lyfeisg00d: Fluoxetine - safe to reduce from 40mg-to-20mg?

[lyfeisg00d]

Hello, 

 

I am here to obtain critical info to support my wife. I come here as recommended by my therapist, and because my wife's psychiatrist is out of office for the next 5 days. Context: She recently switched healthcare providers as a result of a forced insurance change. Her previous provider increased her fluoxetine dosage from 20 mg to 40 mg right before she had to make the healthcare switch. She had been taking increased dosage for 2 weeks before below issue occurred. She started taking dose before bedtime 2 days ago instead of in the morning because of the dizziness, nausea and hot flashes it was causing in hopes she could sleep through the side effects. 

 

Issue: I had to take my wife to the ER last night because of extremely horrible chest pains. After many tests, it was determined that it resulted from the increased dosage. The ER doctor gave us two options. Continue to take increased dosage plus start taking Ativan to offset symptoms or return to 20 mg dosage. We opted for the latter.

 

My wife slept most of the day today and was too scared to take the 20 mg pill in the evening (vs in the morning) given the trauma she experienced the night before. She felt that the switch to night dosage vs morning dosage may have caused the extreme symptoms given that she was semi-okay for two weeks on increased dosage prior to that. We plan to have her take the 20mg pill in the morning now that I read the guidance on this website about not skipping doses; however, I'm terrified that she'll have a negative reaction again.

 

My therapist also reached out to her colleague who is more experienced with medications and the colleague mentioned that it might just be that my wife has adverse reaction to the medication itself as heart palpitations are a less common side effect of this drug. 

 

My question is: Will it be safe if she follows the reduction as advised by ER doctor: 40mg to 20mg reduction?

 

Or should she stop taking it altogether because her body doesn't like this ingredient?

 

Or is there a third safe option here?

[Catwoman73]

Hello, @lyfeisg00d, and welcome to SA!  We are a community of volunteers providing peer support in the tapering of psychiatric medications, and their associated withdrawal syndromes. 

 

I'm so sorry for what your wife has experienced.  I once ended up in the ER with a dangerous arrhythmia following a re-start of a previously tolerated psychiatric medication, so your wife is not at all alone in having cardiac symptoms.  I can certainly attest that just because a side effect is 'less common' doesn't mean it doesn't happen!

 

It sounds like your wife has experienced some nervous system instability as a result of the dosage increase, based on her symptoms.  Keeping it brief, given that she has only been on 40mg for such a short time, she's probably fine to drop back to 20mg all in one shot.  I certainly would not stop the medication though, as she has been on it long enough to have made physiological and genetic changes to the presence of the drug, and a cold turkey stop will throw her into acute withdrawal, and put her at risk of protracted withdrawal issues.  Read more here about how these drugs impact the brain and nervous system over time:

 

How Psychiatric Drugs Remodel Your Brain

 

It may take a while for her nervous system to stabilize again after dropping her dosage.  As she stabilizes, it is very normal to experience periods where she feels better, and periods where she feels worse.  This is known as the windows and waves pattern of stabilization.  Having windows and waves is a good sign that the nervous system is working towards homeostasis again.  Read more here:

 

The Windows and Waves Pattern of Stabilization

 

Given that this is a forum dedicated to tapering and eventually discontinuing psychiatric medications, is your wife planning to taper off completely?  If so, I would be very happy to provide some guidance on safe tapering, in order to help her avoid any further destabilization of her nervous system.  I would recommend that she hold at the 20mg for a while- probably at least a month or two- if she intends on tapering further.  This will give her nervous system time to fully stabilize before throwing any further dosage changes into the mix.  I would recommend that, during that time, she start a symptom journal, rating each of her symptoms on a scale of 1-10 each day.  This will help her identify her windows and waves, and give her a good idea of what her baseline day to day looks and feels like prior to proceeding with a taper.  

 

Do let me know if her plan is to continue tapering once she stabilizes, and I will happily provide some more guidance!  Please tell her that she's in good company- there are thousands of members here who have had all sorts of crazy reactions to these meds.  We've all learned the hard way that they are not as safe as the pharmaceutical companies would lead us to believe!  The good news is that we can all heal from them, so she will get through this!  Sending lots of love and support her way! ❤️‍🩹

 

[lyfeisg00d]

Thank you so much for this comprehensive response. My wife says this feels very validating as she has difficulty putting her symptoms into words.

 

She does plan to continue tapering, but she just started a new job so she wants to stay on the current dose for the next 6 months and then look into tapering. I let her know that it was important to start keeping a symptom journal. I believe I saw there were guidelines on here for that, so I'll find them and share them with her in preparation. 

 

This was definitely such a scary experience and we feel grateful for your time and expertise.