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Edmunds: prolonged Wellbutrin withdrawal

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Edmunds

Yesterday I had something of a window day. The anxiety feeling nearly disappeared after I had been awake for a short time. I experienced an emotionally “lighter” feeling, if only a crack of light. Today however the anxiety has come back for nearly the whole day. No particular trigger that I noticed. I’m learning, though, to accept and make space for it and get on with some work. 

 

I hope I’m making these entries in the right place and participating the way I should. I’ve had no feedback from a moderator in two weeks. Brief feedback really helps. 

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Gridley
23 minutes ago, Edmunds said:

Brief feedback really helps. 

 

Reading over your  posts, you're doing very well.

 

 Yes, you're posting in the right place and manner.  

 

The windows are a great sign that you are healing. 

 

  

 

 

 

 

 

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Edmunds

Gridley 

Thanks so much for that encouragement!

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Edmunds

Another workweek has come to an end with symptoms from Effexor and Wellbutrin withdrawal, especially the anxiety, varying somewhat from day to day, but derealization, fatigue, blurry vision, and diarrhea not changing significantly. This afternoon the anxiety abated quite a lot.That happened following a period of guided and unguided meditation. I had a window open a crack last Monday, but windows have been far and few between in the past 3 months.

 

Question: I'm not very good on the science. When I went off Effexor in May of this year, the idea my psych had was to replace it with Prozac (Fluoxetine), which we did. After I went into withdrawal from stopping both the Effexor and the Wellbutrin (stopped mid-July) and discovered SA, my moderators recommended I leave the 20 mg of Prozac alone, not making any med changes until I stabilize. Once I got off the Effexor, serotonin receptors would be expected to start repairing themselves. But isn't the Prozac preventing that? My plan is to eventually taper off the Prozac but not until SA gives me advice on that.

 

Before 2014, I was on Prozac for many years. For 17 of them, it seemed like a miracle drug but in 2013 stopped working, if in fact it had ever really worked at all. I say that because my main symptoms had always been anxiety, especially a perceptual derealization foggy disconnect. But I had fully recovered from that for years at a time before I ever took any ADs at all. When I tapered quite fast off the Prozac in 2014 after long use I had no withdrawal symptoms--but maybe I did because I went on to other ADs without feeling any better.

 

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Edmunds

Another workweek ended. I had what I would call window days last Sunday through Tuesday. Anxiety ups and down were back the past three days. The derealization remains consistently heavy. Maybe it will be the last symptom to ease up. My wife does most of the driving when we are together. I don't feel any cognitive impairment or slow reaction time. I never feel outside my body or other DP/DR symptoms other than the heavy perceptual haze, which does make driving, especially on routes where I have to look around to figure out where I'm going, quite distressing and very unpleasant. And the DR closely accompanies the basic feeling of anxiety, though unlike the DR anxiety tends to wax and wane. The good news: this past week the cortisol anxiety spikes when I wake up in the am have abated most of the past week. Diarrhea as well. And I haven't had crying jags for several days.

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Edmunds

Today is Saturday, and starting last Sunday afternoon the anxiety symptoms nearly disappeared. That window opened wider throughout the week. The anxiety spike on wakening disappeared as well. I felt a surge of hope all week, although the derealization fog remained consistently heavy. It's a little easier to accept that when not accompanied by gnawing anxiety. But then yesterday afternoon, the derealization tightened so that more than ever I was seeing the world "out there" as if I were peering up through a tunnel--well sort of like that. Anxiety said hello in the early evening, when my wife, who was at the wheel, guided us through choking traffic to get to downtown LA. This morning I awoke with a cortisol anxiety spike again. I went to my Saturday morning ACT class, but the anxiety, derealization, and blurry vision just grew throughout it. I began to wonder what I was doing there and having an especially hard time inviting anxiety and fog to come along with me. After eating lunch at home, the anxiety calmed (eating often helps a bit), though after a short crying spell, lethargy and fatigue pressed in. Now I'm wondering about going to a granddaughter's night soccer game and even accompanying my wife back downtown again. Staying home and keeping visual stimuli low helps endure the derealization and fatigue, but going out to the activities would be much more normal for me, despite having to invite  my disturbing feelings along.

 

How do people in withdrawal decide when it's best to stay home, rest, and try to be calm and when is it better to get on with what one would do in the absence of the distress?

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Edmunds

Sunday November 3

On Friday I had something of a window day in that anxiety feelings nearly disappeared, though derealization fog and mental fatigue remain heavy. Yesterday, however, anxiety returned. Last night we switched back to standard time, an event that always takes a toll in aggravated fatigue. We will see today. 

 

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Edmunds

Since I last reported in on Nov 3, I have been mostly free of anxiety surges and spikes, except for brief spells owing to cortisol elevation when I wake up. The past week has been a blessing regarding the anxiety, which was persistent nearly every day since at least late May. The derealization sensations of having a head wrapped in towels and seeing the world as if not quite connected to it continue, as well as blurry vision, multiple daily bowel movements, and fatigue. But I've had some success with reducing fear, pessimism, and bewilderment over the strangeness of derealization. Continuing work with ACT therapist and EMDR regarding deep family history. Yoga classes 3 times a week  and walking other days.

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Edmunds

Since my last report nearly 4 weeks ago, anxiety surges, cortisol spikes, and crying have all much decreased. The main remaining symptoms are disturbing derealization fog, mental fatigue, and blurry vision.

I WOULD LOVE MODERATOR COMMENT: The blurry vision has gotten somewhat worse in recent days. On moderators' advice I have continued throughout this withdrawal (starting in May 2019) to continue taking 20 mg of Prozac / fluoxetine. Because recovery seems to be progressing, however at micro-speed, should I consider starting a slow taper of the Prozac with expectation that that might help alleviate the vision problem. My vision is also compromised owing to the derealization (perceptual disconnection) and to esophoria, or double-vision, which is partially corrected with prisms in my glasses. Or would I be ill-advised to change the Prozac dose at all until my CNS is in better shape than it is so far? Prozac helped me for several years but pooped out six years ago. I tried it again as a replacement for the Effexor.  It might be helping me now by preventing even slower recovery, but I don't notice any concrete evidence of that. Will you advise?

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Edmunds

Anxiety surges, cortisol spikes, and crying episodes have all greatly receded in the past 6 weeks or so. Woo Hoo. Heavy derealization fog/disconnect and blurry vision have continued steadily if not getting a bit worse. Also sore eyes. No significant diarrhea but multiple, normal looking BMs every day and once or twice during the night.

 

I was able to research my medical record more thoroughly with better electronic tools my HMO has. I discovered that I was on Effexor.venlafaxine much longer that I originally reported on my signature. I took it from 12/14/15 to 05/23/19, that is, 3 years and more than 5 months.

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Welbu

I am also in withdrawal from wellbutrin 300mg. 

Now already 18 months in withdrawal hell!! 

In my first year i was feeling ill everyday.  Later i had my first windows starting in summer.  Now having a horrible wave that started in oktober.  Its sooo hard with a fulltime job and a new boyfriend....  Because of te bad wave my enthousiasme is gone en i am allot complaining because of the symptons.... 

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Edmunds

With my psych's guidance I tapered off Effexor/venlafaxine in mid May 2019 and off Wellbutrin/bupropion in mid June 2019, each in only 3 weeks.

 

Upon the Effexor taper, I substituted 20 mg Prozac (not just as a bridge), which I continue taking. Soon after the Effexor taper, WD ensued. The principal symptoms until November of this year were persistent anxiety surges, cortisol anxiety spikes in the morning, crying episodes most days, heavy derealization (DR) fog, mental fatigue, moderate diarrhea, sore eyes in the PM, and continuous blurry vision.

 

In the past 6 weeks, however, anxiety, cortisol spikes, crying, diarrhea, and lower-level chronic anxiety/depression have all greatly receded. Heavy DR, sore eyes, and blurry vision have remained.

 

After I found SA, @Sassenach advised me (September 15) to make no additional changes until I achieve stablization. Thus, I have continued with 20 mg Prozac, though without benefit that I can clearly attribute to it. I also understand that both the WD and the Prozac may be contributing to my vision problem.

 

My question is whether at this point, considering my significant improvement, I might consider starting a very slow taper of the Prozac in the expectation that eventually getting off it may lead to improvement in my vision as well. Or, will I likely just confuse my recovering brain and retard further recovery?

 

I will add that in addition to blurred vision, the DR derealization seriously affects my visual perception, causing the well-known symptom of feeling partially disconnected from my visual environment. I also suffer from esophoria (double vision), which is corrected, though imperfectly, when I wear glasses with special prisms. I have had recent helpful encouragement from @Gridley on my Introductory thread.

Edited by manymoretodays
spacing for readability

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manymoretodays

Hi Edmunds, and thank you for your patience.  I moved your stand alone post from tapering, back on here to your introduction.  Seems appropriate, as you have some case specific questions, regarding beginning a Prozac taper.  I think we might be running a little low right now on moderators who are active, as well as holidays keeping some of us busier than ever, with our own outside stuff.  You are being quite the trooper, waiting and posting, and waiting.  Thank you.

 

It looks like you found this topic on your own:  Vision symptoms: floaters, snow, blurred/dimmed vision, etc

 

15 hours ago, Edmunds said:

In the past 6 weeks, however, anxiety, cortisol spikes, crying, diarrhea, and lower-level chronic anxiety/depression have all greatly receded. Heavy DR, sore eyes, and blurry vision have remained.

 

That's great!  So good to hear.  The improvements.

 

  Are you consistently on 20 mg of Prozac right now? 

I think if I were you, I might consider starting the Prozac taper now, or at least getting prepared for that.  It may or may not improve your visuals.......I sure hope it does somewhat, at least.  Do you have any difficulty with online reading?

 

I'll repost some of the basics for you to get familiar with, or re familiar with:

Why taper by 10% of my dosage?

Tips for tapering Prozac

 

What form of Prozac are you using now?

 

Thanks again Edmunds, for your patience.

L, P, H, and G,

mmt 

 

 

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Edmunds

Thanks @manymoretodays for the comments and questions. I want to consider starting the Prozac/fluoxetine taper soon, though in courtesy to a new psych I have seen a couple of times, I will wait until after I have had any appointment with him next week. He has been gratifyingly supportive of all I have learned from SA.

I have been consistently on 20 mg of Prozac for more than 6 months. I have 20 mg capsules. One upcoming change is that during this period I have taken brand Prozac capsules because I had them on hand. They are now gone, and tomorrow I will switch to generic fluoxetine, which I also have on hand and can easily get refilled. But I will see if the liquid fluoxetine is available from my HMO for tapering convenience. Thanks also for the article references, which I will reread.

 

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Edmunds

@manymoretodaysOn your advice to consider a Prozac taper now,  I started it yesterday. My psych has been fully supportive and prescribed for me the fluoxetine liquid. I started yesterday. I was on 20 mg fluoxetine capsules. I took 4.5 ml liquid, which according to instructions is equivalent to 18 mg. I could hold at this dose for a month, though I’m thinking three weeks, then dropping another 10%. I’m thinking this because before 2015 I was on Prozac for about 17 years, and the psych took me off it with a pretty short taper with no serous withdrawal. I was then off the Prozac for a few years (and on a series of other ADs) until about 8 months ago, when I started the Prozac again. I’m not taking any other psychotropics at all now. Am i impatient to give the 10% just three weeks? (My psych suggested 2 weeks.)

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manymoretodays

Hi Edmunds,

If I were you, I would not get your hopes too high that you can do another short taper, that goes as well as the one you did in 2015.  Looking at your signature, you've had all sorts of drugs thrown your way in the period of time since then.  And then the medication merry go round too.  On and off of different ones.

Sometimes what this does is it sets up the nervous system(in general terms) for greater sensitivity or dysregulation.  Which means, if it were me,  I would proceed much more cautiously, than you have in the past.

 

Did you manage to stay at a daily dose of the Prozac for a couple of weeks now?

And yes, okay, 18 mg is a 10% drop from 20 mg.

Usually though........when switching from capsule to liquid, it's a good idea to just do the switch, without tapering at all.  Just to start.  We even ask members to consider a cross over from capsule(or any more solid form) to liquid, without any dose changes right at the start. 

3/4 old form + 1/4 new form with no dose change for 3-7 days

1/2 old + 1/2 new for 3-7 days

1/4 old + 3/4 new for 3-7 days

......and then to all new liquid Prozac, in your case

 

Hold please Edmunds, for a good months time, at least, before tapering further.  Prozac has that long half life.......and so oftentimes changes made today might not even register, or be felt for weeks.  I don't want you to get blindsided and surprised with WD symptoms, if we can help it.

 

36 minutes ago, Edmunds said:

(My psych suggested 2 weeks.)

 

And that's good Edmunds, that you have the new psychiatrist and all.  Unfortunately, many of them say they have a really good understanding of tapering and WD........and they do the best they can, but.........they have not really been too privy to any new information on tapering and WD and may have some outdated notions.  I mean don't put your shrink on the spot or anything.......that's just between you and me, and based on what I've seen moderating here and my own experiences too.

 

I encourage you to stick with our harm reduction protocols,  take charge of this taper, and empower yourself.  Listen to your body.  Keep notes with each change and taper.

 

Okay, keep us updated.

 

Thanks.

L, P, H, and G,

mmt

Edmunds, any improvement with your vision yet?  I'm so sorry, I have not attended to that concern of yours.  And I don't know, if a faster taper will help with the vision.  When did the blurriness start?  Was that with the Effexor or with the Effexor WD?

Edited by manymoretodays
blurry vision ?

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manymoretodays

Hi Edmunds,

What is withdrawal syndrome?

^ this one may help you with further understanding

And then we have this forum, if you go back to the Home Page(main page) and scroll down, it's down at the bottom, in Current Events

From journals and scientific sources

I know you mentioned wanting to find more evidence, around WD, and then protracted acute withdrawal

And a good ones to share with doctors, as well as try to understand yourself are from:

Why Taper by 10% of my Dosage?

For scientific data supporting very gradual tapering, see Horowitz, 2019 Tapering of SSRI treatment to mitigate withdrawal symptoms 

 

This paper is based on the concepts discussed in our topic Why taper? Paper demonstrates importance of gradual change in plasma concentration referring to Meyer, 2004 and other research into SERT transporter occupancy.

 

From correspondence with Dr. Horowitz: "...all pharmacological relationships are hyperbolic so the pattern of exponential reduction that you recommend is likely to apply to any target no matter what it is."

 

And you are off and tapering!  Best.

L, P, H, and G,

mmt

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Edmunds

@manymoretodays asked me about my blurry vision. I believe it started last May when I started the too-fast taper off Effexor and switched to Prozac. It got a little worse as time went on, but I don’t think it is progressing though not better. New glasses have this week helped with my double vision, though my eyes also get sore and itchy late in the day. The constant derealization fog and disconnect cause the most perceptual discomfort. 
 

I started the Prozac taper 8 days ago, 10% down to 18 mg, which I will continue for 4 weeks. So far so goodnight the sense that I have no new symptoms. 

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Edmunds

Today I tapered another 10% of Prozac down to 16 mg from  20. I continue to deal with derealization, blurry vision, and fatigue but no return of anxiety surges. Thanks to @manymoretodays

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Edmunds

After 4 months of no crying spells and much reduced anxiety, this morning I had a nasty breakdown, a great flood of sobs, sadness, jitteriness, so derealized I feel like I’m down inside a deep mine shaft. I’m in a slow taper of Prozac, but I don’t think that brought this on. Stressors this morning we’re not unusual.

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Altostrata
On 2/6/2020 at 12:27 PM, Edmunds said:

Today I tapered another 10% of Prozac down to 16 mg from  20.

 

You made this change yesterday. It seems you're feeling some withdrawal. This may go away in a few days. If it does not, your reduction was too much, you might put back 1mg, to take 17mg, stabilize, and taper by a smaller amount than 10%.

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Jmizz

Just popping in, I was browsing around...I wanted to point out that 16mg down from 20 is a 20% reduction. 18mg would have been 10%. I just wanted to point this out in case maybe that is why you felt it more. If it was just a typo, then my apologies.

 

edited: nevermind I see that you said from 20, you had a stop at 18 in between. Apologies. Hope you feel better 

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Edmunds

Thanks to @Altostrata and jmizz for your comments. Yesterday's sudden wave did not repeat itself today. I'm holding at 16 mg of fluoxetine/Prozac for the coming month.

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Rhiannon

Just want to put a little underline to MMT's comments above: I'd recommend being a bit more cautious with your Prozac taper given your history. Tapers can go well for a while and then suddenly everything goes south.  SSRI's are notorious for delayed withdrawal. If a person tapers pretty fast (and people often do at first, I've seen this happen many many times) then when they hit the wall it's pretty rough, they go through a pretty bad patch and often end up updosing or reinstating and lose any progress they might have made.

 

We aren't trying to rain on your parade by any means, we've just seen it happen over and over. This is something where the turtle definitely beats the hare nine times out of ten. Given your history I don't see any reason to expect you to be the one exception.

 

Please consider slowing down with your Prozac taper. Or maybe taking a longer hold, like six weeks, after every couple of cuts. I know it's always easier to push it faster than to go slow, especially when one is basically doing well. I have had more backtracks in my tapering years than I can count!  And if the consequences were minor I wouldn't be taking the time to type this. But people can really crash and burn and end up in a lot of suffering, and I'd hate to see that happen to you. 

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Edmunds

@Rhiannon Thanks for that. I really appreciate being reminded not to get impatient with the slow taper.

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Edmunds

I haven't check in in quite awhile, not since my last exchange with @Rhiannon, @Altostrata, and @Jmizz. I started the taper from 20 mg to 18 mg of liquid Prozac in January 2020. I held there for 4 weeks, then tapered to 16 for another 4 weeks, short of a couple of days. I have now been holding at 14 mg for about 2 weeks and will stay here for another 2. The anxiety symptoms, which started receding last November, are nearly absent and have not returned in any short or long waves. My energy level has crept up slowly. I had one bad day in early February but no repetition of that.

The derealization fogginess remains chronic, though some days it does not bother me as much as others. The other main chronic symptom has been blurry vision and, late in the days, aggravated and itchy eyes. Last week I saw my ophthalmologist, who assured me that he can see nothing wrong with my vision other than what we both already knew about (esophoria). He concurred that my CNS is the culprit, though he doesn't know, and the medical profession doesn't know, much about the CNS-vision connection. As the SA group knows well, taking Prozac, along with WD (from Effexor and Wellbutrin in my case), can cause or contribute to blurred vision. So, I'm eager to get off the Prozac completely. Mentors have helped me try to stay patient about that. The taper is going well so far.

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Gridley
52 minutes ago, Edmunds said:

The taper is going well so far.

Edmunds, it sounds like it's going great.  I'm glad the mentors have been counseling patience.  Yes, the symptoms you describe are very typical WD symptoms and you're coping very well.  Everything you report is very encouraging.

 

Please keep up updated.  

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Altostrata

16mg Prozac is still a substantial amount. Let's cross fingers your symptoms will diminish as you taper -- which you've done so well so far.

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Edmunds

Thanks to @altostrata and @gridley for comments March 15. The world has changed drastically since then, hasn't it? I can report that COVID-19, my wife's and my stay-at-home policy, and concern about family members (among them a ER nurse) have caused no resurgence of anxiety, which has been "in recession" now for a few months.

A few days ago I tapered my Prozac from 14 to 12 mg, with no ill effects so far.

Derealization fogginess, blurry vision, and sore eyes remain, though the vision problems can, as we know, be attributed to the SSRI I'm still on, perhaps aggravated by the Effexor WD, which I went off completely about 9 months ago (off Wellbutrin about 7 month ago).

One indelicate symptom I haven't mention is frequent bowel movements, maybe 5 in a 24-hour period most days. I'm not referring to diarrhea but BMs that are sometimes a bit loose but on the whole normal. No constipation, pain, blood, or other worrisome symptoms. I have also continued to take magnesium chellate on SA's advice, every other day. That might be a factor, though, again, I'm not experiencing diarrhea. I'd like to know if unusual frequency of BMs might be a WD symptom, though I don't see it on the Glenmullen list. Any thoughts?

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manymoretodays

Hi Edmunds,

As far as the frequency of BM's goes......it could be related to your diet too.  Has your household had any change in what you are eating overall?  And I sure think it could be WD related as well........the gut connection and the funky doodle serotonin system now, as you are tapering.  I know that most of the serotonin receptors are in the gut. 

Or some Irritable Bowel Syndrome, IBS:

Irritable bowel syndrome: Gut bacteria and what you can do.

 

Keep in mind, that after each taper, it may take some time for it to catch up to you too.  And especially with Prozac, and it's longer half life.......meaning the change may not register for awhile.  Are you using the liquid Prozac to taper? 

To calculate 10% drops from each previous dose is easy Edmunds.  I use a calculator.

With a current dose of 12 mg here is how it looks.

 

12 mg X .90 = 10.8 mg, which represents your next drop.  Okay to round up, if the number after the decimal point is > 5, so you could go to 11 mg next

 

Try to remember Edmunds.......you don't want to do a fast taper this time.  It sounds like you're doing pretty good and so try and give a really nice long HOLD, before you even do the next 10%.  You might be going a bit fast.

 

Yay, on the no anxiety too!!!  Woohoo.

 

And yes, it's one surreal Palm Sunday today.  Let's just keep our chins up and soldier on through these difficult times now.  And hoping for the best, with precautions, around the spread of this awful virus.  And resolution, without complications, for as many as possible, who do get infected.

 

Thanks for the update.  Keep them coming.  B)

 

L, P, H, and G,

mmt

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Edmunds

Thanks @manymoretodays

I checked symptoms of IBS, and I can say I don't have any.

I am using liquid Prozac to taper. That certainly makes it easier to go slow. I have on the taper for just under three months. More months to go. Maybe the pandemic and my taper will end at the same time!

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Edmunds

My liquid Prozac taper is now down from 20 to 10 mg. I'm holding there for now. Thanks again for recent comments to @manymoretodays

@Gridley and @Altostrata

 

I've been in something of a wave the past few days--heavy derealization fog, like seeing the world from way back in a tunnel. This feeling is aggravated by my blurry vision symptom. I did a RxISK report questionnaire regarding a Prozac side effect of blurry vision, which came back with a score of 11, meaning "Strong possibility of a link between medication and side effect."

 

I continue to work at home, which I would do anyway owing to retirement from my salaried job several years ago. The esophoria (double vision) I've had since well before withdrawal from Effexor and Wellbutrin (May and July 2019 respectively) also adds to my vision troubles. It has more recently affected my up-close vision. I wonder if this might have something to do with my WD, which has now been with me for about 10 months. (I have reported that anxiety symptoms have much receded.)

 

I may be able to correct my reading vision by getting new glasses with prisms that correct for esophoria. The prism glasses I wear for distance vision help greatly with the esophoria. The problem right now is that I can't (do not want to) make an appointment for an eye exam for new prism reading glasses owing to the pandemic. We are all in the same boat there. 

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Altostrata
15 minutes ago, Edmunds said:

I may be able to correct my reading vision by getting new glasses with prisms that correct for esophoria. The prism glasses I wear for distance vision help greatly with the esophoria. The problem right now is that I can't (do not want to) make an appointment for an eye exam for new prism reading glasses owing to the pandemic. We are all in the same boat there. 

 

Yes, that is correct. I need new glasses, too. We need to make do.

 

16 minutes ago, Edmunds said:

I've been in something of a wave the past few days--heavy derealization fog, like seeing the world from way back in a tunnel.

 

How often does this happen? When was the last time you decreased Prozac?

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Edmunds

Thanks @Altostrata

 

The sort of wave I've experience the past few days has occurred only once a month or less, though severity of the symptoms are relative. I've experienced steady derealization fog now since 2013, though for some periods it has abated to the point where it bothers me less, less enough that I have made some trips and socialized more.  When it's heavier, like right now, it's sort of like feeling I have not slept for three days or like I took a nap that was way too long and woke up feeling intensely groggy and with a hyper sensitivity to bright light or motion, as if more disconnected than usual from my perceptual surroundings. (These symptoms are hard to describe, aren't they?)

 

I was at 12 mg Prozac for just short of four weeks, than three days ago dropped to 10 mg. I'm not convinced that my aggravated symptoms are a reaction to that particular decrease. My earlier tapers did not cause an accompanying reaction like that.

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Altostrata

Those symptoms may not be from the decrease. They could be your background symptoms -- which may be the effect of the drug on your nervous system -- or have been caused by something else.

 

Have you changed intake of anything lately? Caffeine? Alcohol? Allergy pills?

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Edmunds

I've had no significant change. Consumption of both caffeine and alcohol have been very low. No allergy pills. I did stop taking Magnesium Chellate about 3 weeks ago to see if it might change my evacuation experience--not diarrhea. Rather more than usual BMs per day--after nearly every meal and during the night. Stopping the magnesium does not seem to have made a difference. Now I'm questioning whether to go back on it.

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