The Prozac switch or "bridging" with fluoxetine

[Altostrata]

Prozac is used as a bridge for all classes of antidepressants, including SNRIs. How this works, I don't know.

 

Doctors will substitute Prozac for an antidepressant when withdrawal symptoms appear, so the switch isn't always done when the person is stable but to relieve severe withdrawal.

[electron]

I was stable before I did my switch but I imagine this technique would be beneficial to anyone having w/d symptoms on another SSRI.

 

Also, glad to hear your withdrawal went well, Shanti!

[jr1985]

Do you think Prozac or Effexor would be more likely to cause anxiety/akathisia?

 

I'm tempted to ask my Dr for Prozac next week, but I'm guessing that may not be the best course of action. I've been able to switch Paxil->Lexapro->Effexor by just stopping the old one and starting the new one the next day, and had no problems. However, after I fast tapered Effexor and went on mirtazapine I went nuts, so I tried Zoloft for a week, which made me feel overstimulated. Then I tried Celexa for a week, which also made me overstimulated and caused akathisia. Eventally I went back on Effexor, which caused overstimulation/akathisia in the beginning but it eventually got better, although mild akathisia still remains.

 

I suspect I had problems switching from the effexor because I had already fast tapered and was in full w/d mode. If I had switched from one to the other immediately it may have gone smoother. That's why I think if I stay on Effexor until I'm as stable as possible and do an immediate switch, or fast cross taper, things are more likely to go smoothly. Trouble is I don't know if the symptoms I have are w/d or side effects. If they're side effects then it feels like I'm wasting time staying on Effexor when I could try Prozac now. OTOH, if it's w/d then staying put is the best course of action. I'm very impatient

[Altostrata]

Your system may have become sensitized by all the drug switching and particularly the adverse reactions.

 

Your reaction to a switch to Prozac cannot be predicted. Note that some methods recommend a lower dose of Prozac, which is less likely to cause an adverse reaction or serotonin syndrome when overlapped with your current medication.

[peggy]

I would be way too scared to try switching to prozac if i was stable incase it induced withdrawal and too impatient to switch if i was in withdrawal - better the evil you know is my motto!

[jr1985]

jr, if you're wanting to come off ADs altogether, it is probably easier with Prozac. It's what I'm currently doing and I haven't found it too bad.

 

Well that's what I think too but I'm afraid it might make things worse. I'm going to hold on Effexor for now until my paresthesia/akathisia and jaw tremors go away (assuming they will eventually).

[Skyler]

Electron

 

I am following this topic as I am in the process of coming off Effexor with Flox. (my abbrev.). Thanks for the encouragement.

It is my goal to get off A.D. meds and hopefully learn to live so I don't require meds. I see you have been decreasing by 2 ML per week.

 

Hi amg.. that would be .4mls. He has usually been cutting the dose by .2 mls. He was able to cut .4 mls this time round because he held for a longer. You are better to keep to a consistent cut for each drop until you get more experience. Try to stabilize where you are for now. Cut sizes vary depending on how our nervous system responds.

[amg2012]

Schuyler

 

Thanks for bringing the .2 mls cut to my attention. Yes, I will wait til I stabilize before I consider cutting anything further at this time.

 

Feel pretty crappy at the moment and feel like summer is passing me by and summers are way to short for that. Still have not gone off the property - 8 days now.

 

When I wake in the morning - and I am sleeping well since I went to Flox. from Venfx. (thank goodness for this)... anyway my body feels terrible in the morning particularly.....feels like I have a horrible flu. Headaches have dissipated since I made the switch over too. So, should I look and the improvement in sleep and less headache as a positve due to the siwtch or is this just due to progression period?

[Altostrata]

The Prozac is taking effect. That's good.

[Gladstone]

I asked this in my intro thread but I wanted to ask again.If we are helped to switch to prozac for withdrawls, why don't the doctors forget the other SSRI's and usually just prescribe prozac? I fear doctors/pharmacy reps have a host of reasons, but the main one may well be M-O-N-E-Y.

[Altostrata]

Good question, and the right answer.

[jr1985]

Are there many on this forum who tried to switch to Prozac and failed? What happened?

[Altostrata]

You might search for Prozac in the Intros forum and post what you find here.

[jr1985]

I had a quick look. Seems one person failed because she didn't overlap the old with the new. Another failed because they tapered off their old AD too quickly, had w/d symptoms, then tried to stop them with Prozac.

 

I guess it comes back to the advice alto gave in the OP - overlap them for a week or so and do it before w/d from the old AD starts.

 

The majority of people who came up in the search made the transition successfully.

[Shanti]

Thank Electron! I'm glad it's working for you too. I'm still doing fine. In fact, getting better every day. Even in the last month I've had a cortisol injection and tubaligation with anathesia, and all went well.

 

Someone had written to me asking exactly how I did the switch. I'll just paste what I wrote to her in case anyone wants to see clarification of my signature in how I switched. However, check with your doctor.

 

11/22/11 - 20 mg Paxil + 5 to 20 mg Prozac titrate.

12/03/11 - 20 mg Prozac

 

I can tell you that I did it in just a few weeks. I stayed at 20 mg Paxil and started at 5 mg. of Prozac, increasing it 5 mg a week until I was at 20 mg Prozac and 20 mg Paxil. Then I simply dropped the Paxil. Then I stabilized on the Prozac for a couple of months at 20 mg to give my CNS time to adjust. Then you can see my taper from there on my signature.

[amg2012]

In Ontario, Canada seniors (65 +) pay only a $100./year deductible for most prescriptions then after that just pay the processing fee which is just a few dollars. Unfortunately the liquid Prozac is not covered.... so I have informed my doctor of the situation and received a prescription for the 20mg capsules which are covered. I know I saw a formula by a doctor on this site for mixing one's own liquid... can you guide me to it, please. Also, has anyone here mixed the powder simply with water? Is it awful tasting - what else can I mix it with? (Actually I find the liquid Prozac very, very sweet). I will not be getting the caps for awhile so no hurry on this.

 

P.S. Liquid Fluoxetine cost me $80., the capsules with our seniors program will cost less than $5.

[Shanti]

Shanti, thanks for posting your cross taper. Can I ask how you felt when you were taking Paxil and Prozac at the same time? How does Prozac feel? Do you notice it being more stimulating than Paxil?

 

 

First I made sure I was stable and not having rough symptoms on the Paxil, at the 20 mg dose. When I added the Prozac, and even when I was on 20 mg Paxil with 20 mg. of Prozac, I didn't feel any side effects. I think that since I was stuck at 20 mg of Paxil for quite some time, that is a low dose so having the 20 mg of Prozac didn't cause over stimulation and side effects. I think my system did pretty well with the Prozac, and no side effects, thank God.

[jr1985]

amg2012, I've read some people dissolve it in cranberry juice ("Cranzac").

[Altostrata]

jr, you may want to take a much lower Prozac dosage because of your hypersensitivity.

 

amg, see Tips for tapering off Prozac (fluoxetine)

[jr1985]

I'm not a doctor so I can't recommend anything

Yet somehow I trust your advice more than theirs...

 

But you had adverse effects at 75mg Effexor, equivalent more or less to 10mg Prozac. If I were you, I might try 5mg Prozac.

 

I thought 75mg Effexor = 20mg Prozac? Maybe I'm wrong...

 

I'm going to hold on the effexor, at least until my sleep improves, before considering Prozac.

[amg2012]

 

I'm not a doctor so I can't recommend anything

Yet somehow I trust your advice more than theirs...

 

 

 

I thought 75mg Effexor = 20mg Prozac? Maybe I'm wrong...

 

 

JR That is what I read too in the Icarus Project so I was looking it up again and found that they have a recent second edition 7/11/2012 as I am not sure which edition I read I will look at the new one for some more help.

I think that my reduction from Effexor 150 to 75 mg was too fast and I did not do the brige. I am feeling very dull and losing time (too old to lose time, not LOL). Wondering if I should take more Prozac - I am now at 20 MG (liquid 5 ML).

Perhaps I will find help in this document.

 

It is difficult to interpret and deal with this when feeling so unwell.... any help most welcome!

 

http://theicarusproject.net/advocacy-rights-politics/coming-off-medications-guide-second-edition

[Altostrata]

jr, you've shown hyper-reactivity at a higher dose of Effexor. It's up to you if you want to try the higher dosage of Prozac. If I were you, I'd go the more conservative route.

 

The amount of Prozac that might "work" for a bridge is individual. The equivalencies are only estimates.

[peggy]

the thing with Prozac is that it has a much longer half life, so it is likely to take longer for you to feel good - i would avoid updosing for a little while if you can - you might go too high and will only have to come down again...

[jr1985]

jr, you've shown hyper-reactivity at a higher dose of Effexor. It's up to you if you want to try the higher dosage of Prozac. If I were you, I'd go the more conservative route.

 

The amount of Prozac that might "work" for a bridge is individual. The equivalencies are only estimates.

 

I understand what you're saying. I thought I'd be ok at 10mg Prozac if it equals 37.5mg Effexor, but I think your way is probably better because I don't really know if I'll be able to tolerate Prozac or not.

 

My only worry is that 5mg won't be enough, then withdrawals will start and they might not go away if I updose. But I guess that's the risk I'll have to take.

 

In your opinion, is it better to just go ahead and try ithe switch sooner rather than later, or wait until I feel more stable on the Effexor before jumping ship?

[jr1985]

I don't know, jr.

 

I thought you might say that . Well I'm gong to see how I am taking the vitamin B6 for a week or so then go from there.

[Shanti]

JR, from my own experience and some that I've read, updosing with antidepressants does fix the issue of the symptoms, unlike with Benzos that sometimes can be unforgiving. But I can not say this is the case for everyone.

[amg2012]

My experience with taking 37.5 mg. Effexor with the Prozac was not a good idea. Brain fog, extreme fatigue, etc. etc. - I think everyone here knows w.d. symptoms. Today, I took only the equiv. of 20mg. Prozac in liquid and hoping I can find stability here.

Comments, welcome.

[Barbarannamated]

I asked this in my intro thread but I wanted to ask again.If we are helped to switch to prozac for withdrawls, why don't the doctors forget the other SSRI's and usually just prescribe prozac? I fear doctors/pharmacy reps have a host of reasons, but the main one may well be M-O-N-E-Y.

 

I suspect many doctors are unaware. Despite all of this information here and various places about the dangers of SS/NRIs, I believe they are still perceived as safe. The startup effects of mania seem to be acknowledged, but not long term physiological maladaptation, worsening of "depression", and acute and protracted withdrawal. I dont know if the rate of prescribing for depression is lessening at all, but I know that SNRIs are being used as preferred agent in chronic pain. My pain management doc is writing the guideline (on steering committee) and just told me this a few days ago. The fear of opiate addiction is so great and docs are being guided to SS/NRIs and Neurontin type drugs for pain. My feeling is that drugs used on daily basis are being pushed as safer than prn meds and addiction is being blamed. More $$ in chronic, daily meds.

 

Sorry, that veered off topic. Bottom line = $$$

[melo]

Do you think getting on prozak slowly because I am very sensitive to meds would calm my anxiety and panic attacks and allow me to get off klonopin. I cant take the severe anxiety getting bed bound. Ive tried tapering slowlyoff k ca nt do it. I .also know prozak is stimulating and I would have to take more klonopin to get on it beca use no matter wha t I try. In sma ll doses I get more anxiety. They tell me I have to get on reg dose for 4 weeks for it to wotk please help I hsve to put ice pscks on chest and neck for psin I was never stable on it. I tried lexspro 1 mg per week until I reached 5mg that is. As far as I could go that was 2 yrs ago my anxiety settled down but then when I tried to get off k I had major attacks but I was cutting. 1mg a time. My klonopin dose increased from .75 mg to 2 mg just to get to 5 mg my dr said if u csnt reach. 10mg it wont work. Any advise because I cant get off k by itself help

[Skyler]

Hi melo, see my response in the other thread you started in this section. Many people think they are tapering small doses of klonopin and do not realize this may yet be too rapid. Did you begin by tapering 10% a month, then the same off each successive dose. This can be too fast for many people, but does work for many.

 

As stated previously, ADs, including Prozac, do not help with benzo WD. You can get off klonopin and need a taper tailored to your needs.

 

I tried to get off k I had major attacks but I was cutting. 1mg a time. My klonopin dose increased from .75 mg to 2 mg just to get to 5 mg my dr said if u csnt reach. 10mg it wont work. Any advise because I cant get off k by itself help

So you went from .75 mgs of klonopin to 2 mgs. You tried 5 mgs.. of Prozac, and your doc wants you to increase this to 10mgs. You are not on Prozac now, is this correct? Prozac will not help with benzodiazepine WD regardless of the dose because the neuro receptors in your body are not the same for the two classes of drugs (they are not the same between classes either, but that discussion if for another time).

 

So you were taking 2 mgs of k... how much did you cut off that? How long ago did you start cutting, when did you start feeling as bad as you do now. Again, what you describe is very much WD symptoms due to cutting your benzo.

 

Take a deep breath and try to focus.. we can help you sort this out and develop an effective strategy, but we need more info.

[Skyler]

PS... Melo, sometimes people use ADs to bridge from one AD to another for purposes of tapering, but benzos are another drug class entirely and useless for this purpose. Prozac is a very activating AD capable of making your anxiety worse. Increasing the dose to 10 mgs would probably only make you more symptomatic. It's not a matter of getting the med into your system before it starts to act and Prozac can give you an unwanted boost straight away.

[Nikki]

Drugs stocks are the ones that soared and made money in the last three years. People became so depressed over the economic downturn they went on meds.

 

Melo I can't advise you on K, I have not taken it. The Prozac bridge is not that good for most people. Prozac is very stimulating and was designed for people with serious depression.

I tried it for a week, years ago and I made the anxiety unbearable (even dangerous).

 

The Psych Nurse I see helps people 'bridge' with a tricyclic 'Imipramine'. It works for me. It is not stimulating like Prozac. It's been around for many, many years. I think Prozac may be considered an old drug by now The tricyclics tend to be sedating and calm anxiety.

 

The chemical structure of Imipramine (tricyclics) and very different from the structure of SSRI's. Alto would know more about the differences.

 

Then again, no one really knows for sure how we will react to another drug.

 

Hugs

[Skyler]

The Psych Nurse I see helps people 'bridge' with a tricyclic 'Imipramine'. It works for me. It is not stimulating like Prozac. It's been around for many, many years. I think Prozac may be considered an old drug by now The tricyclics tend to be sedating and calm anxiety.

 

The chemical structure of Imipramine (tricyclics) and very different from the structure of SSRI's. Alto would know more about the differences.

 

Then again, no one really knows for sure how we will react to another drug.Hugs

Hi Nikki, I've been reading about your progress as you taper onto Imipramine and am delighted for you. I hope this continues!

 

Melo needs to understand that klonopin is in another class of psychotropic drugs, benzodiazepines. The information in this thread is about crossing from one AD to another. Bridging does not work when we go from an AD to a benzodiazepine.

 

Melo, unfortunately, this is not a benzo site, and we are not geared to help with specific benzodiazepine taper protocols, but we can help you sort out what is going on with them and address your AD questions. A lot of folks have issues with both, so we frequently get questions that are not in isolation. If you still want help with benzo tapering specifics, we'll direct you to other resources, and will be here in any event.

 

Skyler

[Nikki]

Melo needs to understand that klonopin is in another class of psychotropic drugs, benzodiazepines. The information in this thread is about crossing from one AD to another. Bridging does not work when we go from an AD to a benzodiazepine.Skyler

 

Melo I can't advise you on K, I have not taken it. The Prozac bridge is not that good for most people. Prozac is very stimulating and was designed for people with serious depression.

I tried it for a week, years ago and I made the anxiety unbearable (even dangerous).

 

The Psych Nurse I see helps people 'bridge' with a tricyclic 'Imipramine'. It works for me. It is not stimulating like Prozac. It's been around for many, many years. I think Prozac may be considered an old drug by now The tricyclics tend to be sedating and calm anxiety.

 

Yes the topic is bridging from one AD to another which is why I posted with my experience. As I explained to Melo I can't advise on K.

 

Melo when you log onto this site there is a section on benzos. I do not participate in it. You may want to take a look at it for info.

 

Hang in there.

[TigerLily]

Hi there,

 

I'm wondering if anyone has used Dr. Glenmullen's method to taper from Effexor? If so, what was your experience like?

I see my Doctor on Friday, and want to come up with a plan before hand.

 

 I need to get down to 37.5 mg from 150 mg. He says to take a month, I'm thinking I should take longer. Any suggestions?

 

Once I'm at 37.5 mg, and have been on it for at least a week (maybe longer?), I will switch to 10 mg of Prozac every day for two weeks.

 

Then, I will take 1 pill out per week, until I am down to nothing?

 

Thank you in advance for any suggestions,

 

Tiger Lily

 

 

[Altostrata]

Dr. Glenmullen's schedule may be too fast for some people. See http://survivingantidepressants.org/index.php?/topic/1463-the-prozac-switch-or-bridging-with-prozac/