Jump to content
Elexis

Elexis: tapering fluoxetine / Prozac - did I come off too fast?

Recommended Posts

scallywag

Elexis you could try decreasing valerian by 25% to 45 mg. Then pay attention to symptoms. 

Share this post


Link to post
Lawyerliz

They switched me from,pr I zav to wellbutrin late last summer. The Wellbutrin had bad effects and I've cut it down. But I have no idea if the Prozac I went cold turkey on 6 months ago is having bad effects

I don't really want to reinstate.

Share this post


Link to post
Elexis

thanks for the advice Scallywag, I've decided to taper off my ibuprofen habit first then will tackle the herbal pills.

Been taking 2 tablets of ibuprofen, three times a day for about 2-3 months now so trying to reduce by 1 tablet per week.

Keeping an eye on symptoms though it's  hard sometimes to tell  what is a reaction to tapering the ibuprofen and what is just a flare-up that would  happen anyway. Having a bit of a bad flare the past couple of days, can't tell if it's because I reduced the ibuprofen last week. First 3-4 days after the reduction were fine so bit hard to tell. :wacko: What do you think? Unsure whether to go back to my previous dosage or whether that would just cause more disruption.

 

p.s.  just wanted to say a big thank you to you all for all your help with this stuff, I'd be a confused and frustrated mess if it wasn't for this forum!! really appreciate it :)

Share this post


Link to post
Elexis

Hi folks, bit  of an update

 

Went to GP today and finally told them about taking the 1mg Prozac and how it's helping my PGAD. They feel this approach isn't 'evidence based' so aren't willing to prescribe me Prozac so I can continue. I've got enough left to do me for about 3-4 months.

 

What do you think, is coming off the 1mg a bad idea if still experiencing the PGAD? I've got enough that I could do a fairly slow taper but  would  hate to damage all the progress that's been made.

 

Should also add the only other option suggested was going back onto 20mg a day to see if that relieves my PGAD as I've had this symptom for about 10 months now. What do you think?

 

Thanks

Share this post


Link to post
KarenB

The doctors are offering you an option to take 20mg Prozac?  That's actually useful.  You can fill that prescription, and use it to continue your careful managing of the situation at 1mg, and then tapering when you are ready. 

Share this post


Link to post
Elexis

wish I'd thought of that! sorry, didn't explain fully in my original post, they offered the 20mg option but I think I've scuppered that by making it clear to them I don't have any mood issues anymore and they'll only prescribe it for that (anything else ain't evidence based y'see).

Share this post


Link to post
Elexis

Hi folks,

 

I came off Prozac, too fast, in May 2016, and developed PGAD symptoms as a result. A few months later I reinstated at 1mg after finding this website and have held at that dosage ever since. My PGAD has been gradually decreasing though  is still a symptom at this point.

 

Unfortunately, I went to see my  Dr recently and finally told them what I'd been doing with the 1mg (they were under the impression I'd not taken any Prozac at all since May). They feel that being on 1mg to control the PGAD isn't 'evidence based' and so I should come off it.

 

My questions are - how would I safely taper from such a low dose? I have enough leftover Prozac to keep me going for 3-4 months, would that be long enough for a safe taper? Also, is it a good idea to be tapering at all while still experiencing PGAD? Is there a potential I'd be undoing all my progress?

 

Any advice appreciated,

 

Thanks

Edited by scallywag
merged topic

Share this post


Link to post
scallywag

Elexis, there's no way of knowing what's too fast in advance. Have you tried making a 10% reduction in your dose?

 

If you want to conserve the tablets/capsules you have on hand, you're best off weighing your dose with a digital scale. If you're weighing the dose, you can save the powder or crumbs you don't use. 

 

I read the posts where you mention the conditions under which your doctor will prescribe Prozac. How do you feel about a return visit and saying that you've noticed emotional symptoms returning? If you're not comfortable with that, I understand.

Share this post


Link to post
Elexis

I could certainly give a 10% reduction a go... though I had to start taking betahistine tablets recently for another health problem so would wait a while before doing the 10% reduction to make sure the betahistine isn't causing me  any issues.

 

I currently make a liquid from my tablets, I use it for about 5 days... there's still liquid left at the end of the 5 days, just I worry about it 'going off', dunno if that's possible though.

 

Hmm, I don't think I'd feel comfortable lying about my mental state...I may be able to convince the doctor if I end up reducing my 1mg dose and get a symptom flare up to give me more tablets so I can taper for longer. Trouble is he thinks the benefit I've had from the 1mg is just a 'placebo effect'.

 

Ideally, if I wasn't having doctor trouble, would it be a good idea to be attempting a 10% reduction right now? My symptoms are much milder and more tolerable but they're not gone. I was never sure whether it's best to wait till they're basically gone before trying to remove the drug.

Share this post


Link to post
scallywag

When did you start the betahistine? Is the plan for you to take it for a short time? If so, how long?

Share this post


Link to post
Elexis

I started it about 3 days ago, I'm monitoring the PGAD but haven't had any increase in symptoms (if anything I'm doing slightly better than usual at the moment).

I'll need  to ring my doctor and find out how long I'm to be on it but it is likely to be for a couple of months (I've had it for the same condition in the past and it was for a few months).

Share this post


Link to post
scallywag

I'd hold off decreasing Prozac dose until you've been on the betahistine for at least 2 weeks.

Share this post


Link to post
Elexis

Okay, will do :) I'll come back in a couple of weeks and let you know how things are going.

Thanks for the help!

Share this post


Link to post
KarenB

Is it possible to find another doctor who will prescribe what you need to safely taper? 

Share this post


Link to post
Elexis

Could be, I could always try getting a second opinion from a different doctor at the same practice (though they don't usually like to  contradict each other).

I'd have to bring some kind of evidence that a long taper is necessary / safest... they think all this stuff is just anecdotal and so are dismissing it all as a placebo effect (it's all in our heads!).

Share this post


Link to post
Elexis

Just wondering - given that holding at 1mg over the past 10 months seems to be producing a slow reduction in my PGAD symptoms, would the ideal thing be to continue holding at this amount until the symptoms are minimal/gone and then taper?

 

Thinking of approaching a new doctor and wondering if I should be asking for them to allow me to stay on 1mg for the time being or to allow me to start a more gradual taper now? What do you think?

Share this post


Link to post
scallywag

Our conventional wisdom (which isn't so conventional) is that it would be best to stay on the 1 mg until your symptoms are fully resolved, hold for at least a month then taper down from the 1 mg with the 10% taper. That's the "ideal" whether that's workable with NHS doctors, well, you have a better sense of what's workable with the docs in your clinic and about your comfort with asking them to colour outside the lines.

Share this post


Link to post
Elexis

Thanks Scallywag, that's the ideal I'll aim for then. I'm seeing a different doctor in a couple of weeks. I'm thinking I  should try and print off some evidence to show to them as the last doctor didn't think withdrawal was even possible to last more than 2 weeks (oh, if only!!)

 

I can find plenty of stuff about SSRI withdrawal syndrome, including it causing PGAD, and reinstatement being the only thing that can help... just struggling to find anything about a small dose like 1mg being beneficial. Do you know of anything?

 

The most aggravating thing is the Dr I saw recently is the same one who got me into this mess with the too-fast Prozac taper! He now wants me off the Prozac and also admitted there's no cure or treatment for PGAD. So, in other words, we've got nothing to offer you but we don't want you having the one thing you say helps. :angry:

Share this post


Link to post
Elexis

I hadn't seen those, thanks for posting, I'm having a read through just now.

It sure sounds like (so far) getting doctors to acknowledge this stuff is tricky!

Share this post


Link to post
Elexis

Quick question - how long is it advisable to keep a liquid solution you've made? I keep mine in a dark-ish container (a dark brown glass jar) in the fridge, usually for 5 or 6 days, is that too long? worried about any risk of the drug degrading.

Thanks

Share this post


Link to post
ChessieCat

From: Tips for tapering off Prozac (fluoxetine)

 

In Post #1 under the heading Making your own Prozac liquid

 

"Refrigerated, it's supposed to be stable for 14 days."

Share this post


Link to post
Elexis

Brilliant, thank you, 14 days is much better than I thought - I'll be able to make  my tablets go further now :)

 

I'm now looking to come off the betahistine tablets I mentioned earlier on... I don't seem to have had any worsening of w/d as result of going on them... my doctor says I can just stop taking them with no taper needed. I've done a little searching but can mostly just find things about sedating antihistamines for sleep. What would you guys recommend?

Share this post


Link to post
Elexis

Hi guys,

 

sorry to push you but I've only a small supply of betahistine tablets left so  if I need to get more for a long taper it'll need to be soon. My doctor thinks I can just stop them with no taper at all, what do you think? I take 8mg, 3 times a day.

 

Thanks very much x

Share this post


Link to post
scallywag

Betahistine is a neuroactive medication. I'd be cautious about tapering it, particularly because you've been sensitive to Prozac, the "easiest" SSRI to taper. 

 

When did you start taking betahistine?  Please add that date and the dose to your signature.

 

You might try reducing by 25% to 6 mg at one or more of your doses to see how you react to the decrease.

Share this post


Link to post
Elexis

Thanks Scallywag, I started Betahistine on the 24th February, looking to come off it now because it's wrecking havoc with my dry eyes. :(

 

I'll try the 25mg reduction.... they're very small tablets, can't see a way to snap them into 4 accurate pieces. I found info online saying they are water soluble though so maybe could make a liquid suspension. If it's water soluble does that mean I can just chuck it in the water & it'll dissolve or do I need to crush it first?

(apologies if asking overly obvious questions, my dry eyes are really bad atm & ability to do much reading is limited).

Share this post


Link to post
scallywag

Dissolving will be easier and faster if you crush the tablet first.  Some people use 2 spoons.

Share this post


Link to post
Elexis

Okay, I'll do that, thanks.

I'll keep up my symptom  diary and watch  out for any changes from  the 25% reduction. Should I reduce all three of my  doses or just one?

Share this post


Link to post
scallywag

I'd start with reducing one dose at first to see what symptoms arise if any. Give it a couple of days, then reduce a 2nd dose. HOld for a few days, reduce the 3rd one. Hold the 3 reductions for 3-4 weeks.

Share this post


Link to post
Elexis

Will do, will let you know how I get on :)

Share this post


Link to post
Elexis

Hi,

I seem to be having a bit of a flare up... I wonder, is  it too early to tell if it's due to tapering the Betahistine? Here's a couple of symptom diaries from before the betahistine taper:

 

25th March

1pm - 4

3pm - 3

5pm - 2

 

26th March

1pm - 3

4pm - 6

6pm - 4

8pm - 2

 

29th March

1pm - 2

3pm - 4

5pm - 3

7pm - 3

 

Betahistine now reduced to 8mg in the morning, 8mg at 6pm and 6mg at bedtime:

 

30th March

1pm - 2

3pm - 4

4pm - 3

6pm - 2

7pm - 3

12am - 4 (settled to a 3 overnight)

 

31st March

1pm - 2

3pm - 3

6pm - 5

7pm - 2

10pm - 3

 

April 1st:

12pm - 1

1pm - 3

2pm - 2

5pm - 5

7pm - 4

8pm - 2

10pm - 6

12am - 4

 

April 2nd

1pm - 1

3pm - 5

4pm - 1

6pm - 4

8pm - 3

10pm - 4

12am - 5

 

Betahistine now reduced to: 8mg in morning, 6mg at 6pm and 6mg at bedtime

 

3rd April

1pm - 1

3pm - 4

5pm - 1

9pm - 3

 

4th April

1pm - 1

3pm - 3

4pm - 1

8pm - 5

9pm - 3

11pm - 5

2am - 2

 

5th April

1pm - 1

3pm - 4

6pm - 5

9pm - 4

11pm - 6

12am - 7

5am - 7

 

It's quite a lot of data, wanted to get as accurate a picture as possible.  What do you think?

 

Also, unfortunately, last night I wasn't paying attention and took an 8mg dose at bedtime. Should I hold that now I've done it or try and go back to 6mg tonight?

 

Thanks!

Share this post


Link to post
Elexis

Good news! I saw a  different GP recently and they have agreed to prescribe me fluoxetine for as long as I need to taper. They clearly thought I was nuts but since it's not causing any harm (being such a small dose) and I "believe" it  is helping they were willing to let me have the pills. Such a relief!

 

On a related note I saw a pelvic pain specialist recently and they  confirmed the link between people coming off SSRIs and developing PGAD right after. It's nice to hear this confirmed rather than being told it's  all a big coincidence but it is also absolutely infuriating! This link is known and yet Doctors don't mention this when they offer you the pills?!? Same for a lot of withdrawal symptoms I guess. I just don't understand... is it all just to do with money? :o They say these things are very rare, maybe they are, but that doesn't help when you're one of the afflicted. Sigh.

 

Betahistine taper is going well btw, down to 6mg 3 x a day, will hold for 3-4 weeks.

Share this post


Link to post
ChessieCat

"is it all just to do with money?"

 

Yep!

 

Gwen Olsen was a pharmaceutical representative for 15 years.  Here are a couple of interviews with her:

 


Confessions of an Rx Drug Pusher (51 minutes Gwen Olsen - ex pharmaceutical representative)

 

And an excerpt from her book, Confessions of an Rx Drug Pusher (bold font is mine):

 

Page 47:

 

I recall an early encounter with a young, marketing executive in the now-
defunct Syntex Laboratories. We were at a company-wide sales meeting. Nearly
1,000 reps from around the country were in attendance. He was discussing
the dosing recommendations for an NSAID that was a counterpart to the then
number one seller for arthritis, Naprosyn (naproxen). The drug’s name was
Anaprox DS (naproxen sodium). It is currently sold over-the-counter in less than
half the prescription strength as Aleve.


Anaprox is the same chemical compound as Naprosyn. The only difference is
the sodium added to improve absorption time. Therefore, Anaprox is promoted
for acute, short-term pain. The drug has a twelve-hour half-life. That means it
takes at least twelve hours following administration for the body to eliminate fifty
percent of the drug. After that, blood levels of the drug fall below their therapeu-
tic range. A drug with a twelve-hour half-life would require a b.i.d., or twice
daily
, dosing regimen
in order to sustain blood levels and maximize therapeutic
efficacy. The Anaprox dosage recommendation, however, was t.i.d., or three
times daily
. This prompted me to ask the product manager, “Why?”


Initially, he disregarded my question and responded, “Because we can. We sell
more pills that way
.” He then moved on; however, I persisted and raised my hand
again. To his annoyance, I asked, “Doesn’t that unnecessarily increase the possi-
bility of GI [gastrointestinal] complications such as bleeding and ulceration?” His
next remark would haunt me for the remainder of my career, “Well, of course it
does,” he said chuckling, “but, luckily for those patients, we have a new H2-
blocker in the pipeline!” The crowd erupted in laughter, and I made a mental
note to ask one of my older colleagues what exactly an H2-blocker was.


During the next coffee break, I discovered H2-blockers (H2-antagonists) were
designed to treat stomach ulcerations. The company, indeed, had one in licensing
negotiations
. Whether this statement was jocular in nature or not, it revealed an
underlying attitude that was pervasive in the industry and would surface time and
again in my experience. Patients were regarded as consumers and, as such, were a
dispensable human commodity.

Share this post


Link to post
Elexis

Thanks for the info Chessie, that's fascinating stuff.

 

I'd figured for a while that money was involved in the sense that where I am (UK) it is much cheaper for the NHS if a doctor gives you pills than to give you long-term psychotherapy. I remember catching a glimpse of my docs screen once and saw the cost of the meds, it was dirt-cheap. The risks associated with the drugs never seemed to be a factor, it was cheaper than therapy so that's what they give you.

 

I'd never thought about the pharmaceutical company's side of things. Makes a whole lot of sense though. Feel like I've been rather naïve up till now... I guess everyone just assumes they can trust their GPs until they find out otherwise. I certainly would approach medication (particularly neuroactive medication) with a lot more caution now and I'm sure as hell never touching an SSRI again!

Share this post


Link to post
Elexis

Got a question about making up liquid solutions...

 

I crush an 8mg Betahistine tablet and add 16ml of water. Is it okay to crush two 8mg tablets in 32mls of water and keep them in the same jar?

I ask because I tried doing a 'bulk' lot of betahistine solution last night - six tablets in the equivalent amount of water - and it didn't look like things dissolved properly. I guess I'm worried there may be too much powder? There's always plenty visible swirling around regardless of how many tablets I use at a time and then it all collects at the bottom of the jar.... could loads of powder collecting at the bottom make it very difficult for any of it to dissolve?

 

Thank you x

Share this post


Link to post
Elexis

Forgot to add, I've just been  prescribed Fluconazole for a suspected yeast infection. It's one tablet, 150mg.

Did a bit of searching and sounds like it can interact with antidepressants.

At a bit of a loss about what to do now. Was supposed to take it tonight but now unsure. :(

Share this post


Link to post

Please sign in to comment

You will be able to leave a comment after signing in



Sign In Now
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy