methuselah: Hi all! Brief intro and advice?

[methuselah]

I’ve been fully checked with cat scan and mri and they can’t find anything.  Even tested for mono and nada.  I only dropped from 15 to 10 when switching to liquid after a month of the aforementioned symptoms.  I know it’s a rather quick drop but I can’t handle the headache anymore and hoping it helps.  Also hoping something in the pill that isn’t in the liquid that was causing the  issue.

[methuselah]

Open to any suggestions/comments on my approach here of course.

[methuselah]

3 hours ago, Poulesportive said:

 

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! 

Taper sounds brutal btw but you’ll get there albeit slowly.  Slow and steady wins the race!  good luck and thanks for chiming in.

[methuselah]

These headaches are unbearable.   If after a week or 2 on the prozac liquid and headaches still present, any thoughts on switching to another liquid  (perhaps lexapro), staying on for a few months with hopes of stabilization then 10% per month taper?   

[Altostrata]

When did you drop from 15mg Prozac to 10mg Prozac in liquid form? (Are all of these generic fluoxetine rather than brand-name Prozac?)

 

Has your symptom pattern changed since you made the decrease? In what way?

 

What times of day do you take your drugs, and their dosages? How's your sleep? Please keep daily notes on paper about your symptoms, when you take your drugs, and their dosages. Use a simple list format with time of day on the left and notation (symptom, drug and dosage) on the right.

 

[methuselah]

Hi Alto, 

 

Dropped on Monday 10/15.  taking 5mg in morning and 5 at night same time every day, 7am and 7 pm.  All generic.  The tab i was taking was Par pharm.  The liquid i started is a different manufacturer still generic, can't recall the name off top of head.

 

Symptoms seem to have decreased a bit.  I always feel better in morning  then about 3-4 hours after dose headache, neck pain kick in.   When i was taking all at once in morning the pain would decrease into the night but was worse during the day.  The split dose really just spreads out the annoyance thru the day and night but lessens severity as opposed to getting hammered during the day and better at night...pick your poison.

 

Sleep is good, too good probably

 

Thanks

[ChessieCat]

Please update your drug signature with ALL the information about Prozac (include 15mg, when changed to liquid, etc).  This way we can see your drug history at a glance and not have to read back through your posts to get the information.  Please remember to update it whenever you make a change.  Thank you.  Account Settings – Create or Edit a signature

[methuselah]

31 minutes ago, ChessieCat said:

Please update your drug signature with ALL the information about Prozac (include 15mg, when changed to liquid, etc).  This way we can see your drug history at a glance and not have to read back through your posts to get the information.  Please remember to update it whenever you make a change.  Thank you.  Account Settings – Create or Edit a signature

 

Done my bad.  

[methuselah]

Saw pdoc today, she’s not sure it’s the meds but what else is new.  She mentioned temporal arteritis, migraine, tension headache...it sounds like I’d b blind or dead from the arteritis by now considering it’s 5 weeks later.  And symptoms aren’t really consistent with that.

 

Either way headaches still present at current dose 10 my liquid fluoxetine.  She wrote me a script for liquid  escitalopram which I’ll likely fill in another 1.5 - 2 weeks if headaches still present, cross taper, then ween off that after stabilizing a few months.  Don’t know what other route to take other than deal with headaches and taper but it’s going to b a relatively long taper did the math like 2 yrs at least.

[Altostrata]

Very few psychiatrists even know common adverse effects.

 

Your daily symptom and drug notes are key to our unraveling this. If she didn't ask for such, she's guessing without essential information, but that's psychiatry for you.

 

What time of day do you take Valium? I would like to see your notes for today in your next post.

[methuselah]

Agreed, it’s really awful.  Pathetic frankly.  And honestly she’s the best one out of several.

 

nonetheless, notes:

 

Prozac split is annoying so dropped that, I could almost feel withdrawal like a flu like feeling before I took second 5 mg dose for day then it would go away.  Pretty weird considering the half life but whatever.  

 

10 mg Prozac at 7am with 1.5 mg Valium same time.  Headache hit at around 11 and it’s been with me since.  Headache=  Pain in back of neck where inserts into skull, sinus area, temples, central head area.  Not all at once typically shifts around that range.  

 

Took some Tylenol but I’ve been taking Tylenol and excedein migraine for awhile (1 month) going to cut that out to avoid med induced and/or rebound headache.  

 

That’s what I have I’ll update tomorrow with when headache dissipates and anything else.  Thx!

[Altostrata]

You had split the Prozac dose but then stopped doing that? Sorry, I don't understand what's going on.

 

When did you first split the Prozac dose? How did the headache pattern change when you were taking Prozac twice a day?

 

Why do you take Valium with Prozac? In your daily symptom notes, I need to see when the headache starts and when it goes away.

[methuselah]

I split the Prozac for a few days in an attempt to alleviate the headaches but it felt off so I stopped doing that today and went to once daily dosing.

 

The valium is bc I’m hooked on benzodiazepines and switched from klonopin.  Not mesing with that right now.

 

headache starts at 11am and mostly goes away by around 8pm

[methuselah]

Yesterday 10 mg Prozac at 7am with Valium 1.5mg.  Headache came on as usual at about 11am and hung around a bit longer actually until 10pm.  Had a few beers around 7 which did not help the situation apparently.

 

Really thinking of jumping to liquid lexapro hope to stabilize for few month then taper off that.  Not sure how much longer I can handle these headaches.  Losing it!  

[methuselah]

All that said, any advice on a proper cross taper from fluoxetine to lexapro?  Assuming that is the best route considering the headaches that is of course.  Tinnitus is a bit bothersome as well.

 

Doc recommended stop Prozac cold and start lex at 2.5mg for a week, 5 mg for a week, then 7.5 mg and stay until stable and taper.  She knows my goal is to get off of these meds btw.

 

I understand the point of the site is to get off of these drugs but this cross taper is a step in that direction as I’d b switching to another liquid with the intention of slow taper from that.

 

 

[Altostrata]

On 10/18/2018 at 2:30 PM, Altostrata said:

How did the headache pattern change when you were taking Prozac twice a day?

 

This is a very important question. Was there no change in your headache pattern when you were splitting the Prozac dose? How long were you splitting the dose?

 

Why do you want to switch to Lexapro, of all things? Switching drugs incurs the risk you might get withdrawal from the first antidepressant even though you're taking the second.

 

A crossover switch would be to take a partial dose of each drug and gradually increase the proportion of the second until you are off the first.

[methuselah]

38 minutes ago, Altostrata said:

 

This is a very important question. Was there no change in your headache pattern when you were splitting the Prozac dose? How long were you splitting the dose?

 

Why do you want to switch to Lexapro, of all things? Switching drugs incurs the risk you might get withdrawal from the first antidepressant even though you're taking the second.

 

A crossover switch would be to take a partial dose of each drug and gradually increase the proportion of the second until you are off the first.

I split the dose for a few days but felt pretty odd when doing so.  Odd meaning felt flu like and as if withdrawing near when the next dose was due (12 hours). There was perhaps a slight change in the headache pattern but I probably did not It give it enough time to be sure.  I suppose I could try this again and deal with it for a bit.

 

switch to lexapro is due to fact that I had luck with lexapro before and it offers a liquid version allowing for a taper without getting into creating my own solutions,  trying new meds, counting beads, and so on.  Half lifes pretty much fall off a cliff when comparing anything to Prozac

so pick your poison.  Is there something else you would recommend?

 

I understand the concept of a cross taper but was asking for specifics with regards to dosing on said cross taper if headache fails to lessen or dissipate 

[Altostrata]

On 10/16/2018 at 7:38 PM, methuselah said:

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.

 

Prior to 10/16/18, you hadn't reported tinnitus, etc., so something happened in the prior month.

 

Can you recall if anything changed in mid-September? Did you reduce the Valium? Did you skip any doses? Earlier you were taking 4mg per day, now you're taking 1.5mg per day? What was your Valium taper schedule?

 

On 10/17/2018 at 8:06 AM, methuselah said:

I’ve been fully checked with cat scan and mri and they can’t find anything.  Even tested for mono and nada.  I only dropped from 15 to 10 when switching to liquid after a month of the aforementioned symptoms.  I know it’s a rather quick drop but I can’t handle the headache anymore and hoping it helps.  Also hoping something in the pill that isn’t in the liquid that was causing the  issue.

 

You changed to liquid Prozac October 15, which is when you reduced from 15mg to 10mg? After you did this, how did your symptom pattern change?

 

You've got to keep notes!!

 

Given Prozac's long half-life, splitting the dose for a few days is not an adequate test.

 

Your system was expecting all 10mg in the a.m. and produced withdrawal symptoms when it didn't get it.

 

Suggest moving 5mg Prozac an hour later each day until you're taking the doses at 7 a.m. and 4 p.m. (or later). If your sleep starts breaking up, stop moving the dose later. Keep good notes about when you take your drugs, the dosages, and symptoms in between.

 

Once you've got the doses separated, you'd have to stick to that schedule for 2 weeks to give Prozac a chance to redistribute.

 

Depending on how the tinnitus pattern changes, you may be able to isolate the Prozac as the cause. If so, you might try a 1mg reduction in dosage to see if that helps. Or, that might justify a drug change.

[methuselah]

Valium is 1.5 mg morning and night so 3mg total daily.  Tapered down from 4mg over a few months.  I could pop back up to 3.5-4mg per day to see if that makes a difference?

 

 I’m terrible at taking notes but will start a journal.  I’m doing this from my phone which also doesn’t help.

 

Mid September is when this whole thing started which I attribute to some change in the manufacture formula as the manufacturer itself did not change.  The pills began to dissolve quickly in my mouth prior to swallowing in late August so that is my theory.

 

the tinnitus was there a bit prior to switch to liquid but increased after switching.  When switching manufacturers it’s like switching to a new drug almost so that would explain the tinnitus I gather.

 

I think the split idea u have regarding 1 hr increments is excellent can’t believe I didn’t think of that.  The half life is so long it should be easy but nothing is easy with these things apparently.

 

ill clean my act up regarding notes, journal, better structure my posts, etc.  thank you for chiming in as always.

[ChessieCat]

This is an example of the format to use:

 

6 a.m. Woke and vomited
8 a.m. Took 2.5mg Lexapro
10 a.m. Had diarrhea
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Stomachache
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Headache got worse
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke with headache

[methuselah]

Got it thanks.  Hoping my day is better than that example however :)

[Altostrata]

Chessie, we really must revise that example. 🙂

[methuselah]

I’m out of town for work this week and will start to split the dose when I return and begin to keep the diary here.  Also the headaches are on and off now same with tinnitus and neck pain.  I’ll keep an eye on this and maybe if I’m lucky I won’t have to split dose and this situation will resolve itself and I can begin to taper off.  I do feel slightly flu like also perhaps due to generic manufacturer switch and dose reduction.  Fun fun fun but it could be worse!

[methuselah]

 

Starting Journal entries.  Valium consistent dosing at 1.5mg liquid daily in morning when dose Prozac and at night before bed unless otherwise mentioned.  My goal is to split the prozac dose so it is same time as valium dosing then taper.   If the split doesn't alleviate the headaches, neck pain, and tinnitus or lessen it significantly after 2 weeks of split i may have to cross taper to the lexapro liquid.  I've cross tapered before with some sides and/or withdrawal but have generally tolerated cross tapers ok.   I'd prefer to taper off prozac rather than lexapro but can't handle headaches and the rest of it much longer.  

 

October 26

7am wake all good (no headache, neck pain, tinnitus, anxiety, etc.)

8am 10 mg prozac

1015 am headache roll in slowly but surely

1230 pm head and back of neck pain (splenius capitis area)

2pm pains lift

430pm headache returns w/ mild tinnitus

6pm pain gone for rest of day

 

Oct 27 - no journal entry

 

Oct 28

830am 5 mg prozac

1030am 5 mg prozac

630pm first headache of day

8pm headache gets milder

930 headache gone but tinnitus starts (mild mostly noticeable when quiet).  Tinnitus lingers until sleep around 11pm

 

 

[Altostrata]

Please make it easier for us -- you've got to include your benzo dosing in those notes!!

 

With only one day's data, splitting the Prozac dose looks promising.

[methuselah]

will do ,sorry and thanks.  headache back today along with neck ache with vengeance so that may have been a fluke   i swear my body is just rejecting this prozac.  i drank 6 beers or so the eve of the 27th and my theory is that had some impact on the level in bloodstream hence the delayed onset of typical symptoms on 28th and me being back to baseline today.

[Altostrata]

With Prozac, it takes a week or so for the dosage to get re-distributed in your bloodstream.

[methuselah]

9 minutes ago, Altostrata said:

With Prozac, it takes a week or so for the dosage to get re-distributed in your bloodstream.

 

i'll hold out a few more days splitting the dose but today is pretty rough.  I know patience is the name of the game here but just out of curiousity...I've not had t too rough a time when switching meds, only when coming off remeron and too quick a taper off of benzo/citalopram at same time to zero.  If this doesn't work out, is there a recommended cross titration schedule to get me off this poison and onto my new poison (liquid lex) until i stabilize and taper?  these headache's and neck pain are borderline debilitating and put me in a foul mood.  

 

Perhaps:

2.5mg Lex, 7.5mg pro week 1

5mg lex, 5 mg pro week 2

7.5 mg lex, 2.5 mg pro week 3

7.5 mg lex, 0 pro week 4+ 

 

 

[methuselah]

Oct 29

730 am 5mg Prozac 1.5mg Valium, no headache mild tinnitus left ear

Tinnitus lifted at 815

1030 headache in back of head and neck pain mostly neck 

12pm 5mg

1230 chills

1245 chills start to go away as does neck ache

1 chills gone and neck gone

230 headache starts

330 Tylenol 500 mg

430 headache gone

9pm  1.5 mg Valium 

 

[Altostrata]

You're probably going to have to give up drinking alcohol for a while. That may be responsible for many of your symptoms.

 

Going on and off drugs makes your nervous system hypersensitive to drugs, alcohol, and even some supplements and foods. Whatever happened in the past, drugs, alcohol, etc. may not have the same effect.

 

Your nervous system is in a different condition now. Please treat it gently.

 

19 hours ago, methuselah said:

Tinnitus lifted at 815

 

Guess what, 5mg Prozac seems to be helping.

[methuselah]

I do have a journal kept on my phone and will add later when time permits, busy week at work and home.  Wanted to get on here briefly and state that I'm pretty sure that abrupt drop from 15-10mg Oct 15th is catching up with me yesterday and more so today.  Shivering/cold...always starts with the shivers/cold feeling, muscle twitching on and off, mild nauseau, some dizziness/somewhat like falling feeling, DR, tracers in vision, somewhat flu like symptoms,  some increased anxiety resulting from aforementioned symptoms.  Thinking about adding another 2.5mg pro to daily dosing to stave this off, thoughts?  thanks!!!!!!!!!  at 12.5 daily i've still dropped from 15mg daily so it's still progress in my book.  

[Gridley]

The drop from 15 to 10mg Prozac was over 30%, which is much more than our recommended 10%, accounting for your symptoms.  Also your system is sensitized from the crossover to Prozac.

 

If I am reading your post correctly, you are thinking about reinstating 2.5mg Prozac.  This may be too much, because your brain has already started to make some adjustments to the lower dose.  I would recommend you reinstate only 1 mg and see if that relieves your WD symptoms.  You can always go a little higher if it doesn't.  

 

About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic

 

 It takes about 4 days for a dose change to get to get to full state in the blood and a bit longer for it to register in the brain, so give the 1mg reinstatement a chance to work before you go higher.

 

[methuselah]

thanks.  So i'd be reinstating 1mg in addition to the 10mg i'm on so i'd be at 11mg/day for several days correct?

[Gridley]

Correct.  But I would hold at 11mg for longer.  With the crossover and the drop from 15 to 10mg, you should hold for 2-3 months to let yourself stabilize.  I know you want to make progress, but now is a time to be gentle with yourself.

[methuselah]

Sanity and functioning > Progress at this point.  thanks for the help.  I also felt pretty good this morning, suppose that was a window too.  It was pretty great actually, didn't recognize it as such though.

[Altostrata]

You were taking 5mg Prozac on Monday, how much are you taking now??  When did you change to 12.5mg? Did your symptom pattern change?

 

Please stop playing with your fluoxetine dosage. It will take at least a week for any dosage change to take full effect.

 

Please update your signature.