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. Add one at a time and start with a low dose to see how it affects you. 

Magnesium

 

Omega-3 fatty acids (fish oil)

 

Avoid alcohol. 

 

Once again, welcome to S.A.

 

Emonda

 

[reverse]

Hello

 

Sorry but this forum is badly managed, too many restrictions, what are you afraid of, spam?

 

Anyway, I wanted to ask any fellow (ex-)sufferer or anyone with relevant knowledge or experience: would effervescence or dispersible tabs be better choice than liquid or tabs or capsules?

 

Thankfully, I can find both effervescence and dispersible fluoxetine and to me it seems much easier (thus more accurate) to dissolve a tab into a glass of water and calculate the tapering dose based on the amount of water in the glass.

 

I do hope to get some answers eventually as both my previous posts were left with no responses

 

Thanks!

[Emonda]

@reverse

I've moved your new post back to your own thread. As mentioned previously:

 

On 5/1/2024 at 11:43 AM, Emonda said:

Each member has only ONE Introduction topic.  Your own Introduction topic is the best place to ask questions and the place to journal your progress.  This keeps your history in one place and means you do not have to repeat your story. 

 

Keeping everything related to yourself in one spot will make it easier for those trying to assist you.

 

13 hours ago, reverse said:

Sorry but this forum is badly managed, too many restrictions, what are you afraid of, spam?

 

The site is run by a very, very small group of volunteers. We do our best to help those in need, at no cost.

 

Most of us have full-time jobs and are dealing with our own withdrawal challenges.

 

While polite, constructive feedback is welcomed, members who are disrespectful about the site or the volunteers have their accounts restricted. 

 

13 hours ago, reverse said:

I do hope to get some answers eventually as both my previous posts were left with no responses

 

Two volunteers have responded to your previous posts, and you haven't acknowledged either.

 

The first asked you to add your signature so they could try to help you. Once you added your signature, I provided you with a lot of relevant information. As you didn't respond, I don't know what you've done, if anything, since your last post.

 

You've stopped your AD way too quickly, and that would leave you with very unpleasant WD symptoms. I suggest you read the information I provided.

 

As to your most recent question:

 

13 hours ago, reverse said:

would effervescence or dispersible tabs be better choice than liquid or tabs or capsules?

 

...consistency is key. You can use the search function in the top right corner of the page to try and find more information. 

 

 

[reverse]

Thanks for the information and apologies if sounded impolite, you know what a hell SSRI withdrawal is, with so much irritability, deep depression and unbearable anxiety.

 

I couldn't find any practical guide to reinstate. After long term on 40-60mg, would reinstating at 20mg make sense? Or start much slower maybe 5mg and go up if needed?

[Alfred1977]

3 hours ago, reverse said:

Thanks for the information and apologies if sounded impolite, you know what a hell SSRI withdrawal is, with so much irritability, deep depression and unbearable anxiety.

 

I couldn't find any practical guide to reinstate. After long term on 40-60mg, would reinstating at 20mg make sense? Or start much slower maybe 5mg and go up if needed?

 

When exactly did you quit? Or was it rather the beginning, middle or end of april?

When did you notice withdrawal symptoms? Are you sure you are experiencing withdrawal?

 

Fluoxetine has a pretty long half-life. It takes a couple of weeks for the drug to leave your body and you actually might right now still have some "reserve". When you retake it it will correspondingly take some time for the drug level in your body to rise again. So Fluoxetine is somewhat difficult to handle and you might not have experienced the full impact of fluoxetine withdrawal yet.

 

Here you can read about reinstatement:

 

https://www.survivingantidepressants.org/forums/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/?tab=comments#comment-33809

 

I would sum it up as follows: If you experience withdrawal, it is generally good to try to reinstate (if you have had no adverse reaction to the drug). At least it is supposed to be the only known remedy with some chance of success for a faster recovery. The sooner you reinstate after quitting the better your chances are. As far as I understood, reinstating within 4 weeks of quitting is associated with very good chances of improvement. The dose you choose for reinstating depends on the time that you were off the drug/the time you took for tapering and the dose you came from before you quit. The more time that passed the smaller the reinstatement dose.

 

For example if you are off for one week, you might simply go back to your original dose and be fine. If you are 6 months off, you might try 2.5-5% of your original dose.

Determining the reinstatement dose is more art than science. If you reinstate too high you might experience stress. I felt "wired and tired" for 4 weeks after reinstating too high. So you need to somehow find a balance between withdrawal relief and mitigating the stress that can come with reinstatement. If you are unsure about the right dose and you somehow have to function, start low and go slowly and gradually upwards if needed. 

 

Fluoxetine is difficult to handle. In my opinion it would also make sense to start somewhat higher and then gradually reduce the dose as the drug level in your body accumulates.

 

 

[Emonda]

8 hours ago, Alfred1977 said:

When exactly did you quit? Or was it rather the beginning, middle or end of april?

When did you notice withdrawal symptoms? Are you sure you are experiencing withdrawal?

 

Great questions, @Alfred1977

 

@reverse, It'll be good for Alfred1977 and I to see your answers.

 

 

Thanks for your reply, too...

11 hours ago, reverse said:

you know what a hell SSRI withdrawal is, with so much irritability, deep depression and unbearable anxiety.

 

It's not nice, I know...

 

Reinstatement as close to the date you stopped is ideal. You just need to work out the amount to reinstate, and that would be dependent on the exact dates you started and finished your taper.

 

We look forward to your reply.

 

Emonda

 

 

 

 

 

[reverse]

Thanks both,

 

Actually, now that I am thinking of it more clearly, my history is a bit complicated mostly because of complete lack of information on SSRI withdrawal and partially due to desperation from relapse (fluoxetine stopped working).

 

Discontinuation schedule:

I cross tapered from Fluoxetine 60mg to Sertraline at the beginning of January within 2-3 weeks let's say until 20/01.

From 20/01 until 20/02 I was on Sertraline 100-150mg.

From 20/02 until 10/05 I was with no SSRI.

 

Symptoms:

Symptoms started developing from January but it was unclear if it was due to relapse or SSRI withdrawal.

They peaked in early March and subsided very slightly until now but are still intense.

 

I have now got back to Fluoxetine 20mg and within a couple of days the desperation, anxiety, depression have been considerably lifted.

I plan to stay for a week at 20mg and see if I need to increase or not. My main concern is now mostly tinnitus and some less anxiety/depression as well.

I am not sure if I should aim for complete symptom elimination (i.e. tinnitus) as a sign that I got into a dose that does not cause withdrawal?

 

I will then use Fluoxetine liquid to taper off at 10% per month while monitoring for any symptoms.

 

[Alfred1977]

1 hour ago, reverse said:

I have now got back to Fluoxetine 20mg and within a couple of days the desperation, anxiety, depression have been considerably lifted.

 

I am happy your situation improved. If you managed to get back on 20mg Fluoxetine after 3months of no ssri at all without any disruption and already having relief, this seems to be a good sign.

 

1 hour ago, reverse said:

I plan to stay for a week at 20mg and see if I need to increase or not. My main concern is now mostly tinnitus and some less anxiety/depression as well.

I am not sure if I should aim for complete symptom elimination (i.e. tinnitus) as a sign that I got into a dose that does not cause withdrawal?

 

I will then use Fluoxetine liquid to taper off at 10% per month while monitoring for any symptoms.

 

20mg Fluoxetine is to the best of my knowledge already a full therapeutic dose. If possible I would stay there for quite some time and wait for stabilisation. Increasing does not sound like a good idea to me...at least not if you plan on tapering later. You gotta at least wait for 4 weeks before you know what 20mg of Fluoxetine really feel like because of the long half life. Give it time...I am also inpatient, but you might need months before you reasonably can start tapering again. Take notes on your symptoms and compare now with in 4 weeks.

[reverse]

Thanks, yes I will try to stabilise on the Fluoxetine 20mg.

 

I am having hard time to tolerate tinnitus. My psychiatrist believes that is due to my relapse and not my withdrawal but I never ever had tinnitus even when my anxiety and OCD were at their peak.

 

Is there any data about tinnitus and SSRI withdrawal?

 

Now another psychiatrist wants to put me on Clomipramine because of OCD relapse. I read that Fluoxetine which I was on for 15 years and it helped with OCD, is considered a low risk for withdrawal yet it crippled me for 3-4 months! I cannot even imagine what will happen with Clomipramine if I even need to get off of it. It seems like a life sentence...

[Catwoman73]

Hi @reverse- I don't know about data on tinnitus and SSRI withdrawal, but I can tell you that it's a very common complaint around here.  Check out this thread:

 

 

I'm not a moderator, but I the general concensus here is that solving one drug problem by starting another drug is generally not the answer.  Especially when said drug is likely to also cause physiologic dependence, and need to be tapered down the road.  I would just say no thank you, I would like to stabilize on this dose of fluoxetine for a while and see what happens.  Take things super slow... I've done the fast taper, I've done the cold turkey... slow is infinitely better.  You may not avoid all withdrawal symptoms, but so far, mine have been infinitely more tolerable with the 10% per month plan.  I know that we would love to get this poison out of our systems ASAP, but it does pay to take time to stabilize before making more changes. 

[Emonda]

11 hours ago, reverse said:

I have now got back to Fluoxetine 20mg and within a couple of days the desperation, anxiety, depression have been considerably lifted.

 

This is very encouraging.

 

11 hours ago, reverse said:

I plan to stay for a week at 20mg and see if I need to increase or not.

 

Once stable, you want to give yourself months. I waited ~5 months after tapering way too quickly. You don't want to start tapering again, even slowly, if you aren't feeling stable.

 

11 hours ago, reverse said:

My main concern is now mostly tinnitus

 

Unfortunately, that is on the WD symptom checklist. For me, it started when I reinstated an AD at too high a dose. It slowly eased, but never completely went away.

 

These days, it also flares up if I try to taper a little too quickly. Also, I find that some foods inflame tinnitus. For me, it's foods with fructose syrup.

 

11 hours ago, reverse said:

I am not sure if I should aim for complete symptom elimination (i.e. tinnitus) as a sign that I got into a dose that does not cause withdrawal?

 

There is a term used on this site referred to as WD normal. You have WD symptoms, but they don't stop you from going about your day. That's what many of us hope for, rather than complete symptom elimination.

 

2 hours ago, reverse said:

I am having hard time to tolerate tinnitus.

 

I find quiet background music helps distract me from focusing on the noise.

 

2 hours ago, reverse said:

My psychiatrist believes that is due to my relapse and not my withdrawal but I never ever had tinnitus even when my anxiety and OCD were at their peak.

 

 

People often say in terms of WD symptoms, "I've never experienced this before..I never had this symptom before starting ADs". The fact that you've made this comment, too, to me suggests WD symptoms, not a relapse.

 

2 hours ago, reverse said:

Is there any data about tinnitus and SSRI withdrawal?

 

It's on the WD symptoms checklist I gave you from Dr Glenmullen. It is also mentioned in the Maudsley Deprescribing Guidelines as a known WD symptom.

 

2 hours ago, reverse said:

Now another psychiatrist wants to put me on Clomipramine because of OCD relapse.

 

Run fast from this advice! You don't want to become dependent on something else.

 

Time and patience are required on this journey. You've responded well, give yourself lots of time.

[Alfred1977]

12 hours ago, reverse said:

Now another psychiatrist wants to put me on Clomipramine because of OCD relapse.

Personally I came across a lot of ignorance among psychiatrists. They throw drugs at people because it basically is the only thing they can do. Imagine they had to realize/accept that often or even most of the times the risks outweigh the benefits by far...what could they do?! Probably 2/3 of them would lose their job and livelihood because they had to tell at least 2/3 of patients to seek help elsewhere. After all the untruth spoken about antidepressants, their side effects and the risks of dependency and withdrawal, I would want my doctor to explain me very precisely why I should take another drug. In my experience they cannot. If you get informed and read some scientific papers about antidepressants, you will be shaken when you talk to the average psychiatrist. They basically know nothing. Their best argument I so far encountered is "It often works. Have a try. Maybe you will feel better. If not try something else". And I think "Yeah, thanks a lot. Did that already and it really f***ed me up badly." 

 

21 hours ago, reverse said:

Symptoms started developing from January but it was unclear if it was due to relapse or SSRI withdrawal.

They peaked in early March and subsided very slightly until now but are still intense.

 

According to the Royal College of Psychiatrists in England there are three criteria to differentiate withdrawal from relapse (not all have to be fulfilled):

1) a temporal connection between changing medication and onset of symptoms

2) the experience of symptoms that are not typical of depression (or not typical of the condition that the medication was prescribed for in the first place; not all symptoms have to be atypical, it is enough if one of them is)

3) reinstating the medication brings relief in a short amount of time (and not only after the usual 4-8 weeks that antidepressants are said to need in order to show effect)

 

If I understand you correctly, your case fulfills all three criteria. There is a close temporal connection between you changing your medication and the onset of symptoms in January. As Emonda pointed out, Tinnitus is not a typical sign of OCD or depression (if you observe yourself closely you will probably notice other atypical symptoms). And you reported fast relief after reinstating.

 

12 hours ago, reverse said:

I read that Fluoxetine which I was on for 15 years and it helped with OCD, is considered a low risk for withdrawal yet it crippled me for 3-4 months!

 

I heard that some scientists say that this is a myth about Fluoxetine. Clinical studies are expensive and usually last only a couple of weeks. Since Fluoxetine has such a long half-life they suppose that the full impact of Fluoxetine withdrawal was missed in most/a lot of studies simply because it takes longer to manifest.

 

[reverse]

Unfortunately the withdrawal symptoms improvement did not last long, almost back to where I was after two days reinstating 20mg  

There seems to be huge fluctuation from being OK to being very poorly. Hope this will stabilise soon towards being OK.

 

@Alfred1977 totally agree, some from ignorance and some from greed as you mentioned, that's how they earn their living.

[Alfred1977]

@reverse

 

When did you exactly reinstate? What happened after 2 days? How are you feeling now and what happened in between?

 

Experiencing ups and downs during withdrawal, reinstatement or recovery is supposed to be normal. See this thread for example:

https://www.survivingantidepressants.org/forums/topic/82-the-windows-and-waves-pattern-of-stabilization/#comment-183

 

 

 

 

[reverse]

5 minutes ago, Alfred1977 said:

When did you exactly reinstate? What happened after 2 days? How are you feeling now and what happened in between?

I reinstated three days ago, this will be my third time I am taking Fluoxetine 20mg. The first two days were very positive until today I got probably a 'wave'.

 

5 minutes ago, Alfred1977 said:

Experiencing ups and downs during withdrawal, reinstatement or recovery is supposed to be normal. See this thread for example:

https://www.survivingantidepressants.org/forums/topic/82-the-windows-and-waves-pattern-of-stabilization/#comment-183

Thanks for that, I also just watched this youtube.com/watch?v=KQtO6HXJfjw (sorry forgot who posted it) and it describes it exactly how I experience it.

I deeply wish best of luck to all going through this, hope we will make it at the end.

 

By the way, you probably have heard the new craze about using ketamine, psilocybin etc. Many mental health sufferers being in despair will definitely put their hopes on these. However, if SSRIs are considered relatively low risk, I dread to think how the psilocybin, ketamine craze will end up. All I can do is to hope everyone will be safe.

 

[Alfred1977]

@reverse

 

Sorry, I got you wrong, you meant you were back where you had been before reinstatement. If you are not "freaking" out completely, I would still consider this to be a "success". You reinstated a really high dose Fluoxetine. I did something similar with Venlafaxine and it gave me instantly severe anxiety and insomnia. But be careful, observe yourself and take notes. I would rather think about slowly!!! and gradually!!! reducing your dose than increasing it.