Andalusian glad I found this forum.

[Andalusian]

Hi Everyone,

 

I guess I am just amazed I have coped as well as I have thus far considering the haphazard way I have been trying to wean myself off Lovan (fluoxetine) 20 mg over the last few years.

No doctor has ever supported me to do it safely. Reading this forum I now realise I have probably been shocking my poor nervous system over and over. Up until a couple of days ago before I discovered you guys, I have been taking 10 mg every second day to try to wean off, but i miss many days and actually there is no constistency whatsoever. I get these awful head aches but I don't know if it's because I am constantly withdrawing or constantly reinstating?!

I am now breaking the pill into half again so it is 5 mg and I am planning on taking it every second day because if I cut it down again it will just crumble and I think 5 mg everyday is too much.

I have managed a couple of times to come off them completely but ended up crashing (crying hysterically and unable to cope, panicing etc) after about 1 month. At that point, each time I have ended up going back on them and feeling awful for about a week then stabilizing again. So the cycle repeats and repeats and repeats. How do I decrease the dose accurately when it's in this pill form?

Thanks for any help.

[Hudgens]

Do not taper by skipping days. This one of the worst ways to taper. It's like playing Ping-Pong with your nervous system. Tapering needs stability and that means a slow accurate reduction of dosage. We recommend no more than ten percent each new drop. That's ten percent of each new amount, not ten percent each time of the original amount. And give yourself plenty of time at each new dosage to stabilize. Six weeks is about right, but longer if you're still feeling a lot of withdrawal. You need to find a way to measure your doses to keep them as consistent as possible. Going too fast or cold turkeying will certainly cause you a lot of unnecessary suffering, and most likely for a very long time.  I'm not sure what your pill is like-capsule with powder, solid pill? so I can't advise you on how to make reductions. I guess you're pretty lucky, though, if you've been skipping days for 2 years and are only experiencing headaches. 

[Andalusian]

I only experience headaches now but for a very long time i was dizzy and getting brain zaps but it wasn't debilitating. I do start to get progressively worse the longer I go and the more I decrease (incessant crying, not coping, panicking). I can see now that I have not been doing it right at all. The pill I take is solid in form. So given that i have been taking 10 mg haphazardly, do you think it would be too much to take 5 mg every day? I want to do the decreasing by 10% but I don't know what dose I should be on as a base line. Maybe I should just try 5mg everyday and see how I go? But I'm scared because when the dose is too much too quickly I get suicidal ideation. 

[Hudgens]

Did you have suicidal thoughts the other times you reinstated?

[brassmonkey]

Hi Andalusian-- Welcome to the group.  I'm sorry to hear that you're having a tough time of it right now.  Whet Hudgens is saying is correct, skipping days is not the way to go.  If you've been doign10m every other day then going to 5mg every day would be a good place to start to get stable.  All of the symptoms you have been feeling are due to the skipping days. Throwing yourself in and out of WD is causing your brain to be in chaos.

 

What is withdrawal syndrome?

 

Why taper by 10% of my dosage?

 

Tips for tapering off Prozac (fluoxetine)

 

Thank you for putting your drug history on a signature block, it really makes it easier for us to help you.

[Andalusian]

Yes Hudgens, thanks for replying. When I have reinstated after being off them completely for over a month, I have had suicidal ideation each time. So I have been really scared to stop them completely again.

 

Maybe I next time I get to the point where I think I need to reinstate after being off them completely for over a month I can just ride it out knowing what I know now. Having the understanding that it's probably WD rather than relapse would help get me through it I think.

 

At that point  It's a case of either riding out the panic, crying and despair (no suicidal thoughts) or starting back up again and feeling numb, heavy, zombified and suicidal for about a week and then I start to stabilize.

 

Thanks for replying Brass Monkey. That information is really helpful. I am breaking the pills into quarters now which is 5mg. And I will take yours and others advice to stay on that EVERY day for say 4-6 weeks, no skipping. (complete opposite to what the Doctor advised me but I feel like you all have far more extensive knowledge of the medication.

 

This might be totally wrong but I was wondering if skipping days all the time has been stopping my brain from becoming too reliant on it and therefore able to cope with the skipping? I'd be really interested in hearing anyone else's thoughts on this. 

 

I am also aware that this thought might be coming from my fear of becoming too reliant on it and may not be true at all  

 

In any case, this whole thing is hard and scary but I want to be off them for good one day. At this point I still don't know if it's possible but I will hang on to the hope this forum has given me. For so long I have been fed the line of "chemical imbalance". 

 

There is also the fine line between taking the drug to make it easier on your family (I am married with 3 children) and taking the drug because you've hit absolute rock bottom and have no quality of life. 

[KarenB]

Hello Andalusian,

 

It's also worth remembering that once you have stabilised somewhat, tapering in a gentle, slow way (as slow as your body needs) should mean you don't experience those withdrawal symptoms as badly.  It should be much easier to cope with.  The key is to start off low and slow, and discover what your individual self needs.

 

It can help to think of offering your brain and body all the healing, nurturing and love it can use as you become drug-free, rather than merely 'getting off meds.'  (And yes, this is something I know in my head, and sometimes in my heart, and yet sometimes I don't know it at all - it's no walk in the park, as you've found out).  

 

You'll get there,

Karen 

[Hudgens]

I'm confused about exactly what you are taking now and when. Are you taking 5 mgs every other day? Or are you not taking anything. If the week of suicidal thoughts only happens after not taking anything for a while and then reinstating, then you might be OK if reinstating after taking something-even though it's every other day.

 

Also, though it's usually a terrible thing to do, because of the withdrawal it brings on-if you feel that you are doing OK with the skipping days method (you said you've been doing this for 2 years now) You could just continue with that, reducing the every other day dosage a little at a time as you go along.

 

It's up to you, of course, you know the risks better than anyone.

[Andalusian]

Thanks Hudgens and KarenB. It's amazing to know there are others out there going through this.

 

Yes Hudgens I am taking 5mg everyday but have only been doing this for 2 days.

My explanations weren't clear, I feel foggy.

 

So if I am understanding correctly, you tapered off effexor over a 4 year period? Did you experience a crash after you were down to nothing?

This is the part I am most unsure about. Like does tapering off very slowly reduce the likelihood of the crash once you have had nothing on board for say a month?

Sorry if this is a silly question, I just want to be sure I am understanding correctly.

 

Thank you.

[brassmonkey]

The tricky thing about these drugs is the way they get their claws into you.  They are not addictive in the accepted sense of the word like say heroin.  ADs change the physical makeup of the brain altering they way it processes neurotransmitters.  Once those changes have been made (which can take as little as one month) the drug in question must be removed very slowly so the changes can be reversed without confusing the brain.  When skipping days the blood level concentration averages out to something lower than the stated dose but still enough to make the changes to the brain.

[Purplestars22]

Hello Andalusian, I tapered similar as you in regards of skipping doses and it is one of the things that I regret the most. That is not the recommended way to taper because it causes unnecessary suffering. Slow, steady and stable tapering wins the race. You might find 'The rule of 3KIS' useful: http://survivingantidepressants.org/index.php?/topic/6632-the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

[Songbird]

This might be totally wrong but I was wondering if skipping days all the time has been stopping my brain from becoming too reliant on it and therefore able to cope with the skipping? I'd be really interested in hearing anyone else's thoughts on this.

 

I doubt that skipping days has done anything to prevent your body becoming reliant.  This might work a little with drugs that work immediately, like sleeping pills, but these drugs don't work that way - their effects tend to occur over several weeks.  Skipping days is likely to be less problematic with prozac than with most other SSRIs because it has a longer half-life.  This can also mean a longer delay before feeling withdrawal kick in - which may be why you crash after one month off.

 

This is the part I am most unsure about. Like does tapering off very slowly reduce the likelihood of the crash once you have had nothing on board for say a month?

Sorry if this is a silly question, I just want to be sure I am understanding correctly.

 

Basically, yes.  In general, the slower you taper, the less withdrawal problems you will have, and the less likely to crash during the taper or afterwards.  It is hard to predict for each individual, for example some people have terrible trouble as soon as they drop dose, others have no trouble getting down to zero but are hit with severe withdrawal much later, sometimes after several months off.  If you've already had a few unsuccessful attempts to get off, your best bet is to go super-slowly this time - very small drops with plenty of time to adjust and stabilise in between drops.  It's about making it easier for the body to adjust to changes in its biochemical systems.  It's kind of logical - small changes are much easier to adjust to than big ones.

 

I know it is difficult to taper down your dose when you are already down to just a quarter of a pill.  Some people use a liquid form of the drug, or if this is not available, have a liquid made up by a compounding pharmacy.  Some people have capsules made up by a compounding pharmacy.  Some people cut or file or crush their pills and use jeweller's scales to weigh their doses.  All of these methods are good options as they give you the ability to make the small dose drops you need to do a slow taper.  You just need to choose one that works for you.  Each method has its pros and cons.  Liquid is easy and gives you flexibility with doses, but some people can't get the liquid.  Compounding gives you precise doses but you need to plan them in advance and it can be expensive.  Scales are fairly affordable and give you flexibility with doses, but the process is labour-intensive.  Have a look around the tapering forum for lots of information about tapering techniques.

 

 

[Andalusian]

Hi Purplestars22 and Brassmaonkey

 

It's funny, I decided to go  for a walk with my dog and as I was walking it became really clear to me why I need to stop skipping doses. Then when I got back I saw your responses which confirmed it for me. Especially after re-reading the 3KI's you put up for me. Thank you, I will stick to 5mg every day and see how i go.

[Andalusian]

Thank you Songbird! I really appreciate you taking the time to help answer that for me. In 4-6 weeks I will start tapering 10% of last dose. I think I will try crushing it up and dividing it up when the time comes. Caffeine has to go too, I'm so sensitive to it. Even 1 coffee in the morning makes it hard for me to sleep. Now I realise my system is probably hypersensitive due to all the mucking around.

[Hudgens]

Months before the end of my taper I started feeling normal and with few withdrawal symptoms-nothing that could be called a wave. Post taper has been very uneventful for me as far as withdrawal symptoms go. There were some 1-4 hours of mild symptoms, but even those have now gone, probably for good. I'm closing in on 11 months post taper.

 

To answer your question then, no, there was absolutely no crash after the first month post taper-no crash any of the other months either. And I do attribute this all to a slow, careful taper.

 

How are you feeling 3 days back on 5mgs every day?

[Andalusian]

Thanks Hudgens. Wow it's really encouraging to hear about your experience. I really mean that. I am following your lead.

 

I feel fine so far 3rd day being on 5 mg. I am really relieved. I was so scared of taking it everyday for fear of adverse reactions but I have had very little.

 

This morning I got totally overwhelmed at one point but I was able to breathe through it and it settled down very quickly.

 

I actually feel a little bit euphoric or it could just be "normal" happiness (?)  I was laughing so hard this morning with my husband over something funny and I can't remember the last time I laughed like that. I know that probably isn't a bad thing (it felt good) but yeah I guess I just can't trust myself anymore. I don't know what is me and what is the medication. 

 

The only other thing is the return of the headache but it's quite mild, I don't even think I'll need to take a paracetemol.

 

Also I slept fairly well last night especially since I've started covering up my eyes with a shirt when it starts to get light (which is far too early here). I normally have 2 shots of coffee everyday but yesterday I only had 1 so that helped too.

 

So far so good. I'm going to look for a pharmacy that will compound for me over the next couple of weeks.

[Hudgens]

If you can switch to liquid that would be the ideal situation for a long, and just as important, accurate taper. I tried to switch but couldn't and couldn't get a dr to give me a prescription for a compounding pharmacy.

 

Take all the time you need to stabilize at 5mgs. Important that you give enough time for any symptoms to show up-so as not to ever get a head of yourself. It's good to hear that you're doing alright so far.This absolutely can be done.

[Andalusian]

Ok thanks Hudgens, I will stay on 5mg for as long as it takes.

I like the idea of giving enough time for symptoms to show up so as to not get ahead of myself.  How will I know when it is time to taper? Is it a case of feeling no WD symptoms for a couple of weeks? Or is it a case of just feeling reduced symptoms for a couple of weeks?

[Hudgens]

Sometimes I went on to make a drop when I only felt "pretty good", and I always had mild brain zaps and usually insomnia when I made a drop. Try to wait at least a week or even two after the end of  any significant withdrawal symptom(s). But no matter how good you feel-never make a drop before 6 weeks-if you're still feeling good at that point, make the drop. 

[Altostrata]

Welcome, Andalusian.

 

After reinstating, you will want to give your nervous system a rest for a good long time, at the very least a month of no symptoms whatsoever, before reducing the dosage by no more than10%.

[Andalusian]

Ok thanks Hudgens and Altostrata. I will stay on 5 mg everyday for at least a month. I will reduce by 10% and hold that for at least 6 weeks and only then 1-2 weeks after the end of any significant WD's.

Writing it here and getting feedback is very clarifying for me, so thank you again. I really am so grateful. 

It sure beats guessing then forgetting and generally being all over the place. I have taken the advice of others here and am keeping a diary also. Very interesting indeed! I have tried so many times to keep a diary of my symptoms but I usually fall out of the habit when I get scattered and foggy which of course adds to my scatteredness and fogginess!

 

This is my fourth day of 5mg and I feel good. Headaches that come and go but are fairly mild. Muscle tension has increased especially in my jaw and shoulders. I have incredible thirst and increased appetite. I found myself eating donuts and frappes yesterday! I wouldn't usually. It happened before I had a chance to realise what I was doing. I hope those cravings don't continue, or if they do I hope I can catch it before I blindly get hooked into it again. 

 

I slept pretty well last night so again today I continue with just one shot of coffee in the morning. Hopefully i will stop that too so it helps me sleep properly when I start tapering.

 

I still can't believe doctors are prescribing dosages for every second day. It has also happened with my sister. Is it because this is what the pharmaceutical companies are advising them to tell their patients? Or are doctors just making it up as they go along? It's not a burning question just something I wonder about.... I would assume it's not coming from the companies because I'd have thought they would be pushing a daily dose if anything. 

[Andalusian]

It's been 6 days on 5 mg Fluoxetine now. This is the most consistently  have taken it for a very long time.

 

I feel quite good, but the type of headache I am getting has changed. It's now in the back of my head. For years prior I have always had pain at the front. Does anyone know the difference in positions of headaches?

 

Overall though I am feeling like I am stabilizing. Yay! At the advice of kind people here, I will stay on this and keep stable for quite a while. My poor nervous system has been put through the ringer.

 

Looking back over the last couple of years form this perspective, wow. I have been withdrawing quite severely without realizing.

The worst symptoms were fits of rage (my poor kids), headaches and insomnia. I also had bouts that lasted days at a time where I would drag myself around feeling like a lump of lead. It became my new normal to be on a rollercoaster. I was even beginning to wonder if I was bipolar or something because of the severity of my moods.

 

Thanks guys.

[Purplestars22]

Hey Andalusian, I am glad that you are feeling better and stabilizing that's all your CNS nedded regular doses. I am in disbelief on the way that I tapered too and caused so much havoc on my CNS. The doctor gave me instructions to taper by skipping doses for roughly six weeks but then I continued tapering for a whole year! crazy. I had lots of symptoms while tapering but still continued. I hope that doctors become more knowledgeable about tapering soon. Best wishes...

[Andalusian]

Thanks Purplestars22. I do too. My sister has just been given the instruction to take a dose of zoloft every other day. I fear for her! I hope you are doing well now?

[Altostrata]

Please tell your sister NOT TO SKIP DOSES TO TAPER. That is a terrible way to go off drugs.

[Andalusian]

Hi Altostrata. She is not tapering, she was given that instruction when she started them. She has been off them for a long time (years) but went back on 2 months ago. I know it is really bad, I only know that now after being educated here on this forum. But she trusts her doctor and knows no different, I am going to tell her but I have to pick the right time so that she is open to me and hears me correctly. Sometimes it's hard for people to understand that doctors know so little especially when they act as if they are an authority. I hope she listens to me.

[Andalusian]

Hi all. I am down to 4 mg fluoxetine. The doc basically laughed in my face when I said I needed a prescription to taper down by 10% to give to the compounding pharmacy. So he gave me a 1% prescription. So I dropped down crm 4 mg to 3 mg. I entered a state of hell. First 1-2 weeks were ok but then 2 weeks of pure hell. It took another 2 weeks to feel ok again after reinstating 4 mg. So, lesson learnt.
After watching what I went through my partner went and bought some scales and is going to help me do this properly. I had told him about this forum and the recommended tapering method. I am mathematically challenged but I know you are all here to help if I need it. I'm so grateful for this forum.
So if I take a 20 mg tablet and weigh it, do I reduce the weight of the tablet by 10%? Or do I work out how much of the active ingredient is in the pill somehow?

Edited May 13, 2016 by KarenB
merged intro's

[savinggrace]

Hi,

 

I use a digital scale too. My husband does the math and talks me through it.

 

Find out how much the 20 mg. pill weighs in grams. You want to find out how much 18 mg weighs (10% cut of 2 mg.)

 

Divide the weight of the 20 mg. pill by 20. Then multiply that number by 18. That will give you the desired weight of the 18 mg. dose.

 

I believe there is a link to using a digital scale on the home page. I am on my phone, but I will try to navigate to it, and send it along. My phone doesn't cooperate with this site very well.

 

Ask all the questions you need. There are lots of good people here to help.

 

You are doing the right thing. Be sure to read all the links on the home page, and be open to the "we are all different" ideation. No one is the exact same as you, so being flexible and open to adjustments in tapering rate is key

 

Good luck

Grace.

[KarenB]

Glad you up-dosed Andalusian - you've saved yourself from a lot of pain. 

 

Here's the link for Using a digital scale

 

There is also info here on getting fluoxetine as a liquid, or making your own liquid, which can be easier at lower doses.  I appreciate though that you have already bought scales. 

 

Karen

[Andalusian]

Thank you for explaining that Grace. I will read back over this when I have more time.

Thank you for the links Karen. I will check them out.

Again, so grateful for everyone's support.

[Andalusian]

Also just as a side note. It's so interesting that when I was recovering from quite a severe flu I had a return of anxiety symptoms badly! I panicked and didn't know why then thought ok you're still recovering, take it easy. I felt far fewer symptoms once my flu cleared up properly.

[nz11]

Hi Andalusian,

Definitely the flu can set off symptoms.

Sounds like you have passed through it well without panicking.

 

You say you have found a compounding pharmacist my understanding is you tell them what dose you want and they make it for you.

 

 I needed a prescription to taper down by 10% to give to the compounding pharmacy. So he gave me a 1% prescription. So I dropped down crm 4 mg to 3 mg.

This has confused me.

 

I guess its irrelevant now cos you are back to 4mg.

 

As Alto suggested wait a month if the coast is clear then try to taper again.

 

If i was you i would try a 5% taper.

If you decide to go for a 10% taper then you multiply the current dose by 0.9 to get the next one.

ie 4 times 0.9 = 3.6

you then go to the compounding pharmacy and tell them you want a 3.6mg dose.  (active ingredient).

 

My understanding is a c.p. will make it up and give it to you (in tablet or liquid form). There is then no need for you to be weighing/measuring anything.

 

Maybe i am missing something here.

 

What is your understanding of the process?

 

At a guess it sounds like in the previous encounter with doc and pharmacist there has been confusion.

[Andalusian]

Hi NZ,

yes I realised after that didn't make sense. I meant to say the doctor would only write me a precription for 2 mg and 1 mg capsules because when I tried to explain the 10% reduction method he said that's ridiculous. ???? So that was all I could give the cp. so then I thought ok I'll just drop down to 3 mg. bad move.

So now I am just going DIY with scales and a calculator. So I think what you are saying is multiply the weight of tablet by 90% to get a 10% reduction. I think that's right?

[Andalusian]

Today I bought a pill crusher and some big gelatin capsules. I hope the scales my partner bought are accurate. I've just realised they only go to 0.00

That's probably not going to be small enough is it?

[nz11]

Thanks for clarifying that.

 

Do you mean 0.00g or 0.00mg or 0.00 kg  ?

 

I'd still be tempted to go back and talk to the c. chemist explain the game plan tell him the doctor was mistaken and you want 3.6mg not twos or ones.

He could always then confirm with the doctor himself ...im sure that is not a big issue they must confirm often looking at how dreadful their writing is.

 

If you are set on the DIY option ..what do you think about liquid?

[Andalusian]

It's 0.00 g.

I did look at the liquid but it didn't make much sense to me. I don't understand how to extract such minimal amounts and does the the drug stay 'ok' in liquid for a week or so...? I might try the cp pharmacy again if I find the scale system too hard. Why do people find the liquid system better? Is it more accurate?