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  1. Note from site administrator: Read this entire topic before attempting a switch to Prozac. Be sure to read details and cautions below . Consult a knowledgeable medical practitioner before changing medications. Also see Tips for tapering off Prozac (fluoxetine) Switching or bridging with another drug, usually of a longer half-life, is a recognized way to get off antidepressants, particularly those that people find difficult to taper. Many people with failed tapers from venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil), and duloxetine (Cymbalta) find they need to bridge in order to go off the drug. For many doctors, a switch to Prozac to go off a different antidepressant is routine. Fluoxetine (Prozac) has the longest half-life of any of the modern antidepressants. Because it takes about a week for a dose to be metabolized completely, if a switch to fluoxetine is successful -- that is, does not cause withdrawal symptoms from the original drug -- a careful taper off fluoxetine is easier for most people -- see information about Tapering off Prozac. And, at least fluoxetine comes in a liquid. (Citalopram or Celexa and its sibling escilatopram or Lexapro have half-lives of about 35 hours, a relatively long half-life among SSRIs, and are other candidates for a bridging strategy. They also come in a liquid form. The drawbacks and advantages of switching to another drug to get off the first drug, described below, apply to a switch to citalopram or escilatopram as well as fluoxetine.) While going off fluoxetine usually has less risk, one might still develop withdrawal symptoms going off fluoxetine. No bridging strategy is risk-free. You must find a knowledgeable doctor to help you to with a bridging strategy. You might wish to print this post out to discuss it with your doctor. When to switch or bridge A direct taper from the drug to which your nervous system is accustomed carries less risk than a switch to a new drug. You may have a bad reaction to a new drug, or the substitution may not work to forestall withdrawal symptoms. This is the "the devil you know is better than the devil you don't know" rule. The risk of a switch is justified if you find a taper from the original drug is simply too difficult. Usually people will do a switch when they find reducing the original antidepressant by even a small amount -- 10% or even 5% -- causes intolerable withdrawal symptoms. (I have heard doctors say they don't even try tapering off Effexor and Paxil, they do the Prozac switch from the beginning.) Sometimes when people go down to a low dose of an antidepressant (such as paroxetine), they find further reduction is very difficult. Substituting a longer-acting SSRI such as fluoxetine may be worth the risk. If you're thinking of switching simply as a matter of convenience, you need to weigh the risks against the amount of convenience you would gain. Generally, switching for convenience is a bad idea. Risks of bridging For most people the switch goes smoothly but for some it doesn't. A bridging strategy has the following drawbacks for a minority of those who try it: Adverse reaction to the bridge drug, such as Prozac. Dropping the first antidepressant in the switch causes withdrawal symptoms even though you're taking a bridge drug. If withdrawal symptoms are already underway, switching to a bridge drug doesn't help Difficulty tapering off the bridge drug. All of the bridge drugs can be difficult to taper themselves. So, like anything else, the Prozac switch is not guaranteed to work. But if you are having intolerable withdrawal from another antidepressant, it may be worth risking the worst case in the Prozac switch: It doesn't help and you have withdrawal syndrome anyway. CAUTION: A switch to a bridge drug is not guaranteed to work. It's safer to slow down a taper than count on a switch. A switch really should be used only when a taper becomes unbearable or there are other serious adverse effects from the medication. You must work with a doctor who is familiar with bridging, in case you develop severe symptoms. Below is information I've gathered from doctors about exactly how to do the Prozac switch. Healy 2009 method for the Prozac switch From Healy 2009 Halting SSRIs withdrawal guidelines: Phelps-Kelly 2010 method for Prozac switch From Clinicians share information about slow tapering (2010) Jim Phelps, one of the authors of the above, posted in 2005 in some detail about the so-called "Prozac bridging" strategy. He said it is described in Joseph Glenmullen's book, Prozac Backlash, maybe in the chapter titled of "Held Hostage." The technique Dr. Phelps described in this post skips doses and finishes with alternating dosages, which we do not recommend for people who are sensitive to withdrawal symptoms. Given that Prozac liquid is available, this is completely unnecessary. Foster 2012 method for Prozac switch Dr. Mark Foster, a GP whose mission is to get people safely off psychiatric drugs includes this in a presentation he gives to doctors. http://www.gobhi.org/spring_conference_powerpoints/safewithdrawal_of_psychotropics%5Bautosaved%5D.ppt. His method involves overlapping Prozac with the other antidepressant. Note on above: If you have tapered to a lower dose of Seroxat/Paxil, Effexor, Cipramil/Celexa, Lustral/Zoloft, etc., an even lower dose of Prozac may be more tolerable. If you are about half-way down, you might want to try 10mg Prozac. If you have decreased further, you may wish to try 5mg Prozac. More is not better for nervous systems sensitized by withdrawal. Prey 2012 method for Prozac switch Another knowledgeable doctor (whom I trust) explained his technique to me (this is the technique I personally would prefer if I had to do it, it seems much gentler­čś× For a "normal" dose of Effexor (150mg per day or more) or Paxil (20mg) or Cymbalta (20mg), he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Effexor. Lower doses of Effexor or other antidepressant require lower doses of Prozac as a "bridge." The lower dose of Prozac reduces the risk of excessive serotonergic stimulation (serotonin toxicity) from the combination of the two antidepressants during the overlap period. Do not stay on the combination of the first antidepressant and Prozac for more than 2 weeks, or you run the risk of your nervous system accommodating to the combination and having difficulty tapering off both antidepressants. Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Effexor. WARNING Serotonergic effects of an SSRI such as Prozac, Celexa, or Lexapro are ADDED when you are taking an SNRI such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), venlafaxine XR (Effexor XR), milnacipran (Savella), and levomilnacipran (Fetzima). You run the risk of serotonergic toxicity if you are taking an SNRI, particularly at a high dose, with an SSRI. This is why doctors familiar with the Prozac switch will add in a LOW DOSE of Prozac to an SNRI. In addition, escilatopram (Lexapro) is several times stronger, milligram for milligram, than the other SSRIs. If you add 10mg Lexapro to, for example, the high dose of 60mg Cymbalta, you will run the risk of serotonergic toxicity -- 10mg Lexapro is equal to approximately 30mg Prozac. What should the final prozac dose be? Please note that if you cross-taper, you will be taking 2 drugs at once for part of the time. Because of the potential of serotonin toxicity by overdosing SSRIs as well as SNRIs, it's probably safest to err on the lower side of a Prozac dose "equivalent" -- such as 5mg -- to your original drug. Given Prozac's long half-life, it may take up to a couple of weeks to reach full effect. The effect of the amount you add at each stage of the cross-taper will build throughout the process. For an idea of equivalent doses of your medication to fluoxetine (prozac) read this post (January 7, 2018) in this topic. It compares fluoxetine 40mg/day (a fairly high dose of Prozac) to other antidepressants. Source of that data: https://www.ncbi.nlm.nih.gov/pubmed/25911132 Also see this discussion about cross-tapering with Prozac: Smoothing out the transition to Prozac Even with a cross-taper, your system might feel a jolt after you finally drop the initial antidepressant, particularly if it is an SNRI, such as Effexor, Pristiq, or Cymbalta, or other drug that is not an SSRI like Prozac. (Other SSRIs include Paxil, Zoloft, Luvox, Celexa, Lexapro). If you go through a rough patch after the transition, patients find they can take a tiny chip of the original drug (or a bead or two, if it's a capsule containing beads) for a week or two to smooth out the transition. Eventually, you'd take a chip as needed only when you feel a wave of withdrawal from the original drug, and then finally leave the original drug entirely behind. (A gelatin capsule might make a tablet fragment easier to get down, but it is not necessary if you can wash it down with a good swallow of water. The gelatin capsule quickly dissolves in your stomach.) Here's an example. There is no shame in doing this. Whatever works, works.
  2. I'm on day 5 without paxil. I switched it out for 20 mg prozac. I am hoping to drop to 10 mg prozac and stay there for a few months to get acclimated and then taper the prozac. Mostly I'm on here because I was absolutely terrified at how this would go and 2 to see how it has gone for others. It took me 3 rather horrific years to get off 4 mg ativan and I was very afraid I had put myself in the same boat when I started paxil. It turns out tho that what really contributed to the difficulty of the benzo taper were hormonal challenges. Those are finally resolved. So I decided to give getting of paxil a shot. Despite all of the fear, I'm on day 5 without paxil, and while I do have some symptoms it is not like I feared. Thanks for having me Wwwi
  3. Junglechicken

    Switching from Escitalopram to Citalopram

    What are people's experiences of doing this? I was anticipating not too many repercussions given how chemically similar they are. My plan would be to switch from 2.5 mg Escitalopram to 5mg Citalopram. Is it wise to do it this way, or should I do it differently? Thanks guys, JC
  4. Hi everyone! Well, here is my story ... I am a 21 year old female, and I have been on Paxil since I was 6 years old, and have maintained on about 40-60mg ever since. I was put on Paxil due to my anxiety disorder and OCD, as I refused to eat in a school cafeteria and would be in a sheer panic everyday about going to school. Apparently they tried to put me on Zoloft at some point early on, but it gave me headaches and nausea, so that is why Paxil was chosen. The Paxil worked wonders for me, and I was able to go to school and live a very normal and happy childhood. In 2010, I was diagnosed with Chronic Lyme disease that was making me feel pretty ill. I saw a Lyme specialist in 2011, and he suggested that I stop taking Paxil. It was attempted to switch my medication to another SSRI (I do not remember what it was), and I ended up with Serotonin Syndrome and had to go to the hospital. While following one Lyme doctor's protocol, I was taking over 25 pills and supplements a day, and I accidentally forgot to take my Paxil for a few days in a row. As you all probably know, I began experiencing severe withdrawl from stopping my medication cold-turkey. I could barely stand up unsupported, I had severe dizziness and nausea, I was light-headed and weepy, and I didn't eat for about three days, I just layed in my bed in the dark and slept and cried. My mom thought that I may have been experiencing what is called a "Herxheimer Reaction," which is a periodic exacerbation of symptoms in response to treatment. We later realized that I had been off of my medication for about 3-5 days, and I immediately started taking my Paxil again and was feeling back to my old self within a day. I experienced some depression and anxiety when my Lyme was diagnosed, and my Paxil dosage was raised to about 80mg for a time. I also experienced some patterns of disordered eating while on some strict diets to help my Lyme's, but for the past 3 or 4 years, I have basically been anxiety and depression free. Anyways! I was talking to my Psychiatrist this week, and I mentioned how I have been trying to lose some weight, as I have become quite unhappy with my body. She mentioned that Paxil may very well be causing my metabolism to be slow, and suggested I switch to Lexapro. Thinking ahead about 6-8 years, I asked her if Lexapro would be something I would be able to take during pregnancy one day, as I already knew Paxil would not be safe for having children one day. She said that when I want to have children, I would probably be switched to Zoloft, so I suggested that we just start there, instead of making me change medication again, to which she agreed. I am a bit scared of switching from Paxil to Zoloft, due to the bad experience I had when forgetting to take my medication before, as well as the experience with Serotonin Syndrome. I am afraid of experiencing withdrawl, and all of the horror stories I have heard about. I am also scared that if the Zoloft doesn't work from me or I am having a hard time, that I will try to go back on Paxil and it will not work anymore. So I joined this site to hopfully learn about anyone else's experience with changing from Paxil to another medication, specifically Zoloft. So far, here is the plan.... Week 1: Drop 10mg of Paxil (watch for withdrawl) 30mg Paxil morning, 10mg Paxil night Week 2: Add Zoloft (watch for reaction to Zoloft) 30mg Paxil morning, 10mg Paxil and 25mg Zoloft night Week 3: 20mg Paxil morning, 10mg Paxil and 50mg Zoloft night Week 4: 20mg Paxil morning, 75mg Paxil night Week 5: 10mg Paxil and 50mg Zoloft morning, 50mg Zoloft night
  5. Hello, I have been following this forum since I (regretibly) stopped taking Pristiq because I was trying to lower my costs and started taking Cymbalta. I recently (June 23rd) went to my Primary Dr who out me on Pristiq, and discussed options with him. We talked about Cymbalta, he made it sound like a good alternative to Pristiq and again, I was looking to save money and find a generic SNRI. The last 4 days have been miserable, he told me to stop taking Pristiq (even when I suggested lowering from 100 to 50mg first) and start Cymbalta, 30mg. I am at the point where I just want to go back on Pristiq, saving some money is not worth this feeling. I called Dr and was told I would have to set appt to see him again to go back on Pristiq, which I do have prescription for and refills. I just moved to another state and flying back there is not an option. And considering the way I was taken off one and put on the other, he will simply tell me the same thing. Has anyone had experience with starting an AD then switching back to your initial AD without any issues? Any advice would be appreciated, considering my Dr. wont even discus this with a simple phone call! Thank you in advance!! Echo
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