methuselah: Hi all! Brief intro and advice?

[methuselah]

Hi All,

 

Firstly thanks for the excellent site and taking the time to review my post.  History is long, so in the interest of time, 20 yrs on SSRI's (i've tried virtually all but had most luck with prozac and lexapro) with a 4 month bout of Remeron (awful w/d not helped by cross taper) and benzo's on/off for 8 years or so. 

 

Benzo: I've successfully switched from .5mg of clonazepam/day to 10mg valium and i'm now at 2mg per day.  A bit more about this below.

 

SSRI: Was on 20 mg for celexa for the last several months but completely zombified so decided it's finally time to be done with this sh1t I dropped relatively quickly per docs orders with really no impact down to 5mg celexa completely stopping the celexa and valium on May 1.  Started 10 mg prozac only May 1, by May 4 really awful DR with anxiety, inability to focus, sleeplesness, headaches.  Reinstated 1-2 mg valium which helped a little bit.  Yesterday i tested the waters and dropped the prozac down to 5 mg to see if agitation was from that which resulted in bad anxiety, chills,and shaking.  Took the other 5 g prozac and an additional 1mg valium which helped a bit.  Today slightly better back at 10mg prozac and 2mg valium in the morning.

 

I have a pdoc appointment tomorrow and really don't know what to do and not sure i trust his opinion frankly but do believe he will be fine with what i recommend.   I consider these the following my options:  

1.) Reinstate celexa at last dose (5mg?), drop prozac entirely after a week or 2, and keep valium, then micro taper off at 10% per 3 weeks or so.

2.) Hold steady on prozac and valium for awhile (how long?) then micro taper

3.) Something else?

 

Any thoughts are much appreciated and i apologize for any incoherence in this post but just got back from work trip and wanted to get this out there for the educated folks to review asap.  Many thanks for any input and your time!!!

 

methuselah

 

Edited June 8, 2018 by ChessieCat
corrected member name

[methuselah]

I'm happy to provide more detail if that helps i just sorta wanted to get to the crux of the matter and didn't know if anyone wanted to read a full history.  I feel like i was "stable" on the celexa and SHOULD have got the liquid version and dropped from 10 or even from 5 using the 10% method maybe every 4-6 weeks even.  Now i'm not sure about going back to celexa to taper and dropping the prozac as the drop in prozac from 10mg to 5mg was brutal yesterday and only after being on it for 3 weeks.  I also don't want to reinstate celexa at 2.5mg or 5mg, stay on prozac at 10mg, stay on valium at 2mg...then 10% drop each.  Maybe the best bet is ride out the current situation for a while and then 10% pro and val after a month or two of being stable.  thanks again for any thoughts folks. 

[Petunia]

Welcome methuselah,

 

Thank you for filling in your signature and for writing the details of your most recent history. I'm sorry you find yourself in this difficult situation, but have come to the right place for help and support.

 

As you may now realize, you have been tapering too fast. We suggest reducing by no more than 10% of the current dose every 4 weeks, this reduces the risk of withdrawal symptoms arising. Please read through this which will explain why:

  

Why taper by 10% of my dosage?  (The general philosophy of gradual tapering) 

 

It sounds to me that you are beginning to stabilize on 10mg of Prozac and I would be inclined to stay with what you are on now. If you make any more changes, you will likely cause more delay in stabilization. Prozac and Valium are some of the better drugs to taper from, so if you can stabilize on those, you will be in a good position for a future successful taper.

 

Expect to stay where you are for several months before starting a new taper. It may take quite a while before you are stable enough to safely begin tapering again. In the mean time don't make any more changes and do what you can to minimize stress, help your nervous system settle back down.

 

I'm going to list some topics relevant to your situation, they will help you understand better what might be happening now and how to best move forward in the future to reach your goal of safely becoming drug free. There is a lot of information here, so please take your time to read through everything at your own pace.

 

About reinstating and stabilizing to stop withdrawal symptoms

 

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

The Windows and Waves Pattern of Stabilization

 

Taking multiple psych drugs? Which drug to taper first?

 

Preparing to taper

 

Tips for tapering off Prozac (fluoxetine)

 

Only taper one drug at a time and I suggest that would be Prozac first. When you are ready to begin your Valium taper, please start a topic for yourself in our

Members-only benzo forum

If you have questions related to Valium dosing or tapering, its best to ask them in our benzo forum.

 

You can use this thread as your ongoing journal to track progress, write about symptoms, ask questions and communicate with the community, add to it whenever you want. Its a good idea to bookmark it or follow it, so its easy to find again. 

 

I hope your appointment goes well, do let us know what you decide. Please stay in touch and let us know how you are doing. 

 

Petunia.

 

 

Edited June 8, 2018 by ChessieCat
corrected member name

[methuselah]

Thanks for your feedback and the information.  I’m going to stick with the  10 mg Prozac and 2mg Valium for at least a month probably two with the hopes of stabilizing.  Doc was cool with it and is going to humor me but believes there is no “biological” reason for what I’m dealing with.  He does recognize these things are happening and considers me an outlier though a lot of people would say otherwise. I sorta stabilized but do feel pretty irritable some times, slightly agitated, some obsessing, some memory issues, trouble sleeping, some anxiety.  Not sure if it’s the quick taper off celexa and Valium or Prozac SE or just me.  Always welcome input from the pros on here.  Thanks!

[methuselah]

I noticed a lot of talk regarding reinstatement of the original drug on this site vs switching up like I did to Prozac 10 mg for the taper.   I’m curious on other people’s thoughts as to sticking with Prozac and how long before it’s clear that is the right move versus crossing back over to low dose celexa say 5mg where I dropped off in the first place one month ago.  Is it a feel it out thing or what, maybe there is no absolute answer?  I’m definitely getting waves and windows maybe 60/40 respectively.

[methuselah]

PS - many thanks again to Petunia for chiming in to my original post!!!

 

PPS - damn shame about Anthony Bourdain, unbelievable.  It’s always terrible of course, just saying, that one in particular is tuff to swallow for some reason.

[methuselah]

Can anyone chime in here please, suffering with pretty bad anxiety for over a week now and really thinking about trying to cross titrate from Prozac back to citalopram then taper to zero from liquid citalopram after stable.  Is that logical or do I need to just hold out on the Prozac?  Any feedback is much appreciated.  

[SkyBlue]

On 6/1/2018 at 9:35 AM, methuselah said:

Thanks for your feedback and the information.  I’m going to stick with the  10 mg Prozac and 2mg Valium for at least a month probably two with the hopes of stabilizing.  

 

Hi M, 

 

Generally, the fewer changes, the better; usually, picking a dose and sticking with it is best. Your system is likely still sensitized from the recent changes. I know it might seem like a long time, but it is still very early, even for the changes made in February. 

 

If your most recent dosage a reinstatement? Or are you doing a Prozac bridge (looks like you've only been on the Prozac 3 weeks)?

What the moderators who have been doing this for a while (I'm learning from them) are seeing is that it can take 7-10 days for reinstatements to become steady and begin to have an effect.

 

Is the anxiety you've had for a week new or much worse than before?

 

Having this info will help us best determine where to go from here.

 

Glad your doctor is willing to "humor" you --that's really all we need, is someone to "humor" us enough to keep writing us the Rxs while we safely taper on our own. : )

 

41 minutes ago, methuselah said:

Can anyone chime in here please, suffering with pretty bad anxiety for over a week now and really thinking about trying to cross titrate from Prozac back to citalopram then taper to zero from liquid citalopram after stable.  Is that logical or do I need to just hold out on the Prozac?  Any feedback is much appreciated.  

 

[methuselah]

Hi sky blue, thanks for the input.  I was on citalopram for awhile 8-12 mos then decided I wanted to come off everything entirely for first time in 20 yrs.  of course the other variable here is benzos as well.  I think I have most of it spelled out in my intro and sig. it’s a Prozac bridge with 1-2 week cross taper from citalopram.

 

To answer your question this is new anxiety.

[methuselah]

I think I’m probably at a place where I want to do something but need to do nothing, dunno.   Very frustrating 

[SkyBlue]

1 hour ago, methuselah said:

Hi sky blue, thanks for the input.  I was on citalopram for awhile 8-12 mos then decided I wanted to come off everything entirely for first time in 20 yrs.  of course the other variable here is benzos as well.  I think I have most of it spelled out in my intro and sig. it’s a Prozac bridge with 1-2 week cross taper from citalopram.

 

To answer your question this is new anxiety.

 

You're welcome. 

 

There are so many variables with many switches and fast tapers, it can be hard to know what exactly is going on (where the new anxiety is coming from).

 

There is some good information in this thread, especially Alto's post (November) on the first page:

https://www.survivingantidepressants.org/topic/1463-the-prozac-switch-or-bridging-with-prozac/

 

[methuselah]

@SkyBlue

 

thanks that info it is exactly what I was looking for.  I noticed the following text in that post, felt the same way intuitively, and sorta feared the same:

 

“Do not stay on the combination of the first antidepressant and Prozac for more than 2 weeks, or you run the risk of your nervous system accommodating to the combination and having difficulty tapering off both antidepressants“

 

Pretty sure My crossover was only 1 week where on both citalopram and Prozac and probably could have used another week... guess I’ll hold at current doses 🤔

 

i suppose the the question is when would I go back to citalipram and give up on the Prozac....or is it too late for that...or some other permutation?  Too many variables!!!

[methuselah]

I would also add roughly 5 days ago I started getting chest tightness that accompanies the anxiety only at night, I’m relatively young so not worried about cardiac issues.  Could b Prozac SE, cit w/d, or Benzo w/d from too fast taper from 1mg/day klonopin to 2mg Valium daily over roughly 3 months...  I really need or could use some guidance on what to do here as I have no confidence in psychiatrists, please!!!

[SkyBlue]

You're welcome, and glad you read the reinstatement thread. 

 

There are so many variables involved here. I've asked the other moderators for their advice and we will get back to you soon.

[methuselah]

Cool thank you.  I added another 1 mg valium back last night to see where that takes me with no personal issue of adding another for a total of 4mg per day.  this feels like some form of w/d as I’ve dealt with it before coming off remeron save the chest tightness.  I’ve also had decent success with cross tapers save remeron (though this most recent from cit to pro was the most aggressive thanks new pdoc!) so I’m really inclined to look at the Benzo here.  If the additional Valium helps then I’m fine with an up dose to stabilize.  Seems my 1mg klonopin equivalent of Valium is 20mg and I went to 10 then dropped over 3-4 months or so to zero before reinstating a few days later to 2 mg.  Have a stressful job and Had a stressful event a week and a half ago (outpatient procedure complication and still trying to work) which def didn’t help matters.  Thanks again folks.

 

best,

 

M

[Altostrata]

Hello, methusalah.

 

On 5/23/2018 at 5:31 PM, methuselah said:

completely stopping the celexa and valium on May 1.  Started 10 mg prozac only May 1, by May 4 really awful DR with anxiety, inability to focus, sleeplesness, headaches.  Reinstated 1-2 mg valium which helped a little bit.  Yesterday i tested the waters and dropped the prozac down to 5 mg to see if agitation was from that which resulted in bad anxiety, chills,and shaking.  Took the other 5 g prozac and an additional 1mg valium which helped a bit.  Today slightly better back at 10mg prozac and 2mg valium in the morning.

 

As SkyBlue said, there are a lot of potential factors here, with your coming off Celexa and Valium simultaneously. Here's more reading for you What is withdrawal syndrome?

 

In a nutshell, coming off both drugs suddenly destabilized your nervous system. That is where the strange and ever-mutating symptoms come from. Your nervous system is struggling to stabilize.

 

As you accomplished the Prozac switch via a cold switch (dropping Celexa and taking Prozac the same day), there was no real overlap such as you would have had with a gentler cross-taper. As Celexa has a short half-life and it takes at least 4 days for the Prozac to ramp up, you had approximately 4 days or more with inadequate SSRI in your system, causing severe withdrawal symptoms. The Valium you quit had a longer half-life, but no doubt your system felt that deficiency, too.

 

As I read your posts, you saw some slight improvement in symptoms over the 4 days, as the Prozac ramped up. But you made other drug changes, including the experiment with decreased Prozac, which cloud the picture.

 

How are you feeling since you upped the Valium by 1mg? What is your drug dosing schedule?

 

What is your daily symptom pattern? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. As you make changes, it's important to track the results for at least 4 days, to see what the effect is.

[methuselah]

Thanks Alto, i was hoping you would chime in eventually : ) !!!  

 

56 minutes ago, Altostrata said:

As you accomplished the Prozac switch via a cold switch (dropping Celexa and taking Prozac the same day), there was no real overlap such as you would have had with a gentler cross-taper. As Celexa has a short half-life and it takes at least 4 days for the Prozac to ramp up, you had approximately 4 days or more with inadequate SSRI in your system, causing severe withdrawal symptoms. The Valium you quit had a longer half-life, but no doubt your system felt that deficiency, too

 

Im pretty sure there was a week where i was at 5mg prozac and 5 mg celexa overlap but not 100% certain, things are a bit cloudy.

 

57 minutes ago, Altostrata said:

How are you feeling since you upped the Valium by 1mg? What is your drug dosing schedule

 

I feel ok today i guess, just upped the valium yesterday so maybe too soon to tell.  Taking 2mg in morning 7-9am and another 1mg at 7-9pm.  I take the prozac in the morning 7-9 am same time as valium.  I feel decent in the morning and maybe 1-2 hours after taking the prozac i start to feel anxious and moody/irritable.  I usually don't eat breakfast but found that eating with the dose seems to help a bit there.  I usually drink quite a bit a coffee (thanks citalopram) but haven't been able to handle any for the last few weeks as it increases agitation/anxiety and already have quite a bit of nervous energy.

 

As the day progresses anxiety/fear/frustration/anger waves and some windows more waves at the moment.  I've been getting chest tightening in the evening anywhere from 6pm to 9pm but the 1mg valium seems to knock that out.  Memory and sharpness could be much better.  Maybe a touch of agoraphobia...

 

thank you again, i hope you know how much you and the other mods mean to the people on this site such as myself!

 

~M

 

 

[Altostrata]

How long have you been taking 2mg Valium in the morning?

 

Has the symptom pattern changed since you increased Valium night of June 10?

 

We need to see what the increased Valium does.

 

There's several hours variation in your daily dosing. Please take your drugs at a consistent time every day, that will make it easier to isolate drug-induced symptoms.

 

FYI

On 5/23/2018 at 5:31 PM, methuselah said:

.... down to 5mg celexa completely stopping the celexa and valium on May 1.  Started 10 mg prozac only May 1, by May 4 really awful DR with anxiety, inability to focus, sleeplesness, headaches.  Reinstated 1-2 mg valium which helped a little bit.  Yesterday i tested the waters and dropped the prozac down to 5 mg to see if agitation was from that which resulted in bad anxiety, chills,and shaking.  Took the other 5 g prozac and an additional 1mg valium which helped a bit.  Today slightly better back at 10mg prozac and 2mg valium in the morning

.....

 

Please put date of starting Prozac in your signature.

[methuselah]

1 hour ago, Altostrata said:

How long have you been taking 2mg Valium in the morning?

2mg Valium in the morning since May 3rd.  

 

1 hour ago, Altostrata said:

Has the symptom pattern changed since you increased Valium night of June 10?

Today has been perhaps a bit better then yesterday, will be better able to tell in a few days as you said.

 

1 hour ago, Altostrata said:

here's several hours variation in your daily dosing. Please take your drugs at a consistent time every day, that will make it easier to isolate drug-induced symptoms

Will do

 

1 hour ago, Altostrata said:

Please put date of starting Prozac in your signature.

done!

[methuselah]

so yesterday i had an excellent window from about 3pm until 930-10.  Around 10 my chest started hurting again, a tightness/pain paired with anxiety of course.  It was pretty uncomfortable.  I had taken 1mg valium at 7pm or so but took another 1mg at 11pm with the hopes of just being comfortable.  That seemed to sort of take care of it but mostly just put me to sleep.  I woke up with anxiety and maybe a slight level of the same chest discomfort as the night before mostly concerned about the chest being some other medical issue.  I took the prozac 10mg and 2 mg valium this morning at 8 and the chest pain is gone only lingering anxiety/frustration.  

[methuselah]

Correction, the chest pain is gone but the tightness remains.  I'd also add that prior to my window yesterday i felt rather tired for around 30 minutes to an hour before hand.

[Altostrata]

Please give more detail about the chest area sensations. Are they internal? In the muscles?

 

Do you spend a lot of time hunched over a computer? If so, you might try some upper body stretching exercises. The hypersensitivity kicked off by adverse drug reactions extends to hypersensitivity to postural bad habits.

 

We'll need a couple more days of drug and symptom notes to see what the Valium increase does. A list form with time on the left and notes on the right is easiest for staff to scan.

[methuselah]

Chest area sensations are hard to describe, they are like tightness in the ribs almost, like anxiety is concentrating on that specific point, say my right, left pec and sternum in a physical manifestation and branches/spreads out from there to the rest of the body.

 

I do spend a lot of time at the computer and will start doing stretches this evening after work.  i'm in decent shape and fairly flexible but my upper body is the least flexible with slightly hunched shoulders from years of desk work.  

 

Will do bullet points from now on thanks.  

 

I'm super super tempted to dump prozac as it's 6 weeks in and not really doing anything positive that i can tell and going back to say 5mg celexa then liquid taper off that in a few months.  Thoughts on a cross taper back to celexa?  I feel like the longer i wait the more i'm stuck with Prozac and while bloated, sweaty, and tired on celexa, it felt better than this.  I only went on prozac this time for it to be temporary....3 weeks was the plan as it "self tapers".  I've been on it a few times before for extended periods (8 years one time and a few months in another instance) and fear kindling/paradoxical effect from it is occurring.  

 

thanks.

 

[methuselah]

bumping this with hopes on advice to go back to celexa and drop prozac or hold on.  Have a refill i need to grab depending on advice.  thanks!

 

M

[Altostrata]

Changing more than one drug at a time confuses things, that's why I said we need to see what the Valium increase does first.

 

Do you get any definite symptom pattern after you take Prozac? What time of day do you take it?

 

Your responses so far have been very clear and to the point, thank you.

[methuselah]

730 am - 2mg Valium and 10mg Prozac.  The anxiety and chest tightness has been present upon waking and not present when waking at this time so no consistent pattern yet.  

 

12-1 pm - anxiety starts to taper off no pun intended

 

330pm - headache daily for last several days.  Ibuprofen knocks it out.

 

8pm - 2 mg Valium

 

8-10pm - anxious energy, agitation, anxiety, heart palpitations and chest tightness  sensation kick in making it rather difficult to sleep.

 

Notes - Caffeine is virtually out, maybe half a 12 oz Diet Coke at dinner which I’m going to cut as well.  No coffee not even decaf and I love coffee!  May have to get decaf.  Valium dose increase to 4 mg for last 2 days not super helpful maybe for a few hours at best.    Lastly, I’ve actually had 3 runs with Prozac so this is actually #4.

 

Appreciate the continued support.  

 

~M

[Tarheel109]

Glad to hear that you’re running. I find that exercise helps a ton!

[methuselah]

44 minutes ago, Tarheel109 said:

Glad to hear that you’re running. I find that exercise helps a ton!

 

Hey!  While I do run and love to exercise especially HIIT, here 3 runs is a figure of speech and I meant 3 go’s at it, was on it 3 times before this most recent.  

[Tarheel109]

9 hours ago, methuselah said:

 

Hey!  While I do run and love to exercise especially HIIT, here 3 runs is a figure of speech and I meant 3 go’s at it, was on it 3 times before this most recent.  

Oops! Gotcha... Well hopefully the fourth time’s the charm 🤞

[methuselah]

Went to see my old psychiatrist today who I should never have left in the first place.  She is adamant that my symptoms were withdrawal due to too fast a taper from Valium.  She told me to hold at 4mg Valium daily and Prozac at 10mg daily for a few months prior to ultra slow taper which is funny as it’s the same advice I got here : ).  Plan is drop Prozac first then benzo.  I seem to have stabilized for the moment, I’ll check back in a few days to update.  Thanks to all who chimed in to help when I needed it most.

 

~M

[SkyBlue]

M, that is great. Thanks for letting us know! 

 

 

[Poulesportive]

Methuselah, how are you feeling now? I hope things have stabilized. 

[methuselah]

On 7/17/2018 at 4:43 AM, Poulesportive said:

Methuselah, how are you feeling now? I hope things have stabilized. 

Hi!  I was rather stable for awhile on 15mg Prozac and 3mg Valium since roughly July 1 hence my lack of posting (no news is good news).  but, always a but,  within the last 4 weeks I started to get relatively nasty headaches and sinus pressure pain even into my teeth, pain in neck on Mack of head base of skull, tinnitus, crashed libido, super lethargic, malaise, no motivation.  I suspected sinus infection at first but two courses of antibiotics and nothing.  CT scan and mri w/ and w/out contrast showed nothing.  Generic brand of Prozac didn’t change but I feel like they may have changed the formula as the pills started to dissolve quickly in my mouth when taking which they didn’t do before, this was maybe enough to do it.

 

 that’s my working theory as lexapro generic brand change got me once before with similar SE plus Prozac and I have a somewhat sordid history.  

 

I’m switching to liquid now, will try 10 mg per day and likely taper off the Prozac first then follow with taper of Valium.  I can’t chase the dragon anymore with another new med though I’m tempted to do so if just to get rid of these headaches.

[methuselah]

I feel like there is a term for when the drug seems to turn against u,  it doesn’t necessarily poop out as it really hasn’t, but rather your body starts to treat it or react like it’s poison, anyone?  Thx all

[ChessieCat]

1 hour ago, methuselah said:

it doesn’t necessarily poop out as it really hasn’t, but rather your body starts to treat it or react like it’s poison, anyone

 

It called paradoxical.

 

"A paradoxical reaction or paradoxical effect is an effect of medical treatment, usually a drug, opposite to the effect which would normally be expected. An example of a paradoxical reaction is pain caused by a pain relief medication."

[Poulesportive]

9 hours ago, methuselah said:

I’m switching to liquid now, will try 10 mg per day and likely taper off the Prozac first then follow with taper of Valium.  I can’t chase the dragon anymore with another new med though I’m tempted to do so if just to get rid of these headaches.

 

Methuselah, if you are going from 15 to 10 mg that seems like a big jump. When did you do that drop, and how fast? That could be the cause of the problem. Because I switched antidepressants a bunch (paxil to wellbutrin to lexapro to zoloft) in a relatively short period of time a few years ago, and because I ended up on zoloft for a year, I seem to have super-sensitized my central nervous system. I had to get off zoloft (huge digestive problems) so I switched to prozac (increased the digestive problems) and then quickly to cymbalta, which I'm tapering off of now. All that switching drugs (and a failed attempt to cold turkey zoloft) left me where I am now: on the world's SLOWEST micro taper. I can only take out one microbead a week of cymbalta. Trying to taper any faster crashes my system. I also now cannot eat gluten, good times.

 

Anyway the switch to liquid seems like a good idea, as it's my understanding that it's easier to taper prozac that way.  If it were me, I would switch to liquid and hold steady at the current doses for a good long time - like 4 weeks. And get absolutely everything else checked out (sinus infection? allergies?). 

 

Anyway that's my non-medical take on things. Keep posting on how it goes!