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Saffron: tapered fluoxetine fast now don't know what to do

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Saffron

Hi everyone. I wish I had found you all a few months ago. A pal who is a psychiatric nurse told me about this forum. So, my story.... Fluoxetine years ago during a messy divorce. Tapered easily. Severe anxiety after giving birth 3 years ago took me back on fluoxetine. Tried weaning off last summer but stopped when dreams got vivid and unpleasant. Had another go this summer, GP led. 20 mg a day became every other day for 3 weeks (GP said for 2 weeks), then every 3rd day for 4 weeks (GP said for 2 weeks) then just stop! GP said that was tapering slowly, but I can see it is very fast, based on this forum's info, and spacing out days for a long half life drug rather than cutting dose seems wrong . I started getting a bit wobbly during taper, hence pushing to 4 weeks on the last lot. Now i know that that was nowhere near enough. Symptoms have climbed, until I have ended up tearful, fatigued, forgetful, anxious, angry, short tempered....   i thought my problems were back...but the symptoms seem a bit different. Life is however different and overwhelming. Demanding job. 3 hour commute daily. Stubborn and high energy child when i get home. 

 

I feel like it is probably withdrawal but I am not sure. I am seeing my GP tomorrow. I feel like my choices are to go cold turkey and see if this passes, go back on fluoxetine and taper in a year over a far longer timescale, or go on a drug with shorter half life. All thoughts very appreciated. My GP is lovely but I feel like the medical profession is far less informed on this than Mind and you. 

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Gridley

Welcome to SA, Saffron.  I'm sorry you're suffering.

 

Doctors unfortunately know nothing about proper tapering and invariably taper their patients far too fast. We strongly advise against skipping doses, a method much beloved by doctors.  It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse.  
 

 You are suffering from withdrawal.  You should be aware that doctors don't believe in withdrawal and yours will likely attribute your symptoms to "return of the underlying condition."  

 

 
 
When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.  
 
These explain it really well:

 

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 
When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.
 
Reinstatement of a very small dose of the original drug, in your case fluoxetine, is the only known way to help alleviate withdrawal syndrome.  This is a better idea than switching drugs.  The only other alternative is to try and wait out the symptoms and manage as best you can until your central nervous system returns to homeostasis.  Unfortunately no one can give you an exact timeline as to when you will start feeling better and while some do recover relatively easily, for others it can take many months or longer.  
 
Reinstatement isn't a guarantee of diminished symptoms for everyone but it's the best tactic available.   Reinstatement predictably works, up to 3 months after last dose.  Am I correct in understanding that you were taking 20mg every three days for four weeks?  Very important: When was your last dose?
 
 We usually suggest a much smaller reinstatement dose than your last dose.  These drugs are strong, and when reinstating it is better to start with a small amount and increase if symptoms remain unbearable. Your system has become sensitized and If you take too much, such as your original 20mg dose,  it may be too much for your brain and can cause you become unstable.  Sometimes it can be hard to regain stability after this happens.  Please read:
 
About reinstating and stabilizing to reduce withdrawal symptoms. -- at least the first page of the topic
 

If you are interested in reinstating, please let us know and we can suggest a dose to reinstate.  Then, after you stabilize, which can take several months, you can begin a slow safe taper of 10% of current dose every four weeks.

 

 http://survivingantidepressants.org/index.php?/topic/1024-why-taper-by-10-of-my-dosage/

 

Please be sure to answer my questions above.  

 

This is your Introduction topic, where you can ask questions, post updates and connect with other members.  We're glad you found you way here.

 

 

 

Edited by Gridley

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Saffron

Hi. Thank you so much for reading my intro and for your post. My taper from 20mg a day was 3 weeks at 20mg every 2 days then 20mg every 3 days for 4 weeks then stopped 3rd week of July. So around 6 weeks ago. 

 

Saw GP. Predictable outcome. She didn't recognise my symptoms as what she called serotonin syndrome as I didn't have the physical elements of shaking and brain/muscle zaps etc. She thinks I sound anxious and depressed. She said I could go back on fluoxetine or follow talking therapies, exercise etc.

 

She wouldn't prescribe liquid fluoxetine, even privately, because "anything less than 20mg is not a treatment dose". She said she could not do it.  She read Mind.org and Nice's note re reviewing guidance during the appointment (she didn't just dismiss me out of hand) but clearly felt unable to prescribe smaller doses. I pointed out the 10% taper technique which even Mind.org recommend but she said "even psychiatrists don't do that. In fact, they usually taper in a week". 

 

So I came away with a 20mg prescription. My choice is continue cold turkey or try 20mg doses again with no clear/better way to taper in future.  My concern is I am worried about impact on my job if I continue as I am with no meds. I am sole earner in our house. 

 

I feel I have to go back on the meds then but have no choice re dose. I am of course fearful of kindling. 

 

Any bright ideas very welcome but I suspect I am between a rock and a hard place. 

 

 

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Saffron

I have now seen threads about dilutinf capsule contents. Is that an option for mw with fluoxetine to reinstate safely then?  If so, please let me know what dose may be suggested. Thankyou.

 

Ps it has occurred to me that this could be a USA mainly forum. If so, to explain my earlier phrasing, a GP is a general MD, our first port of call Doctor. MIND.ORG is a mental health charity which is very reputable and well known here. NICE is the body that issues treatment guidelines to our medical profession and other things. 

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Sassenach

Good morning saffron

I am a UK based moderator four surviving antidepressants.

You are correct it is quite possible to split and dilute both tablets and capsule.

Which do you have have a tablets or capsules.

If capsules do they contain beads or powder.

This information is available to me on drug websites but as it is still quite early if and if you are around it would be helpful if you could tell me, if not what I will check the websites and get back to you later.

As you have only been off off.the antidepressants for about 6 weeks it should be possible to reinstate successfully.

We will will look at your history and drugs taper

during the course of the day day.and be back to you you later with a proposed dose.

It is essential that you do not not not

reinstate at 20mgs.

Sassenach

 

 

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Saffron

Hi. Great to meet you Sassenach. I just checked and they are powder. In case relevant, the packet says MA holder: strides pharma uk ltd, herts. I really appreciate your help. I have sat on the prescription and not taken anything yet. After seeing the threads on diluting, I hoped it would be possible. 

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Sassenach

Hi Saffron.

 

I apologise this may be a bit short but I do not have much time at present.

We can cover the important stuff.

 

You are in W/D withdrawal as you correctly deduced.

There is only one known way to mitigate W/D symptoms and that is small dose reinstatatement.

As you are 6 weeks from your last dose reinstatement is  viable .

about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

the-windows-and-waves-pattern-of-stabilization/

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

why-taper-by-10-of-my-dosage/

You are obviously an intelligent woman as you have found the threads on diluting.

Make up a 2mg dose and take it in the morning.

It is very important you get this dose correct

If you are unsure or unable then please do nothing and we will chat tomorrow to sort it out.

Catch you tomorrow.

 

Sassenach

 

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Saffron

No apology needed. Thankyou. Got it! I shall be cutting up powder in the morning.😮

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Sassenach

@ChessieCat

 

Thanks CC appreciate the reinforcement

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Saffron
9 hours ago, ChessieCat said:

Please note that Sass suggested 2mg, not 20mg.

 

Tips for tapering off Prozac (fluoxetine)

Thanks both. Yes. The powder capsules I have are 20mg so I need a tenth. 

 

Two questions if I may:

1- now I have my tenth, any reason not to just lick it off the sheet of paper and have a good swig of water? It is a tiny looking amount and it seems the best way I get it all in. 

2 - was there any reason you suggested the morning Sassenach? If related to keeping a steady time each day, how accurate would you recommend that is? (I have seen threads about ttiming each day being important but that may be for shorter half life meds). I used to just take my 20mg before bed, whatever time that was, but was usually within the same hour each day. 

 

Sorry if my questions seem daft. I am new to this so am navigating the stuff the really matters. 

 

Your time is hugely appreciated.  

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Sassenach

Morning Saffron

 

1- This is fine as long as you ensure you get all the powder. We need to keep track of your symptoms over the next few weeks to ensure this method is accurate enough. Some people can very sensitive to even tiny variations in dose.

 

2. Most SSRIs are activating and therefore better taken in the AM.

Prozac does seem to react differently depending on the person.

If you used to take it at night and did not experience insomnia, then continue to do so.

 

Your questions are not daft. We prefer members to ask rather than take a guess.

These drugs take effect very quickly, it takes much longer to undo the changes they make.

Your brain will register the reinstatement in four days and it will take a week to reach full state in the blood.

This is when you should begin to sense changes if the dose is sufficient.

Unfortunately there is no formula to calculate the dose needed.

What we do know is that too high a dose will cause havoc to your already sensitised CNS.

Unfortunately doctors and psychs to not yet recognise this, so pile on more meds.

You need to listen to your body and keeping a symptom diary often helps.

We all think we will remember how we felt last week but rarely do while in withdrawal.

 

I need you to complete your drug signature please.

This is basically the info you gave in your early posts in chronological order.

Drug/dose/date/s

include taper info.

You should also include any supplements you are taking along with dose.

I appreciate this seems like a repeat task for you but it has a very important purpose.

It will appear at the bottom of every post you make, which means any of the mods can see at a glance your history.

It takes time to read back through posts looking for this info.

All mods are volunteers and very busy so it really helps us.

Go to top right corner next to your screen name.

Click small arrow.

Account settings.

Complete details.

Thanks in advance.

 

We will need to stay in touch regularly during the first few weeks. If you have any questions or concerns do not hesitate to ask.

In view of your doctor's attitude it makes sense not to tell her you are tapering as long as she continues to issue prescriptions.

 

Please feel free to browse the site, it is a wealth of info.

Other members threads will give you an insight and the opportunity to share experiences.

 

Sassenach

 

Again welcome.

 

Sassenach

 

 

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ChessieCat
11 hours ago, Sassenach said:

I need you to complete your drug signature please.

This is basically the info you gave in your early posts in chronological order.

Drug/dose/date/s

include taper info.

You should also include any supplements you are taking along with dose.

I appreciate this seems like a repeat task for you but it has a very important purpose.

It will appear at the bottom of every post you make, which means any of the mods can see at a glance your history.

It takes time to read back through posts looking for this info.

All mods are volunteers and very busy so it really helps us.

Go to top right corner next to your screen name.

Click small arrow.

Account settings.

Complete details.

Thanks in advance.

 

This link goes straight to your drug signature.  Remember to click on Save.

 

Account Settings – Create or Edit a signature

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Sassenach

Hello Saffron.

 

I hope you are managing your doses OK.

Thank you for completeing your drug signature.

 

If you experience any adverse reactions from the reinstatement , stop immediately and contact us.

 

Self care is very important during W/D.

A young child, job and daily commute are bound to put a strain on you.

Good sleep is especially important as this is when your CNS has most reserves available to heal itself.

 

The following links may help.

non-drug-techniques-to-cope-with-emotional-symptoms/

non-drug-techniques-to-cope-with-emotional-symptoms/

dr-claire-weekes-method-of-recovering-from-a-sensitized-nervous-system/

http://www.junior-anxiety-depression-exchange.org.uk/relax.html#HowToRecover

 

Please keep in touch this week as to how you are feeling.

 

Good luck

 

Sassenach

 

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Saffron

Hi Sass. Thanks for the tips and I was very interested to learn that 4th day 7th seem to be key dates. I confess to a chuckle re the sleep comment as my partner's back 'went' on thurs and so I have been nurse, worker, housekeeper and mum since then. All improving now but I am knackered. Really helps to have the support of this forum.

 

I will be syringe buying. It is tricky indeed to cut powder to size. It tastes pretty foul too. 

 

I am very much hoping reinstatement will help with my impatience/short temper. Am tracking how I am feeling, as suggested.

 

Will keep you posted and will keep reading and learning. Keep well. 

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Sassenach

Hi

 

Hope you are not too knackered.

On 9/8/2019 at 10:12 PM, Saffron said:

nurse, worker, housekeeper and mum since then

That's tough in W/D.

 

On 9/8/2019 at 10:12 PM, Saffron said:

I am very much hoping reinstatement will help with my impatience/short temper

Really tempted to be a smartass👿.

It will help. I remember terrible uncontrollable anger for no reason, even the dogs used to duck.

It was horrid but only lasted a couple of weeks.

Catch you later in week for an update.

 

Sass

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Saffron

Hi Sass. Ha!! Cheek!! My short temper/angry outbursts are a new thing for me (if I don't count shouting at computers) and one of the hardest parts of what was either a recurrence of problems or withdrawal. I am really hoping that will pass. 

 

Switched to dilution and syringe this morning. Much easier than dry cutting powder and more precise I am sure. 

 

Have had a slight headache and slightly poorly tum but I think that is actually lack of sleep and the stress of the week I have had, completely unrelated to reinstatement. Day 4, which I know you mentioned as a key date. Had a good day today so am interested to see if that continues.

 

Hope you are keeping well.

 

Sue 

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Sassenach

Hello Sue.

 

It will definitely pass.

 

You are doing very well after the stress you have been through.

 

Hope your partner's glass back is ok now.

We men need looking after😇.

 

Can't guarantee no more ups and downs for a while but a promising start.

 

Sass

 

 

 

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Saffron
4 hours ago, Sassenach said:

 

Hope your partner's glass back is ok now.

 

 You've met!! 😉🤣

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Sassenach

Only if he is a Yorkshireman😁

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Saffron
On 9/12/2019 at 11:34 AM, Sassenach said:

Only if he is a Yorkshireman😁

😯 Lancs 

 

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Sassenach

Hi Saffron

 

Wrong side of the hillsHow about you, Essex girl, My bet is no.

 

Serious stuff.

Are you feeiling any better than before the reinstatement overall?

Are you feeling worse than before?

Have you experienced any new symptoms?

Has your child felt any less stubborn as the week has progressed?

Has your patrner needed less help as the week progressed?

 

Sass

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Saffron

Hi Sass. Sussex girl who lived up north for 12 years and loved it. Manchester and then York. Would have happily stayed in York (less rain) save for family being in the south. Loved it there. 

 

Anyway, back to business. Day 5, 6 and 7 I felt like my old self. Very tired due to the exceptional week it had been by then with high workload and home pressures, but clear headed and with some get up and go. Day 6 I was very aware that despite my toddler pushing boundaries, I wasn't having to contain a short temper. It wasn't there. I was patient. It was amazing. Today started the same and then at 12.15pm, as we were going out, I started to feel anxious and struggled to make simple decisions again. It just came on so suddenly, it was so bizarre. Really disappointed because it felt like something magical had been happening, I had started to feel so much clearer again after weeks of forgetfulness and short temperedness. 

 

Have had headaches by mid aft but that could well be the extra screen time I have put in at work and tiredness. Bit sniffly but that could actually be a cold. I have pushed myself this week. Had a dodgy tum the first few days. Poss related but poss not.  Nothing new or obviously linked to reinstatement. 

 

What would you recommend? 

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Sassenach

Hows today

 

Back 6pm

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Saffron
1 hour ago, Sassenach said:

Hows today

 

Back 6pm

Rubbishness has continued. 

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Sassenach

Hi Saffron

 

Can you be sure you have picked up a cold?

I got one two weeks ago and has really knocked me, just improving today.

Unfortunately could not have happened at a worse time as we try and assess whether the dose is correct.

One week in, your brain is processing the prescence of the drug so a wobble is not uncommon.

the-windows-and-waves-pattern-of-stabilization/

 

Basically- you have a building where the MAJOR steel structures are trying to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were trying to rebuild the tower - WHILE people were coming and going and trying to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while life is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.  

 

20 hours ago, Saffron said:

Really disappointed because it felt like something magical had been happening, I had started to feel so much clearer again after weeks of forgetfulness and short temperedness. 

The magic is what will eventually become permanent, but it will take time.

You have also been pushing yourself to the limit by the sound of it.

Do the screens at work have blue light filters?

Do you drink coffee, and if so is it de-caf?

Are you sleeping well?

For the next few days I may become Sassenag as one former member called me.

We need to assess the dose and the only way to do that is by regular communication.

We really have all experienced that disappointment but you will get better.

 

Chin up

 

Sass

 

 

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Saffron

Thanks Sass. To be fair, this weekend I have mostly felt like I have done for the last few weeks, which led me to the forum and GP. It was the few days of clarity that I probably got carried away with. 

 

Yep, I do drink caffeinated coffee and my sleep is interrupted. I have filters on my screens. I definitely have pushed myself too far since reinstating. Work deadlines coincided with home life needing more of me. 

 

Am I guessing I could do with ensuring no caffeine, try to get good sleep, no booze, anything else? 

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Sassenach
2 minutes ago, Saffron said:

Work deadlines coincided with home life needing more of me. 

This whole withdrawal thing would be so much simpler if we existed in a sealed chamber for a few months, but we could die of boredom.

It has to happen inreal life, but in order to help we have to try and be kind to ourselves.

7 minutes ago, Saffron said:

Am I guessing I could do with ensuring no caffeine, try to get good sleep, no booze, anything else?

No caffeine

Good sleep is essential, it is when a lot of the repair work happens.

No alcohol is desirable. It is a stimulant.

Are you taking your meds AM or evening and at the same time every day?

12 minutes ago, Saffron said:

I definitely have pushed myself too far since reinstating.

The fact that you recognise this will help going forward.

 

Born in York, lived in Poppleton for forty years before moving north.

 

Sass

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Saffron

Hi Sass. Thanks for the advice. Got it. Will move to decaff. Meds in AM. Not exactly the same time because I have forgotten till later in the morning at the weekend. Same time mid week though.  

 

Small person in bed. Off for a chill on the sofa then early night. 

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Sassenach

Hi Saffron

 

Great name by the way, if you look at some of them we have to remember.

 

How was today?

What time do you take meds mid week?

What time did you take them at weekend?

 

Sass

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Saffron

Hi Sass. Ah, the forum name choice is never easy but then it has to be lived with!  Or does it? I noticed you have been a member since March....or do you switch name now and again? 😉 

 

Today has been good. I had a focus though. Work. No opportunity for the mind to wonder to negative thoughts perhaps. It would be a sad old state if I have to work to feel ok though. Completely against my life ambitions! Ha. 

 

If I go to the office, I tale them at 7.20am. If, like today, I work from home, or it is the weekend, it can vary. Today was 9.15am. Sat or sun I forgot till 11.30am one day. I shall start noting. 

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Sassenach

Hi Saffron.

 

How has today been?

 

21 hours ago, Saffron said:

Ah, the forum name choice is never easy but then it has to be lived with!  Or does it? I noticed you have been a member since March....or do you switch name now and again? 😉

The name can only be changed at the start, something to do with the way threads work.

I have only been a member since March and a mod since June.

If you have concerns about the advice I am giving you should speak to another mod for their input.

I have absolutely no problem with that.

It is important that you feel confident in the guidance you receive.

 

Sass

 

 

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Saffron
2 hours ago, Sassenach said:

 

I have only been a member since March and a mod since June.

If you have concerns about the advice I am giving you should speak to another mod for their input.

I have absolutely no problem with that.

It is important that you feel confident in the guidance you receive.

 

Not at all Sass. You seem very knowledgeable and your kind amd patient manner is spot on. I honestly thought you might have joined, left, rejoined. Thankyou for helping me . I am indeed confident in you. 

Quote

 

How has today been?

Not good but took me a while to realise. Slept badly last night. Woke within 2 hours of going to bed and struggled to sleep after. I can now see i was reacting in a stressy way to things at work this morning, then by 3pm i hit an energy slump and felt really down. Had a short nap on train home to try and correct my.mood a.bit. Then got home and had extreme anxious thoughts about what could be wrong with my son and felt tearful and anxious just because he looked a bit poorly. Sigh. 

 

Am i right in thinking you are trying to assess whether my reinstatement dose needs to increase a bit? Is all this normal? 

 

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Sassenach

Hi Saff

 

Out at friends tonight, will reply tomorrow.

Unfortunately normal.

Try and sleep.

 

Sass

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Saffron
10 hours ago, Sassenach said:

 

Out at friends tonight, will reply tomorrow.

Unfortunately normal.

Thanks Sass. Well, that is reassuring though.

 

Woken at.3.30 by small person then took a long time (poss hours) to get back to sleep. This is tending to be the current problem..can get to sleep but not back to sleep if I wake in the night..

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Sassenach

Hi Saff

 

First how is your son?

Second, how is your partner?

Oops nearly forgot,  how are you?:rolleyes:

 

Sometime a quick post to reassure is worse than no reply

4 hours ago, Saffron said:

Well, that is reassuring though.

What I meant was W/D normal.

As we accept what is happening the symptoms become a normal of their own.

Accepting is an essential part of getting better.

With time W/D normal morphs into real normal.

It allows us to measure our symptoms and keep perspective.

 

15 hours ago, Saffron said:

Am i right in thinking you are trying to assess whether my reinstatement dose needs to increase a bit? Is all this normal? 

It is, there are no scientific results to help us calculate the required reinstatement dose.

Here it is done by discussing with senior mods who have years of anecdotal experience.

Everyones  brain reacts differently but we use well established parameters collated by Alto and the rest of the boffins.

The drug you are taking.

How long you were on it originally.

The original dose

How you ceased the drug.

How long since you took last dose.

Too high a reinstatement can cause kindling.

Too low can be ineffective.

There is one final thing to factor in. At SA it is our mission to help people manage without drugs in the longer term.

The higher the reinstatement dose the longer it will take to taper off.

So quite a balancing act.

 

On 9/16/2019 at 8:25 PM, Saffron said:

No opportunity for the mind to wonder to negative thoughts perhaps. It would be a sad old state if I have to work to feel ok though. Completely against my life ambitions! Ha

You will be ok, you are confident and positive, good qualities for W/D.

 

On 9/11/2019 at 5:33 PM, Saffron said:

My short temper/angry outbursts

Have these returned?

 

We need to sort out your medication times.

 

On 9/16/2019 at 8:25 PM, Saffron said:

If I go to the office, I take them at 7.20am. If, like today, I work from home, or it is the weekend, it can vary. Today was 9.15am. Sat or sun I forgot till 11.30am one day. I shall start noting

This very important.

You are training you CNS to expect the drug at 7.20.

Within one hour of that time it can begin to backpedal when the dose does not arrive. Another couple of hours and the level in your body will be dropping.

This can trigger change of symptoms that can last for several days before you do it all over again next weekend.

The drugs play such havoc with our brains that when the system is sensitised, the slightest change causes issues.

As you sound very PC savvy.

Imagine a large network running on a basic OS with no backup or UPS.

Power cut then power returned.

Would you expect expect no problems?

You need to bring the weekend into line.

Alarm on the phone works for me.

 

Apologies for long post but you are able to understand the reasons for your symptoms and knowledge helps.

 

If you got through this maybe you want another mod now.👿

 

Sass

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