bungalowdeb: SSRI discontinuation or a stomach bug?

[bungalowdeb]

I have been on 40 mg. fluoxetine for past 5 years as treatment for Major Depression and Social Anxiety.  

 

June 2016 I began a slow tapering using liquid solution of fluoxetine.  Additionally I reduced my nightly dose of  Imiprimine and I am successful and holding at 10mg.

 

Dec. 4 2016 I took 16.8mg=4.2ml of the liquid fluoxetine.  Dec. 5 I made the decision since I was at such a low dose I could stop.

 

 All was well until Dec. 17, at 13 days of no dose, my stomach began having painful cramping, bloating, gas, cold sweats, faint feeling, nausea, fatigue, husband says maybe a stomach bug?

 

Pain and bloating went away on Dec. 21 but nausea and fatigue still with me as of today 12/24.  Could this be a virus or very likely discontinuation?  I am tempted to try a small dose of Fluoxetine to get some kind of normal back for a few weeks. 

 

​Any help or suggestions greatly appreciated.  I would like to get better quickly to enjoy the holidays.

Edited December 29, 2016 by scallywag
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[ChessieCat]

Hi deb,

 

Welcome to SA.  Thank you for completing your signature.  It will be helpful if you could add some additional details for your taper, please add dates and doses so that we can see at a glance how you tapered.  SA recommends a taper of no more than 10% of the previous dose of a psychiatric drug followed by about a 4 week hold to allow the brain to adjust to not getting as much of the drug.

 

The stomach issues you are experiencing are most likely a withdrawal symptom.  You started tapering from 40mg in June.  SA considers this a fast taper, so it is possibly a combination of your taper and jumping off at 16.8mg.  Many members here find that they have to taper slower and/or hold for longer as their dose gets lower.  Also 16.8mg of fluoextine is not considered a low dose.  These drugs are stronger than we think they are.

 

For me personally, when I attempted to halve my Pristiq I had an upset stomach for 3 days, thinking it was a stomach bug.  After finding SA I realised that it was probably a withdrawal symptom.  You may have been experiencing other withdrawal symptoms which you haven't recognised as such.  There is a link to a checklist below.

 

So, you have a couple of options.  You can either leave things as they are or reinstate a small dose.  You could try 1mg and see if they takes the edge off your symptoms.  It takes about 4 days for the drug to get to full state in the blood and a bit longer for it to register in the brain.  Please read the link below.  We suggest if you reinstate to keep daily notes of symptoms, improvement, worsening, staying the same, so that you can see if reinstatement is working.  Because improvement can sometimes be very small, it may be a good idea to rate your symptoms.

 

Please have a read of the following and then you can ask questions and journal your progress in this topic.  I'm going to close the other topic you started so that all of your information is in one place.  Click Follow, top right, and you will be notified when someone responds.

 

Before you begin tapering what you need to know

 

Why taper by 10% of my dosage?

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Tips for tapering off Prozac (fluoxetine)

 

About reinstating and stabilizing to reduce withdrawal symptoms

 

These helped me to understand SA's recommendations:

 

Brain Remodelling

Video:  Healing From Antidepressants - Patterns of Recovery

[bungalowdeb]

Chessie, thank you. i have been obsessively reading everything I can on this site.  I also have Glenmullen's book and it has been helpful.  After reading everything this afternoon here, then your response, I think I need to take a bit of fluoxetine, like right now!  Especially since it has not been that long since I stopped, a reinstate should prove to be a good option.  I will add the tapering schedule I experienced to my signature.  Thank you.  I will stay in touch.

[bungalowdeb]

Quick thought.  If my last dose was at 16.8mg Dec. 4, why would I reinstate at a dose of 1mg and not closer to the 16.8mg?

[bungalowdeb]

I really need more advice on increasing my reinstatement dose to be closer to where I left off before suddenly stopping?  (16.8mg was the last dose before I erratically stopped)  I have done 1mg for 3 days now.  Actually feeling better, nausea has subsided a great deal and other stomach issues are resolved. 

[ChessieCat]

Hi Deb,

 

What are your current symptoms?              Can you live with them?

 

The idea of reinstating a small dose is to bring your symptoms to a manageable level, not necessarily to eliminate them altogether.  SA suggests a small dose reinstatement because some people can react badly to reinstatement and if they have a reaction, they can stop straight away with (hopefully) no problems.

 

Because our CNS becomes sensitised when coming of the drugs, we don't know how people will react to going back up or back on the drug/s.  Also your brain has already made some adjustments since being off the drug, and of course we don't know how much adaptation it has made.  It is safer to start with a low dose.

 

My suggestion would be to stay on the 1mg for a total of 10-14 days, assuming your symptoms are bearable, and see how you go.  If at any time during that period your symptoms consistently become unbearable you could go up another 1mg and take 2mg.

 

Just remember that the lower the dose you can reinstate on, and then stabilise, then the less drug you will need to taper.  These drugs are stronger than what many of us think/realise.

[bungalowdeb]

Thank you.  I more fully understand. The gastro issues are resolved.  I would say I am feeling physically and mentally pretty stable.  I take this one day at a time.  I just remembered I am supposed to keep a journal of this.  Especially important since I need to have a baseline if I should need to go up a mg. or not.  You are awesome and I do not know what I would do without this site.  Seriously, Drs. just don't know.  I will make some journal entries on my calendar.  Thanks again.

[ChessieCat]

You are welcome.  I felt the same as you when I got the information I needed.

 

I'm really pleased that you understand.  Some members panic and take a much larger dose than they needed to and sometimes they end up in a mess because of it.

 

Stabilising comes in windows and waves, so try and handle any symptoms with non-drug techniques and it may pass.  If you find that the symptom persists AND it is unbearable, that is when you would consider increasing by a small amount.

 

And yes, keeping a journal will help you to know if and how things are changing.

 

Good luck.  I hope it goes well.

[bungalowdeb]

Yuck, I feel awful today.  Dizzy, disequilibrium, nausea, everything is annoying.  Sinuses are draining, takes me forever to settle into sleep.  I reinstated with 1mg fluoxetine on dec. 24.  Maybe I need to up this amount.  I can't keep on feeling this way, I have things I need to do, friends I need to be around this weekend.  They are expecting me.  What should I do?  My husband is fixing me some ginger, peppermint and fennel tea.  That will help with the nausea.  But only temporarily.  I hate this rollercoaster, theses meds. should be illegal.  POT should be legal.  Things are way out of whack in reality.

[ChessieCat]

It would appear that your brain still needs more drug so you could try increasing by 1mg to 2mg OR you might want to go up to 5mg.  Of course these are suggestions and you will need to make your own decision.  However please do not panic and take a high dose.

[bungalowdeb]

Request for help here.  Day 13 of my having to reinstate fluoxetine after crash and burn from cold turkey at around 16mg, down from 40mg June 2016.  

 

Life sucks, I suck, depression sucks.  

 

Drinking every evening, maybe self medication attempt?

 

I hate life in general and see no point to it, really.

 

Self loathing has really kicked in and I self talk to shut the **** up I don't want to do anything about it.

 

No motivation-infrequent bathing, teeth brushing, makeup etc....wtf attititude also wtf about groceries, cooking food, doing art.

 

Snacking all day until cocktail hours. Feeling a bit agoraphobic, no desire to go outside. Again wtf attitude. No point to the bullsh*t.

 

Should I increase my dose until I get out of this slump?  Like I probably need a big ******* dose increase so I may never get off this **** my brain is so fucked up 

 

 I am almost out of vodka and need to convince my husband to go buy more, I don't know if I have the motivation to go myself for it.  So if not more meds, then need more vodka.  Don't tell me it makes depression worse, i ******* know that.  I am no amateur.

 

The 10mg imipramine at night doesn't seem to be holding this depression at bay.  

 

Thoughts?

[scallywag]

Hi Deb, I've moved your post/question to your introduction topic so that all your information, questions and answers are in one place. We have a "one introduction topic per user" rule for that reason. Please post updates and questions about your situation here in this topic.

Sorry to hear that the symptoms haven't lightened for you yet. It can take some weeks for things to stabilize

Are you keeping notes of your symptoms? If not please keep notes on paper of your symptoms and the times of your dose(s). This post has a useful format for a daily log:
Take notes of doses and symptoms
 
To answer your question about increasing from 2 mg fluoxetine, please post a few days of symptoms notes.

To assist you quickly, we need you to simplify your signature. I'll edit this post shortly with a suggested revision.
 
Possible simplified signature:

---

Fluoxetine, 40 mg 2011 - June 2016
-taper 40 to 16.8 mg 22-June to 5-Dec, drop every 2-3 weeks, 13.5% per month,
-CT from 16.8 mg on 5-Dec 2016
-reinstated: 1 mg 24-Dec, 2 mg 28-Dec.

Imipramine, 20 mg 2013 - July 2016, 10 mg July 2016
Clonazepam 0.5 mg as needed, rarely taken 2015-16
5HTP 50 mg ried for 2 days in Dec. 2016

Currently taking: 2 mg fluoxetine; 10 mg imipramine; as needed 0.5 mg clonazepam (rarely taken)

[bungalowdeb]

Hi, can i just use what you did for my signature?  I don't have the energy to re-do right now.  my symptoms are identical each day as the day before and the day before that.  there is no change. So in my signature I need to delete all the symptoms stuff?  Just write it down on paper each day?

[scallywag]

You can copy + paste what I've posted for your signature.

 

Symptoms notes: keep them on paper and post them here in your introduction.

[bungalowdeb]

This is part of my introduction that I think I haven't posted before?  A brief history.

 

Since 1970's on and off variety of medications for treatment of Major Chronic Depression

 

Treatment for GAD and Panic Disorder since 2000

 

mild OCD, I just prefer perfection, order, neatness and organization, and hate clutter

 

Have experienced various withdrawals from meds: brain zaps, flu like symptoms, joint aches, head aches, facial pain, visual tracers, LOUD tinnitus that is permanent.

 

Arthritis in jaw-take 400mg gabapentin at night

 

Acid Reflux-take 40mg Nexium 

 

 

[bungalowdeb]

8/23/16-      5.625 ml=22.5mg  bad headache for 2 days, flat feeling, unhappy, angry outbursts toward husband

8/25/16-      6.00ml=24.0mg headache and mood resolved

 

Rocking along doing tapering at approx. 2 week intervals, some mood swings, nothing major though until.....

 

11/11/16-    4.2ml=16.8mg  after this reduction I began to lose motivation to engage in life, stopped going to my gym for workout, after I had joined and gone regularly for a year.

 

Very despondent over election results too. Feeling blah, tired, alcohol consumption increased, my commentary regarding my behavior is “my personality is on a pendulum swing the other direction, I always do this.  

 

Positive swings to negative & self destructive. Self loathing sets in.

 

12/5/16-     0 ml-0mg

 

12/17/16    severe stomach cramps, abdominal pain, gas, nausea, faint feeling, clammy, sweating, hot flashes, fatigue, stuffy nose, severe bloating, food makes symptoms worse. Appetite is off, taste buds aren’t registering flavor correctly, sense of smell and odors bothering me. Is this a virus?  Is this SSRI discontinuation syndrome? Life sucks. 

 

12/20/16    Stomach seems better, still have nausea, smell is off, taste buds are off, fatigue, hot flashes and sweating. Life sucks. 

                  add 50mg 5HTP to help my gut with Serotonin and increase my Omegas.

 

12/22/16    Stopped 5 HTP maybe making nausea worse. don’t know for sure.

 

12/24/16    Reading on Surviving Antidepressants site, joined, posted a topic, made decision with Chessie's help to reinstate to 1mg Fluoxetine and keep a decent daily journal. 

 

12/28/16    After still having nausea and feeling low and despondent increased to 2mg.  Nausea gone.

 

1/9/17       Still doing 2mg Fluoxetine in a.m. and the same 10mg Imipramine in p.m. Also Nexium and Gabapentin remain in the nighttime meds.

 

Mood is really low energy and flat, a give a **** attitude, drinking every evening, no motivation to do positive things, or shower, brush teeth, do art, shop for groceries, do cooking, none of those normal things. 

 

1/10/17  Through all of Dec 2016 to now, I am staying up late, I am retired so thankfully I can sleep late too.  I use  6mg Melatonin gummies to try and get sleepy.  I think Melatonin  helps.

 

I go to thrift stores and this is like therapy.  Getting away from my head and brain and using all that stuff to look at as distraction.  Helps.  Yesterday I spent $32 for a leather cross body purse, Gap jeans, linen rayon tunic, Columbia teeshirt, 3 vintage looking pillow shams.

Had two martinis starting at 4pm.