The Prozac switch or "bridging" with fluoxetine

[Melany]

On 11/17/2011 at 9:23 PM, Altostrata said:

 

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.
 

Anyone was extremely angry on prozac? I was never ok on it, was just keeping my panic atacks away. Now I am on prozac WD and I wish to bridge with the above if you consider them a good candidate. Is that ok?

[ChessieCat]

@Melany

 

According to your drug signature you have already tried Cipralex which is escitalopram (Lexapro).

[Dubcity]

Hey guys is cross tapering and bridging the same thing? I’m having a hard time understanding. Thanks

would it look like this going from 10mg of celexa to Prozac? 
week 1 7.5 mg celexa plus 5 mg Prozac 

week 2 5mg celexa plus 10 mg Prozac 

week 3 2.5 mg celexa plus 15 mg Prozac 

week 4 stop celexa and go to 20 mg Prozac 

[ChessieCat]

Yes cross tapering and bridging are interchangeable terms for changing from one AD to another.  The term drug switch is also used. 

 

You might also come across the term cross over.  Here at SA we use the term cross over  when changing form of the drug (eg tablet to liquid), not changing to a different drug.

[ChessieCat]

36 minutes ago, Dubcity said:

Hey guys is cross tapering and bridging the same thing? I’m having a hard time understanding. Thanks

would it look like this going from 10mg of celexa to Prozac? 
week 1 7.5 mg celexa plus 5 mg Prozac 

week 2 5mg celexa plus 10 mg Prozac 

week 3 2.5 mg celexa plus 15 mg Prozac 

week 4 stop celexa and go to 20 mg Prozac 

 

I have responded to your second question in your Introduction topic here:

 

dubcity-about-to-start-celexa-taper

 

And for the information of members reading here, replacing 10mg Celexa (citalopram) with 20mg Prozac (fluoxetine) would probably be way too high a dose.

 

From https://ahpnetwork.com/wp-content/uploads/2017/09/Switching-Scenarios.pdf

 

20mg citalopram = 20mg fluoxetine

 

Edited March 23, 2021 by ChessieCat

[Sebas]

Hi everyone,

 

Found this table online in the Netherlands that was created by pharmacists for switching from one ssri to another. They provide with switch strips based on these values.

 

It's a 28 day proces followed by another 28 days of stabilisation. They based these values on the half-life and bloodvalues of both ssri's. 

 

Link: https://www.taperingstrip.nl/switchstrip/

 

Example below: switch paxil-prozac 20mg (Screenshot, file exceeded max KB). You can fill in a number of switching combinations.

 

Check it out and let me know how you think. Main purpose is to share information and good (or even bad) practices.

 

Bye Sebas

 

[JessB]

Hello! 
unfortunately due to a very hard time tapering Effexor I may joint this group of switching to Prozac. even 1 bead of Effexor drop makes me very sick (1/3 of a mg)
I have read this post very carefully many times over. 
Key aspects I am gathering so far from here and searching key words on the website are as follows: 

-to be stable at a dose before trying to bridge

-to drop the first drug rather quickly into bridging so body does not get used to 2 drugs at once

 

i have a doctors appointment this week to discuss, unfortunately I feel I am playing with fire and have no hope this method will work for me. As if 1 bead of Effexor makes me sick, how is dropping off completely going to make me feel. 
I currently take 42mg of Effexor after tapering down this far from 75mg over 2 years and have hit a wall in my journey I can’t go farther. 
this is the following play I am going to propose to my doctor based on gathered information:

-Week of may 8th, take 10mg of Prozac for a week

-week of may 15th take 20mg of Prozac drop to 37.5mg

-week of may 22 drop Effexor, continue to take Prozac until stable. 
(week of may 22 I am on vacation off work so I am trying to plan around this as my job is very mentally demanding)

I have read on SA some contradictions that 37.5=10 mg of Prozac and also =20mg or Prozac. 

Any additional information I should take to my doctor regarding this? Have I missed anything? 
I believe she will be on board as she has offered a Zoloft switch before to minimize withdrawals but who knows. 

[Pezglobo]

On 11/17/2011 at 8:23 PM, Altostrata said:

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.

Does this apply to any SSRI? When changing from lexapro to Zoloft? It sounds quick 🙈

[Altostrata]

11 hours ago, Pezglobo said:

Does this apply to any SSRI? When changing from lexapro to Zoloft? It sounds quick 🙈

 

Please confer with your doctor about drug switches. We suggest such substitutions only for the purpose of going off drugs.

[Ruthie3]

On 4/4/2022 at 9:30 PM, JessB said:

Hello! 
unfortunately due to a very hard time tapering Effexor I may joint this group of switching to Prozac. even 1 bead of Effexor drop makes me very sick (1/3 of a mg)
I have read this post very carefully many times over. 
Key aspects I am gathering so far from here and searching key words on the website are as follows: 

-to be stable at a dose before trying to bridge

-to drop the first drug rather quickly into bridging so body does not get used to 2 drugs at once

 

i have a doctors appointment this week to discuss, unfortunately I feel I am playing with fire and have no hope this method will work for me. As if 1 bead of Effexor makes me sick, how is dropping off completely going to make me feel. 
I currently take 42mg of Effexor after tapering down this far from 75mg over 2 years and have hit a wall in my journey I can’t go farther. 
this is the following play I am going to propose to my doctor based on gathered information:

-Week of may 8th, take 10mg of Prozac for a week

-week of may 15th take 20mg of Prozac drop to 37.5mg

-week of may 22 drop Effexor, continue to take Prozac until stable. 
(week of may 22 I am on vacation off work so I am trying to plan around this as my job is very mentally demanding)

I have read on SA some contradictions that 37.5=10 mg of Prozac and also =20mg or Prozac. 

Any additional information I should take to my doctor regarding this? Have I missed anything? 
I believe she will be on board as she has offered a Zoloft switch before to minimize withdrawals but who knows. 

Hi there, I’m wondering how you got on? I’m trying to wean off Effexor too, by bridging with Prozac but have no proper help from docs, all different ideas cut fast. I am on 112.5 still from 150 and probably cut too fast but stuck with it. I want to get down lower but al confused do you totally drop the Effexor when add in Prozac liquid after two weeks? How did you do it if you don’t mind me asking as I’m so lost thanks so much 

[JessB]

On 11/18/2022 at 1:53 PM, Ruthie3 said:

Hi there, I’m wondering how you got on? I’m trying to wean off Effexor too, by bridging with Prozac but have no proper help from docs, all different ideas cut fast. I am on 112.5 still from 150 and probably cut too fast but stuck with it. I want to get down lower but al confused do you totally drop the Effexor when add in Prozac liquid after two weeks? How did you do it if you don’t mind me asking as I’m so lost thanks so much 

Hi Ruthie, 

sorry I didn’t end up bridging, I am holding my dose indefinitely. I can say You do not drop the Effexor completely before you add Prozac. There will be a time when you take both Effexor and Prozac. @ChessieCat and others would be better to guide you than myself if they are available. 

[rmce72a]

How are you doing? I am so miserable I am considering the bridge too, but I don't want to add more meds. I am tapering from poop out, so holding won't necessarily improve things.  I have only managed to come down to 72.8 from 75mg Effexor XR since May and I still have constant symptoms, some days worse than others. 

[JessB]

16 minutes ago, rmce72a said:

How are you doing? I am so miserable I am considering the bridge too, but I don't want to add more meds. I am tapering from poop out, so holding won't necessarily improve things.  I have only managed to come down to 72.8 from 75mg Effexor XR since May and I still have constant symptoms, some days worse than others. 

Holding was the best thing for me, personally. But did not have poop out. I am very stable now and definitely needed the break. 
sorry you are not well! Best wishes in your journey

[rmce72a]

Thank you for your reply. I am happy to hear that you are stable. I think one problem may be that I count the beads in every capsule. Since the # of beads varies, some days I take 72.97 and others as low as 72.8. I don't know if even that slight change affects things. I didn't expect the taper from Effexor to be easy or pleasant, but I sure didn't expect feeling sick 24/7 with only the occasional window. Thank you again for replying. I feel so lost.

 

[Lauren90]

On 11/22/2018 at 1:20 PM, gardenlady said:

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? 

 

Hey how did your bridge go?

[Lauren90]

On 4/25/2021 at 8:57 AM, Sebas said:

Hi everyone,

 

Found this table online in the Netherlands that was created by pharmacists for switching from one ssri to another. They provide with switch strips based on these values.

 

It's a 28 day proces followed by another 28 days of stabilisation. They based these values on the half-life and bloodvalues of both ssri's. 

 

Link: https://www.taperingstrip.nl/switchstrip/

 

Example below: switch paxil-prozac 20mg (Screenshot, file exceeded max KB). You can fill in a number of switching combinations.

 

Check it out and let me know how you think. Main purpose is to share information and good (or even bad) practices.

 

Bye Sebas

 

Did you do a bridge? I’m considering doing one from Sertraline to Prozac (fluxotine). I can’t get past the first step in the link you sent because it’s not translating to English :/. 

[Lauren90]

On 12/6/2011 at 6:43 PM, Altostrata said:

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.

Hi Alto!

 

im assuming you’ve gotten much more information regarding this subject over the last decade. I was wondering if you could give me your opinion. I don’t want to hijack this thread so feel free to move it on over to mine. I’ve been holding at 50mg sertraline since Feb. had (3) bouts of inner restlessness/akathisia for one week periods  before but it always went away. In May I had a three and a half month wave of akathisia. Went away for two months then came back mid November and it’s unbearable. Currently it is the only withdrawal symptom, that I’m aware of at least. I do get the occasional bout of derealization. I spoke to my psych today, who spoke to the chief medical officer who is a neuro and psych?? And she said she would like me to do a bridge to Prozac after I speak to her in a couple of weeks. I have hear many horror stories about bridging but she seems to be under the impression that because of my symptoms and timeline it has something to do with me still being on the Sertraline. Do you have any thoughts? Would it be absolutely catastrophic to bridge? I really feel like I’m running out of options, but as you wrote, the devil you know is better than the devil you don’t and that’s what I’m afraid of. Have you heard of any people successfully bridging in a similar situation then successfully getting off of the med bridged to? I need to get off of these meds but withdrawing from Sertraline completely messed me up. 
thanks in advance! 

[Altostrata]

You've had frequent drug changes since 2018, often monthly.

 

Have you ever forgotten to take a sertraline dose or taken it off-schedule, such as during a change in time zone? Do you drink alcohol? Have you had antibiotic treatment in the last 2 years?

[Lauren90]

2 hours ago, Altostrata said:

You've had frequent drug changes since 2018, often monthly.

 

Have you ever forgotten to take a sertraline dose or taken it off-schedule, such as during a change in time zone? Do you drink alcohol? Have you had antibiotic treatment in the last 2 years?

This is very true. 
 

I usually take my pills at the exact same time every day. If there’s a fluctuation it’s maybe twice a month and a one to two hour fluctuation. 

yes to antibiotic treatment in 2021, once in the summer for a sinus infection, once in the winter after an invasive procedure.

 

I am guilty of drinking an occasional glass of red wine when the akathisia is too much to deal with at night but have been avoiding for a couple of weeks now, I know it’s not helping.  

[Sebas]

On 12/9/2022 at 2:21 AM, Lauren90 said:

Did you do a bridge? I’m considering doing one from Sertraline to Prozac (fluxotine). I can’t get past the first step in the link you sent because it’s not translating to English :/. 

1st step: current med

2nd step: switch to

 

No i didn't bridge, i am staying on paxil.

 

[Altostrata]

@Lauren90 people sometimes find they get a bad reaction to antibiotics that might cause something like akathisia. For further discussion of your particular situation, please post questions in your Introductions topic.

[littlebird]

This thread has been SO helpful! Talked to a psychiatrist about my Pristiq issues, and he recommended going cold turkey. Told him I'd tried that, and tapering it on my own, and he prescribed Prozac as a bridge. Reading through this thread, I'm thinking the timing he recommended is a bit quick. From what I've read here, a few weeks to let the Prozac build up is needed, and I was wondering if anyone could advise if what I'm thinking is correct.

 

Doctor's recommendation to take 10mg Prozac with my same dose of Pristiq for 1 week, then up the 10mg of Prozac to 20mg and stop taking the Pristiq. If cold turkey was too much, I could take Pristiq every other day (a 50% taper) for a week, then stop and keep taking the Prozac and then check in on how it's going with whoever my assigned psychiatrist is at the end of February, 7 weeks from now.

 

2 weeks seems fast! One week of Prozac, then taper for a week, then done. Also, I know he said I could just stop taking the Pristiq completely after a week of Prozac without tapering at all, but I'm really unsure about that. Seems like a taper would help me out a lot more.

 

I'm thinking of doubling his timing. 2 weeks instead of 1 of taking everything, then start tapering for 2 or maybe even 3 weeks with Pristiq. I'm leaning towards cutting the Pristiq instead of doing a 50% taper by taking Pristiq every other day. Would 2 weeks be enough time for the Prozac to build up? What was in this thread made it sound like more was needed, so I'm second guessing my timing.

 

Also, I looked up Prozac after the appointment, and it has a major interaction with Wellbutrin and Pristiq, and a moderate one with Seroquel and Gabapentin... it interacts with everything I'm taking. Trying to figure out when to take Prozac during the day is a puzzle! I have a few days before it comes in the mail, so I have more time to keep researching.

[Ruthie3]

How are you getting on with the bridging and what way are you doing it in the end? On Effexor but similar bridge. Thanks a million 

[LostInCanada]

On 11/17/2011 at 11:23 AM, Altostrata said:

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. You will need to consider whether taking the risks of substituting another drug are worth possibly alleviating your current withdrawal syndrome.

 
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.

 

Citalopram has a half-life longer than other SSRIs but shorter than fluoxetine, so you may wish to bridge with citalopram instead, since if it causes adverse effects of its own, they will not last as long as they would with fluoxetine.

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:

 

 

If you are making a switch to Prozac, the second antidepressant is fluoxetine (Prozac). Given fluoxetine's long half-life, it will take a couple of weeks to reach full effect ("steady-state"). You will not be able to tell if your fluoxetine dose is enough in a day or a few days. The effect of your initial dose of fluoxetine will build throughout the process of cross-tapering.

 

It's best to avoid increasing fluoxetine throughout the cross-taper, you could end up with an adverse reaction or even serotonin toxicity from too much fluoxetine (see below). 

 

(Unlike fluoxetine, you will be able to assess the effect of citalopram as a bridge within 5 days. Due to its shorter half-life, it takes a shorter time to reach a steady state level in your bloodstream.)

 

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 another antidepressant.

 

Start low, the effect of fluoxetine will increase over at least a couple of 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 have decreased your antidepressant dose by a half or more, 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:

 

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

 
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.
 

 
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.

@Ambs9 have you read this?

[acidicgeisha]

Has anyone have successfully bridged from Cymbalta to Prozac? I couldn’t tolerate the withdrawal symptoms anymore after quitting C/T 7 weeks ago so I talked to my pharmacist and he told me to take Fluoxetine 10 mg for a month then stop C/T. Is it considered more of a reinstatement since I haven’t been on any antidepressants for almost two months? Should I stay longer on Fluoxetine? Maybe it’s just a gut feeling but I feel like I should taper off of Fluoxetine gradually even if stopping at 10 mg is tolerated in some individuals. After my first dose of Fluoxetine last night it made me drowsy, I now have a horrible stomachache (despite taking the pill with food) that I didn’t have during my withdrawal syndrome and diarrhea. I’m so sick of taking drugs that make me feel worse, never better. 

[LostInCanada]

@acidicgeishaI tried twice to bridge with Prozac only to have worse nausea, diarrhea etc. Your central nervous system is destabilized from  withdrawal. There is no quick fix unfortunately. You may have a timetable for your life but your body has to heal and that can't be rushed. Trust me when I say we all are living this and wish we weren't but we can't go back. Your moderator mentioned a reinstatement of the original drug  takes up to 10 days. You know how your body reacts with it, prozac is an unknown plus you will still need to taper off the prozac. My reinstatement was almost 4 months ago and the improvement was small but some improvement was better than where I was at. Be patient with yourself and kind. Don't know if this helps.

[acidicgeisha]

@LostInCanada in your signature I don't see how long and how much Prozac you took to bridge from your AD? 

[LostInCanada]

@acidicgeisha

So when I started the Prozac, I almost immediately went from nausea if the withdrawal to dry heaving and vomiting for the 5 days I took it. This was in August 2022. I tried the Prozac again as suggested by a pharmacist in December just for 2 days with the same result.

 

If you go to my very first post on my intro I mentioned it. Never put it in my drug history but I will.