Guest: Struggling with withdrawal and reinstatement

[Guest]

Hi all, I am new here and need some feedback.  I was on Sertraline for 10 years at 25 mg.  Then, had doctor do a direct switch to Lexapro 10 mg in July of 2023.   After 6 months on that, I tapered down to 5mg of Lex for a month then 0 mg of Lex for a month.  About 6 weeks after on 0 mg of Lex the bottom fell out.  Shaking, nausea, vomiting, blurred vision, anxiety, panic all to an unbearable level.  Reached back out to psych and was put on 25 mg of sertraline.  That started to stabilize but then about 3 weeks in nausea, anxiety, shakiness, nervousness came back. Dealt with that for 6 weeks and then called psych again and was put back on 10 mg of Lex.  Saw some stabilization but after about 2-3 weeks nausea, anxiety, shakiness, nervousness came back again.   Called psych and was switched to 20 mg of fluoxetine.   That was "okay" for about 2 weeks.  Although in the 2 weeks had a lot of warm body feelings.   After 2 weeks noticed depression, anxiety and nausea/vomiting started to return.  Cut fluoxetine down to 15mg for the past 4 days and that is where I am at currently. 

 

I have read about reinstatement and kindling here.   Looks like reinstatement is best done at low doses.  However, what does someone in my case do when the psych reinstated me at 25 mg of sertraline, then direct switched to 10 mg of lexapro then direct switched to 20 mg of fluoxotine and now cut that to 15mg? 

 

Feeling scared and hopeless here. 

Edited June 5, 2024 by Emonda
Name to title

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  It sounds like your psychiatrist has you on a drug merry go round.  Unfortunately, this is not uncommon, and the drug switches will tend to destabilize and confuse the nervous system, and the effects build up with each and every drug switch.  Your psychiatrist is just compounding your situation each time he/she switches you to another drug.  

 

What I believe would help you is to reinstate to a small dose of the drug that your brain is the most used to, and stick with that for a while until your nervous system stabilizes, then very slowly taper off of that.  

 

Question: When the doctor switched you from sertraline to Lexapro the first time in July 2023, did you have any problems with that?  

 

Can you please give us specific information in your signature about your drug history for all drugs and supplements you are on and have been on, especially for the past 18-24 months?  Please only give us drug names, dosages, and dates, as best you can remember, in a list format.  Please read the link below for instructions.  

 

How to List Your Drug History in Your Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from switching and going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our drugs and our doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Tapering is best done extremely slowly, and we generally taper by 10% of the current dose no more than once every 4 weeks, so that the reduction becomes exponentially smaller.

 

 Why Taper by 10% of my Dosage  

 

 

I would like to confer with the other staff, and see if it would be best to reinstate sertraline, or Lexapro.  In the meantime, please read the links (mainly the first post of each thread).  When you understand how these drugs actually work on the brain, all this will make more sense to you.  Do not make any more drug changes until you hear back from us.  We can help you get through this, but it will take time and patience.

[Guest]

I did not have any issues on the first switch to Lexapro.  However, when we reinstated it I had problems about 2 weeks in and they got worse for the next 6 weeks until doctor direct switched me from Lexapro to Prozac.   Went from 10 mg Lexapro to 20 mg prozac.   Then a few weeks later tapered to 15mg prozac, then a week later tapered to 12.5mg prozac which is where I am at now.  

 

I am so scared.   Ears ringing, shakes, anxiety like in my body at all times for the most part, depression, vomiting about 1 - 2 times per day.   I had my doctor get me liquid prozac and also order tapering strips.

[getofflex]

41 minutes ago, Backnforth said:

I did not have any issues on the first switch to Lexapro.

That's good to hear.  

 

Thank you for the drug signature!  Can you please add the specific dates, as best you can remember, for any drug changes/dose changes in April, May and June?  Thank you.  

 

How are you feeling right now, while you are on the Prozac?  Do you feel about the same, worse or better than you did when you were switching back and forth from sertraline to Lexapro and back again?  

 

41 minutes ago, Backnforth said:

Then a few weeks later tapered to 15mg prozac, then a week later tapered to 12.5mg prozac which is where I am at now.  

Please stop changing your dose of prozac.  Your nervous system is currently destabilized from all the drug changes and dose changes, and it desperately needs some stability right now.  For right now, until advised further, please take the current dose every day, no missing doses, at the same time each and every day.  Please be precise in measuring your dose.  These links will explain why stability is so important.  

 

Keep It Simple, Slow, and Stable

 

 

 

[Guest]

I feel like I am just hanging on each day barely.   The 3 drugs have all been awful after about 2 weeks.   Right now my anxiety is super charged and its more of a constant state of panic, I am experiencing depression, my ears are ringing louder than ever, vomit 1-2 times a day, lightheaded/dizzy, blurry vision on and off, so scared I won't get back to my normal self and I have a business to run and 2 kids under age of 15.   I can't focus very well.  On weekends I don't leave the house except to force myself to the gym for my saturday workout.   

 

Ive heard/read that bridging to prozac can make tapering easier?    I feel like now that I am 4 weeks into prozac Ill mess myself up more if I switch back to anything else but then also feel stuck because the prozac is not helping me feel stable or functional - quite the opposite.  Do I just taper down on prozac? 

 

If so, am I stuck feeling this way for months?   Im not quite sure how I have gotten through the past 4 months as I have no joy, no motivation and have all these symptoms making life sad and miserable.  I feel like my business is going to fall apart and I am losing my relationship with my kids and no direction toward a solution as the past 4 months has just been a crapshoot.   Very scared. 

[getofflex]

16 minutes ago, Backnforth said:

I feel like I am just hanging on each day barely.   The 3 drugs have all been awful after about 2 weeks.   

So from this, I'm assuming you feel about the same.  If that's the case, then I suggest that you just stay on the prozac 12.5 mg for a long time, until your nervous system stabilizes.  Every time we change the drug, or the dosage, it further destabilizes the brain.  If you stay on this, and are consistent, you should eventually stabilize and feel better.  Our nervous systems have adapted themselves to function in the presence of the drug, and if it is removed or changed, the nervous system then becomes confused and destabilized, hence the symptoms.  It is very important not to jump around on drugs and drug dosages, trying to find a magic fix for your withdrawal symptoms.  Unfortunately, it will take time for you to stabilize and for these symptoms to reduce and resolve.  In the meantime, I'll give you some links that will help you learn some ways to cope with and manage your symptoms.  This can be very helpful.  

 

As I said, please do not taper down the prozac at this time.   Your nervous system desperately needs consistency and stability.  If you keep tapering, you will just get worse and worse.   You don't want to crash your nervous system.  

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you.  I suggest you start with magnesium, as this can be calming and help reduce panic and anxiety. 

Magnesium

Omega 3 Fish Oil

 

I just want to reassure you that there is a way out of this, but it will take time, and patience.  Do you have anyone to help you with the business you are running, or the kids?  I can understand that you are scared.  We have been led to trust in psychiatrists, and health care professionals, and when they let us down, it is scary.  Please be reassured, because many of us here have been in the same boat you are in, but we have gotten through it, and gone on to recover, and live normal lives again.  This site has helped ten's of thousands of people to recover from cold turkeying and fast tapering psych meds.  

Edited June 10, 2024 by getofflex

[Guest]

Thank you.  I also finally did a Genesight test and got the results back a week or so ago.  It shows that Lexapro, Sertraline and Prozac are ALL in my "red" category which means I am likely a poor metabolizer of these drugs.   Not sure how that factors into the plan. 

 

How long do I stay at this dose on prozac? 

What if my symptoms never improve while holding?  What do I do then?  

 

I feel like I have been suffering on a massive scale for over 4 months and it feels like Im just supposed to keep suffering inevitably.  

[getofflex]

I also want to suggest to you that you get a different doctor than the one that jumped you around on all these drugs.  They sound like they don't know what they are doing.   

 

2 minutes ago, Backnforth said:

How long do I stay at this dose on prozac? 

I would stay on it for at least 6 months, perhaps longer.  Your nervous system will thank you.  

 

2 minutes ago, Backnforth said:

What if my symptoms never improve while holding?  What do I do then?  

Let's cross that bridge when we get to it.  We will take this one step at a time. 

 

3 minutes ago, Backnforth said:

I feel like I have been suffering on a massive scale for over 4 months and it feels like Im just supposed to keep suffering inevitably.  

Yes, you have, and my heart goes out to you.  I'm so sorry you have had to go through this.  I want to reassure you, that you are not doomed to keep suffering permanently!  Right now, you are in the worst of it, and honestly, it will probably take months to stabilize.  However, you should very gradually feel better and better, with ups and downs.   Do please take a look a the links I gave you.  

 

Please keep us posted on how you are doing.  I'm following your thread, so I will keep tabs on you.   It's really hard right now, I know, but it will get better!  

 

 

[Guest]

Ty.  What are your thoughts on the Genesight test results I shared?

 

And also, I am very thankful for your promptness.   Its hard to express gratitude right now in this panic state but I need to make sure you know I appreciate you.  

[Catina7]

Hello Guest and welcome to SA.  I'm so glad you found your way here ❤️.  You are in the best of hands with our wonderful moderators and other experienced members.  You're never alone, there are so many who have been through similar situations.  Stabilization, healing, and recovery take time but you've been give excellent advice so far.  I think the biggest fear any of us had in the beginning was that we're permanently damaged.  It's simply NOT true!  Once you hold where you are for a period of time you should feel things calm down.  In the meantime, give yourself lots of kindness, patience, and permission to not feel okay.  If you check out the Symptoms and Self-Care section there are many great non-drug coping techniques that you can implement to get through this rough time.

 

You're going to be okay, and we're all here to help and support you!     

[Guest]

@Catina7 thank you for your message of support.  I desperately need to get at least to stabilize so I can live life at a minimum and then deal with taper then.  The scary part is not knowing how long stabilization will take.   Do you have any insight on how long stabilization may take in a case like mine?  

[Guest]

@getofflex can you help me understand why I didn't start to stabilize but in fact got worse when I started both Lexapro the 2nd time (stayed on it for about 8 weeks) and then same with the 2nd time starting with Zoloft the 2nd time (stayed on it for about 8 weeks)?  

 

I am wondering if since I went back in at a high dose on the 2nd Lexapro, 2nd Zoloft and now Prozac - after my sensitivity going way up after the first / fast Lexapro withdrawal, aren't I doing more harm by staying at a 12.5 mg of Prozac?  In other words, isn't this dose just going to keep frying my nervous system if I in fact increased my sensitivity after the first / fast Lexapro withdrawal?   I know the site says you should stabilize starting at very low doses but since my doc didn't know this I reinstated at full doses and here I am - struggling with massive side effects for over 4 months between the 3 drugs.   My original thinking was to taper down to a low dose of prozac (esp since it is on the list of drugs I am a poor metabolizer of) because it says I should have reinstated at a low low dose.  

[Catina7]

43 minutes ago, Backnforth said:

@Catina7 thank you for your message of support.  I desperately need to get at least to stabilize so I can live life at a minimum and then deal with taper then.  The scary part is not knowing how long stabilization will take.   Do you have any insight on how long stabilization may take in a case like mine?  

 

You're very welcome.  As far as a timeline for stabilization, it's hard to say as everyone is different.  GetOffLex said you should wait at least 6 months, so that should give you a general idea.  At least you know that you need to hold and not to keep changing meds and doses as per your doctor.  Hang in there!  

[Guest]

@Catina7 I feel like that means I’m going to be in this state of suffering for 6 months and I can’t do that. 

[Catina7]

9 minutes ago, Backnforth said:

@Catina7 I feel like that means I’m going to be in this state of suffering for 6 months and I can’t do that. 

 

Oh no, that may not be so.  As I said everyone is different.  Just because you were advised to hold for that long doesn't mean you won't stabilize before then.  Have you had a chance to look at the links that were recommended to you?  They can help us to understand what's going on and what to expect.  You're going to be okay!  

[Guest]

@Catina7 yeah I’ve read them all - super helpful.  Just really fearful because of the last 4 months of hell. 

[getofflex]

2 hours ago, Backnforth said:

can you help me understand why I didn't start to stabilize but in fact got worse when I started both Lexapro the 2nd time (stayed on it for about 8 weeks) and then same with the 2nd time starting with Zoloft the 2nd time (stayed on it for about 8 weeks)?  

It's because your doctor had you on a drug merry go round, and you were starting and stopping various SSRI drugs abruptly.  Your nervous system was already very destabilized, and so any drug change would just further confuse and destabilize you even more.  You were making frequent changes in your drugs and dosing, which is extremely hard on the brain.  Also, when you were switched, your nervous system may have been in withdrawal from the previous drug you were on.  

 

2 hours ago, Backnforth said:

I am wondering if since I went back in at a high dose on the 2nd Lexapro, 2nd Zoloft and now Prozac - after my sensitivity going way up after the first / fast Lexapro withdrawal, aren't I doing more harm by staying at a 12.5 mg of Prozac?  In other words, isn't this dose just going to keep frying my nervous system if I in fact increased my sensitivity after the first / fast Lexapro withdrawal?   I know the site says you should stabilize starting at very low doses but since my doc didn't know this I reinstated at full doses and here I am - struggling with massive side effects for over 4 months between the 3 drugs.   My original thinking was to taper down to a low dose of prozac (esp since it is on the list of drugs I am a poor metabolizer of) because it says I should have reinstated at a low low dose.  

The problem is, you've been at a pretty high dose of fluoxetine for the past almost 4 weeks.  This means that it's likely your nervous system is now dependent on this.  That is why I asked you if you felt better, worse, or the same on the fluoxetine.  From your reply it sounded like you felt about the same.   I didn't want to put you through yet another drug change.  However, if you end up feeling worse on the fluoxetine than you did on the lexapro and sertraline reinstatements, then we could consider switching you one last time to sertraline 5 mg.  Please keep track of your symptoms.  Do you feel worse in the 4 to 6 hours after you take the fluoxetine?   

Edited June 11, 2024 by getofflex

[Guest]

@getofflex yes I think I feel worse in the 4-6 hrs after my Prozac dose.  

[getofflex]

If I were you, I would stop taking the fluoxetine, and instead, reinstate to 5 mg of sertraline.  Please don't stop the fluoxetine, until you have the liquid sertraline and can take that.  I hate to have you do another drug change; however, you were on the sertraline for the longest time, and I think that a low dose of this drug would probably eventually help you to stabilize. I would get the liquid, and use a syringe to measure it.  The liquid will make it very easy to taper in the future, and to measure non standard doses.

 

Please don't expect this to fix you right away.  It will take 4-7 days for it to get fully into your system, and then it could take a while for your system to stabilize on it, because of all the past drug changes.  

 

We will get all this straightened out.  

[getofflex]

Please find out from your pharmacist how many mg of sertraline are in one ml of the liquid, so we can calculate the correct amount to put in the syringe.  Please get a small 1 ml syringe, because in the past, 1 ml of sertraline had 20 mg of the drug.  If that's the case, you would take 1/4 of a ml, or 0.25 ml.  

[Guest]

@getofflex so do a direct switch?

[Guest]

@getofflex so just a direct switch - stop Prozac one day and start sertraline the next?

[Guest]

@getofflex  also are you saying that staying at 12.5mg Prozac won’t stabilize me? 
 

im so confused 

[Emonda]

On 6/5/2024 at 6:28 AM, Backnforth said:

I was on Sertraline for 10 years at 25 mg.  Then, had doctor do a direct switch to Lexapro 10 mg in July of 2023. 

 

I'm sorry if I have missed this, but why did you change away from Sertraline back at the start of this process?

 

 

[getofflex]

11 hours ago, Backnforth said:

stop Prozac one day and start sertraline the next?

Yes.  

[getofflex]

17 hours ago, Backnforth said:

the prozac is not helping me feel stable or functional - quite the opposite. 

 

13 hours ago, Backnforth said:

yes I think I feel worse in the 4-6 hrs after my Prozac dose.  

Your comments above show that you are having an adverse reaction to the prozac.  You were on the sertraline for 10 years, and so your brain has adjusted itself to function on the sertraline.  From your first post, it seems as thought the sertraline is least disruptive.  This is my rationale for suggesting you switch to the 5 mg of sertraline.   

[Guest]

@getofflex I was throwing up and doing poorly on the 2nd round of lexapro and 2nd round of sertraline too though.  
 

do you think it might be wise to slowly taper down a bit on Prozac to say 10mg or 5 mg and stabilize from there or just stay at 12.5 mg or do I absolutely need to switch to 5 mg of sertraline?

[getofflex]

54 minutes ago, Backnforth said:

do you think it might be wise to slowly taper down a bit on Prozac to say 10mg or 5 mg and stabilize from there or just stay at 12.5 mg or do I absolutely need to switch to 5 mg of sertraline?

Yes, you could also stick with the Prozac, and slowly taper down on that.  The key word here is "slowly".  You are, unfortunately, in the position of having to balance withdrawal with adverse reaction.  We don't want to taper off so fast that you go into severe WD (withdrawal).  I think you are currently having a combination of both WD and adverse reaction.  

 

I would really like to see you keep some notes of your daily symptoms, and daily activities for right now.  You just did a reduction 4 days ago.  Lets do the notes for a few days, and see how bad your adverse reaction is.  That will help us figure out whether you should stick with the 12.5 mg dose for now, or drop down further.   

 

Keep track of taking your drug, symptoms, eating, sleeping, etc.  Write the time on the left, and describe the event on the right.  Pay attention especially to how you feel before, and then after, you take your drug. Please do this for 24 hours, and post an entry in here for each 24 hour period.  Here is an example: 

 

January 31, 2023

 

6 AM woke with anxiety

8 am took 2.5 mg lexapro

10 am stomach is upset

10:30 am ate breakfast

11:35 am got a headache, lasted one hour

12:35 ate lunch

4 pm feel a bit better

5 pm took 2.5 mg lexapro

6 pm ate dinner

9:20 pm headache 

10:00 pm took 50 mg Seroquel

10:30 pm feeling dizzy

10:30 pm fell asleep 

2:30 am woke, took 3 mg Ambien

2:45 am fell asleep

4:30 am woke, but got back to sleep 

 

 

[getofflex]

In the meantime, I would like to give you some good simple techniques for helping with the panic and anxiety.   It won't take it away, but it will help you cope with it, and might help to reduce it, as well.  Please try them.  Claire Weekes is especially good.  If you listen to her, and follow her simple technique, it should help you to lessen and contain the panic.  

 

video: Claire Weekes: Managing Anxiety

 

 

video: Claire Weekes on Anxiety and Panic

 

Claire Weekes - Hope and Help for you Nerves Audiobook  

 

Emotional Spirals

 

Acknowledge Accept Float

 

Music to Calm Anxiety

 

Breathing Technique for Anxiety

 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Audio:  First Aid for Panic (4 minutes) Female voice - getselfhelp.co.uk

 

Audio:  First Aid for Panic (4 minutes) Male voice - getselfhelp.co.uk

 

Meditation

[Guest]

 

@getofflex

 

Ok - I will do that.  I have a separate question.  I see comments online where people have said they lost their jobs, lost all their $, ended up in psych wards, have lost their minds, battled for 20 years after quitting etc....  regarding getting off these meds.  It is scaring the life out of me and I wanted to ask why does this happen and am I doomed for that fate? 

[getofflex]

This happens because many people are put on a big drug carousel.  For example, a doctor will put on person on a cocktail of 5 or 6 meds all at once - an antidepressant, an anti psychotic, a Benzo, a gabapentinoid, a sleep aid.  Then, these people will do cold turkey and fast taper off their drugs all at once.  Also, many of these people refuse to give up stuff like alcohol, and don't take good care of themselves, and continue to jump on and off psych drugs.  That was why I warned you so emphatically in my previous posts about not jumping back on and off drugs in the future.  I didn't want you to end up like that.  For me personally, I will never ever touch another psych drug again.  

 

Fortunately, you were only on SSRI antidepressants.  However I also want to reassure you that even people on these cocktails can and do recover!  

 

I would suggest that you please consider refraining from reading these negative stories.  A lot of what you read online is exaggerated and sensationalistic.  I suggest you read our success stories. This will give you a lot of hope, and will help you to manage your anxiety.   From the home page, just click on the "forums" link, second link from the top.  They are in there.  

[Guest]

@getofflex I read a bunch of those success stories and while they are so amazing - it still is freaking me out that I need to feel the way I have been for 2-3 even 4 years??   Seems like so many of those stories have people talking about being in "hell" for years.   

[getofflex]

Take things just one day at a time.  Even if it takes people years to recover, they are not in acute withdrawal that whole time.  Not only that, there are windows along the way where people feel OK or good.  This link will go into how long withdrawal may take. It's different for everyone. 

 

How Long is Withdrawal Going to Take, Factors Affecting Withdrawal

 

 

[Guest]

@getofflex

June 11, 2024

 

5:15 AM woke up 

6:30 am took 12.5 mg prozac

6:30 am ate breakfast (bottle gatorade, banana, protein shake) 

6:45 am laid back down

11:30 am drove to work - light headed and "swimmy" vision 

10:00 pm took Magnesium, b complex, multi vitamin

10:00 pm laid down - had slight head ache and some kind of muscle twitching on right side of my head

10:15 pm had an anxiety surge

10:45 pm laid back down and went to sleep

 

[getofflex]

Thanks for the notes.  Please continue to do these.  Be sure and list all your symptoms.  So you had no vomiting yesterday, and only anxiety at 10:15?  No shakiness? It sounds like you had a pretty OK day yesterday, considering you are in withdrawal.  You are sleeping pretty well, it looks like.  Did you eat anything besides breakfast?  

 

I will caution you to either avoid the B vitamins, or take them in the morning.  They are activating, and a sensitized nervous system, such as yours, could have an exaggerated reaction to them.   I see you had an anxiety spike 15 minutes after taking them.   I know a lot of vitamins have high amounts in them.  I make sure to only take modest amounts of the B vitamins myself.  

 

Hang in there.  This too shall pass. 

[Guest]

@getofflex no vomiting yesterday.  First time in a few weeks of that.   No vomiting yet today.   Shakiness was way better yest and today.  Monday the shakes were really bad.  My mood is not amazing today - feel more down than I would normally feel still.