Yushan: Tapering SSRI

[Yushan]

I am now 60. In 2000 when I first took Prozac, it is 20mg. In 2003 when I tapered it off at 2mg every month, symptoms appeared about 9 months later, I am very sensitive to sound. So I retook it again to the previous dose. In the following 4 years. I have tried 3 times to taper it, the last time I am so cautious I tapered it off at 1mg every month. I wish I could succeed. I don't mind waiting. I took more than 1 and half year to go to the last phase, at which I took only 2mg. One day, in a cruise, I have a serious dizziness and can't stand. I thought it is seasick. After that,  the problem is aggravated, I had all the flue symptoms,  say feeling cold, fatigue, headache, irregular heartbeat and highly sensitive to light and temperature. Always felt freezing. No doctors could render me any help. Their treatment is invalid. I was left in deep depth of darkness, I have been struggling for 6 months lying on bed in deep depression until I gave up and retook Prozac again.However,  I have to increase my dose to 30mg from that time onward.

 

In Hong Kong, no doctors can help patients out with these situation. They are not taught in school nor do they open their minds  to learn the facts. When I consulted my Phsychiatrist  on my tapering symptoms before, he was quite shocked to hear about it.  It seems that it is the first time in his life to hear about this case. And I am the only one who have ever had these withdrawn symptoms.

 

The Chinese are very prejudiced against people who took any kind of psycho drugs. All these years, I am so lonely and so delighted to find your organization to walk with.

 

My daughter is now working in London, I visit them very often. I am thinking to find a reliable  neuropsychiatrist to help me to withdraw the Prozac.

 

Wish someone could give me advice.

[savinggrace]

Hi Yushan,

Here in the US, doctors appear just as clueless as the doctor you described. I think doctors who aren't clueless (or don't choose to be in denial) are the exception to the rule.

 

If you read my story, you will see how hard I have tried, and how little progress I have made with my tapering as well. I do not bother to try and get my doctor to understand. I just tell him what he needs to hear for me to get what I need to taper as I need. Hopefully, you can find a doctor who doesn't put you on an aggressive tapering schedule, and won't prescribe what you need to taper slowly, making adjustments along the way. That's who you need to find. The answers on how to taper slowly, you will get here.

 

I will leave that technical advice to the moderators, but you are in the right place. No matter how slowly you have to go, don't beat yourself up over it. When you feel so depressed, hang out here, where there are people who care, and understand.

 

Best wishes,

Grace

[LexAnger]

Hi Yushan,

Welcome to SA! I'm glad you found us.

I am very sorry you have been going through tough years dealing with Prozac WD.

 

I in particular understand how difficult for ppl in such situation in China as I am from China and know the culture.

 

Before our mods come along with advice, can you add your medication history to your signature so ppl cane see it quick and easy? They will be attached to each of your posts.

 

Also, how are you feeling now with the 30 mg Prozac?

 

Lex

[SquirrellyGirl]

Hello, Yushan - welcome to SA!  I am so glad you found us!

 

Yes, it would be nice to put your med history in your signature block so that we can see your history at a glance.  It appears beneath all your posts, and as your thread grows, it will be easier to have context.  Please put your Withdrawal History in Signature.  Please include all meds you take, your history with regards to past usage, dosages, dates to the best of your knowledge.  Thank you!

 

How much time had passed between coming off Prozac and the cruise?

 

I am sorry that you have had such a tough time tapering Prozac, with failed attempts and subsequent withdrawal.  Your taper off 20 mg, at 1 mg a month, was arduous and much slower than most doctors would have you do, so I'm sorry that it didn't turn out for you.  It may have been that at the end you were dropping by progressively larger amounts.  I think even when we taper off very slowly, our nervous systems are very delicate, and any big stress can trigger withdrawal that may have otherwise laid dormant. That may have been what happened with the cruise.

 

Are you stable now?  If so, we recommend a 10% taper schedule, which is based on the previous month's dosage.  So, up front, you will cut larger amounts than you did with the 1 mg/mo taper you did before, but as time goes by, the cuts will get smaller and smaller until at the end, it will be fractions of a mg.  This is important when you consider the paper in this topic:  Why taper?

 

On page 4 you will see the graph for fluoxetine.  At 30 mg, your serotonin receptors are pretty much saturated at 80%.  As you cut between 30 and 20, starting with a 3 mg cut, you can see that there isn't that much of a change in receptor occupancy.  But look at what happens below 10 mg!  Whoosh!  Big freeing up of receptors!  Prozac's long half life may have padded things out towards the end before, but it has a way of catching up with you.  A cut from 2 to 1 mg is a 50% cut, and the nervous system doesn't like such big drops!

 

I'm going to include more links that I think you will find helpful.

 

Introduction to AD Withdrawal Syndrome

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's Symptoms Checklist
Symptoms:  Important topics about symptoms

 

When you begin tapering, it is important to track your progress on paper daily, documenting dosage changes, time you take meds, times that symptoms arise, when they disappear, etc.  This will help you gauge what your pattern is like relative to a cut.  This makes things feel more predictable in the future.

 

Meanwhile, your Intro is the place for you to ask questions about your situation and give updates.  Bookmark it so you can find it more easily.  Click Follow above so that you will be notified when someone responds in your thread.

 

So have a read, and then come back with questions!

 

SG

[Yushan]

I used to keep a detailed record of my tapering. However, after my failure of my 4th attempt. I was totally in despair and I threw all the records away. I believed that I would not succeed to withdraw Prozac and will take it for the rest of my life.

 

The followings are the rough dates I try to remember

 

Fluoxetine

 

Since 2000                    20mg

 

2003-2004                     tapered to 2mg

 

2006-2007                     the 4th attempt  - taper to 1mg  (withdrawn symptoms burst out after the cruise)

 

2008-2016                      increase dosage to 30mg

 

Now is working and living normally in Hong Kong

[Yushan]

 Thank you Shep ! So glad to hear from you guys  your valuable advice and experience. Thank you for the useful links that you suggest, I wish I can understand those medical terms and graphs.

 

In the long road to withdrawal, wish you guys can give me consistent support.

 

Again, could anyone give me some information on doctors in London or in UK that they can help tapering anti-depressant?

[JanCarol]

Hey Yushan, welcome to SA!

 

The doctors who understand safe tapering and withdrawal are few and far between.

 

At best, we can often find a doctor who will cooperate, while scratching their heads in disbelief.  At best, sometimes we have to lie and say we are taking full dose, please prescribe, until we are safely tapered off.

 

Did you understand what Shep was saying about straight line taper?  For example, if you are on 30 mg, your first drop will be 3 mg to 27 mg, and hold for at least a month (or until symptoms settle) before tapering again.  Your second month, from 27 mg, will be 2.7 mg to 24.3 mg.  You see how your decrements will be smaller each time your taper?  This makes for a gentle curve, and makes it possible to get off the drug. 

 

We prefer this gentle curve, and when your symptoms are minor and your dose is below 1 mg, you can then discontinue.  It takes longer - but as you know from your 3 years experience, it is better to take 3 slow, steady years, than to bounce up and down like a basketball!

 

Please resist the doctors who will tell you "this is relapse" or "this is your original condition."  In our experience, withdrawal effects can continue for well over a year, and sometimes significantly more.

 

How do you talk to a doctor about tapering and withdrawal?

What Should I Expect From My Doctor About Withdrawal Symptoms?

 

 

Here is where you can find a few SA recommended doctors:  Recommended doctors, practitioners and clinics

 

There is another site, called Mad In America, which also has a list of "anti-drug" doctors (but they may not be as savvy about tapering):  http://www.madinamerica.com/service-directory/

 

You are lucky:  Prozac is available in a liquid, which can make it easy to taper by tiny amounts.  

 

Here are some things to think about while you are getting ready to taper (if your trip to London is only a visit, I do not recommend tapering while travelling - but if you can get enough liquid Prozac to take home to Hong Kong, that may be an option for you):

Preparing to Taper

Psych Central 6 Ways to Prepare for Antidepressant Withdrawal

Tips for tapering off Prozac (fluoxetine)

Healing from Antidepressants: Patterns of Recovery (Toxic Antidepressants)

 

Additionally, when stopping psych drugs, it is vitally important that you replace them with a toolkit for dealing with emotional symptoms.  These tools, while meant to help you in withdrawal - also are awesome tools for managing your mood so that you never need to consider taking the drugs again.  My personal favourites are Mindfulness, Yoga and Tai Chi, but your toolkit will look different from mine.  Start by looking here to find tools and practices to replace the drug for management of mood:  Non Drug Techniques for Coping with Emotional Symptoms

 

I am envious of your trip to London, I haven't been there since the late 90's, and really wish I could've seen more!

 

Please keep us posted on what you decide to do.  And please complete your signature:  How to complete your Signature or Complete your Signature from Phone or Tablet  It really is important for us to have your history in your signature so that we can better understand everywhere you post.  

 

I am sorry there are so many links, I know it is quite overwhelming.  But you have some long flights coming up  and may be able to be well versed by the time you have read them all!

[Yushan]

Thank you so much Jan!! I will read the links bit by bit. I am now gathering information on it and wish I will have a more solid plan in near future.

 

Just read your history. Feel glad and joyful for you because you manage to be drug free after that long long 30 years. Wish you succeed in knocking the Lithium out!