whatshappening: Did I reinstate too late?

[ChessieCat]

Please check out the following information.  From it I would say that you are taking an extremely high dose of Prozac.

 

From the calculations I've done below if you were taking 5mg Effexor then the equivalent Prozac dose would be more like 1.33mg Prozac

 

Calculation:  [40mg Prozac divided by 150mg Effexor x 5 (to get 5mg Effexor) =]

 

The first part of the equation is to find ? = 1mg Effexor.  The second part is multiplying the ? x 5 = 5mg Effexor.

 

And you will also see from the quote below that Prozac takes a long time to build up to full level.

 

29 Sept  - 3mg Effexor

9 Oct      - 3.5mg Effexor

18 Oct    - 4/4.5mg Effexor

4 Nov     - 0mg Effexor, 10 > 25mg Prozac, PLUS mirtazapine (low dose ?mg)

 

From this post:  dose-equivalents-equivalency-for-antidepressants-and-second-generation-antipsychotics

 

fluoxetine 40mg/day was equivalent to venlafaxine 149.4mg/day.

 

fluoxetine 25mg =  93.75mg venlafaxine

 

From Post #1 of this topic:  tips-for-tapering-off-prozac-fluoxetine

 

On 7/3/2011 at 4:11 AM, Altostrata said:

 

Prozac has the longest half-life of any SSRI. After you take it for a few days, half-life is about 16 days. Fluoxetine itself has a half-life of 2-4 days, but as it is processed, your body creates an active antidepressant metabolite, norfluoxetine, which has a half-life of 7-15 days. So Prozac keeps on extending its half-life as it is metabolized.

According to http://en.wikipedia.org/wiki/Fluoxetine , fluoxetine and norfluoxetine inhibit each other's metabolism, extending the half-life of the drug. Because the half-lives are so long, the full effect of Prozac on the brain may not be felt for several weeks.

fluoxetine (1-6 days) ---> norfluoxetine (up to 16 days) ---> other metabolites

 

 

 

[Altostrata]

It's not unusual for people to use Prozac to bridge from Effexor or Paxil when they get to a low dose, those drugs are extraordinarily difficulty to taper.

 

You've also been tapering through withdrawal symptoms, which can compound the neurological chaos.

 

What benefit do you feel from Prozac? Which symptoms have improved? What new symptoms do you have? How has your symptom pattern changed since November 4, when you started Prozac? Have you felt any different in the last week?

 

What time of day do you take Prozac? How do you feel before and after you take it?

 

Prozac can be activating, but so can Zoloft. Taking 10mg Prozac is roughly equivalent to taking 37.5mg Effexor. You were taking 3.5mg-4.5mg Effexor (it was never clear to me if this was the pill weight or active ingredient weight), a substantially lower dose.

 

Please update your signature with the mirtazapine information.

[whatshappening]

1 minute ago, ChessieCat said:

Please check out the following information.  From it I would say that you are taking an extremely high dose of Prozac.

 

From the calculations I've done below if you were taking 5mg Effexor then the equivalent Prozac dose would be more like 1.33mg Prozac

 

Calculation:  [40mg Prozac divided by 150mg Effexor x 5 (to get 5mg Effexor) =]

 

The first part of the equation is to find ? = 1mg Effexor.  The second part is multiplying the ? x 5 = 5mg Effexor.

 

And you will also see from the quote below that Prozac takes a long time to build up to full level.

 

29 Sept  - 3mg Effexor

9 Oct      - 3.5mg Effexor

18 Oct    - 4/4.5mg Effexor

4 Nov     - 0mg Effexor, 10 > 25mg Prozac, PLUS mirtazapine (low dose ?mg)

 

From this post:  dose-equivalents-equivalency-for-antidepressants-and-second-generation-antipsychotics

 

fluoxetine 40mg/day was equivalent to venlafaxine 149.4mg/day.

 

fluoxetine 25mg =  93.75mg venlafaxine

 

From Post #1 of this topic:  tips-for-tapering-off-prozac-fluoxetine

 

 

 

Hi ChessieCat,

 

New provider also mentioned that the 10mg of prozac was too much and wanted me to cut to 5mg. When I told her that I am on the capsule form she instead just said to drop the fluoxetine all together and start zoloft instead. I think the lowest dose she could prescribe to me is 25mg of that. But she is concerned about my OCD and anxieties and wants to get that controlled.

 

She also didn't agree with the other doctor about the increased doses if mirtazepine didnt work at 3.75 to keep bumping it up and also to not take any antipsychotic pills as those are very strong. 

 

She seems knowledgeable and I'm just trying to find one provider that will guide me the best route. 

[Altostrata]

Please read my recent post and answer the questions completely.

 

Please update your signature with dosage information for Prozac and mirtazapine.

[whatshappening]

3 minutes ago, Altostrata said:

Please read my recent post and answer the questions completely.

 

Please update your signature with dosage information for Prozac and mirtazapine.

 

5 minutes ago, Altostrata said:

It's not unusual for people to use Prozac to bridge from Effexor or Paxil when they get to a low dose, those drugs are extraordinarily difficulty to taper.

 

You've also been tapering through withdrawal symptoms, which can compound the neurological chaos.

 

What benefit do you feel from Prozac? Which symptoms have improved? What new symptoms do you have? How has your symptom pattern changed since November 4, when you started Prozac? Have you felt any different in the last week?

I can't tell any difference in improvements from taking the prozac aside from hot flashes and burning sensations within the first few days of stopping effexor have deminished. Since taking Prozac I have noticed some internal agitation and irritation but can't tell if that's from the withdrawal of effexor or new medication? My sleep pattern hasn't really gotten any better. Obtrusive thoughts and ear worms are still the same. 

 

What time of day do you take Prozac? How do you feel before and after you take it?

12 noon. I guess okay. First few days were some getting used to as it made me kind of spacey but now not.

 

Prozac can be activating, but so can Zoloft. Taking 10mg Prozac is roughly equivalent to taking 37.5mg Effexor. You were taking 3.5mg-4.5mg Effexor (it was never clear to me if this was the pill weight or active ingredient weight), a substantially lower dose.

I understand that zoloft can be activating also but would it be worth a try? The new provider can only prescribe 25mg right now as a starting dose and I wouldn't be able to know if it's a good baseline if I don't try?

 

Please update your signature with the mirtazapine information.

 

I've gotten to a point where I just want some stability with a new medication whether that be prozac or zoloft. My OCDs and sleep anxiety are challenging to manage at the moment on my own.  Also sad about the fact that my long and deliberate taper from effexor has caused such a chaos in that I'm in this trail and error situation now. I will need to worry about tapering later as I just need to get through this slump.

 

some encouragement would be very much appreciated at this point.

 

[whatshappening]

So just to be clear this is what is recommended going forward from my new provider:

 

- discontinue Prozac 10mg today

- Start Zoloft 25mg tomorrow for 1 week then 50mg 2nd week. 

- start natural probiotic capsules

- Do Not add mirtazipine or any other prescription sleep aid

 

[Altostrata]

You got a new treatment from a doctor. I have no idea if it's going to be effective or if it's the right treatment for you.

 

I gave you my best guess -- that 10mg Prozac might be too much. It takes 2-3 weeks for Prozac to take full effect. What time of day is the "internal agitation and irritation" the worst?

 

I have no idea if you'll feel better on Zoloft than Prozac. If you like this new doctor, suggest you work with her. The success of her treatment is her responsibility, not ours.

[whatshappening]

Yah I was hoping to stick it out with the prozac and she wanted me to do a lower dose like 5mg but then decided that zoloft would be a better to switch since she said it's less activating. I usually get agitated and irritable later in the day is what I've noticed. 

 

Would anyone know the dose equivalent for 25mg zoloft?

 

Edited November 16, 2020 by ChessieCat
removed quote, extracted response and blackened font

[ChessieCat]

Zoloft / sertaline is not in this list (Post #2):

 

dose-equivalents-equivalency-for-antidepressants-and-second-generation-antipsychotics

 

I suggest you do an internet search for dose equivalent/equivalency for the two drugs.

 

As Altostrata, this site's owner said:

 

51 minutes ago, Altostrata said:

 

I have no idea if you'll feel better on Zoloft than Prozac. If you like this new doctor, suggest you work with her. The success of her treatment is her responsibility, not ours.

 

 

[whatshappening]

thank you all. It's been a very confusing time for me so just trying to carve out a clear path for myself.  Your opinions are always so valued to me and I wish I could have just done the direct taper off effexor as intended but it just came to a spiral towards the end.

 

It's all about trail and error now and gaining stability. I hope to keep everyone updated

[ChessieCat]

Instead of starting a new drug you might consider reducing the dose of Prozac.

 

the-prozac-switch-or-bridging-with-fluoxetine

 

Please note that because of the long half life of Prozac and venlafaxine being an SNRI, if you start Zoloft it could be several weeks before have a reasonable idea of what is happening.  And if you have a bad reaction to Zoloft, because of the Prozac still being in play owing to the long half life you will not know what is causing any issues, after 3 weeks your brain will have make a fair amount of adaptation to the Zoloft.  It can take as little as 4 weeks for the brain to fully adapt to a psychiatric drug.

 

Here are a couple of sites that you may wish to join patientslikeme.com or depressionforums.org

[bijay]

28 minutes ago, ChessieCat said:

Instead of starting a new drug you might consider reducing the dose of Prozac.

 
This might be overall kinder to your CNS in the long run (rather than introducing another drug) and fix the agitation you feel.  And both Prozac and Zoloft are approved for OCD.  

 
Whatever your decision I hope you can stabilize soon and get some better sleep.  

[whatshappening]

1 hour ago, ChessieCat said:

Instead of starting a new drug you might consider reducing the dose of Prozac.

 

the-prozac-switch-or-bridging-with-fluoxetine

 

Please note that because of the long half life of Prozac and venlafaxine being an SNRI, if you start Zoloft it could be several weeks before have a reasonable idea of what is happening.  And if you have a bad reaction to Zoloft, because of the Prozac still being in play owing to the long half life you will not know what is causing any issues, after 3 weeks your brain will have make a fair amount of adaptation to the Zoloft.  It can take as little as 4 weeks for the brain to fully adapt to a psychiatric drug.

 

Here are a couple of sites that you may wish to join patientslikeme.com or depressionforums.org

 

I dont know. I think she believes since it's been only 12 days since I've taken the prozac it might be better to just switch over to zoloft now (another ssri).

 

I"ve been trying to get a hold of her to see if we could at the very least do 5 mg of prozac for awhile but have been unsuccessful at reaching her. I think she believes zoloft will be better for me immediate needs in controlling my anxiety, OCD, and sleep. 

[whatshappening]

24 minutes ago, bijay said:

 
This might be overall kinder to your CNS in the long run (rather than introducing another drug) and fix the agitation you feel.  And both Prozac and Zoloft are approved for OCD.  

 
Whatever your decision I hope you can stabilize soon and get some better sleep.  

 

I'm just trying to find a doctor that will help me with the best course of action. I think she might be knowledgeable enough as she seems to know about the proper doses according to SA for melatonin, mirtazipine, and duoxepine. When other doctors said to take more mgs she agreed with me that lower doses are better to take (confirming to me that she apparently knows her stuff).  She also said don't take the antipsychotic drug that the other doctor recommended.

 

But yes The stress of a new drug being added is of course is causing me anxiety. but if I take the prozac longer at lower dose and it still not work then won't my CNS have gotten used it by then and then introducing the zoloft later rather than earlier may be problematic? I don't know.

[whatshappening]

I was thinking that if she doesn't want to try the 5mg prozac with me then maybe I should let a few days pass before taking the zoloft that way I don't get too confused as far as what is causing what. Thoughts?

[ChessieCat]

You do not have to get your doctor's permission to reduce to a lower dose of Prozac.

 

Tips for tapering off fluoxetine (Prozac)

[whatshappening]

2 hours ago, ChessieCat said:

You do not have to get your doctor's permission to reduce to a lower dose of Prozac.

 

Tips for tapering off fluoxetine (Prozac)

Problem is that I have the capsule form of the Prozac. I wouldn’t know how to break that down.

[bijay]

@whatshappening  The link from @ChessieCat explains how to do it.  Probably the easiest method is to dissolve in water and split that.

[whatshappening]

I'm in a bit of pickle. Would it be unwise if I took the Zoloft for 2 days now only to go back to the prozac course I was already on? 

[whatshappening]

On 11/17/2020 at 11:01 AM, ChessieCat said:

Zoloft / sertaline is not in this list (Post #2):

 

dose-equivalents-equivalency-for-antidepressants-and-second-generation-antipsychotics

 

I suggest you do an internet search for dose equivalent/equivalency for the two drugs.

 

 

I found this online for sertaline dose equivalency:

 

Fluoxetine 40 mg/day was equivalent to:      

• Paroxetine dosage of 34.0 mg/day
• Agomelatine 53.2 mg/day
• Amitriptyline 122.3 mg/day
• Bupropion 348.5 mg/day
• Clomipramine 116.1 mg/day
• Desipramine 196.3 mg/day
• Dothiepin 154.8 mg/ day
• Doxepin 140.1 mg/day
• Escitalopram 18.0 mg/day
• Fluvoxamine 143.3 mg/day
• Imipramine 137.2 mg/day
• Lofepramine 250.2 mg/day
• Maprotiline 118.0 mg/day
• Mianserin 101.1 mg/day
• Mirtazapine 50.9 mg/day
• Moclobemide 575.2mg/day
• Nefazodone 535.2mg/day
• Nortriptyline 100.9mg/day
• Reboxetine 11.5 mg/day
• Sertraline 98.5 mg/day
• Trazodone 401.4 mg/day
• Venlafaxine 149.4 mg/day

 

Edited November 19, 2020 by ChessieCat
reduced font size

[ChessieCat]

2 hours ago, whatshappening said:

I found this online for sertaline dose equivalency:

 

That was the same list that I gave the link to.  I missed seeing the sertraline in the list.  I did check it several time and just didn't see it.

 

However, I have already stated the issues with starting Zoloft / sertraline.

 

And Altostrata, this site's owner stated this:

 

On 11/17/2020 at 10:08 AM, Altostrata said:

 

You got a new treatment from a doctor. I have no idea if it's going to be effective or if it's the right treatment for you.

 

I gave you my best guess -- that 10mg Prozac might be too much. It takes 2-3 weeks for Prozac to take full effect. What time of day is the "internal agitation and irritation" the worst?

 

I have no idea if you'll feel better on Zoloft than Prozac. If you like this new doctor, suggest you work with her. The success of her treatment is her responsibility, not ours.

 

 

_____________________________________________________________________

 

6 hours ago, whatshappening said:

I'm in a bit of pickle. Would it be unwise if I took the Zoloft for 2 days now only to go back to the prozac course I was already on? 

 

Q:  What are you currently taking and at what doses?

 

We need to get a clear picture of what drug changes you have made.   Please tell use ALL the dates for the drug and doses changes for ALL OF NOVEMBER.  If you started/stopped the drug, please state that clearly.  Having a concise timeline will be much easier for us to see what you've been doing.  Thank you.

 

You need to decide which drug you want to take.  We cannot do that for you.  Chopping and changing drugs and doses sensitises your nervous system and is very confusing for the brain.  Whenever you make a change your brain has to adapt to it.  It takes about 4 days for Zoloft to get to full level in the blood and a bit longer for it to register in the brain.  However Prozac has a very long half which I've already explained here. 

[whatshappening]

45 minutes ago, ChessieCat said:

Q:  What are you currently taking and at what doses?

 

We need to get a clear picture of what drug changes you have made.   Please tell use ALL the dates for the drug and doses changes for ALL OF NOVEMBER.  If you started/stopped the drug, please state that clearly.  Having a concise timeline will be much easier for us to see what you've been doing.  Thank you.

 

You need to decide which drug you want to take.  We cannot do that for you.  Chopping and changing drugs and doses sensitises your nervous system and is very confusing for the brain.  Whenever you make a change your brain has to adapt to it.  It takes about 4 days for Zoloft to get to full level in the blood and a bit longer for it to register in the brain.  However Prozac has a very long half which I've already explained here. 

 

I updated my signature to show current medication. I understand about changing medications. I asked one of my older doctors what I should do because the new provider I am unable to get a hold. He just said to stay on zoloft and hold. but we had to decrease it by half (12.5 mg) because of symptoms of nausea, lack of appetite, and making insomnia even worse. It overstimulates more than when I was on the prozac.

 

I understand my nervous system is trying to eliminate the prozac at the same time right now due to long half life. I should have just listened to you guys about decreasing prozac dose first but listened to the convincing remarks of this new provider in that zoloft would be better for me. But there has been some red flags since my last conversation with her soooo from this point I am just listening to you guys.  I am stuck on zoloft for now so unless there are adverse reactions that will be what I am staying on to stabilize.

[ChessieCat]

2 minutes ago, whatshappening said:

I asked one of my older doctors what I should do because the current provider I am unable to get a hold of and he just said to stay on zoloft and hold but we had to decrease it by half (12.5 mg)

 

If you are consulting a doctor (who gets paid - we do not) and have decided to follow their advice, SA moderators are not going to spend time providing suggestions when there are many other members who ask for our assistance and are following SA's protocols.

 

You have been a member of SA for 2 years now.  You have decided to follow your doctor's advice which is not in line with SA's protocols.  This is your prerogative.  However, I hope you understand that we cannot help you further.

[whatshappening]

I’m so sorry. I wasn’t  trying to disrespect any of you and I know that you guys spend time helping. Please know all of your advices are always in the back of my mind which drives a lot of my decisions. Please don’t let this deter you. I’m in a fragile state right now and always am happy to hear from the moderators.

[ChessieCat]

29 minutes ago, whatshappening said:

I’m in a fragile state right now

 

We understand this.  The moderators also go through times when they are fragile since many of us are tapering or post withdrawal.  Spending time trying to assist members who are not following SA advice is extremely frustrating for the moderators and burns them out.  We work with members who are following our suggestions because it is the best use of our limited time.

 

 

We hope that your doctor's plan works for you.

Edited November 20, 2020 by ChessieCat
typo

[whatshappening]

Need desperate HELP!!!! New Offending drug is causing paradoxical reactions

 

I need to get off Prozac immediately as it has not responded well to my body due to bad side effects and paradoxical reactions (burning hot body temperature, tremmors, bladder, Akasthesia, etc)  

 

I've been on 10mg since ( 11/4) as a bridge from Effexor. Doctor has been trying to reduce my dose after a month on prozac to find relief from symptoms as he believes I have seratonin toxicity.  So 7.5mg (12/4) and then 4mg (12/20) right now.

 

12/18 developed another paradoxical symptom of relentless intense Akasthesia and it is not the good type!  So doctor reduced dose to 4mg on 12/20 to see if this brings relief. It has not so far. I am trying not to go on a benzodiazepine so I have a small window to decide what to do with Prozac going forward. But it is not agreeing with my body and need to come off before creating new long term dependancies.

 

I do understand the method of tapering 10% every 4-6 weeks but what are options when offending drug is causing paradoxical reactions to the body? Reinstate Effexor? Go on different AD?

 

Your thoughts are extremely appreciated at this dire moment in my choices going forward.

 

 

Edited December 26, 2020 by whatshappening
adding more info

[Holly26]

Hi,

 

just wanted to check on you. Hope you are doing ok. 

Im at 6mg of Venlafaxin myself and think about bridging aswell. 

 

 

 

[whatshappening]

On 4/5/2021 at 12:00 AM, Holly26 said:

Hi,

 

just wanted to check on you. Hope you are doing ok. 

Im at 6mg of Venlafaxin myself and think about bridging aswell. 

 

 

 

DONT DO IT!!!!