jevang: over 2 months of ssri withdrawal am now expected to complete college health program

[jevang]

Hi, new user been on meds for 8 years or so, varying combinations of ADs, AAPs and benzos. have tapered the last drug (Lexapro) and been going through withdrawal for over 2 months, details are in signature, hopefully it's adequate.

i should mention that i am dealing with pretty severe brain fog through this withdrawal, so the way i organize my ideas and structure sentences might be pretty awkward....  OK, it has been 65 days since 2 months since coming off all meds, first it was antipsychotics, then benzodiazepines, and finally antidepressants over the course of several months after being on the meds for 7+ years.

 

overall I feel pretty useless right now, and extremely self conscious and self critical as well. my affect and anxious tone of voice seems to draw attention to myself more often than not, depending on how anxious i am. don't think this is entirely in my head or a mere judgment, i distinctly notice grimacing from people pretty often, or sometimes laughing if i'm walking past a group of people. so it's not entirely irrational. and i often have an extremely difficult time forming proper words and ideas. sometimes i don't even wish to be around my parents.  i just don't feel like myself.

 

this feels 20x worse than run of the mill anxiety, especially considering that i have an anxious personality to begin with, so it's anxiety (disorder), on top of anxiety (anxious personality) on top of anxiety (withdrawal symptoms).  add to this that i am expected to continue going to school in the fall to complete a polysomnography program (i would be a sleep tech) i honestly do not feel ready at all, yet getting through this polysomnography program could ultimately mean my financial independence and it's even more so a pressing issue considering my father may be retiring next year meaning that i wont have the same health insurance and wont be able to see my current therapist who i feel very comfortable with atm, any longer. other therapists have been deameaning and patronizing because of my timidity.

 

now all that brings me to the question how i can cope with these symptoms so that i don't humiliate myself on a regular basis and become demoralized. my therapist who specializes in ACT tells me to "be present".. he suggests thought defusion exercises, mindfulness, grounding and acceptance. a lot of these concepts are pretty vague to me; what is "acceptance" supposed to  look like? what is mindfulness? what are the steps that have to be taken to get to these states, when do i use them, how do i use them? being that i tend to micromanage every little thought feeling and event  that goes on in my daily life, these coping skills drives me crazy and brings me more in my head than before leaving me mentally exhausted.

are there any supplements that could take the edge off?

my biggest fear is being judged to be incompetent and unqualified to do sleep lab work. perhaps i might be told that i'm making the patients or the students uncomfortable. perhaps my fear-laden affect and anxious/passive/unattractive tone of voice will be too off putting for others. i don't even feel that i'lll have sufficient motivation or mental energy to study the material properly.

overall i feel like there's a lot of pressure on me to do well when i may not be ready to function yet. yet at the moment i am in a way committed to the program: i have already on  more than a few occassions gone back and forth with my decision to complete the program. so if i call the program coordinator again telling her for the fourth or fifth time that i don't feel ready, i will likely not be accepted when i DO feel ready. moreover, explaining my situation and thus letting them know that i have a history of psychiatric issues would probably make acceptance in the future even more unlikely, rather than help the situation.

any help at all would be much appreciated.

Edited August 5, 2016 by scallywag
tags added

[nz11]

Welcome jevang

There are heaps of good threads here on non drug ways of coping.

http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/

 

Wow your situation sure is complicated. If you dont mind me asking what was the reason for such a cocktail of drugs for the 7-8 yr period. Have you been seeing a therapist for 7-8 yrs too?

Seems odd to be given a benzo to help wean off the benzo? Still im not a doctor so who am i to criticize.

 

Are you able to advise the dosages of the prozac,  lex and benzo.

So are you saying you weaned off all drugs from oct to dec last year except for the benzo and prozac.

You then weaned off the ? mg of benzo in the month of jan 15 at the same time you switched the ?mg of prozac to ? mg of lex

Then in the month of may you tapered off the ?mg of lex. And you are now 2.5 months drug free and experiencing a whole heap of withdrawal symptoms. I think you are right you are experiencing a cacophany of withdrawal sounds and to determine from where they are originating is a curly one.

 

To be honest you deserve a medal for making it to 2.5 months drug free. imo

 

Don't know what to say at this point except so glad you found sa

 

nz11

[jevang]

Welcome jevang

There are heaps of good threads here on non drug ways of coping.

http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/

 

Wow your situation sure is complicated. If you dont mind me asking what was the reason for such a cocktail of drugs for the 7-8 yr period. Have you been seeing a therapist for 7-8 yrs too?

Seems odd to be given a benzo to help wean off the benzo? Still im not a doctor so who am i to criticize.

 

Are you able to advise the dosages of the prozac,  lex and benzo.

So are you saying you weaned off all drugs from oct to dec last year except for the benzo and prozac.

You then weaned off the ? mg of benzo in the month of jan 15 at the same time you switched the ?mg of prozac to ? mg of lex

Then in the month of may you tapered off the ?mg of lex. And you are now 2.5 months drug free and experiencing a whole heap of withdrawal symptoms. I think you are right you are experiencing a cacophany of withdrawal sounds and to determine from where they are originating is a curly one.

 

To be honest you deserve a medal for making it to 2.5 months drug free. imo

 

Don't know what to say at this point except so glad you found sa

 

nz11

i think the main reason for the cocktail of drugs during that 7-8 year period was that they were under the impression that i had psychosis as well as depression and anxiety. but the fact that i have been off anti psychotics for many many months now without psychotic symptoms would seem to definitively suggest otherwise.

 

i have also been in therapy for those 7, 8 years too. the main reason being social isolation, social anxiety and depression. i saw multiple therapists off and on, i lsot count how many, probably close to 10, but really have only seem three main therapists. two of them had an analytic bent to their approach, and the current one i'm seeing is more pragmatic and scientific, although he rejects CBT approaches. the analytic types seemed to do more harm than good, one was a real patronizing prick. my current thearpist, says that most of my symptoms can be traced to trauma.

 

the valium was prescribed to wean me off the benzos becaue the half life for valium is longer than most other benzos. it's often used for that purpose as far as i'm aware.

 

unfortunately i don't remember the exact dosages of the drugs. none of the dosages were at all extreme or in the high range. i know the prozac dose was 20 mg and the lexapro dosage was around 10-20 mg.

 

"So are you saying you weaned off all drugs from oct to dec last year except for the benzo and prozac.

 

You then weaned off the ? mg of benzo in the month of jan 15 at the same time you switched the ?mg of prozac to ? mg of lex

Then in the month of may you tapered off the ?mg of lex. And you are now 2.5 months drug free and experiencing a whole heap of withdrawal symptoms. "

 

all of that is correct. (font changed, not sure why)

 

anything else that i may have missed, or if anything about my situation needs to be clarified please let me know, thanks.

 

edit: not sure if i mentioned this, but i was taken off the drugs with permission from my psychiatrist. my therapist and father also thought it would be a good idea for me to do a total med wash, because it was thought that the psychiatric drug dependence would be too much of an issue in the long term, that the meds were obscuring the underlying issue (generalized anxiety, social fear, effects of trauma, etc.) and that the meds were creating problems that weren't there to begin with (such as borderline psychotic symptoms, which my therapist has noted have gone away)...

 

 

 

[nz11]

Thanks for the clarification.

I did a typo s/b jan 16 not jan 15.

 

Personally i think there could be some serious withdrawal symptoms yet to surface.

How are you holding up at the moment. What symptoms do you currently have. eg crying spells,  diarrhea, nausea, insomnia, restlessness, etc

You might like to complete a checklist daily to track symptoms

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

my current thearpist, says that most of my symptoms can be traced to trauma.

If she is referring to iatrogenic trauma then i agree with her.

I dont see here that you mentioned trauma as a reason for going on the drugs. So i can only assume it didnt exist prior to the drugs. 

 

You might be interested in reading this

http://survivingantidepressants.org/index.php?/topic/607-whitfield-2010-psychiatric-drugs-as-agents-of-trauma/

 

No disrespect but do you really think therapy is of any help to you after 7 yrs of it. Aren't you just going in circles at this stage?

What do you think about self-soothing?

 

It was a good idea of the pdoc to get you off these drugs but he has tapered you too fast.

You would be well worth you while to read this thread about tapering

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Feel free to update this intro any time this is a thread to track your healing journey.

 

nz11

[scallywag]

jevang -- Welcome to Surviving Antidepressants (SA)

nz11 -- thanks for posting the links and getting things clear(er) with your questions.

 
One comment off the top:  Lexapro is a much stronger drug than Prozac and has a shorter half-life. 20 mg of Lexapro is approximately equivalent to 40 mg or more of Prozac. The doctor who prescribed that switch did you no favours.
 
You asked about supplements.  We have found that 2 supplements are worth trying:

Magnesium, nature's calcium channel blocker

Omega-3 fatty acids (fish oil)
 
 
Are you open to testing a tiny dose of Lexapro or Prozac to see if your symptoms ease?

You are still within the window where the likelihood of effectiveness outweighs the risks. The more time that passes, the lower the likelihood of success. Reinstating isn't a guaranteed solution: some people get results, some don't, and unfortunately some people's symptoms worsen.

 

I hope you'll read our topic: About reinstating and stabilizing to reduce withdrawal symptoms

 

Please post any questions or concerns you have about this.

[jevang]

Thanks for the clarification.

I did a typo s/b jan 16 not jan 15.

 

Personally i think there could be some serious withdrawal symptoms yet to surface.

How are you holding up at the moment. What symptoms do you currently have. eg crying spells,  diarrhea, nausea, insomnia, restlessness, etc

You might like to complete a checklist daily to track symptoms

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

my current thearpist, says that most of my symptoms can be traced to trauma.

If she is referring to iatrogenic trauma then i agree with her.

I dont see here that you mentioned trauma as a reason for going on the drugs. So i can only assume it didnt exist prior to the drugs. 

 

You might be interested in reading this

http://survivingantidepressants.org/index.php?/topic/607-whitfield-2010-psychiatric-drugs-as-agents-of-trauma/

 

No disrespect but do you really think therapy is of any help to you after 7 yrs of it. Aren't you just going in circles at this stage?

What do you think about self-soothing?

 

It was a good idea of the pdoc to get you off these drugs but he has tapered you too fast.

You would be well worth you while to read this thread about tapering

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Feel free to update this intro any time this is a thread to track your healing journey.

 

nz11

at the moment i'm feeling OK, not feeling frantic or overly worried. however the symptoms seem to come in waves or vary depending on how well i'm coping. I think the worst of the withdrawal symptoms have passed, although the symptoms i'm usually dealing with in varying degrees arent exactly easy either. those include: anxiety, excessive worry, rumination, depersonalization, hyper vigilance, extremely self-conscious social avoidance, brain fog, groin pain, constipation, muscle aches and urinary problems.

 

those are really the main ones. the most debiliating symptoms are the social avoidance/anxiety/depersonalization/hypervigilance, because depending on how intense they are i may not feel motivated to get out of the house at all because i get caught in this loop where i have anxious thoughts about seeming weird/unattractive/creepy to others, and then thinking about those thoughts which makes it more likely that i'll act in ways that i fear; i.e. self-fulfilling prophecy. which is kind of why i'm in therapy, the more i stay in the house with no one to talk to the more i'm prone to regress, severely. basically i don't have much of a social life, i have one friend who i've known for years who lives out of state, the main people i'm in contact with are my parents and my therapist. i don't really have much of a life to speak of.

 

regarding trauma, I have never really considered the possibility that the drugs themselves caused some from of trauma, either directly or indirectly. i'll have to look into that. what my thearpist had in mind was that the trauma was brought on by bullying/teasing and dysfunctional family relations growing up (would prefer not to get into the specfiics of that). however i could see how the side effects of the drugs could indirectly cause things like embarrassment in social situations, perhaps exacerbating the sense of inferiority and self-consciousness

 

you asked about self soothing; what exactly is self-soothing?

 

 

 

replies to scallywag: i have looked into magnesium in the past. can it be taken on a regular basis and are there any major interactions to be concerned about? especially if my nervous system is more sensitized?i was considering purchasing this formulation: https://www.amazon.com/Pure-Encapsulations-Magnesium-Glycinate-Physiological/dp/B0058HWV9S/ref=sr_1_8_s_it?s=hpc&ie=UTF8&qid=1470438750&sr=1-8&keywords=magnesium+glycinate

 

i have also tried fish oil (Nordic Naturals brand) when i was starting withdrawal, but my body reacted negatively to it (more irritable, more angry and on edge, prone to outbursts, etc.) even though i had tried salmon oil in the past without any problems. any alternatives that would likely not lead to negative reactions?

 

 

regarding trying tiny doses of prozac, 1. i don't think my psychiatrist would allow it since i haven't been caling him as often after coming off all drugs. that's a problem i tend to obsess about every little symptom and side effect so he's reluctant to prescribe me anything anymore, also perhaps part of the reason i was taken off meds to begin wtih. 2. if he did prescribe it i think my body would react to it wtih irritability, agitation and anxiety just like i did with the fish oil. i think my psychiatrist tried to give me a tiny dose of prozac when i was beginning withdrawal and it seemed to make me more depersonalized and irritable.

 

 

[nz11]

In memory of blue i give you this link.

 

http://survivingantidepressants.org/index.php?/topic/10115-how-to-self-soothe/

 

Have you ever thought of joining 'Toastmasters' ?

[jevang]

thanks. i have tried self soothing in the past, perhaps not as much as i ought to. i find that deep breathing also calms me down quite a bit

i have thought of joining toastmasters, when i was looking for social skills groups i came across toastmasters through internet searches. i jsut wasn't sure if i would fit in (i.e. my presence being unwanted) because of my extreme shyness/awkwardness

regarding the magnesium is it safe to take on a long term basis? is it liable to be less effective over time?

[scallywag]

jevang -- meetup [dot] com has been helpful to many members. You can see if there are any groups that get together in your area doing something that interests you. There's groups for almost anything: fitness activities (hiking, biking), hobbies, dog/cat breed owners, professional interest, etc.

 

Magnesium is safest when we get in our food. Sometimes that's difficult so supplementation may be desirable. Like any substance, you need to start with a low dose, increase slowly while paying attention to your symptoms.  The formulation you linked to is Mg Glycinate, one of the easiest forms of magnesium to tolerate/digest. When I was working with a naturopath on orthomedicine routine for mental wellness, that is the magnesium he recommended for me. It should allow you to titrate the dose reasonably well; if I recall correctly each capsule contains 125 mg of Mg as glycinate.

[jevang]

i've been reading the link about reinstating. i dont know why i didn't consider this aspect more thoroughly when you guys first mentioned it. i guess it didn't occur to me that the taper may have been too fast. on the other hand, wouldn't the symptoms be pretty severe (to more or less the same degree) once the drug is out of my system no matter how slow the taper is?

 question: if i were to reinstate the SSRI is there a chance that i could develop PSSD (Post SSRI sexual dysfunction) even if i never had sexual symptoms in the past (or only mild ones)? or for that matter any sort of potentially permanent adverse effect as a result of reinstating an SSRI? any adverse effect that is mentioned alongside the word "permanent" greatly concerns me.

but then so does everything lately, i'm stressing myself out so much in overthinking, analyzing and weighing the pros and cons of every personal decision it's making me sick.


edit: does the SSRI to be reinstated have to be the one that was initially tapered? (in my case lexapro) or could it be any SSRI? prozac liquid allows for a lot of variability in doses whereas most others including lexapro have limited dosing

re-edit: it was mentioned here earlier that i'm within the window where there's a likelihood of symptom improvement from reinstating; what exactly is that window; 4 months? 5 months?

I guess what i'm really asking is, what do you guys recommend overall? i am obviously ill-equipped to make the decisions that would be best for my situation (i am sorry if this comes across as frantic and needy)

[nz11]

The idea of a slow taper is that the withdrawal symptoms are minimized allowing you hopefully to get off the drug well,  then to be able  walk into the sunset and live happily ever after.

There is no guarantee that a slow taper (years) will be withdrawal symptom free but hopefully they will be totally manageable.

Check the taper rock star moderator Brassmonkey's taper.

 

If it is such that you have no option but to reinstate then pssd concerns would then not be priority, right?

 

It appears that you took prozac for 7-8 yrs and lexapro for about 6 months. So its up to you to choose which one to try to ri .

Switching to a new drug may not cover the withdrawal symptoms from the previous one.

 

In terms of the window of ri being closed on you. I don't know so much about that, people have reinstated at many different time-frames and found relief from wdl. One member recently reinstated after 2 yrs. Regarding any difficulty in ri you wont know unless you try. 

 

i am obviously ill-equipped to make the decisions that would be best for my situation (i am sorry if this comes across as frantic and needy)

You don't need to be ill-equipped.  You have found sa and a mountain of informative stuff here that will allow you to be able to be very equiped. Even more so than your doctor.

[jevang]

i don't mean any offense (if i'm wrong please correct me) but even with a slow taper, no matter how slow, i would think that there would still be Post Acute Withdrawal once the drug is out of your system. a slow taper would help minimize acute withdrawal but not the PAWS (which to me is far, far more difficult than the acute phase). so wouldn't that just be prolonging the process, in my case?

 

"If it is such that you have no option but to reinstate then pssd concerns would then not be priority, right?"

 

it's not that i have to reinstate, i'm just considering ri to possibly ease the process. however, i'm having doubts about that as the above comment llustrates. also, if there is in fact even a remote chance that i could develop PSSD or something else potentially permanent, then i would probably rule out the option of ri atm

 

"It appears that you took prozac for 7-8 yrs and lexapro for about 6 months."

 

going to have to edit my signature soon.

 

i actually took three ADs. i  took lexapro for only a couple months. the prozac on the other hand i took from 2010 or 2011 (not sure which atm) to around Feburary 2016 so about 5-6 years. i'm guessing that would mean most of my withdrawal symptoms can be attributed to the prozac. i also took effexor beginning in 2008. those were the three primary ADs: Effexor, Prozac and Lexapro. and after ECT i was taken off the Effexor and put on prozac (no taper involved and no adverse effects from the switch).

 

but since all three of the ADs i was prescribed affect serotonin isn't it more of a matter of the length of time taking ADs overall rather than any particular one?

edit: either it's me or the brain fog symptoms are fluctuating a lot, if there's anything unclear about this post i will try to clarifiy.



 

[ChessieCat]

Hi jevang,

 

These helped me to understand why SA recommended a 10% taper of the previous dose followed by a 4-6 week hold to allow the brain to adapt to not getting as much of the drug:

 

Brain Remodelling (Rhi's Description of Brain Healing)

Video:  Healing From Antidepressants - Patterns of Recovery

 

This one goes into a bit more detail about how the brain is affected:

What is Happening in Your Brain

[nz11]

i don't mean any offense (if i'm wrong please correct me) but even with a slow taper, no matter how slow, i would think that there would still be Post Acute Withdrawal once the drug is out of your system. a slow taper would help minimize acute withdrawal but not the PAWS (which to me is far, far more difficult than the acute phase). so wouldn't that just be prolonging the process, in my case?

 

Here is how i see it ...if you taper safely and carefully there should be no PAWS (in theory). And if there is it will be very minimal.

From what is see you have no experience with a slow taper over several years. Your drug sig. infers one-two month tapers when you may well have needed to taper for 4-5 yrs say. Then you throw drugs at it so it appears to me that you haven't suffered PAWS cos you haven't been able to get through acute wdl. and hung around drug free for that long.

 

I don't know at what time frame AW is thought to have morphed into PAWS.

This may be of interest to you.

http://survivingantidepressants.org/index.php?/topic/509-protracted-withdrawal-or-paws-post-acute-withdrawal-syndrome-how-long-does-it-last/?p=222587

[jevang]

if i reinstated prozac and it's only been one dose is it likely that i could devleop PSSD if i have a sensitized nervous system? i never had pssd in the past (at least i dont think so) my doctor decided to reinstate the prozac to know whether the anxiey i'm experiencing is withdrawal related. he said if you get worse its not witdhrawal and if i get better then it is withdrawal. however, i would rather not take another dose because the possibility of something permanent developing (not just PSSD but anything regarded as potentially permanent) is worrying.

[scallywag]

jevang - I've moved your post to the Introductions Forum so that more people will see your question.
 
There's a delicate balance between being fully informed about the risks and being scared out of our socks, isn't there? 
 
Reinstating has its risks, which appear to increase with the dose. Said another way, if you reinstate to a typical startup or maintenance dose the risk of negative effects seems to be greater than if you test your response with a much smaller dose. Once you know that a reinstatement hasn't made your symptoms worse after a month of careful monitoring of symptoms, someone who's reinstated faces a choice: hold at current dose or make a minor upward adjustment to monitor your body's response to an increased dose. 

How your brain responds to psychiatric drugs - aka "Brain remodeling"

A long post discussing some of the possible mechanisms of recovery in different parts of the brain -- it's about being on and coming off a benzodiazapene but the hypothesis and description may be helpful

What is happening in your brain

Nobody can predict what reinstatement will be like for you nor can anyone guarantee that you'll avoid PSSD by reinstating or by not reinstating.
 
For better or worse, making this choice with so many unknowns is something each of us has to resolve for ourselves.

[jevang]

Nobody can predict what reinstatement will be like for you nor can anyone guarantee that you'll avoid PSSD by reinstating or by not reinstating.

by NOT reiinstating? you mean that if i were to continue with the withdrawal without reinstating there's no guarantee that i won't develop PSSD, even if iv never had it in the past and don't have it currently?

 

if that's true then i think the best option would be to go with ri, because if i develop PSSD on top of feeling overwhelmed by feelings of withdrawal from not ri, i don't see how i could possibly cope with that. i also have a feeling that if i do develop it it wouldn't be permanent, i'm only 28 years old and iv never had PSSD in the past, i would think those factors would have to work in my favor, right?

 

understand i am not looking for a guarantee of not getting PSSD, per se, merely the likelihood of developing PSSD given all these factors. if anyone can answer that question about contributory factors in PSSD, i would like to hear from them.

 

 

"someone who's reinstated faces a choice: hold at current dose or make a minor upward adjustment to monitor your body's response to an increased dose."

 

why would one increase the dose after ri if you're theyre doing fine at the current dose?

 

 

 

 

 

FYI: I don't know if i was clear enough in saying this, but I have already taken the first 10 mg dose of Prozac, and will probably continue taking it for a month or so to see how i react to it.

[ChessieCat]

Hi jevang,

 

When it comes to being on, off or reducing these drugs there are many questions that cannot be answered.  What works for one person may not work for another person.  The suggestions which are made here at SA are based on observations over many years of many members' situations/reactions and lots of reading of research by Alto (site owner).

 

 

"someone who's reinstated faces a choice: hold at current dose or make a minor upward adjustment to monitor your body's response to an increased dose."

why would one increase the dose after ri if you're theyre doing fine at the current dose?

 

Excellent question!

 

Some people expect to be free of all symptoms when they reinstate.  The idea of reinstating is to make withdrawal symptoms bearable and able to be lived with, not disappear completely.  For some people, increasing their reinstatement dose may even make them feel worse.

 

It is preferable to try and stick to the same dose and not mess around changing doses.

[jevang]

I am very concerned that i won't be able to make it through school while i'm going through prozac withdrawal. although i have reinstated prozac at 10 mg and so far have noticed no major adverse effects, i am concerned that as the med is tapered (even if it's a micro taper) that i won't be able to cope cognitively with the demands of the health program i'm going into.

so far it has only been a few days at prozac 10 mg, i am hoping that there will be some cognitive improvement so that my mental stamina can come back. if it doesn't i may consider a low dose of wellbutrin to give me a boost until i'm at a much more stable place in my life (i.e. finished with the program, taken the exam and fully registered as a sleep tech and have my own place) by that point i will probably  taper off the wellbutrin and finally be med free. of course on the other hand there's no guarantee that the wellbutrin would help. perhaps something like ginkgo biloba would be another possibility.

is this a good or bad idea? perhaps i'm thinking too far ahead but i like to prepare even though things might not transpire the way i imagine them to, perhaps part of me is still chemically dependent and conflicted about going through withdrawal...

[jevang]

An Update:

I have been taking 10 mg of Prozac for four days, at the direction of my psychiatrist who wanted to minimize the anxiety i was experiencing due to withdrawal. However, i am concerned about being misdirected and thus having to endure protracted withdrawal. What I would like to know is whether 10 mg is the right dose to be reinstated if i was taking 20 mg of Prozac the majority of the time i was on it.

a few times i tried going up to 40 mg and stayed there for a while, but i would say that the majority of the time my dose was 20 mg.

The Prozac was the AD that i took for probably the longest amount of time (somewhere between 4-5 years), far longer than the AD that came after which was Lexapro (i only took that for a few months. perhaps less than that..).

James Heaney writes this regarding reinstatement/tapering: "In order to decide what dosage to reinstate at, take your previous maximum dosage and reduce that number by 10% for each month since you started weaning."

So if it had been 6-7 months since i last took Prozac before I reinstated it a few days ago, is 10 mg the proper dose to reinstate at? or should i also be taking into account the 40 mg that i took, even if for only a brief time?

[ChessieCat]

Hi jevang,

 

I've moved the post you made in Tapering into your own topic so that your history stays together.

 

If you had reduced your drug by 10% of the previous dose and held for 1 month afterwards you would be down to 9.63 mg after 6 months so 10 mg is consistent with what James Heaney writes.  However, when reinstating SA suggests starting with a small dose to "test the waters" and to see what effect it has on the withdrawal symptoms.  Here is the SA link for information on reinstating:

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

It takes 4 days for the drug to get to steady state in the blood.  That means having the same amount of drug in your system each day.

 

Healing comes in windows and waves:  Windows and Waves Pattern of Stabilization.  You may still get some withdrawal symptoms.  The idea of reinstating is to reduce the withdrawal symptoms, not try and get rid of them altogether.  Please keep notes on paper.

 

If you do get symptoms, it is better to see if they will pass or lessen, instead of increasing your dose.  You need to Keep it Simple, Slow and Stable

[scallywag]

 

someone who's reinstated faces a choice: hold at current dose or make a minor upward adjustment to monitor your body's response to an increased dose."

why would one increase the dose after ri if you're theyre doing fine at the current dose?

 

If a person is stabilized at a reinstated dose, s/he wouldn't increase.

[jevang]

Thanks ChessieCat and ScallyWag,

after looking at the SA link on reinstating and stabilizing, iv decided that assuming i continue to feel okay at 10 mg throughout this next month, i will probably stay at this dose for several months, probably til end of December or so, and then slowly taper off.

Are there any medical articles written by MDs about withdrawal that are in line with what's said here at SA, that i might show to my psychiatrist? I don't think he would;d have an issue with slowly tapering the Prozac, (he might see it as unnecessary), but just in case he does..

[scallywag]

Check the journals and scientific articles forum.

[nz11]

see also

http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

to read:

 

The 10% per month reduction method is recommended by

• Peter Breggin in Your Drug May Be Your Problem
• The Icarus Project Harm Reduction Guide To Coming Off Psychiatric Drugs
• MIND-UK's Coping With Coming Off Psych Drugs Guide
• NHS Advice: Benzodiazepine and z-drug withdrawal - Management
• Gianna Kali's Withdrawal 101 on BeyondMeds.com

 

The MIND booklet can be downloaded for free.

Turn to page 35 for the tapering plan.

This book is very good however the tapering plan on pg 35 would still be considered too aggressive by many here.

[ChessieCat]

These might also provide some tips on how to talk to them:

 

What should I expect from my doctor about withdrawal symptoms?

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

[jevang]

thanks everyone, will refer back to these sources as needed.

[jevang]

so as mentioned I have resumed prozac 10 mg, but it does not feel the same... it seems my nervous system tainted at this point and there is no way to get the same SSRI effects

...like james heaney says here:  "Once withdrawal symptoms have appeared, the nature of SSRI use has changed.  There is a point where you put yourself on a track to wean off the drug and can’t really get back to the previous state of SSRI use.  You can take your original dose, but the effect will be different.  Instead of creating the mental environment that you experienced before, it’s now a mix of withdrawal and the SSRI numbness.  Once you’ve experienced a mental state without an SSRI, it’s very hard to go back."

is there any way to get those effects back?? I wonder, would taking Wellbutrin help with energy and brain fog or would i have a bad reaction to it since my nervous system is sensitized due to wd?

I am starting to think that going off this med was absolutely worst decision i've ever made and been coerced into by my therapist and father. i am thinking of firing my therapist..

it's not that I didn't want to go through with withdrawal, but this is the absolute WORST time to do so. i am in a position where if i don't commit to the Polysomnography program i likely wont' be accepted again given that i have been waffling over going into the program with the coordinator more than enough.

I can barely read, barely think, my memory and concentration is shot and i require more than 12 hours of sleep per day. how can i possibly have the energy and ability to take 12 credit hours twice during this program??? not only that, but then even if i do finish the program and  i manage to find employment it's still quite a while of work before i can take the exam and obtain the RPSGT credential enabling me to score sleep studies at home.

if i had gotten to that point while on meds (which would have been substantially easier), that would have been the right time to decide to come off them.

 

i don't even feel competent enough to do healthcare work right now, they likely will judge me incompetent, my interpersonal skills are atrocious

... to be honest, i don't even feel that i've fully thought through my decision to go into Polysomnography in the first place... aside from the fact that it seemed a good fit  in terms of salary, job outlook and overalll ability in light of my introversion, social anxiety and tendency to be a night owl.

On the other hand given my history of agoraphobia and social anxiety, staying at home for 2-3 years (withdrawal may even be longer than that...) will surely only cause me to regress..

I need suggestions, anything.


Edit: ok, on top of everythine else, my writing sucks. this post is extremely dense, if anyone needs clarification on my situation, please let me know...

[ChessieCat]

I would be very reluctant to add any other drugs to the mix.  You have made many changes in both drugs and doses since October last year.  This makes it virtually impossible to work out what may be causing the issues/symptoms you are currently experiencing.  It may be that you are experiencing withdrawal symptoms from Lexapro and/or experiencing start up symptoms from Prozac.  It has only been about 1 week since you started back on 10 mg Prozac.

 

What symptoms are you currently getting?

 

Since going back on Prozac:  Have any symptoms improved?  Have any symptoms worsened?

 

Please keep daily notes on paper of your symptoms.

[jevang]

current symptoms:

- difficulty thinking clearly (by that i mean difficulty forming ideas, word recall, understanding things that were previously understood, low mental stamina, poor short term memory),
- extremely self-conscious and hypervigilant in social situations so much that my tenseness is off-putting to others. sometimes my tone of voice is also either low,  strained or otherwise awkward
- physical clumsiness,

- lack of enjoyment in anything
- excessive worry/rumination

Since going back on prozac the only symptoms that have really improved is the overall level of anxiety that i was experiencing prior to reinstatement. dont know if this helps but if i think of my anxiety level as being a 10 on a scale of 1 to 10, right now my anxiety would be at about a 7.. i also seem to be far less depersonalized...as far as symptoms worsening, i would say that it seems like my concentration has lessened a bit..

it seems unlikely to me that the lexapro would be causing these issues, i was only on it for a month or so...

[bubble]

Can you please update your signature with the date when you reinstated Prozac?

 

The fact that your anxiety and depersonalisation has improved is a very good sign. It means your symptoms will continue to decrease as you hold the dose steady. The stabilisation comes in windows and waves (see the link posted for you above). The reinstatement doesn't take all the symptoms away immediately. The simplest way for me to explain what our brains have been through after abruptly stopping psychotropic medication is comparing them to a broken leg. Only time and rest heal a broken leg.

 

Try to respect the process and be patient (as hard as it is). Jumping around in doses and adding new drugs will only make things worse. It's still early days yet and gradually you will start seeing more improvement.

[ChessieCat]

Hi jevang,

 

Just wondering if you drink alcohol at all?

 

From the drug checker (drugs.com):  Alcohol can increase the nervous system side effects of FLUoxetine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with FLUoxetine.

[jevang]

ChessieCat, no i don't drink alcohol at all, don't want to develop an addiction on top of withdrawal, since i have something of an addictive personality to begin with..


I understand what you guys are saying about withdrawal and everything, but what about the situation regarding the health program? what would you do in my position?

 

edit: it's very good to know that the symptoms will decrease over time, i'd just like to know what that would look like, i.e. will the brain fog clear up. i am hoping i don't make the wrong decision to stay in the program only to find that the brain fog and anxiety hasn't cleared up after months at the same dose

[bubble]

When is the program starting?

 

Given your history of coming off of quite a few drugs it might take a while for you to stabilise... But on the other hand you should gradually start getting better and better. So you shouldn't assume that you will feel the same throughout the program. Also what are the consequences if you enrol and after a while see that it is too much for you after all? How about talking with the program manager if they have any accommodation for people with health problems?

 

When I didn't know what these drugs are and I would stop taking them I was able to work through periods of stabilisation following reinstatement. It was very diffficult and very often I would just perform the basics of the job (and then catch up on things later on when I would get better).

 

These are just some of the things that crossed my mind.

[ChessieCat]

Hi jevang,

 

"... but what about the situation regarding the health program? what would you do in my position?"

 

This is a decision that only you can make.  In the past when I have been in a situation where I have had to made a decision (one I can remember was deciding whether to stay or leave the church I attended) and I can't make up my mind I have sat down with a sheet of paper and write down the pros and cons and then for cons try consider how likely that is to happen or if there is a way you could solve it or work around it.

 

Getting it down on paper stops the thoughts from whirling around in your head and then you can look at each one in turn.

 

If you are still seeing a therapist, you could do the above and then discuss it with them.

[jevang]

bubble, the program starts the 22nd of this month. i've already been accepted and gone through fulfilling the health requirements which included a CPR class that i somehow managed to get through before i reinstated the Prozac. i may consider asking for accommodations, hadn't thought of that.