The Prozac switch or "bridging" with fluoxetine

[frederike01]

Yes altostrata you are right and if i could make that decision again i would definitely do that. 

My psychiatrist told me i could start tapering.

Foolisch of me to believe that of cource.

On the other hand though, i never was stabel before, because of my earlier fast tapering off fluvoxamine an paroxetine.

And the reason i started tapering off fluvoxamine was because i already was experiencing "poop out" (i think because my symptoms worsened more then they had ever been)  after using the meds 12 years.

Wich i did not know back then by the way....So i think i never could have done it without being unstable. That's what makes it so difficult......

[Altostrata]

Please post questions about your particular situation in your Intro topic.

[InvisibleUnless]

im sorry if i am overlooking information posted in other areas, but i was wondering if there are any studies supporting the decision to cold swap between SSRIs rather than tapering or cross-tapering.

 

a lot of psychiatrists seem to think SSRIs, in particular, are okay to switch between without a taper--and not just drugs being exchanged with active metabolites ala citalopram/escitalopram or fluoxetine/norfluoxetine.  is this backed by evidence or is this just massive assumption paired with 'discerning clinical judgement' from 'years of experience with hundreds of patients'?

[scallywag]

Invisibleunless: have you done a web search, e.g. google "prozac switch" "research OR study"?

[InvisibleUnless]

nope.  frankly, i would not be asking here unless i was too sick to be trying to track down things on my own.  relying on journal databases is less useful than the experience of users here in terms of finding pertinent articles, as well, because most do not take into account withdrawal syndrome in the first place.  of course, even those potentially inappropriate articles are good to know of at least as part of a rebuttal.

 

i have pretty limited cognitive and energy resources so i try to be tactical about asking for help.  it is fine if this request is not fielded over here, but i figured to make the attempt.  i have pre-identified articles to parse numbering into the hundreds at present, on the general topic of psychotropic side effects, and reading even one a day is usually not feasible most of the time.  reading through search results, even just titles, is overtaxing a lot of the time and i try to spend my limited resources or more urgent issues like acute instances being presented to me rather than clashing with psychiatrists in public forums.  convergences of those concerns are where i occasionally ask for assistance.

 

i do appreciate your suggestion, though.  many other individuals here are not well enough to be running the literature, either, and people that are are likely to have their hands full with other issues.  this was just asking if someone has something handy.

[scallywag]

Here are the results of a search I did:

 

https://encrypted.google.com/search?hl=en&q=%22prozac%20switch%22%20research%20OR%20study#hl=en&q=%2Bprozac+bridge+OR+switch+research+OR+study

 

 

In the SA journals forum:

 

Benazzi, 2008

[Altostrata]

There are no studies supporting a cold swap. Psychiatrists who believe this is a good idea are not listening to their patients.

 

There are studies recommending cross-tapering.

[InvisibleUnless]

Here are the results of a search I did:

 

https://encrypted.google.com/search?hl=en&q=%22prozac%20switch%22%20research%20OR%20study#hl=en&q=%2Bprozac+bridge+OR+switch+research+OR+study

 

 

In the SA journals forum:

 

Benazzi, 2008

thanks for combining the two sources.  i am too sick to rigorously parse the google search, but it has nice booleans.  i peeked at the study but will have to do so again when i am more able.

 

There are no studies supporting a cold swap. Psychiatrists who believe this is a good idea are not listening to their patients.

 

There are studies recommending cross-tapering.

i suspected as much, but did not want to jump to any conclusions.  thanks for jumping in.

 

then again, when has "do you have any research to support that?" ever flown with the average psychiatrist.

[LynneR]

"then again, when has "do you have any research to support that?" ever flown with the average psychiatrist."

Or the other way around, when a patient says, "I've looked at the research, and I think this is the best way to handle X"...
and the doctor generally doesn't take it very well.
I actually have a copy of some fairly snarky notes from my GP when I explained why I am no longer on buproprion. [Patient says she "did some research" and decided to stop taking it.]      *
In this practice, all notes, labs, etc. are available online, so she had to know that I'd be able to see it. Her notes were really poorly written too.

I had my last shrink pretty well trained. When I'd tell him, "this is my plan, and I've done my research", he'd generally accept it, sometimes ask a few questions, usually check back in the following weeks to see how I was doing. He also knew my educational background, and that I don't mess around with poor-quality evidence.   
Of course, when I decided to stop buproprion, and taper off slowly, I came up with probably 20 recent relevant journal citations, and would have had no problem handing him the list if he'd questioned my decision.

* In most cases, me doing research for something involving my health starts with PubMed, which should be at or near the top of the list of where that doctor should head when she needs to look up recent, relevant, peer-reviewed, published journal articles. But she didn't bother to ask anything about my "research" (as she put it), just assumed I'm an uneducated idiot.

[Henosis]

I'm wondering if there are people who used Prozac as a "stepping stone" from another SSRI near the end of the taper. I'm on ~1.8mg of Paxil after a long taper, and I'm considering a switch to Prozac to make the final stretch easier. I understand the risks involved, but I seem to find a lot of people who have succeeded with a cross taper. 

[nz11]

Henosis  there may well be people who have succeeded with a cross taper but it depends on how you define success. I guess if one was successful they wouldn't be here right. However this site is voluminous  in bridge switch attempts that  have been problematic.

I wouldn't call being on  paxil one day and then on (many) multiples of that dosage in Prozac the next and then still stuck there many months later a 'success' while pushing the drug free ETA out by many years in the process.

Reading through your drug sig I get the feeling that you shoudnt go there. Just look what happened  with the prior cross taper attempt with nortrip. Not to mention the many failed past drug switch attempts sending you into a complete mess only to end up back on paxil again. Qu. Will things will be any different this time? Answer : What do you think? 

 

I think you should be congratulated on getting down to 3.5mg and being free of other drugs.  

By the way if you tapered from 3.5 to 1.8 in the last 3 months then that is faster than the 10% rate rec here. You are tapering too fast. Personally I wouldn't be in any hurry at this stage. If it was me I would be conservative by dropping the taper rate so I make even smaller cuts with longer holds following in the Brassmonkey footsteps. To go from 1.8 mg to 0.5 mg with cuts every 4 weeks (at 5% of previous dose) will take another 2 years but is that such a big deal if you have a life and can function. You may hardly notice it. Whats another two or three years in light of the 14 years prior drug use.

In my opinion especially for you anyway it would be a high risk move.

Heres the thing say you manage to pull off a 1mg to 1mg switch to Prozac  are you thinking that you can then speed up the taper? If so that would be a big mistake.

What if things turn bad then what ? I am in no doubt about what the doctor will then do ....it will be an escalation of dosage and  an introduction of other drugs to quell wdl symptoms and on top of that your intelligence will be insulted by the doctor  establishing for all of time that you have now had a relapse, while talk of  withdrawal symptoms will be non existant.

 

nz11

[ChessieCat]

Henosis, I agree with NZ.  In general it is better to taper off the drug you are currently taking rather than risk trying to change to a different drug.  Changing over can be difficult because you can experience WD from the first drug and start up/side effects/bad reaction to the new drug and you will not know what is causing what.  Slow and steady wins this "race", but it's not a hurrying race, it's slow and steady reaches the goal of getting off.

[grandmaD]

At this point I am wondering if I will ever improve.   Doctor wanted me to switch to Prozac several years ago, but I was too scared and I thought "surely this will be all over this year," which is what I said every year, but now I don't have that hope any more after 6+years. 

 

I have read the thread on SA about bridging and switching about 4 times but never felt confident about doing it.  The one thing that put me off was the fact it said that switching does not cover any w/d symptoms you have and I guess that would be the one thing I would be hoping for - some letting up with all the w/d symptoms.  I also noticed Prozac was stimulating so that put me off.  I thought about Endep which was calming in the past, but also made me like a zombie but it didn’t have much of a half life.

 

Then when things went downhill badly about a year ago, and got worse and worse, I was ready to switch to Prozac a few months ago, but that is when Doc wrote the script for Cymbalta saying it was better, etc. along with a script for taking Serapax every day.  I was furious and tore the scripts up.

 

Now it has come to my attention that the tablet I am taking is not made my GSK but by an Australian company called Aspen!  I have posted that on SA and been told by a Mod that it is a generic brand, so I now wonder if that has been the cause of all my distress???

 

I am now feeling so hopeless and so mad that all this suffering was a result of being put on this drug for pain and never told it was addictive and now been switched without knowing it to a generic form.  Even the active ingredients listed on the front of the packet have an extra ingredient to the GSK one!  Does anyone know anything about this?  Does this mean I have basically switched to a different a/d???

 

After seeing Songbird’s update I am now seriously considering a switch to Citapolam.  She has been on the drug a long time like myself, tried a long slow taper and is about my age and seems to have successfully switched over.  I like the fact it is calming and has a longer half life than most and while not as long as Prozac, is longer than Paxil, so it has some things in its favour.

 

I still have concerns about this, of course, but I think this info will do for today.  I would appreciate any input in the meantime.

Edited August 23, 2017 by grandmaD
to put in paragraphs

[scallywag]

I found a meta-study (study of many studies) that evaluated equivalent doses to 40 mg fluoxetine (prozac) which may be useful in identifying an end cross-over/bridge dose to discuss with the person who prescribes your medication(s).

source: https://www.ncbi.nlm.nih.gov/pubmed/25911132

 

From the abstract at that link:

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 (wellbutrin) 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
 venlafaxine 149.4mg/day.

 

Sensitivity analyses corroborated the results except for doxepin.

[Henosis]

Thought I’d add my experience here.

 

after a horrific withdrawal, I reinstated Paxil and tapered down to about 2mg before really running into wall. I slowly added Prozac, of which I’m now on 10mg (approx 4 months).

 

it doesn’t especially help cognitive or physical issues related to withdrawal, but I have noticed less intrusive thoughts and haven’t had a panic attack since starting.

 

Overall, I’d rate it as mildly helpful. I’m still just as sensitive to Paxil reductions, and there is no way I’d be able to do a quick cross taper. I’m essentially just using it as a buffer until I’m off of Paxil completely at which time I’ll start to taper it as well.

[Itzakadoozee]

I want to switch from escatalopram to prozac to continue my taper. Tapering escatalopram produces extreme withdrawal at low doses. Very scared to try though.

 

[Iatrogenesis]

On 1/7/2018 at 3:07 PM, scallywag said:

I found a meta-study (study of many studies) that evaluated equivalent doses to 40 mg fluoxetine (prozac) which may be useful in identifying an end cross-over/bridge dose to discuss with the person who prescribes your medication(s).

source: https://www.ncbi.nlm.nih.gov/pubmed/25911132

 

From the abstract at that link:

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 (wellbutrin) 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
 venlafaxine 149.4mg/day.

 

Sensitivity analyses corroborated the results except for doxepin.

 

Great info! Funny thing, when I was planning to switch over to Prozac from Zoloft, I looked for info online on dose equivalence and there was a website, sadly I can't find it now, where certified doctors post answers to questions and there were 3 (I think) different answers on what dose of Prozac is equivalent to 50mg Zoloft and none was correct. Hahaha! Another proof it's better to do your research than trust a doctor who can't even be bothered to look that info up online.

 

(I think it was HealthTap and they've deleted the question and answers by now)

 

But I have a question. I was wondering, and I'm simply trying to understand better, not criticising anything, why is your policy to discourage bridging? I understand you want to recommend people the least dangerous approach, but don't a lot of people try different drugs over time and have no problem switching between them? Doesn't it mean in that case switching to Prozac would carry no risk for them and even if they couldn't tolerate it, they could safely go back on their original drug and that would be a waste of maybe a few months time? Isn't it still worth it to potentially waste some time if it could mean not only a safer process, but potentially a (much) shorter one (if one wanted to try a shorter taper)? For example, I was able to quit Olanzapine and I'm having no problems quitting Prozac, but was unable to quit Zoloft over about the same amount of time. So isn't it worth it to try switching to another drug, doesn't even have to be Prozac but something with a longer half-life (Olanzapine has around 30, Zoloft around 20 I believe) if it could potentially mean less time spent quitting the drug, so being free sooner? Personally, I really wouldn't want to spend 3 or more years tapering off Zoloft when I can spend a year tapering off Prozac. I despise these drugs and that difference is a lot of time, and that's very important to me.

[Andie]

Hi Everyone 

 

please feel free to move this post if it needs to be in my introduction topic. 

 

My Doctor is asking me to consider making a switch to Prozac as I am struggling on low doses of Pristiq. I am currently on 12mg. I have had my Pristiq compounded and the pharmacy can only guarantee a sustained release of 6-8 hours( I’m hitting the wall every morning) My doctor has instructed me to divide the doses up during the day.  I am going to see if dividing the dose helps. 

 

I have an appointment with my doctor next week and I would like to be prepared if the topic of switching to Prozac is brought up. 

 

With 149.4mg of Venlafaxine = 40mg Prozac and 100mg of Venlafaxine= 50mg Pristiq.

 

I have calculated I need about 6.5mg of Prozac to equal 12mg of  Prozac Pristiq. Does this sound right? 

 

I wouldn’t ever consider a cold swap, so I am wondering how I would dovetail the Pristiq and Effexor in together before dropping the Pristiq. 

 

Swapping over is really my final option, but I’d like to be prepared for my appointment next week. I believe I can have the Prozac compounded into a liquid. 

 

Thankyou in advance and apologies if I have put this in the wrong place. 

 

Edited November 21, 2018 by ChessieCat
correction as per following post

[Andie]

1 hour ago, Andie said:

have calculated I need about 6.5mg of Prozac to equal 12mg of  Prozac. Does this sound right? 

12 mg Pristiq sorry. 

[gardenlady]

On 1/7/2018 at 8:07 AM, scallywag said:

I found a meta-study (study of many studies) that evaluated equivalent doses to 40 mg fluoxetine (prozac) which may be useful in identifying an end cross-over/bridge dose to discuss with the person who prescribes your medication(s).

source: https://www.ncbi.nlm.nih.gov/pubmed/25911132

 

From the abstract at that link:

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 (wellbutrin) 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
 venlafaxine 149.4mg/day.

 

Sensitivity analyses corroborated the results except for doxepin.

What about duloxetine (Cymbalta)?  

[bubbles]

On 11/22/2018 at 8:06 AM, gardenlady said:

What about duloxetine (Cymbalta)?  

 

PLEASE SEE:  this post   (about the information which was provided below)

 

This is a flyer I found, but I'm not sure of its provenance: https://www.healthalliance.org/media/Generics_antidepressants_comparison_chart.pdf

 

 

Edited December 4, 2018 by ChessieCat
link not recommended Alto/CC added link to info post

[Andie]

On 11/22/2018 at 12:42 PM, bubbles said:

 

This is a flyer I found, but I'm not sure of its provenance: https://www.healthalliance.org/media/Generics_antidepressants_comparison_chart.pdf

 

PLEASE SEE:  this post   (about the information in the quote above and what is being discussed below)

 

Thankyou for this. I can see Pristiq in there too. 

 

Edited December 4, 2018 by ChessieCat
link not recommended Alto/CC added link to info post

[gardenlady]

PLEASE SEE:  this post   (about the information which is being discussed below)

 

From this chart, 20 mg of Prozac equals 30 mg of Cymbalta.  So, if I'm on 25 mg of Cymbalta and want to bridge to Prozac, is 10 mg of Prozac too little?  My doctor gave me 10 mg Prozac capsules and told me to take it for a week and then cut the Cymbalta.  I'm scared since even 2.5% cuts of Cymbalta are brutal.  I'm afraid I'll get psychotic & suicidal when eliminating the Cymbalta with only 10 mg of Prozac to fight off the withdrawals.  I live alone and have absolutely no one whom I can call or who can help me.  How can I attempt this bridge in this situation? 

 

Edited December 4, 2018 by ChessieCat
added link to info post

[Andie]

On 11/23/2018 at 8:20 AM, gardenlady said:

From this chart, 20 mg of Prozac equals 30 mg of Cymbalta.  So, if I'm on 25 mg of Cymbalta and want to bridge to Prozac, is 10 mg of Prozac too little?  My doctor gave me 10 mg Prozac capsules and told me to take it for a week and then cut the Cymbalta.  I'm scared since even 2.5% cuts of Cymbalta are brutal.  I'm afraid I'll get psychotic & suicidal when eliminating the Cymbalta with only 10 mg of Prozac to fight off the withdrawals.  I live alone and have absolutely no one whom I can call or who can help me.  How can I attempt this bridge in this situation? 

 

PLEASE SEE:  this post   (about the information in quote above and which is being discussed below)

 

Hi Gardenlady 

 

I am in the exact same situation as you are re Prozac. If I do switch, I won’t be doing it for a while. I live alone too so I like to be fully prepared. 

 

Edited December 4, 2018 by ChessieCat
added link to info post

[bubbles]

@gardenlady and @Andie

 

It sounds like these are good questions to ask in your personal threads so that a moderator can see them and help you make a decision.

All the best.

[Andie]

On 11/21/2018 at 11:13 AM, Andie said:

Hi Everyone 

 

please feel free to move this post if it needs to be in my introduction topic. 

 

My Doctor is asking me to consider making a switch to Prozac as I am struggling on low doses of Pristiq. I am currently on 12mg. I have had my Pristiq compounded and the pharmacy can only guarantee a sustained release of 6-8 hours( I’m hitting the wall every morning) My doctor has instructed me to divide the doses up during the day.  I am going to see if dividing the dose helps. 

 

I have an appointment with my doctor next week and I would like to be prepared if the topic of switching to Prozac is brought up. 

 

With 149.4mg of Venlafaxine = 40mg Prozac and 100mg of Venlafaxine= 50mg Pristiq.

 

I have calculated I need about 6.5mg of Prozac to equal 12mg of  Prozac Pristiq. Does this sound right? 

 

I wouldn’t ever consider a cold swap, so I am wondering how I would dovetail the Pristiq and Effexor in together before dropping the Pristiq. 

 

Swapping over is really my final option, but I’d like to be prepared for my appointment next week. I believe I can have the Prozac compounded into a liquid. 

 

Thankyou in advance and apologies if I have put this in the wrong place. 

 

Moved to personal thread. 

[Andie]

1 hour ago, bubbles said:

@gardenlady and @Andie

 

It sounds like these are good questions to ask in your personal threads so that a moderator can see them and help you make a decision.

All the best.

Thanks bubbles. Will do. I wasn’t sure where to put this and now I know. 

[powerback]

9 hours ago, Andie said:

Hi Gardenlady 

 

I am in the exact same situation as you are re Prozac. If I do switch, I won’t be doing it for a while. I live alone too so I like to be fully prepared. 

Hi gardenlady and andie ,im in the same boat for a switch and waying it up as best I can .take care to you both.

[Andie]

Just now, powerback said:

Hi gardenlady and andie ,im in the same boat for a switch and waying it up as best I can .take care to you both.

Hi Powerback 

 

I was actually just looking at your thread this morning. You and I seem to in a similar quandry. Effexor and Pristiq are very similar. 

 

My doctor actually wanted me to switch to Effexor and taper off from there using the bead method. I didn’t want the fuss of counting beads so I stayed with Pristiq. 

 

I just wanted to let you know a childhood friend of mine came off Effexor and has been problem free now for 5 years.  Another friend of mine just came off Pristiq and is also doing well. 

[Altostrata]

On 11/22/2018 at 12:42 PM, bubbles said:

 

This is a flyer I found, but I'm not sure of its provenance: https://www.healthalliance.org/media/Generics_antidepressants_comparison_chart.pdf

 

On 11/22/2018 at 1:00 PM, Andie said:

Thankyou for this. I can see Pristiq in there too. 

 

On 11/23/2018 at 8:20 AM, gardenlady said:

From this chart, 20 mg of Prozac equals 30 mg of Cymbalta.  So, if I'm on 25 mg of Cymbalta and want to bridge to Prozac, is 10 mg of Prozac too little?  My doctor gave me 10 mg Prozac capsules and told me to take it for a week and then cut the Cymbalta.  I'm scared since even 2.5% cuts of Cymbalta are brutal.  I'm afraid I'll get psychotic & suicidal when eliminating the Cymbalta with only 10 mg of Prozac to fight off the withdrawals.  I live alone and have absolutely no one whom I can call or who can help me.  How can I attempt this bridge in this situation? 

 

On 11/23/2018 at 10:48 AM, Andie said:

Hi Gardenlady 

 

I am in the exact same situation as you are re Prozac. If I do switch, I won’t be doing it for a while. I live alone too so I like to be fully prepared. 

 

@bubbles

    

@Andie

 

@gardenlady

 

I can't see any basis for the equivalencies in that chart, as I explained here

 

 Please review the information here

 

Switching to Prozac is enough of a shock to your system, there's no reason to pound on it with a high dose of Prozac.

Most methods do not recommend more than 10mg Prozac to bridge from any antidepressant.

 

 

 

Edited December 4, 2018 by ChessieCat
link not recommended Alto/CC link updated

[Greenriver]

I’m not sure, but I think my last two posts were deleted? Can someone please explain why, or is it some kind of computer glitch?

[Altostrata]

@Greenriver look at your Introductions topic.

[Kdot]

Hi all, 

 

Has anyone switched from amitriptyline (or any tricyclic) to Prozac? 

 

I'm struggling to reduce by less than 10% monthly and wondering if this would be an option for me. 

[Biloelagirl89]

On 7/11/2012 at 5:02 PM, dalsaan said:

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

I am also curious about this and wanting to know, as I am withdrawaling from mirtazapine. Please let me know how you went ?

[ChessieCat]

@Biloelagirl89

 

You can see member's drug history in their drug signature.  You can also find their Introduction topic by hovering over their avatar, clicking on find content and then clicking on Topics.

 

From dalsaan's drug signature it looks like she did not change to Prozac.

 

From her Intro topic:

  

On 6/8/2017 at 10:31 AM, dalsaan said:

I finally jumped off my microdose of mirtazapine two weeks ago.

 

 

[Yesyes123]

Has anyone here switched from Escitalopram (Lexapro) to Prozac?

 

If so, I would really like to talk to you! 

 

Thanks