RileyProzac: Prozac Reinstatement After Protracted Withdrawal - Has Anyone Been Fully Successful

[RileyProzac]

Hello all - First time posting. I was on Prozac 60mg from May 2021 until June 2022, when I recklessly decided to discontinue cold turkey. I experienced mania for the first month or two, but then sunk into an unbelievable state of depression, suicidality, cognitive impairment, autoimmune issues, metabolic issues, etc. Now, 2.5 years later, my brain, personality, mood, outlook on the world, immune system, gut, and a host of other things have still not returned anywhere close to my previous baseline.

 

Over the past 2.5 years I have lived an extremely healthy lifestyle and have attempted with multiple functional doctors to get relief from my physical and mental symptoms, to very limited avail. It was not until a few months ago after seeing some similar reports on Reddit that I started to fully realize the extent to which my CT discontinuation of Prozac caused these symptoms, and how I was most likely rendered into a sort of dysfunctional equilibrium as a result.

 

First Reinstatement Attempt:

It was after this realization this summer that I decided to try reinstating Prozac. I started with a 20mg dose, which is the dose I started at the first time around. Within one day it improved my mood, got rid of my PTSD-like anxiety about harmful chemicals in the air (most prominently mold), and allowed for at least somewhat of an improved internal experience that felt more like "me". However, within just a few days, I began having difficulty sleeping through the night, getting only four hours of sleep, experiencing a racing mind, and having a different but overwhelming type of anxiety take over. So I discontinued within a few days of starting. 

 

Second Reinstatement Attempt:

 

Then, in September of this year, still convinced that Prozac played a significant role in my persistently ill state, I attempted to go back on Prozac at 10mg. Again I felt an improvement in anxiety, cognition, mood, digestion, etc. all within just one day. However, after just a few days, I got significantly worse side effects, including only being able to sleep for ~2 hours per night, muscle tension, confusion and anxiety/dread, and other symptoms. I was forced by the insomnia primarily to discontinue after just 5 days. I went through a bunch of ups and downs over the next 4 weeks or so as it worked out of my system, experiencing varying degrees of both the positive and the negative effects that Prozac has for me, before landing back in a very low place of very dark mood, very impaired cognition, digestion issues, etc. Knowing what I know now, I think my reinstatement attempt a few months prior may have made me even more sensitive/prone to kindling. 

(*Sidenote: I actually made a pretty detailed Reddit post about this phenomenon of vastly different reactions to Prozac over time:

 

Third/Educated Reinstatement Attempt and Current Situation:

 

So all of this confirmed to me 1) that Prozac discontinuation had clearly caused a significant alteration of my nervous system that was semi-permanent, and 2) that I respond very strongly, both positively and negatively, to Prozac. Basically that Prozac has a lot to do with the bad state that I currently experience life in. 

 

So, after reading more about antidepressant withdrawal, kindling, etc., and desperate from relief in any form possible, I decided last week to attempt to reinstate at a way lower dose. I started with just .5mg on the first day. Within an hour, I felt my mood changing, as well as my general perception and cognition (which is crazy to think about at such a low dose). I had a slight sleep disturbance that night, so after further consideration I decided that I would decrease the dose to .2mg per day, which I have been on for 7 days now. 

The effects have been very noticeable. My mood is no longer absolutely abysmal. I am not seeing the worst in everything as much as normal. My cognition has shifted noticeably to the point where I can actually turn my thoughts into speech decently well again, and I can actually think through more complex issues. The digestion basically immediately improved, to where I now take two well-formed bowel movements per day. Appetite has improved as well. I am still waiting to see if this is just a temporary improvement, but a whole host of things have improved. 

My question(s)/reasons for inquiring:

 

1. For one, I am curious if anyone can offer comments regarding what my plan should be. At what pace and by how much can I safely increase the dose? How should I decide to stop increasing the dose and hold (for instance, I would say my long-term withdrawal symptoms have improved maybe like 40-50%, which is why I am interested in increasing eventually)?

I would like to see if I can work up to 1mg per day. My thinking is that in about a week (which would be two weeks from starting the therapy), I might go from the current .2mg/day to .5mg per day. And I would see how that goes for two weeks, and then increase to 1mg if there are no side effects.

 

2. I have done a bunch of googling around, but I cannot really find anyone that has gone through the process of reinstating a micro-dose of their medication, and then after some time period has successfully tapered off that medication and gone back to baseline. Do we have any examples of that working? It wouldn't be the end of the world to have to stay on micro-dose Prozac indefinitely (as long as it helps my symptoms), but I am curious if anyone has actually successfully completed the reinstatement + taper idea that some people talk about. 

 

 

[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 can take years for people to recover from a cold turkey, and we generally do not suggest a reinstatement.  It is good that your very low reinstatement dose is helping you.  

 

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

 

On 12/9/2024 at 5:13 PM, RileyProzac said:

At what pace and by how much can I safely increase the dose? How should I decide to stop increasing the dose and hold (for instance, I would say my long-term withdrawal symptoms have improved maybe like 40-50%, which is why I am interested in increasing eventually)?

I suggest that you hold at your current dose of 0.2 mg Prozac for at least 4-6 weeks.  Doing the cold turkey and multiple prior reinstatement attempts have likely kindled and sensitized your system.  When this happens, it is very important to be extremely careful with drug changes, which means changes in dose, manufacturer, form (solid vs liquid), etc.  Can you please indicate what day in December you reinstated, as best you can remember?  Estimate if necessary, and please add this to your signature.  Once you do this, then you could try to increase the dose from 0.2 mg to 0.3 mg.  I would not jump from 0.2 mg to 0.5 mg.  These drugs are very powerful, even at very low doses.   You may not even need to go all the way up to 1.0 mg. A reinstatement will probably not completely take away all symptoms, but just make them more manageable.  The benefit of not going all the way up to 1.0 mg, is that then you won't have as much to taper off once you are ready to taper.  I don't know if you are aware that at the lower doses, these drugs have a disproportionately larger effect on our serotonin receptors. Because of this, it can take a very long time to taper from 1.0 mg to 0 mg.  This link explains more about this.  

 

SERT Occupancy Studies

 

If I were you, I would very gradually titrate up by 0.1 mg at a time (0.2 mg, 0.3 mg, 0.4 mg, etc), and wait about 4 weeks or so between each dose change, and see what happens.  Take things one step at a time.  

 

You can try reading the success stories.  We have many people who have done small reinstatements, and then gotten off the drug and recovered.  I did several updoses as I was tapering, and am now off for 2 years and 7 months, and I'm about 80 to 85% recovered.  

 

 

 

[Yichin]

What did the functional doctors do for you? Give you supplements that might have made things worse? I would give anything to go back in time and not have reinstated. I would have been closer to healing. As is, i have years and years and years of tapering hell. 

[RileyProzac]

Thank you getofflex for those resources, especially the one detailing the SERT occupancy showing how important it is to do abosolute micro-tapering at the low doses. I take you advice about adjusting my reinstatement microdoses very minutely. Still feeling decent at .2mg, though the initial contentment and seeing things positively that I mentioned in my post has waned significantly. I am guessing that does not warrant an increase to .3mg per day at this point, and that I should still stick it out the full 4 weeks before increasing the dose, in your opinion, right?

[getofflex]

On 12/14/2024 at 7:21 PM, RileyProzac said:

Still feeling decent at .2mg, though the initial contentment and seeing things positively that I mentioned in my post has waned significantly. I am guessing that does not warrant an increase to .3mg per day at this point, and that I should still stick it out the full 4 weeks before increasing the dose, in your opinion, right?

Yes, that is correct.  If you read the link about windows and waves, you will see that it is normal for your symptoms to wax and wane.  In fact, if you are able to function at .2 mg, and the symptoms are not too bad, you could even stay on the .2 mg for a while, before eventually tapering.  I would suggest that as you are titrating up, once you reach a dose at which you can tolerate the symptoms, stay at that dose for a while, as in 3-6 months or even longer, then micro taper off.  You might not have to go all the way up to 1.0 mg.