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Gaebbi: reinstatement gone wrong?

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Gaebbi

Hey Sassenach,

I will give you all updates as soon as there are any!

I‘m in a psychiatric unit and I went there voluntarily. I‘m in a closed station, but only because there wasn‘t a free place in the open station, which changes this afternoon. I will get a mri of my head in the next few hours and will talk to another doc later. I will talk to him about increasing my dosage up to 2.5mgs and wait for 4-7 days until maybe increasing again, which for me seems like a good option.

I only took the quetiapin when experiencing  absolutely unbearable conditions and of course I‘m giving my best not to take it. It‘s all voruntarily, the nurses and doctors never forced me to take something!

I will definitely stay here until I‘m feeling better. I‘m not able to function outside when a bad wave hits. And sadly those waves last very long and I already told you how horrible they are.


thank you all for your kindness and support in this horrible time! Next update and my answer to manymoretodays will follow in a few hours.

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Sassenach

Hi Gaebbi

 

How has today gone?

 

Sassenach

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Gaebbi

So, new update

first of all and most important: I‘m feeling a bit better! I was able to go through my city for a few hours without having a mental breakdown!

just a few answers to manymoretodays: I‘m not working right now. My boss at work knows of my condition and also he is a good friend of mine, it‘s really not a problem to stay away from work for a few weeks.

I don‘t have to care about my household or anything right know, since I‘ll stay in the psychiatry for a while. I cancelled EVERYTHING I had to do in the following weeks and everybody understood my current situation and was supportive.

For the escitalopram, yes I took a liquid and measured it with an insulin syringe.

 

but now the news I got today.

I talked to the chief doctor of the whole psychiatric station. And I never would have thought to find anyone that knows about ssri withdrawal, but he did. He published many studies about psychotropics and really knew what he was talking about.

he described my problems this way: being on escitalopram for 7 months before withdrawing it was a too short period for my brain to stabilize. Cold turkeying it, then reinstating and withdrawing again was just too much for my brain to handle. Especially with lexapro even minimum dosage changes can destabilize one‘s nervous system to a degree where one can have as horrible symptoms as I have, and now I have a mix of a destabilized brain, withdrawal symptoms and rebound panic and depression.

 

he suggested to switch from my 2mgs of lexapro to 10mgs of fluoxetine, since I won‘t be able to reduce lexapro any further without experiencing heavy symptoms.

then I should stay on that 10mgs for about 3 - 4 years, until I can be sure that my panic attacks are gone, My brain has stabilized and I am in a point in my life where everything is more.. stable. And after that we can reduce the fluoxetine veeery carefully.

 

I know that many of you would adwise me otherwise, but honestly I‘m trusting him. He really knew what he was talking about, and I think when experiencing so bad problems with lexapro that I want to kill myself, it‘s time for a chance.

 

Treatment with fluoxetine will start tomorrow. He told me that it will take a few days before feeling better, but I‘m staying in the psychiatry and the docs and nurses will keep an eye on me.

 

Also I will get psychotherapy, music therapy, arts therapy, sports therapy and work therapy as long as I‘m staying here.
I have to say I‘m very optimistic about all of that. 
Let‘s just hope I‘m getting better

 

thanks for all of your help!

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Gaebbi

Oh and yeah, I stopped smoking completely. I thought for a few weeks that it was the reason for my heavy symptoms, which made quitting pretty easy for me.

Of course I‘m still craving for cigarettes but I think I‘m strong enough to never touch one again!

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Altostrata
5 hours ago, Gaebbi said:

he suggested to switch from my 2mgs of lexapro to 10mgs of fluoxetine, since I won‘t be able to reduce lexapro any further without experiencing heavy symptoms.

then I should stay on that 10mgs for about 3 - 4 years, until I can be sure that my panic attacks are gone, My brain has stabilized and I am in a point in my life where everything is more.. stable. And after that we can reduce the fluoxetine veeery carefully.

 

Gaebbi, you may do better with fluoxetine to settle your SSRI withdrawal problems but 10mg fluoxetine is TOO MUCH. Since your nervous system is already sensitized by going on and off drugs, it may react badly to a "normal" dose of any SSRI. If I were you, I might start with 0.5mg liquid fluoxetine. You'll have to take it at least a week to see the full effect of even that low a dose.

 

You have a history of taking drugs inconsistently. This has caused many of your problems. You have to be very regular in your dosing and observe carefully to see what works. Do not be impatient, give it time.

 

Not sure how much control you have over this, since you're in the hospital. Please let us know how you're doing.

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Gaebbi

****. I already took my first dosage today, because I didn‘t look for answers first. Now your opinion of course gives me high anxiety.

guess the only thing I can do right now is waiting. If there‘s no bad reaction the next few days, could you say I‘m safe to go?

Should I talk to the doc about lowering my dosage, even though I took the 10mgs today? Or should I wait and see?

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Sassenach

Hi Gaebbi

Alto is right, 10 mg is too high a dose how to switch from 2 million mg of citalopram.

Your doctor certainly sounds as though he knows a good deal more about antidepressant withdrawal than most.

I believe this shows there is is a lack of knowledge with this parts of withdrawal.

There is a link on this site to the the Prozac fluoxetine bridge which is what this procedure is called.

I cannot send the link from my phone but if you cannot find it get back to me me.and I will send it from my PC later in the day.

Sassenach

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Gaebbi

Yup I already read everything of this topic.

it‘s been 3 hours since I took the Prozac and honestly I‘m feeling better than I did the last few days, but of course I know that I can‘t say much after just 3 hours.

I will talk to the doctor again as soon as I see him!

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ChessieCat

It would be okay to start taking the lower dose from when you take your next dose.

 

Because Prozac has a long half life it can take a couple of weeks for the dose to get to full level in the blood.  If you are starting to feel improvement now when the dose hasn't yet built up to the full amount, it might be a good idea to reduce your dose now instead of risking the full amount being too much one it gets to full level in the body.

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manymoretodays

Hi Gaebbi,

Yes, on all the above.  I'm just going to include this:

 

 Dose Equivalents for Antidepressants

(the below is taken from ^ and I bolded the escitalpram)

RESULTS:

We included 83 studies (14 131 participants). In the primary analysis, fluoxetine 40mg/day was equivalent to paroxetine dosage of 34.0mg/day, agomelatine 53.2mg/day, amitriptyline, 122.3mg/day, bupropion 348.5mg/day, clomipramine 116.1mg/day, desipramine 196.3mg/day, dothiepin 154.8mg/day, doxepin 140.1mg/day, escitalopram 18.0mg/day, fluvoxamine 143.3mg/day, imipramine 137.2mg/day, lofepramine 250.2mg/day, maprotiline 118.0mg/day, mianserin, 101.1mg/day, mirtazapine 50.9mg/day, moclobemide 575.2mg/day, nefazodone 535.2mg/day, nortriptyline 100.9mg/day, reboxetine 11.5mg/day, sertraline 98.5mg/day, trazodone 401.4mg/day, and venlafaxine 149.4mg/day. Sensitivity analyses corroborated the results except for doxepin.

 

So then: 10 mg fluoxetine: 4.5 mg escitalopram

You would be updosing a lot, on a 10 mg dose of fluoxetine from what you had been on, in equivalent approximation of escitalopram.

 

In any case, I absolutely agree 0.5 mg of the fluoxetine to start.  That's more equvalent to what you had been taking with the escitalopram.  And if it's a cold switch, no cross over, it will be much gentler on your nervous system now.   At some point, some WD may kick in from your escitalopram.......hopefully buffered a bit by the fluoxetine, when that gets at a steady state.

And I am happy to hear that you are getting some moments and time of feeling okay and safe.  There might still  be lots of bumps and symptoms, going forward, yet hopefully much more manageable.  Getting honed up on non-drug coping now, should be great too!

 

You are a bit sensitized and dis-regulated(nervous system).   I think that the sooner you can stay steady with preferably, a lower dose,  the better.  Give it the whole week........like Alto said......before drawing conclusions.  And if possible, before updosing again.  See what your doctor thinks too, as you are "in psychiatry" now, and this is all sounding, like what may have needed to happen, to get you back to further stability now.   That's the present goal.  And..... it's okay Gaebbi.  You haven't failed at anything.  If you can avoid poly drugging too, that will be great.  Or using several drugs/medications at once.

 

Recompiling a few more links:

The Prozac switch or "bridging" with Prozac
About reinstating and stabilizing to reduce withdrawal syndrome

 

 

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

and a great pearl of wisdom ^ here

 

All my best, and congratulations too on being smoke/nicotene free too!

Love, peace, healing, and growth,

mmt

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Sassenach

Hi Gaebbi

 

How are you doing this morning?

 

Sassenach

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Gaebbi

Hey Y‘all

I‘m Way better! I still have all the symptoms of last weeks but they‘re much much milder and managable.

I talked to the doctor about taking a smaller dosage. And I talked to him for a long time! But in the end with everything he said I‘m convinced that the 10mg dosage is right for me.

he had many patients that had massive problems with ssri withdrawal and he takes care of those people for 20 years now. And he told me that most of the people he cared for felt much better after just about 1 week of a mildly higher dose of fluoxetin than the ssri they took before.

I know the studies about switching, cross tapering etc, and trust me, I‘ve been deeply concerned after you‘ve told me that 10mgs is too much. And I know that you all are professionals about this topic!

But I feel like the doctor really knows what he is doing. And so far I‘m getting better so I will stay with his treatment!

 

I will keep you updated about every two days until I‘m fine!

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Erell

Hello Gaebbi

I'm really curious of your prozac bridge, keep update so we can know how you manage it!

I also want To congratulate you for quitting cigarettes during these tough days, what a strong mind you have!

 

All my best!

 

Ps : apologize for my English!

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Sassenach

Hi Gaebbi

 

I am glad you are feeling better today.

Please keep in touch.

Wishing you all the best

 

Sassenach

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Gaebbi

Just a small update, which isn‘t really an update but more of an information.

I won‘t come back to this forum until I‘m better. My problem is that I‘m making myself go crazy with my symptoms. For every symptom I have I‘m searching this forum for somebody other who has similar symptoms, just to feel safe. Because then I know that it‘s from withdrawal. But lately I experienced very weird symptoms that are not listed here. Also I‘m reading too much about switching to prozac and I‘m still concerned about everything. When in reality I know that I would be much better just trusting the doctor and telling myself I‘m gonna be better soon!

 

and don‘t worry about me. Even if some symptoms are absolutely unbearable, I won‘t kill myself or even think about it.

I‘m strong and I couldn‘t do this to my family and friends.

 

So hopefully I will be back in a few days or weeks until I‘m better.

Thanks to all of you, especially you, manymoretodays!!

See ya!

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Gaebbi

So, here I am again with nothing but bad news..

Last thursday, as I was writing my last update, my doc wanted me to increase my dosage up to 20mgs of prozac.

I knew it‘s way too much. I told him I‘m worried but he assured me that I‘ll feel better in about two weeks. So I trusted him.

This night was again the worst of my life. I don‘t really know how to describe my symptoms but I was over stimulated as hell, felt like being in a horror movie with no escape, only had nightmares in which I dreamt I had wd symptoms and ran to other people begging to help me, but they couldn‘t. Then I wake up and realize that the reality is exactly as bad as the dream and there is no escape and no waking up anymore.

I don‘t know how long I can stand this.. I didn‘t know that a person can feel so miserable.
 

So what are your thoughts about this?

And especially, what do you think where my symptoms come from? Is it really withdrawal? Is it a rebound from my underlying panic attacks, depression and benzo withdrawal, which broke out since 2mgs of escitalopram couldn‘t hold it back? Is it both + overstimulation from the prozac?

Is it heavy withdrawal from the escitalopram, and it wasn‘t long enough for the prozac to counteract the wd and I should stay on the 20mgs?

again for the record. I‘m taking Prozac since Tuesday, 10mgs for 2 days and then updosing to 20mgs.

I personally want to go back to 10mgs and see if I get better the next days.

And please tell me how I could talk to my doctor.. he is very nice but I don‘t think I will convince him of anything..

 

 

 

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Sassenach

Hi Gaebbi

Sorry to hear you are not feeling well.

are you feeling better or worse now and when you admitted yourself to hospital?

If your doctor will not listen you are going to have to decide whether you wish to stay in hospital.

I will look back through your thread and drug history during the day and get back to you this evening.

There is a link on this site about how to talk to your doctor, unfortunately I am doing this on my phone and cannot access the link on here 

Get back to you later.

Sassenach

 

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Gaebbi

Well the symptoms changed a bit but not in severity. So no, I‘m not better than before

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Erell

Hi Gaebbi,

 

I Feel sorry for you Being in a rough state, but also wanna reassure you : you're not alone in this and we can support you!

 

I can't give you advices for your doses, but I hope someone with more knowledges and expérience Will answer you soon about your Prozac doses.

 

I know how High level of anxiety can be rough, what strategy do you have To cope?

 

As you said, maybe it's not a good idea To read too much stories here if it increases your anxiety. Focus on success stories.

 

I send you my warmest wishes, keep telling us how you're doing and how it is going with the doctor.

 

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Sassenach

Hi Gaebbi

 

Did you manage to reduce the dose as you wanted.

10 hours ago, Gaebbi said:

And please tell me how I could talk to my doctor.. he is very nice but I don‘t think I will convince him of anything..

 

You say you cannot convince him of anything but he cannot make you take the dose he suggests as you entered hospital voluntarily.

We really want to help you but there is little we can do if you are under the care of a doctor.

He is doing exactly what we would expect which is the opposite of what we would recommend.

It is what they are taught and the reason why so many people end up on this site.

We are ready to help if you need us.

All the best

 

Sassenach

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Gaebbi

I need you.

i really need you

please tell me what to do!!!

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Gaebbi

Please if anybody can tell me what i can do to feel better tell me! If this holds any longer i don‘t know if i end up killing myself. It‘s not a joke anymore, this is extremely serious. Tell me what to do and I‘ll make it, the doctor can‘t tell me what to do!

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Sassenach
1 minute ago, Gaebbi said:

the doctor can‘t tell me what to do!

What has the doctor said to you?

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manymoretodays

Hi Gaebbi,

 

When did you come off the escitalopram?  Date. And how did you discontinue it?

Dates as well, starting fluoxetine 10 mg.  Dates of increased dose.

 

It's not that the 2 mg of escitalopram could not hold back some underlying panic disorder and depression.  I think you were going a bit too fast with your taper, as well as some inconsistencies with your dosing.  You were experiencing WD when you chose "inpatient psychiatry".

Withdrawal, yes.   Then.  And now.  Continuing. 

None of this now has much to do with any "underlying condition of panic or depression'.

 

I hate to see you continuing with inconsistencies of dosing, and as fluoxetine has a really long half life, it's not going to do much in the way of buffering acute WD, or even post acute withdrawal, until 2 weeks from the time you started it. 

 

And, I don't know if you are, in the meantime, getting more or too much, seratonergic action now.......  something along the spectrum of serotonin syndrome.  As the fluoxetine builds up and the escitalopram goes down.  That's part of the reason why we, suggest, such very small doses to start, when bridging or crossing over, or whatever you might be doing now, while "in psychiatry".   Another reason, is it may, in the long run, be harm reduction, and reduce the time and intensity of healing, from medication dependencies.  Don't know for sure, but very likely......that slow and steady, careful and cautious, wins the race, in this area. 

 

I think you had, at least, the desperation, that led you to the inpatient, in psychiatry before.  It will improve, the desperation.......you know this. 

You get very close attention to symptoms now.   Are you allowed pen and paper, or pencil and paper?   Choose a mantra, or something you can say over and over again to yourself.......something that's brief and positive.  You got this Gaebbi.  More than likely.......acute WD now, from escitalopram has hit with a vengence.  I mean that's what I think. 

 

You don't have to go against your intuition and swallow any doses larger than you want.  You do need to speak calmly, not desperately, to your doctor when you get your time with them. 

 

If I were you I'd go back to 10 mg of fluoxetine with your next dose.  Or 5 mg.   Find your safe place in hospital too.  Supportive staff and peers(other patients) can do wonders too.  Learn coping skills too.  Any movement therapy or other offered?  Outside time? 

 

Best Gaebbi, breathe,  in through nose for a count of 4,  hold for 7, and out again through nose for 8.  Keep working it until you feel a bit calmer.  And can think straight.  This too, will pass.  You got this Gaebbi.  You got this.  ((((Gaebbi))))

 

L, P, H, and G,

mmt

 

 

 

 

Edited by manymoretodays
edited general for clarity, and elaboration and hugs

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Gaebbi

Thank you manymoretodays! A detailed answer will follow in the next hour!

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manymoretodays

Just edited Gaebbi.  No other details needed, with the exception of the facts.  B)  Just the facts.

 

 

 

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Gaebbi

I‘ve already updated my signature with everything I changed the last few days.

 

- last dose of escitalopram 2mg on september 23rd. Cold turkey.

- was switched to 10mgs prozac on september 24th

- updosed to 20mgs prozac september 26th

also I was taking quetiapin on nearly every evening since sept 20th. Mostly 25mg and two times 50mgs. I hope I didn‘t get dependent on those as by now.
yesterday evening and today afternoon was, again, the worst of my life. Can‘t really describe my symptoms yesterday, but today I freaked out. I went to my best friend (i am allowed to leave the psychiatric unit on weekends) and suddenly it hit so incredibly bad that I had to scream and hit my head against the wall few times. It was so bad I felt like blacking out. My forearms and fingers were completely numb and afterwards I was only shaking and couldn‘t talk at all. Haven‘t eaten anything the whole day.

 

So of course that showed me I should listen to you, not to any doctor at all. I hope it‘s not too late for my system to regain its balance..

I just don‘t know how to go on. I won‘t stand symptoms like today for another time.

should I go down to 10 or 5mgs?

and most importantly.. I know that one can‘t really tell the future.. but do you think I will get better in a few days? If yes, how long will it approximately take? If I know I will feel better soon it‘s much easier for me to keep sane during the horrible withdrawals.


I will get psychotherapy soon, also sports therapy, music therapy, work therapy and arts therapy.

the nurses are great and always take their time when I need to talk

I‘m allowed to go outside 4h a day and on weekends. But in my condition I prefer being here.

 

I ended escitalopram 6 days ago. I feel like my horrible experience today was due to the drug being completely out of my system. And because the 20mgs of fluoxetin make me extremely nervous. It‘s just too much, I knew that you were right but I didn‘t listen. I can see where this takes me.

 

If necessary, I made a list of my bad WD symptoms the last few days. Would be too much to write right now, but if you want I can post it!
 

thanks to all of you in this incredibly disastrous time!

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manymoretodays

Can you change your dose, before the doctor gives orders, to the Nurse's who manage the medications?

Are you taking the Prozac/fluoxetine in the morning?

My best guess, and if at all doable, and if it were me, I'd go with the 10 mg fluoxetine and stay put, just stay put with the same dose, same time of day.

 

I came up with 10 mg fluoxetine approximating a 4.5 mg dose of escitalopram.  When you last did a reinstatement or updose, you seemed to level out on 5 mg of escitalopram.   After some time.

 

I don't know how long, Gaebbi, until you level out.  It'll happen sooner, I think, with just sitting with a stable dose for a good while......while your system begins to stabilize.  The 20 mg dose did not go well.  That's a really valid case for a dose reduction now.

 

And go low stimulation for awhile.  If a trip out to a friends was too much, so might be too much activity.  I actually hit a point in hospital after my CT, done in hospital, where I would retreat, when the agitation crept up, to my room, and mummify myself in one of the "bath type blankets".   I suppose it might have prevented some head banging, which I also really felt like doing.   Some kind psych techs were on staff, who would then come and sit on the end of my bed, and read to me, out of a book I had with me.  Just a paragraph.  Inspirational stuff.

 

And yes, fine.  If it helps to elaborate, at the end of your day tomorrow, give us all your symptoms......or even now, if it's not quite lights out time yet there.  As long as it doesn't distress you.  This is your journal page.  I did a lot of entries on mine, early on, and it helped me shift to positive and creative mind and lighten my internal load quite a bit.

 

Sleep tight Gaebbi,  much can be done while we sleep.......and hoping the helpless/ fearful dreams are limited tonight.

 

Edited by manymoretodays
none

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Gaebbi

manymoretodays, i owe you my life! Never would i have thought to get so much help from someone I don‘t even know!

 

yes I can change the dose, that‘s not a problem. And yes, I take it in the early morning. I talked to another doc earlier and he also wanted to lower my dose to 10mg. I didn‘t agree  at first because I wanted to wait for your answer! But in the end, it‘s all voluntarily. I can change doses as I want.

I will take 10mgs and hope to get better in a week. I just hope the fluoxetin will lower my WD symptoms of the escitalopram as soon as it starts working.

right now I‘m better. Panic and derealisation started a few hours ago, but that doesn‘t really bother me anymore. I was able to tell my mother that I love her and that I am extremely thankful that she is always by my side. An hour earlier I couldn‘t really say a single word.

I feel like the fluoxetin very slowly starts to work right now, but I could be wrong. 6 days might not be enough time for it to start working. Most likely I will feel horrible again tomorrow.. But let‘s see. I just hope to get some sleep tonight..

 

nah, if you don‘t need to know my symptoms I won‘t write them down again. Thinking of it may trigger a new bad wave.

 

Thank you for your help! Will keep you updated!
 

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Altostrata

Gaebbi, you need to tell the doctor that you got a bad reaction to 20mg and you want to stick with no more than 10mg.

 

On 9/26/2019 at 1:59 PM, Gaebbi said:

Just a small update, which isn‘t really an update but more of an information.

I won‘t come back to this forum until I‘m better. My problem is that I‘m making myself go crazy with my symptoms. For every symptom I have I‘m searching this forum for somebody other who has similar symptoms, just to feel safe. Because then I know that it‘s from withdrawal. But lately I experienced very weird symptoms that are not listed here. Also I‘m reading too much about switching to prozac and I‘m still concerned about everything. When in reality I know that I would be much better just trusting the doctor and telling myself I‘m gonna be better soon!

 

and don‘t worry about me. Even if some symptoms are absolutely unbearable, I won‘t kill myself or even think about it.

I‘m strong and I couldn‘t do this to my family and friends.

 

So hopefully I will be back in a few days or weeks until I‘m better.

Thanks to all of you, especially you, manymoretodays!!

See ya!

 

Gaebbi, I think we can assure you we have people here who have experienced the same symptoms. We don't usually find them surprising. Rest assured that you have withdrawal syndrome.

 

Please let us know how you're doing as you've taken 20mg for a couple of days and gone back to 10mg. How your symptoms change from day to day will be very informative.

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Gaebbi

Hey Altostrata,

the doctor agreed to go back on 10mg starting today. He said in about 3 days I will be on steady-state and he will measure it in my blood stream to see if I‘m metabolizing it normally.

 

You know, I‘m having wd symptoms for so long now and even made it through benzo wd.. then out of nowhere after staying on the same dose for 8 weeks, there are new symptoms more horrifying than anything I ever experienced. Of course I was scared that it‘s not wd, especially because I have never thought that wd symptoms can be THIS severe.

 

let‘s see how I‘m doing the next days.. last night was the first night in about 3 weeks where I was able to sleep for a long time and it felt so good.. right now I‘m not doing well, but it‘s not as severe as yesterday.

 

Will keep updating!

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Gaebbi

So, update for today.

like I said, I slept extremely well last night, which helped a lot!

started the day with pretty high anxiety levels and circulation problems. Went for a small walk but it didn‘t get better and I had a panic attack at lunch.

later at about 1 pm my best friend came to visit me and we just walked for 3 straight hours. I had high depersonalization and thought I am in a nightmare, but I didn‘t cry and it got a bit better over time.

Later I was lying in bed and felt that terror I was feeling suddenly for weeks now. Feelings of being completely lost and helpless, with no place on this earth where I could feel safe. 
Then my mother came and we went walking for another hour, where my symptoms were pretty severe. Still the feeling of terror and restlessness.

Right now I‘m sitting on the balcony listening to music and writing this text to distract me.

Symptoms are still severe but I can hold on and I think I will stand the night without taking any more Quetiapin.

Wish me luck for the following days!

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Rhiannon

We are all wishing you luck dear Gaebbi.

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Gaebbi

Thank you.. I‘m having the worst depression of my life since shortly after my post yesterday.. it doesn‘t seem to end or get any better..

do you think all my problems will lift in the next days? When the prozac starts to work? Right now I‘m on day 8 and it doesn‘t seem to do anything..

I‘m so desperate right now it kills me

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