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ADMIN NOTE:

Read this entire topic before attempting a switch to fluoxetine. Be sure to read details and cautions below . Consult a knowledgeable medical practitioner before changing medications.

 

Also see Tips for tapering off fluoxetine (Prozac)


Switching or bridging with another related drug, usually of a longer half-life, is a medically recognized way to get off psychiatric drugs, particularly if you find tapering your original drug to be intolerable.

 

Many people with failed tapers from venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil), and duloxetine (Cymbalta) find they need to bridge in order to go off the drug. For many doctors, a switch to Prozac to go off a different antidepressant is routine.

 

Because of the risks of switching drugs -- see below -- we recommend attempting a very gradual direct taper from your drug, with bridging with a different drug only a last resort. There are a lot of unknowns in bridging.
 
Fluoxetine (Prozac) has the longest half-life of any of the modern antidepressants. Because it takes more than a week for a dose to be metabolized completely, a careful taper off fluoxetine is easier for many people -- see information about Tapering off Prozac. And, at least fluoxetine comes in a liquid.

 

(Do not assume fluoxetine is "self-tapering"! We have many people here with Prozac withdrawal syndrome. While going off fluoxetine usually has less risk, one might still develop withdrawal symptoms going off fluoxetine. No bridging strategy is risk-free.)

 

Citalopram (Celexa )and its sibling escilatopram (Lexapro) have half-lives of about 35 hours, a relatively long half-life among SSRIs, and are other candidates for a bridging strategy. They also come in a liquid form.


You must find a knowledgeable doctor to help you to with a bridging strategy. The cross-taper method discussed below is probably the safest way to make a change in drugs. You might wish to print this post out to discuss it with your doctor.


For most people the switch goes smoothly but for some it doesn't. The drawbacks of switching to another drug to get off the first drug, described below, apply to ALL bridging strategies for ALL drugs, including benzodiazepines (where people often want to bridge with diazepam per the Ashton method).

 

Risks of bridging

A bridging strategy has the following drawbacks for a minority of those who try it:

 

  • Dropping the first antidepressant in the switch may cause withdrawal symptoms even though you're taking a bridge drug.
  • Adverse reaction to the bridge drug, such as Prozac.
  • Serotonin toxicity or adverse effects of a drug combination.

  • If withdrawal symptoms are already underway, switching to a bridge drug may not help.
  • A cross-taper requires a number of careful steps.
  • Difficulty tapering off the bridge drug. All of the bridge drugs can be difficult to taper themselves.

 

So, like anything else, a drug switch is not guaranteed to work.

 

When to switch or bridge
"The devil you know is better than the devil you don't know". A direct taper from the drug to which your nervous system is accustomed carries less risk than a switch to a new drug. You may have a bad reaction to the substitute drug, or the substitution may not work to forestall withdrawal symptoms.
 
The risk of a switch is justified if you find a  taper from the original drug is simply too difficult. Usually people will do a switch when they find reducing the original antidepressant by even a small amount -- 10% or even 5% -- causes intolerable withdrawal symptoms. (I have heard doctors say they don't even try tapering off paroxetine (Paxil) or venlafaxine (Effexor ), they switch to Prozac at the beginning of the tapering process.)


If you are having intolerable withdrawal or adverse effects from an antidepressant, it may be worth risking the worst case, which is that a switch to a bridge drug doesn't help and you have withdrawal syndrome anyway.


If you're thinking of switching simply as a matter of convenience, you need to weigh the risks against the amount of convenience you would gain. Generally, switching for convenience is a bad idea.

 

CAUTION: A switch to a bridge drug is not guaranteed to work. It's safer to slow down a taper than count on a switch. A switch really should be used only when a taper becomes unbearable or there are other serious adverse effects from the medication. You must work with a doctor who is familiar with bridging, in case you develop severe symptoms.

 

Overview of cross-tapering method

For drug switches, many doctors prefer cross-tapering, where a low dose of one drug is added and gradually increased while the first drug is reduced. For a period, both drugs are taken at the same time.

 

Here is a graphic representation of cross-tapering:

 

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If you are making a switch to Prozac, the second antidepressant is fluoxetine (Prozac). Given fluoxetine's long half-life, it may take  a couple of weeks to reach full effect. The effect of the amount you add at each stage of the cross-taper will build throughout the process. As it is possible to overshoot Prozac dosage, it's best to be very conservative about increasing fluoxetine throughout the cross-taper, you could end up with serotonin toxicity from too much fluoxetine (see below).

 

Also see this discussion about cross-tapering with Prozac:

 

Serotonin toxicity and serotonin syndrome

You run the risk of serotonin toxicity if you are taking too much serotonergic. Most antidepressants (and some other drugs, such as triptans and MDMA) are serotonergics.

 

Serotonergic effects of antidepressants are added when you take more than one of them, particularly if you add an SSRI (such as Prozac, Celexa, or Lexapro) to an SNRI (such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), venlafaxine XR (Effexor XR), milnacipran (Savella), and levomilnacipran (Fetzima)). (Other types of antidepressants should not be combined with tricyclics or MAOIs.)

 

Symptoms of too much serotonergic can be: Nervousness, anxiety, akathisia, sleeplessness, fast heartbeat. Symptoms of serotonin toxicity can be these plus disorientation, sweating, and others. Serotonin syndrome is even more serious. See Serotonin Syndrome or Serotonin Toxicity Reduction of the drug dose should resolve serotonin toxicity. 

 

Note that if you cross-taper, you will be taking 2 drugs at once for part of the time. Because of the potential of serotonin toxicity by overdosing SSRIs as well as in combination with SNRIs, it's safest to err on the lower side of a Prozac dose "equivalent" -- such as 5mg -- to your original drug. This is why doctors familiar with the Prozac switch will cross-taper by adding an initial LOW DOSE of Prozac to an SNRI.

 

Start low, the effect of fluoxetine will increase over several weeks.

 

Another concern: Escilatopram (Lexapro) is several times stronger, milligram for milligram, than the other SSRIs. If you add 10mg escilatopram to the high dose of 60mg duloxetine (Cymbalta), for example, you run the risk of serotonergic toxicity -- 10mg escilatopram is equal to approximately 20mg-30mg duloxetine.

 

How much fluoxetine (Prozac) to substitute for my drug?

Since fluoxetine's half-life is so much longer than those of other antdepressants, its effect is a little different. It's not a stronger antidepressant, but the effect of each dose lasts much longer. This may be the reason a lower dose of fluoxetine often seems to adequately substitute for other antidepressants.

 

For an idea of equivalent doses of your medication to fluoxetine (Prozac) read this post (January 7, 2018) in this topic. It compares fluoxetine 40mg/day (a fairly high dose of Prozac) to other antidepressants. Source of that data: https://www.ncbi.nlm.nih.gov/pubmed/25911132

 

If you have tapered to a lower dose of an antidepressant, an even lower dose of Prozac may be more tolerable. If you are about half-way down, you might want to try 10mg Prozac. If you have decreased further, you may wish to try 5mg Prozac.

 

If you have substituted fluoxetine for your drug and after two weeks, you feel you have withdrawal symptoms, you may wish to gradually the fluoxetine dosage. After each change in fluoxetine, wait at least 2 weeks to see the effect before deciding on another increase. More is not better for nervous systems sensitized by withdrawal.

EXAMPLES OF THE PROZAC SWITCH
Below is information I've gathered from doctors about how to do the Prozac switch. You will see there is no standard protocol.

Healy 2009 method for the Prozac switch
From Healy 2009 Halting SSRIs withdrawal guidelines:

 

Quote
  • 1A Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid. Seroxat/Paxil 20mg, Effexor 75mg, Cipramil/Celexa 20mgs, Lustral/Zoloft 50mgs are equivalent to 20mg of Prozac liquid. Or 40 mg of Paxil/Seroxat to 40 mg Prozac. The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.
  • Some people may become agitated on switching from Paxil/Seroxat to fluoxetine in which cases one option is take a short course of diazepam until this settles down. Whether this agitation is caused by fluoxetine or because for some people the substitution simply cannot be made may be difficult to determine. If the agitation gets better when the dose of fluoxetine is reduced then its more likely to be caused by fluoxetine, if it gets worse, then it is more likely to be linked to withdrawal.
  • 1B A further option is to convert to a liquid form of whatever drug you are on. Many people cannot change easily from paroxetine tablets to fluoxetine and switching to paroxetine liquid may do the trick instead.
  • 1C Yet another option is to change from paroxetine to a mixture of half the previous dose in the form of paroxetine and the other half in the form of fluoxetine, and then to reduce the dose of paroxetine gradually.

 
Phelps-Kelly 2010 method for Prozac switch
From Clinicians share information about slow tapering (2010)
 

Quote

For any anti-depressant you can add in 20 mg of Prozac, get them off the anti-depressant, then taper the Prozac.

 
Jim Phelps, one of the authors of the above, posted in 2005 in some detail about the so-called "Prozac bridging" strategy. He said it is described in Joseph Glenmullen's book, Prozac Backlash, maybe in the chapter titled of "Held Hostage."
 
The technique Dr. Phelps described in this post skips doses and finishes with alternating dosages, which we do not recommend for people who are sensitive to withdrawal symptoms. Given that fluoxetine liquid is available, this is completely unnecessary.
 
Foster 2012 method for Prozac switch
Dr. Mark Foster, a GP whose mission is to get people safely off psychiatric drugs includes this in a presentation he gives to doctors. http://www.gobhi.org/spring_conference_powerpoints/safewithdrawal_of_psychotropics%5Bautosaved%5D.ppt.
 

Quote

Special Situations: The Prozac Switch

  • For patients that have a hard time withdrawing from other SSRIs (such as Effexor or Paxil), switching to Prozac can be effective bridging.
  • Prozac has the longest half-life and therefore the most gradual withdrawal effects.
  • Start the patient on a low dose of Prozac when severe withdrawal symptoms occur.
  • Wait two to four weeks, and then resume the prior tapering schedule.
  • Once the first SSRI has been stopped, then taper the low dose of Prozac over another 4-8 weeks.

 

 
His method involves overlapping Prozac with the other antidepressant -- cross-tapering.
 
Prey 2012 method for Prozac switch
Another knowledgeable doctor (whom I trust) explained his technique to me (this is the technique I personally would prefer if I had to do it, it seems much gentler)

  • For a "normal" dose of Effexor (150mg per day or more) or Paxil (20mg) or Cymbalta (20mg), he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Effexor. Lower doses of Effexor or other antidepressant require lower doses of Prozac as a "bridge."
  • The lower dose of Prozac reduces the risk of excessive serotonergic stimulation (serotonin toxicity) from the combination of the two antidepressants during the overlap period.
  • 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.
  • Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be easier than tapering off Effexor.

 

Smoothing out a transition to fluoxetine

Even with a cross-taper, your system might feel a jolt after you finally drop the initial antidepressant, particularly if it is an SNRI, such as Effexor, Pristiq, or Cymbalta, or other drug that is not an SSRI like fluoxetine. (Other SSRIs include Paxil, Zoloft, Luvox, Celexa, Lexapro).

 

If you go through a rough patch after the transition, patients find they can take a tiny chip of the original drug (or a bead or two, if it's a capsule containing beads) for a week or two to smooth out the transition. Eventually, you'd take a chip as needed only when you feel a wave of withdrawal from the original drug, and then finally leave the original drug entirely behind.

 

(A gelatin capsule might make a tablet fragment easier to get down, but it is not necessary if you can wash it down with a good swallow of water. The gelatin capsule quickly dissolves in your stomach.)

 

Here's an example. There is no shame in doing this. Whatever works, works.

Edited by Altostrata
updated

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Good question.   I have read that with most ADs, you should wait a minimum of 3 weeks before making the next cut. With Prozac, you might want to wait a minimum of 4 weeks.   Personally, I exp

One thing I just can't work out is this. In the cases of SRNI's it is working on two systems. How does Prozac, cover the effects of withdrawal and brain function that needs to heal? It may cover the pain, but how does it pick up and replace the actual function of noradrenaline? I would be so scared because noradrenaline is involved in the heart beating and other bodily functions. Any ideas? Of course it is tempting, but if it goes wrong it could go wrong horribly.

 

The charity who helps me contacted David Healy and he would only suggest liquid Cymbalta. I wonder why he did not recommend Prozac for me? He had all the details of what had happened to me but did not suggest it, I wonder why?

Sept 2010 - Citalopram 1 day

Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)

Ocober 2010 - Cymbalta 30mg

November 2010 - Cymbalta 60mg

February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg

March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)

March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.

26th June - 26mg

3rd July - 25mg

17th July - 24mg

24th July - 23mg

7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall

24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.

8th Jan 2012 17.8mg (currently reducing 0.2mg a week)

8th Jan 2012 17.6mg last reduction was 6 days ago.

15th Jan 17.4mg

21st Jan 17.2mg

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  • Administrator

Only David Healy could answer that, InNeed.

 

As for how Prozac manages substitution even for SNRIs, nobody knows how that works. Perhaps the actual mechanisms of these drugs are not completely understood.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • Moderator Emeritus

Is it possible for the charity helping you to contact David Healey again and ask those questions for you?? Have you thought about liquid Cymbalta?

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/
Original drug was sertraline/Zoloft, switched to Prozac in 2007.
Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, in July 2013 I reinstated Sertraline (Zoloft) 50mg, feeling better now. 

A few months down the line I switched to 5ml liquid Prozac and tapered down to a compromise dose of 3ml liquid Prozac and have stayed there ever since, no withdrawals and no emotional blunting/loss of libido.

 

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Cymbalta does not come in liquid form. I just got off the phone with Lilly. The pellets have a timed-release coating on them. They cannot be dissolved.

 

I don't know what Dr. Healy was thinking. Something must have gotten lost in translation.

 

Info about Cymbalta tapering http://survivingantidepressants.org/index.php?/topic/283-tips-for-tapering-off-cymbalta-duloxetine/page__p__3034__hl__cymbalta__fromsearch__1#entry3034

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I thought that, but I spoke to a chemist in Wales I think it is called Rosemount(they were in one of Dr Healy's protocol guides, an old one I think) and was told it can be done, but it costs a huge amount. Can't remember how much, around £400 for a months supply. I wonder if they are mistaken, they must be, if Lily themselves say no. It is strange because I wrote to him in February and he suggested imipramine, which my psychiatrist said no way to. The charity wanted to check out if he had any more ideas as things move on all the time, hence why they wrote again. They were worried I lack an enzyme that breaks it down and wanted his input and that is when he suggested liquid Cymbalta saying it was expensive but I should insist upon it. He must have made a mistake.

Sept 2010 - Citalopram 1 day

Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)

Ocober 2010 - Cymbalta 30mg

November 2010 - Cymbalta 60mg

February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg

March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)

March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.

26th June - 26mg

3rd July - 25mg

17th July - 24mg

24th July - 23mg

7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall

24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.

8th Jan 2012 17.8mg (currently reducing 0.2mg a week)

8th Jan 2012 17.6mg last reduction was 6 days ago.

15th Jan 17.4mg

21st Jan 17.2mg

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There's no way to tell where the miscommunication was.

 

The enzyme question involves liver enzymes. If you lack or are weak in a liver enzyme, you are a "poor metabolizer" and may have adverse reactions when you take even a low dose of a drug.

 

I can't see how CITA or Dr. Healy could have supposed you are a poor metabolizer because Cymbalta is metabolized by 2 liver enzymes, not one. It's unlikely you are a poor metabolizer in both enzymes.

 

At any rate, the liquid Cymbalta suggestion is not actionable.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Can I just say, I know a lady who tried to taper off tablets and had terrible results because she used a jewellry scale, but it was really hard to get a consistent reading and she struggled dreadfully. The tablets will be ok to stabilize on for a month or so but when it comes to the taper, you would be much better off with liquid Prozac and a 5ml syringe to get an accurate measurement. For example I was able to go from 5ml to 4.90ml for my first reduction.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/
Original drug was sertraline/Zoloft, switched to Prozac in 2007.
Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, in July 2013 I reinstated Sertraline (Zoloft) 50mg, feeling better now. 

A few months down the line I switched to 5ml liquid Prozac and tapered down to a compromise dose of 3ml liquid Prozac and have stayed there ever since, no withdrawals and no emotional blunting/loss of libido.

 

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Thank you InNeed :)

 

Strawberry, I was just looking at your Prozac timeline. So you've been tapering since 2008? Wow, that's a long time. But, if I have to do that I will. I just want to get far far away from this Paxil and I feel like Prozac will really help. I'm glad you kept a blog.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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I can't exactly remember my Prozac taper... but, Prozac definitely helped me taper off Paxil. I think I started Prozac (20mg) when I had tapered down to around 5mgs of Paxil. At that point I went off the Paxil, and that worked really well for me. Once I was ready, I tapered the Prozac (cutting the pills) with little or no problems. Really can't remember any.

 

I eventually started taking Celexa, but that's a whole other story.

 

 

Charter Member 2011

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Thanks Summer. I'm glad to hear that.

 

Does anyone know why a longer half-life makes withdrawals easier? It seems to me it would just delay the withdrawal symptoms.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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  • Administrator

A longer half-life means it's leaving your body slower, giving your nervous system more time to adapt to the change.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Thanks Summer. I'm glad to hear that.

 

Does anyone know why a longer half-life makes withdrawals easier? It seems to me it would just delay the withdrawal symptoms.

 

Good question.

 

I have read that with most ADs, you should wait a minimum of 3 weeks before making the next cut. With Prozac, you might want to wait a minimum of 4 weeks.

 

Personally, I experienced hell with Prozac cold turkeys which supposedly doesn't happen due its long half life. Another story.

 

In spite of these questions and concerns, if I was having the experience from hell in tapering off of my current AD and there was no hope for improvement, I would take the risk and cross taper to Prozac.

 

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Temazepam on a PRN basis approximately twice a month - 2014 to 2016

Beginning in 2017 - Consumption increased to about two times per week

April 2017 - Increased to taking it full time for insomnia

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Strawberry, how exactly did you do the switch? I mean go off the Lustral after you started liquid Prozac.

 

Here's the thing:

 

Nobody knows exactly how the Prozac makes up for the disappearance of the other drug. It's just known to work sometimes.

 

As I understand it, you go off the first drug fairly soon after starting the Prozac. I'm thinking that's while your brain is still "lifted up" by the new drug.

 

My worry is that if you wait too long, you lose the element of surprise. Your brain accommodates to the combination of your first antidepressant and Prozac, and then you still have problems withdrawing from the first drug.

 

Some doctors call this a "cross-taper" and as far as I know, it's done in a short amount of time.

 

I won't be able to confirm this for 10 days, when I talk to a doctor who knows this method very well.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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Strawberry, how exactly did you do the switch? I mean go off the Lustral after you started liquid Prozac.

 

Here's the thing:

 

Nobody knows exactly how the Prozac makes up for the disappearance of the other drug. It's just known to work sometimes.

 

As I understand it, you go off the first drug fairly soon after starting the Prozac. I'm thinking that's while your brain is still "lifted up" by the new drug.

 

My worry is that if you wait too long, you lose the element of surprise. Your brain accommodates to the combination of your first antidepressant and Prozac, and then you still have problems withdrawing from the first drug.

 

Some doctors call this a "cross-taper" and as far as I know, it's done in a short amount of time.

 

I won't be able to confirm this for 10 days, when I talk to a doctor who knows this method very well.

 

I didn't think of that. I planned on taking my time. I'm glad you said something. Do you think this applies to the amount of time you spend on titrating up?

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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I didn't do any cross taper, I just switched from Lustral one day to equivalent dose Prozac the next day and miraculously that worked, strangely I was always able to switch from one SSRI to another no problem, just couldn't get off the bloody things!

I don't know if this would work for everyone though, sorry that wasn't much help?

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/
Original drug was sertraline/Zoloft, switched to Prozac in 2007.
Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, in July 2013 I reinstated Sertraline (Zoloft) 50mg, feeling better now. 

A few months down the line I switched to 5ml liquid Prozac and tapered down to a compromise dose of 3ml liquid Prozac and have stayed there ever since, no withdrawals and no emotional blunting/loss of libido.

 

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Yes, I think the switch is like changing a tire: you jack up the car, then pull the tire out.

 

Or I hope this is the case!!!! As I said, I won't be able to ask a knowledgeable doctor for a week. But that will be enough time to get back to you, Shanti.

 

I know that after suffering horrible withdrawal symptoms, it can be scary thinking about just dropping the offending drug.

 

As we discussed, Shanti, you might consider coming off Paxil in 4 steps, but rather quickly. In consultation with your doctor, of course.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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One thing I just can't work out is this. In the cases of SRNI's it is working on two systems. How does Prozac, cover the effects of withdrawal and brain function that needs to heal? It may cover the pain, but how does it pick up and replace the actual function of noradrenaline? I would be so scared because noradrenaline is involved in the heart beating and other bodily functions. Any ideas? Of course it is tempting, but if it goes wrong it could go wrong horribly.

 

The charity who helps me contacted David Healy and he would only suggest liquid Cymbalta. I wonder why he did not recommend Prozac for me? He had all the details of what had happened to me but did not suggest it, I wonder why?

 

 

T I am disappointed that Healey isn't aware of that there is no liquid Cymbalta, and because it is extended release, compounding pharmacists cannot work with it by grinding it.

 

1989 - 1992 Parnate* 

1992-1998 Paxil - pooped out*, oxazapam, inderal

1998 - 2005 Celexa - pooped out* klonopin, oxazapam, inderal

*don't remember doses

2005 -2007   Cymbalta 60 mg oxazapam, inderal, klonopin

Started taper in 2007:

CT klonopin, oxazapam, inderal (beta blocker) - 2007

Cymbalta 60mg to 30mg 2007 -2010

July 2010 - March 2018 on hiatus due to worsening w/d symptoms, which abated and finally disappeared. Then I stalled for about 5 years because I didn't want to deal with W/D.

March 2018 - May 2018 switch from 30mg Cymbalta to 20mg Celexa 

19 mg Celexa October 7, 2018

18 mg Celexa November 5, 2018

17 mg Celexa  December 2, 2019

16 mg Celexa January 6, 2018 

15 mg Celexa March 7, 2019

14 mg Celexa April 24, 2019

13 mg Celexa June 28, 2019

12.8 mg Celexa November 10, 2019

12.4 Celexa August 31, 2020

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I know that Altostrata on here said it can't be done, the charity rang Eli Lily to check today as they usually follow David Healys advice. As I expected, no, it can't be done.

Sept 2010 - Citalopram 1 day

Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)

Ocober 2010 - Cymbalta 30mg

November 2010 - Cymbalta 60mg

February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg

March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)

March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.

26th June - 26mg

3rd July - 25mg

17th July - 24mg

24th July - 23mg

7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall

24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.

8th Jan 2012 17.8mg (currently reducing 0.2mg a week)

8th Jan 2012 17.6mg last reduction was 6 days ago.

15th Jan 17.4mg

21st Jan 17.2mg

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I phoned Lilly myself some time back, asked about liquid Cymbalta, and posted what I found on this site in several places. No, there is no liquid Cymbalta.

 

Either Dr. Healy erred, CITA misunderstood him, or CITA misspoke and said InNeed was on citalopram instead of Cymbalta.

 

It's quite easy to phone any pharmaceutical company to get details like this, and I urge everyone on this site to do this if they have any questions about the forms a medication comes in.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 2 weeks later...
  • Administrator

Yes, I think the switch is like changing a tire: you jack up the car, then pull the tire out.

 

Or I hope this is the case!!!! As I said, I won't be able to ask a knowledgeable doctor for a week. But that will be enough time to get back to you, Shanti.

 

I know that after suffering horrible withdrawal symptoms, it can be scary thinking about just dropping the offending drug.

 

....In consultation with your doctor, of course.

 

I checked with a knowledgeable doctor and he confirmed the "changing tires" metaphor. To do the Prozac switch, you quit the offending drug (Paxil, Effexor, Pristiq, Cymbalta, etc.) fairly soon after starting Prozac -- within 2 weeks.

 

Any longer than 2 weeks, you run the risk of your nervous system accommodating to the combination of the two antidepressant. He said if this happens, you lose the advantage of the Prozac boost and you could have difficulty tapering off both of them. He also was concerned about excessive serotonergic stimulation from taking two antidepressants together.

 

He said he's seen it frequently that people manage to taper about half-way off Paxil, Effexor, Pristiq, Cymbalta, etc. and get stuck, any further reductions in dosage causing unacceptable withdrawal symptoms. That's when he does the Prozac switch, with a half-dose (10mg) of Prozac.

 

Please be aware the Prozac switch has these drawbacks for a minority of those who try it:

  • Adverse reaction to Prozac
  • Switch causes withdrawal symptoms on its own
  • If withdrawal symptoms are already underway, switching to Prozac doesn't help
  • Difficulty tapering off Prozac

More information at http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/page__view__findpost__p__13616

 

Please consider this in consultation with your doctor, of course.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I thought it would be a good time for an update on my Prozac switch.

 

The switch was easy and without incident at all. I was doing great until I went from 20 mg Prozac to 16 mg. It was too big a drop. I didn't have severe symptoms though. Only some zaps upon sleep. I updosed to 18 mg Prozac and am fine now. I have to taper a bit more slowly off the Prozac than I thought I would. I didn't have any mood changes, no depression or anxiety.

 

One thing that bothers me is that I have had tinnitus but it started just before the Prozac switch. This hasn't gone away. I pray it isn't permanent.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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That is such good news, Shanti.

 

You might want to stabilize on Prozac for a bit, then think in terms of decreasing it 1mg at a time, or less if you get any withdrawal symptoms at all. Remember, your system has gone through a lot of stress!

 

The tinnitus may be a legacy of the Paxil withdrawal symptoms. All the more reason to go very slowly with any more changes in your nervous system balance.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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I am seconding Alostrata's comment, it would be best to stabilize on the Prozac first, in my experience there really is no such thing as too slow, even with Prozac. Trying to work out the maths as over here in the UK I measure it from a starting dose of 5ml. I think 20mg to 18mg. you've dropped by 1/10th, which is still a biggish drop (well for me it would be).

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/
Original drug was sertraline/Zoloft, switched to Prozac in 2007.
Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, in July 2013 I reinstated Sertraline (Zoloft) 50mg, feeling better now. 

A few months down the line I switched to 5ml liquid Prozac and tapered down to a compromise dose of 3ml liquid Prozac and have stayed there ever since, no withdrawals and no emotional blunting/loss of libido.

 

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Okay. I'm taking both your advice. I wanted to hurry off of Prozac. But yeah, I need to let my CNS rest. I'll stay on 20 mg a little longer then go slow drops. At least I'm far away from that horrid Paxil. I feel like I'm on the lesser of two evils now. Or the evil of two lessers lol.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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My tinnitus is gone! Thank God! I haven't had it for 2 days now. I'm sure it was left over from the Paxil now.

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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  • 4 months later...

Now if Only I can get her to switch me from Xanax to Valium. I'll find out tomorrow. That's another story unrelated to ad.

 

I wanted to post an update on my Prozac switch. I am so grateful to have learned of this option here! It has been hundreds of times easier to taper off the Prozac than it was trying to taper even by 1 mg below 20 mg of Paxil. I have motivation and feel hope for my future. I'm not done yet, but I'm very close and I feel good :)

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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  • 2 weeks later...

Hello everyone,

 

I'm new to the forum but wanted to let you know that I successfully switched to Prozac from Sertraline. I was taking 100 mg Sertraline to begin with, then down to 50 mg each day, then 25 mg. I then explained to my doctor what I wanted to do and then managed a straight switch to 20 mg Prozac with no overlap. I had no withdrawal symptoms from the Sertraline. I put the success of this switch down to tapering off the first drug as much as possible to begin with and then switching to an equivalent dose of Prozac with no overlap between the two drugs. I think 20 mg Prozac is roughly equal to 10 mg Sertraline. I then stabilised on the Prozac and am now on my second withdrawal attempt from that. I hope this is helpful!

 

electron

Currently withdrawing from fluoxetine after a switch from sertraline.
04/12-12/12 5.0-0.9 ml
30/01/13 - 0.88 ml     29/08/13 - 0.72 ml     21/11/13 - 0.66 ml     16/04/14 - 0.63 ml     29/03/15 - 0.58 ml
22/02/13 - 0.86 ml     12/08/13 - 0.74 ml     04/12/13 - 0.64 ml     21/11/14 - 0.62 ml     08/05/15 - 0.57 ml
14/05/13 - 0.84 ml     25/09/13 - 0.72 ml     19/12/13 - 0.62 ml     26/12/14 - 0.61 ml     23/05/15 - 0.56 ml

11/06/13 - 0.80 ml     13/10/13 - 0.70 ml     31/12/13 - 0.63 ml     23/01/15 - 0.60 ml

06/07/13 - 0.76 ml     07/11/13 - 0.68 ml     06/01/14 - 0.64 ml     08/03/15 - 0.59 ml

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Altostrata

20mg Prozac, considered to be the usual adult dose, is equivalent to the usual adult dose of 50mg sertraline.

 

Good to hear this worked for you, electron! Please let us know how you're doing in your topic http://survivingantidepressants.org/index.php?/topic/2168-electron-tapering-off-prozac

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 5 weeks later...

RE; The Prozac Bridge, would a safer method be to take 5mg with your current dose for a week. Then increasing to 10mg for the second week and decreasing your current AD to half current dose. Then just drop the current AD completely, after the second week?

 

So..

 

Week 1: 5mg Prozac + 37.5mg Effexor (for example)

Week 2: 10mg Prozac + 18.75mg Effexor

Week 3: 10mg Prozac

 

The smaller starting dose would allow you to assess how Prozac affects you before going up to the full dose, plus the smaller dose of Prozac during the first week, and smaller dose of current AD in second week, could prevent any complications from too much serotonin (serotonin syndrome, etc).

2003-2011: Paroxetine,Citalopram,Effexor; Aug/Sept 2011: Effexor to Mirtazapine; Oct 2011: C/T Mirtazapine back to Effexor; Nov/Dec 2011: Fast Tapered Effexor - w/d hell; Feb 2012: Reinstated Effexor 37.5mg; June 2012: Dropped to 35.6mg; Jan 2016: Propranolol 2.5mg per day for general anxiety; Feb 2016: Finasteride 0.25mg per week to slow hair loss; 18th May - 8th June 2019: Started Vyvanse 7.5mg and increased by 7.5mg weekly to 30mg (lowest “therapeutic” dose for adults).; 21st June 2019 - 12th July: Cross tapered from venlafaxine brand Rodomel to Efexor (1/4 > 1/2 > 3/4 weekly before ditching Rodomel); 13th July 2019: Cut Vyvanse dose to 15mg; 15th July 2019: Akathisia returned after years of being free; 16th July 2019: Went back up to Vyvanse 30mg

Supplements: Omega-3, Vitamin D, Zinc, Phosphatidylserine 

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jr, I moved your post here, with the accumulated wisdom about the Prozac switch.

 

That method is called cross-tapering and it's the way I've heard some doctors describe they do it.

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

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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  • 3 weeks later...

Those of you who made the switch to Prozac - were you still having w/d symptoms on your previous AD before you switched, or did you wait until you were completely stable before switching?

2003-2011: Paroxetine,Citalopram,Effexor; Aug/Sept 2011: Effexor to Mirtazapine; Oct 2011: C/T Mirtazapine back to Effexor; Nov/Dec 2011: Fast Tapered Effexor - w/d hell; Feb 2012: Reinstated Effexor 37.5mg; June 2012: Dropped to 35.6mg; Jan 2016: Propranolol 2.5mg per day for general anxiety; Feb 2016: Finasteride 0.25mg per week to slow hair loss; 18th May - 8th June 2019: Started Vyvanse 7.5mg and increased by 7.5mg weekly to 30mg (lowest “therapeutic” dose for adults).; 21st June 2019 - 12th July: Cross tapered from venlafaxine brand Rodomel to Efexor (1/4 > 1/2 > 3/4 weekly before ditching Rodomel); 13th July 2019: Cut Vyvanse dose to 15mg; 15th July 2019: Akathisia returned after years of being free; 16th July 2019: Went back up to Vyvanse 30mg

Supplements: Omega-3, Vitamin D, Zinc, Phosphatidylserine 

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I was somewhat stable at 20 mg of Paxil before I did the switch. I got stuck at 20 mg Paxil during my Paxil taper. Every time I tried to go below 20 I'd get bad symptoms. So, yes, I'd say I got pretty stable at 20 mg before switching. I wasn't totally stable, as I was still healing from the taper from 40 to 20. But only mildish symptoms like tinnitus and feeling out of whack. But not brain zaps and harsh symptoms. I'm trying to recall how I felt but it's blurry :(

Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.

Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)

My Paxil Website

My Intro

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strawberry17

Yes I think I made sure I was stable before I switched.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/
Original drug was sertraline/Zoloft, switched to Prozac in 2007.
Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, in July 2013 I reinstated Sertraline (Zoloft) 50mg, feeling better now. 

A few months down the line I switched to 5ml liquid Prozac and tapered down to a compromise dose of 3ml liquid Prozac and have stayed there ever since, no withdrawals and no emotional blunting/loss of libido.

 

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Has anyone switched from Mirtazapine (remeron) to Prozac? Or from an AD that was in a different class to Prozac. Am thinking about this but am nervous

that I will still have withdrawal effects due to the different mechanisms of action between Mirtazapine and Prozac.

 

dalsaan

Please note - I am not a medical practitioner and I do not give medical advice. I offer an opinion based on my own experiences, reading and discussion with others.On Effexor for 2 months at the start of 2005. Had extreme insomnia as an adverse reaction. Changed to mirtazapine. Have been trying to get off since mid 2008 with numerous failures including CTs and slow (but not slow enough tapers)Have slow tapered at 10 per cent or less for years. I have liquid mirtazapine made at a compounding chemist.

Was on 1.6 ml as at 19 March 2014.

Dropped to 1.5 ml 7 June 2014. Dropped to 1.4 in about September.

Dropped to 1.3 on 20 December 2014. Dropped to 1.2 in mid Jan 2015.

Dropped to 1 ml in late Feb 2015. I think my old medication had run out of puff so I tried 1ml when I got the new stuff and it seems to be going ok. Sleep has been good over the last week (as of 13/3/15).

Dropped to 1/2 ml 14/11/15 Fatigue still there as are memory and cognition problems. Sleep is patchy but liveable compared to what it has been in the past.

 

DRUG FREE - as at 1st May 2017

 

>My intro post is here - http://survivingantidepressants.org/index.php?/topic/2250-dalsaan

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Switching from Effexor to mirtazapine didn't work for me. I had withdrawals which appeared as moments of rage and suicidal thoughts. It was very bad. I was able to switch between other antidepressants, but they were all ss/snri's. So I suspect the mechanism does make a difference. I wouldn't risk it.

2003-2011: Paroxetine,Citalopram,Effexor; Aug/Sept 2011: Effexor to Mirtazapine; Oct 2011: C/T Mirtazapine back to Effexor; Nov/Dec 2011: Fast Tapered Effexor - w/d hell; Feb 2012: Reinstated Effexor 37.5mg; June 2012: Dropped to 35.6mg; Jan 2016: Propranolol 2.5mg per day for general anxiety; Feb 2016: Finasteride 0.25mg per week to slow hair loss; 18th May - 8th June 2019: Started Vyvanse 7.5mg and increased by 7.5mg weekly to 30mg (lowest “therapeutic” dose for adults).; 21st June 2019 - 12th July: Cross tapered from venlafaxine brand Rodomel to Efexor (1/4 > 1/2 > 3/4 weekly before ditching Rodomel); 13th July 2019: Cut Vyvanse dose to 15mg; 15th July 2019: Akathisia returned after years of being free; 16th July 2019: Went back up to Vyvanse 30mg

Supplements: Omega-3, Vitamin D, Zinc, Phosphatidylserine 

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  • Altostrata changed the title to The Prozac switch or "bridging" with fluoxetine

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