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stellar: Delayed fluoxetine withdrawal?


stellar

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Hi everyone,

I have a history of long-term antidepressant use going back to when I was 13, and have wrestled with devastating health issues for the last 8 years.

 

Recently, I have come to suspect that my serious GI issues / IBS (bloating, sharp abdominal pain, generalized cramping/pain) are a delayed reaction to SSRI withdrawal. I first tapered quickly off of citalopram in 2016 and the symptoms came on a month later. I then went back on fluoxetine (symptoms mostly resolved) and conducted a 9-month taper under the guidance of a psychiatrist going from 20mg of fluoxetine to 10mg, 5mg, and then ramping down off the 5 with every other day. It has been 9 months since my last dose, and just a week ago my GI symptoms have returned.

I was also diagnosed with chronic fatigue syndrome in 2010, a few months after reducing my 40mg of fluoxetine to 20mg.

It's hard to tell what is related to the SSRIs and what isn't; there is so much information out there about CFS and IBS it is overwhelming and impossible to sort through it all. My questions for folks who have had or read of similar experiences are:

 

  1. Is it really possible that the GI issues are withdrawal, even though they began 9 months after my last dose of fluoxetine on a relatively long taper (though not the 10% method, which I didn't know about at the time)?
    1. If so, would it be more beneficial at this point to go back on a low dose of fluoxetine and try an even slower taper from that, or to try to ride it out for however many months or years it may take?
  2. Has anyone ever heard of chronic fatigue syndrome coming on from a history of SSRIs (even if not strict withdrawal, as it came on while I was still taking them), and if so if energy returns after a true withdrawal?

 

Thank you so much.

Long-term SSRI use since age 13, ongoing on-and-off usage since age 20.

 

2003-2015 various SSRIs and SNRIs including fluoxetine (primarily, 40-80mg), buproprion, citalopram, duloxetine, escitalopram; trazadone 100mg

2010 fluoxetine 20mg; trazadone 50mg

2015 citalopram 20mg; trazadone 50mg

2016 rapid taper off citalopram (20-0 within 2-3 weeks); trazadone 50mg

2017 fluoxetine 20mg; trazadone 50mg

2017-2018 slower taper off fluoxetine (20-10-5-alt-0); trazadone 50mg

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  • ChessieCat changed the title to stellar: Delayed withdrawal? and questions
  • Moderator Emeritus

Hello, Stellar, and welcome to SA. 

 

I think you are wise to suspect SSRIs and withdrawal for your health issues. 

 

On 8/14/2018 at 7:49 AM, stellar said:

Recently, I have come to suspect that my serious GI issues / IBS (bloating, sharp abdominal pain, generalized cramping/pain) are a delayed reaction to SSRI withdrawal. I first tapered quickly off of citalopram in 2016 and the symptoms came on a month later. I then went back on fluoxetine (symptoms mostly resolved) and conducted a 9-month taper under the guidance of a psychiatrist going from 20mg of fluoxetine to 10mg, 5mg, and then ramping down off the 5 with every other day. It has been 9 months since my last dose, and just a week ago my GI symptoms have returned.

 

Even if the taper was 9 months, it sounds like your prescriber was still taking you off really fast, if the rate was 20-10-5, and the very alarming "every other day," which is very destabilizing to the nervous system. 

The timing of onset of symptoms is very suspicious. I don't think you would just suddenly develop IBS unrelated to a fast taper of a powerful drug. 

 

The good news: If it's withdrawal, it will heal as the nervous system repairs itself. So yes, it is likely that energy will return when your system heals. : ) Feel free to peruse the Success Stories section for similar cases.

 

This list of SSRI withdrawal symptoms will confirm that fatigue and GI issues are indeed withdrawal symptoms: https://www.survivingantidepressants.org/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

 

Prozac does have a tendency for delayed withdrawal, so even though it was 9 months since your last dose, withdrawal showing up that much later is actually quite common with that drug.

 

What have you been able to do to cope with these symptoms? There is a great self-care section here on this forum. Many people do better with magnesium and fish oil, but it's important to start small, especially with a sensitive GI system. More info: https://www.survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

We recommend keeping daily notes on paper about your daily symptom pattern. Doing so can help find patterns and see what self-care strategies are working best. 

Edited by SkyBlue
typo

Current: 2019: 0.04 mg Paxil!! This is real. Soon, after taking Paxil my entire adult life, I will be free.

Long story short: After 18 years on Paxil, "tapered" almost completely off over a month, at doctor's advice in July 2015.

Self-care includes magnesium, reasonable exercise, mindfulness, this forum and nutrition/eating enough food.

Also on 100 mg Zoloft unfortunately!! (which I now will have the knowledge to taper properly)

-------------------------------------------------------------------------------------------

Longer version: On Paxil since 1996--anxiety & depression caused by (undiagnosed) under-eating / eating disorder.

Doctor kept increasing dose, up to 60 mg; it never really helped but said it really was the best "med" for me.

Rapid doctor-led "taper" July 2015, down to 5 mg, with Zoloft as a "cross-taper" = Essentially a cold turkey. 

Severe withdrawal but didn't know it; believed it was my "underlying condition," and kept tapering, 5mg to 4 to 3  to 2 to 1.  

Feb 2016: Found SA! As of June 2016, tapering from 1mg at rate of 5-10% per month, Brassmonkey Slide! 

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  • Moderator Emeritus

 

Here is specific info on https://www.survivingantidepressants.org/topic/759-tips-for-tapering-off-prozac-fluoxetine/

 

To help us out, please fill out a drug history signature using these instructions: https://www.survivingantidepressants.org/topic/18343-please-put-your-withdrawal-history-in-your-signature/

 

You asked about reinstatement. Here is a thread on that topic (first page is most important): https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

 

 

 

 

 

Current: 2019: 0.04 mg Paxil!! This is real. Soon, after taking Paxil my entire adult life, I will be free.

Long story short: After 18 years on Paxil, "tapered" almost completely off over a month, at doctor's advice in July 2015.

Self-care includes magnesium, reasonable exercise, mindfulness, this forum and nutrition/eating enough food.

Also on 100 mg Zoloft unfortunately!! (which I now will have the knowledge to taper properly)

-------------------------------------------------------------------------------------------

Longer version: On Paxil since 1996--anxiety & depression caused by (undiagnosed) under-eating / eating disorder.

Doctor kept increasing dose, up to 60 mg; it never really helped but said it really was the best "med" for me.

Rapid doctor-led "taper" July 2015, down to 5 mg, with Zoloft as a "cross-taper" = Essentially a cold turkey. 

Severe withdrawal but didn't know it; believed it was my "underlying condition," and kept tapering, 5mg to 4 to 3  to 2 to 1.  

Feb 2016: Found SA! As of June 2016, tapering from 1mg at rate of 5-10% per month, Brassmonkey Slide! 

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  • SkyBlue changed the title to stellar: Delayed fluoxetine withdrawal?

Thanks so much for the excellent thoughts and references! I agree that the gastro symptoms seem pretty clearly related. The material on reinstatement is interesting - I may suggest that to my prescriber as she seemed open-minded about experimenting with tapering in the past. But I fear that if this is all withdrawal related it will draw out the recovery period, since I have already been off for 9 months.

 

My biggest question is: I don't know whether it's better to taper slowly and be on the meds longer or push through at this point - would reinstatement and a true taper would be a better path?

It's less clear if the decade of chronic fatigue is related, as it doesn't disappear when I am back on a full dose of SSRIs, but re-stabilizing and tapering to manage the GI symptoms would eventually allow me to be off of them for longer and test that hypothesis, I suppose. Feels like that could take years. To add confusion, other doctors have suggested it could be chronic Lyme disease, so it's hard to know how everything interacts.

I have taken magnesium for anxiety/sleep issues and it didn't seem to make much of a difference; mostly I am focused on meditation and stress reduction as I am afraid to experiment with too many supplements for fear of making the gastro issues worse. I will definitely be reviewing more of the self-care material, though!

Long-term SSRI use since age 13, ongoing on-and-off usage since age 20.

 

2003-2015 various SSRIs and SNRIs including fluoxetine (primarily, 40-80mg), buproprion, citalopram, duloxetine, escitalopram; trazadone 100mg

2010 fluoxetine 20mg; trazadone 50mg

2015 citalopram 20mg; trazadone 50mg

2016 rapid taper off citalopram (20-0 within 2-3 weeks); trazadone 50mg

2017 fluoxetine 20mg; trazadone 50mg

2017-2018 slower taper off fluoxetine (20-10-5-alt-0); trazadone 50mg

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  • Administrator

Hello, stellar.

 

We always urge a slow taper rather than "pushing through" unless you have life-threatening adverse effects from the drug. What is your taper schedule now?

 

If Lyme disease is in the mix, it could be your chronic fatigue symptoms are from an underlying medical condition. They could also be related to withdrawal syndrome. It's hard to tell without a detailed timeline showing when the symptoms emerged. I'm sorry this is all so vague but the nervous system is still a mystery to doctors.

 

Please see Important topics about symptoms, including sleep problems

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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That's very helpful, thank you. I am currently not on a taper schedule as I completed my last taper 9 months ago, but that taper was much more of a stair-step than a real taper (going from 20 - 10 - 5 - 2.5 / every other day) so it sounds like it may make sense to reinstate and attempt the real 10% taper.

Long-term SSRI use since age 13, ongoing on-and-off usage since age 20.

 

2003-2015 various SSRIs and SNRIs including fluoxetine (primarily, 40-80mg), buproprion, citalopram, duloxetine, escitalopram; trazadone 100mg

2010 fluoxetine 20mg; trazadone 50mg

2015 citalopram 20mg; trazadone 50mg

2016 rapid taper off citalopram (20-0 within 2-3 weeks); trazadone 50mg

2017 fluoxetine 20mg; trazadone 50mg

2017-2018 slower taper off fluoxetine (20-10-5-alt-0); trazadone 50mg

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