Edmunds: prolonged Wellbutrin withdrawal

[Altostrata]

On 7/6/2020 at 6:39 PM, Edmunds said:

It's getting harder to pull a precisely accurate amount into the syringe. I may have to buy one that measures relatively tiny amounts.

 

Did you resolve this?

 

What are your current symptoms?

[Edmunds]

Thanks @Altostrata Sorry I forgot to tell you. I have a more finely calibrate syringe.

[Altostrata]

Is your taper going more smoothly now?

[Edmunds]

Thanks for asking @Altostrata I'm having no significant negative effects from the taper. My symptoms have remained much the same for some months now. I'm in a continuous state of foggy derealization with blurry vision and anxiety that comes and goes but remains at a low level. Unlike many others in WD, I don't have roller coaster waves and windows, rather small ups and downs between one day in the next, even some days when I think I might be getting better--but then don't.

 

My spouse does most of the driving, Between the derealization disconnect and the blurry vision, I don't feel confident driving on busy roads. My eye doctors all agree that they cannot correct my vision problem with changes to my spectacle prescriptions. Rather, it's a CNS issue.

 

Members in WD speak of experiencing visual snow. Is that different from blurred vision?

[Altostrata]

I don't know what the vision problem might be. Have you tried holding at a dosage for a while to let your nervous system settle to a new baseline?

[Edmunds]

Thanks. I will hold at 4 mg for awhile. But my dose is so low now that I’m eager to be holding at 0 mg, as it were, because Prozac is known to cause vision problems for some people. And I know that even after I stop the Prozac, it will take a while to clear it out of my body.

[Edmunds]

Thanks again to @Altostrata and @ChessieCat regarding taper of Prozac. I started a fluoxetine taper in January 2020, and I'm currently holding at 4 mg of liquid. I've noticed that symptoms have been aggravated, though not drastically, since I got down to relatively low doses. The symptoms are heavy feelings of derealization (visiual disconnect like I'm looking at the word through an invisible shield), blurred vision, sore eyes at night, and periods of a couple of hours of moderate distress/anxiety.

 

I have just read an interesting article in the American Psychological Association titled ""How Hard Is it to Stop Antidepressants, by Kirsten Weir, v. 51, no. 3, April 1, 2020, https://www.apa.org/monitor/2020/04/stop-antidepressants. Here's a quote from the article:

 

At low doses, a small amount of an SSRI has significant effects on serotonin activity. But as the dose goes up, the drug’s effects on brain activity level off. The precise numbers differ depending on the drug, but in general, SSRIs all seem to follow this pattern, Horowitz explains. “When you get above a certain dosage, every extra milligram of the medication does less and less to affect the brain,” he says. “The practical implication is that when you stop the medicine, you need to reduce it more slowly at lower doses.”

 

In other words, cutting a 2 mg dose to 1 mg might have a bigger effect on brain chemistry than dropping a 20 mg dose down to 10 mg. If people go down too quickly, they may experience withdrawal effects—especially at lower doses, Horowitz says. “And if a doctor is not well versed in withdrawal symptoms, he or she might conclude the underlying illness is back and put the patient back on the drug, when in reality, that patient may just need to come off the drug more slowly.”

 

I wonder if I have been experiencing the moderate aggravation of symptoms because I'm getting down to a very low dose. Contrary to some advice, I have done a linear 10% taper since January 2020. I sent from 8% to 6% and 6% to 4% in 3-4 weeks each. I it was during taper from 8% to 6% to I believe I started noticing the aggravated symptoms.

 

Any thoughts on this idea of tapers getting harder when one is getting nearer to zero?

[ChessieCat]

24 minutes ago, Edmunds said:

 

I wonder if I have been experiencing the moderate aggravation of symptoms because I'm getting down to a very low dose. Contrary to some advice, I have done a linear 10% taper since January 2020. I sent from 8% to 6% and 6% to 4% in 3-4 weeks each. I it was during taper from 8% to 6% to I believe I started noticing the aggravated symptoms.

 

Any thoughts on this idea of tapers getting harder when one is getting nearer to zero?

 

 

That is why SA recommends no more than 10% reduction of the current dose, not the original dose.

 

I reduced my Pristiq from 100mg to 50mg and experienced very bad brain fog for 2 weeks and got to the stage that I was unable to type.  SA suggested increasing my dose.  I took an additional 50mg and about 4 hours later I was able to type again.  I'm a professional typist so I had a benchmark and knew for a fact that it was not placebo.  Because I was experiencing mild serotonin toxicity on 100mg I needed to reduce fairly quickly, so after about 2 days I started taking 75mg and found that I was fairly good at that dose.  I held on that dose for about 2 months and then tapered at no more than 10% of current dose until I got to 50mg (which was a tablet; I have to get my drug compounded) and I held on 50mg for 3 months to allow my brain a chance to catch up if it needed to. 

 

And yes we have members here who have found that as their dose gets lower they need to go slower by reducing less and/or holding longer.

 

This topic discusses the SERT occupancy:  Why taper paper: dose-occupancy curves

 

 

 

[Altostrata]

Yeah, we know all about that. Taking into account your linear taper, which may not have given your nervous system time to adapt at each step, this is my advice:

 

On 7/27/2020 at 10:27 AM, Altostrata said:

I don't know what the vision problem might be. Have you tried holding at a dosage for a while to let your nervous system settle to a new baseline?

 

[Edmunds]

It's time I checked in and thanks again to @ChessieCat and  @Altostrata

 

I signed up for the event on August 22.

 

Ive' been holding at 2 mg Prozac for a few weeks now. I often feel very discouraged owing to the persistence of the same symptoms day in and day out: constant derealization (living in a dreamscape), blurred vision, ebbing and flowing distress/anxiety feelings throughout the day (though not acute), constant lethargy/fatigue/drowsiness.

 

Should I stay at 2 mg Prozac until I feel some greater improvement/stablization, maybe for a long time, or start micro-tapering at 10% of current dose?

 

I wonder how much of my "stalled" condition is attributable to 1) being at low dose of Prozac but not off it, 2) continuing protracted stabilization process going back to fast taper of Effexor and Wellbutrin nearly 15 months ago, or 3) the having been on on or another psych medication most of the time since 1987.

[Edmunds]

The psychiatrist I talk to about every 6 weeks has been supportive of my tapering off ADs--Prozac in my case. Yesterday, however, he pushed back, if amicably. His main points were that 1) my report of WD lasting more than a year is "very unusual;" 2) the numerous reports of lengthy WDs on support group sites like SA are not to be doubted, but nevertheless they are all anecdotal and not supported by clinical testing --they aren't "scientific"; 3) millions of people are perfectly happy with their ADs and benefit greatly from them; and 4) maybe I should consider that I "really need medication." I reminded him that over the years I had tried a drugstore of meds without any significant help in the past 8 years, so which med did he think I "really needed." He had no answer for that but referred me to an acquaintance of his who is a well-known psychopharmacologist and head of a large research institute! My psychiatrist knows, however, that my primary and chronic symptom is derealization and that there is no AD that treats it directly.

 

In short, I came up against the psychiatric wall yesterday, and I probably knew it was coming.

 

 

 

 

[Erell]

On 7/27/2020 at 7:27 PM, Altostrata said:

I don't know what the vision problem might be. Have you tried holding at a dosage for a while to let your nervous system settle to a new baseline?

 

On 8/17/2020 at 7:59 PM, Edmunds said:

Should I stay at 2 mg Prozac until I feel some greater improvement/stablization, maybe for a long time, or start micro-tapering at 10% of current dose?

 

As Altostrata said, it could be good to hold your dosage and see how your symptoms evolve.

 

I'm sorry your psychiatrist is not supportive, unfortunately this is often the case.

 

Take care ☀️

[Altostrata]

You don't need a psychiatrist on your payroll to prescribe drugs while you taper, any doctor can do it.

[ChessieCat]

2 hours ago, Edmunds said:

4) maybe I should consider that I "really need medication." I reminded him that over the years I had tried a drugstore of meds without any significant help in the past 8 years, so which med did he think I "really needed." He had no answer for that

 

Good on you for speaking up.

 

how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

[Edmunds]

Thanks for the replies. Thankfully, I have an excellent health plan!

[Edmunds]

Warm thanks to @Altostrata , panelists, and organizers for the excellent film and discussion today. The event gave me courage!

[Altostrata]

Thanks, Edmunds. Which part stood out to you?

[Edmunds]

In watching both the film and the panel, it's heartening to have visual contact with and hear the stories of individuals who have been dealing with, and in some cases are still dealing with,  withdrawal, which takes so many different forms. One feels less alone in experiencing strange and bewildering symptoms, especially symptoms that most medical professionals I have talked to don't really grasp.

 

One small question about the program: I think viewers had the impression that following initial statements by the panelists, there would be ample opportunity to hear questions and answers. I wish there had been more time for that part of the event.

[Edmunds]

Four days ago I tapered from 2.0 mg of Prozac to 1.8 mg. The derealization symptom has been even denser and my anxiety level, though not acute, has ticked up. Is my brain resisting a .2 taper? Now that I'm down to such a low dose (from 20 mg last January), part of me wants to just stop the Prozac and get it out of my symptom. If I'm not getting either better or worse, I have little appetite for holding at a dose month after month without any change. And I wonder if my protracted symptoms, mainly derealization, moderate up and down anxiety, and blurred vision, are all continuing WD troubles from the Effexor I tapered from (too fast) 14 months ago. I know that's possible. And part of me, thanks to SA, tells me to hang on with this tiny taper month by month. At no time in the Prozac taper of the past 8 months have I felt significantly better, maybe just a little worse by small degrees. I don't have noticeable wave and window swings. All-in-all I'm pretty discouraged.

[Erell]

Hello Edmunds

 

I utterly get the frustrating aspect.

 

However, I would be very cautious about wanting to rush things :

we tend to think that we already suffer and that things can't be worse, while they actually can be a lot worse.

Ct really is not fun, as well as a highly destabilised CNS.

 

You are so close to your goal, it would be very sad to ruin all your efforts.

 

A lot of members report having to slow down their taper when they reach a low dose : 

going from 2mg to 1.8mg is a 10% drop,

you might want to try a lower percentage and see if the drop is gentler for your CNS.

 

Take care ☀️

[Edmunds]

Thanks, Erell. I'm sure you are right.

 

[Edmunds]

@Altostrata , @ChessieCat , and @Erell have all advised me not to rush my taper of Prozac. But now I offer a cautionary tale. Following some degree of stabilization following prolonged WD from Effexor and Wellbutrin, I started tapering a Prozac dose of 20 mg. in January 2020 by linear 10% increments every 3-4 weeks. My optimistic reasoning was that 1) I had fast tapered off Prozac a couple of times before (in the past quarter century!) without much trouble, 2) Prozac is supposed to be easier to drop than most other SSRIs because of its long half life, and 3) continuing use of Prozac might be contributing to my blurred vision so I've been anxious to get off it. My linear 10% withdrawal went all right until I dropped from 4% to 2%. I understand clearly now that that represented a sudden drop of 50%. Since I did that my symptoms have become aggravated--denser derealization, continued blurry vision, more surges of anxiety (though not acute), and in the past several days anxiety on awakening in the morning and, on some days, crying spells. Even though these symptoms ramped up I decided several days ago to reduce the taper by 10% of previous dose, dropping from 2% to 1.8%. (I have liquid Prozac and a 1 ml syringe.) I'm holding there and will stay there awaiting better times. Or should I go back up to 2%?

 

My moderators gave me good tapering advice back in January that I resisted following. This process requires infinite patience.

[Erell]

1 hour ago, Edmunds said:

  dropping from 2% to 1.8%. (I have liquid Prozac and a 1 ml syringe.) 

 

You mean 2mg and 1.8mg right ?

 

Edmund, the rythm of your taper is not clear for me : can you detail the dates of your last drops ?

Edited September 1, 2020 by Erell

[Edmunds]

Yes @Erell I meant 2 mg to 1.8 mg.

 

Here is a record of my tapers for the past few months.

May 13  10 to 8 mg

June 7  8 to 6 mg

June 29  6 to 4 mg

July 15  4 to 2 mg

August 26  2 to 1.8 mg

[Erell]

@Edmunds : since you've only been on 1.8mg since 26 August, you could try to go back to 2mg and see how it goes.

 

Because of Fluoxetine long half-life, you might not see change in your symptoms before a week or so.

Let us know how you're doing. 

[Edmunds]

@Erell : Thanks so much for that reply. I had a more aggravated than usual surge of anxiety this morning, though it abated after an hour or two. But I like to think that what I'm feeling there is my brain work hard to get stabilized. I will hold at 1.8 mg of fluoxetine for a day or two before going back to 2 mg if I think I should.

[Altostrata]

Please let us know how you're doing every day.

[Edmunds]

Thanks @Altostrata I'm holding at 1.8 mg of Prozac/fluoxetine. Symptoms continue about the same: derealization, blurry vision, little surges of anxiety, and fatigue. I have a good therapist now, and making a greater effort to apply ACT and CBT practices in relation to DP/DR.

 

I've been reading and listening to Peter Breggin. I'm pretty well convinced he is right when it comes to the conventional psychiatric approach to WD. The only thing I can't figure out is how I remained mentally in good shape for a full 17 years while taking 20 mg of Prozac every day. I thought it was my miracle drug, protecting me against derealization and anxiety. (My doctors invariably diagnosed me with depression, though I had few or none of the classic symptoms.) Then, after those 17 years, quite suddenly derealization and anxiety symptoms returned, albeit in a time of unusual stress. But now I wonder why a bad reaction to my Prozac brain diet didn't occur much sooner than it did.  I also wonder if the Prozac had much of anything to do with how I felt al those years. When I  went off the Prozac in 2014, the taper was very short. I had no adverse WD that I can recall, but, never mind, I went straight on to Lexapro!

[Altostrata]

On 9/1/2020 at 11:21 AM, Edmunds said:

June 29  6 to 4 mg

July 15  4 to 2 mg

August 26  2 to 1.8 mg

 

Did you feel any effects from the 2-week reduction of 6mg to 2mg (66%)? You might not have felt those effects for several weeks, i.e. mid-August.

[Edmunds]

I held at 6 mg Prozac for 3 weeks, then at 4 for 2 weeks, so that was 5 weeks. That was no doubt still too short a taper. So you might well be right about the timing because anxiety swells have been a bit more troublesome since early to mid August. I held at 2 mg for six weeks and dropped to 1.8 mg 10 days ago.

 

[Edmunds]

Yesterday, Sept 6, I experienced a welcome drop in the anxiety hum. That relief is continuing  today so far. I'm holding at 1.8 mg fluoxetine.

 

 

[Edmunds]

After a Sunday and early Monday of something of a welcome window, today opened with a siege of crying, dread, fear, you name it. The derealization fog remains as heavy as ever. I started to fantasize (briefly) about running to the psychiatrist to get some new pill! (I won't). After no doubt dropping to fast from 4 to 2 mgs of fluoxetine, I'm holding at 1.8.

[manymoretodays]

How are you Edmunds?

Are you still  holding with the 1.8 mg of floxetine/Prozac?

[Edmunds]

@manymoretodays Thanks for writing today. I was just about to write an update myself. Yes, I am holding at 1.8 mg of fluoxetine. Symptoms tend to vary somewhat from day to day. Yesterday and today I've experienced very little anxiety but greater fatigue (drained, lethargic), dense derealization, and continued somewhat blurred vision. I've had no significant windows for many months, just slight variations in the same old symptoms. I've been holding at 1.8 for 17 days so far.  When should I consider dropping another 10% from that dose?

I'm so eager to get off the fluoxetine. That might help my vision, though who knows?

This whole withdrawal process, starting with termination of Effexor and Wellbutrin and slow tapering from Prozac has been going on now for 15 months. Do you think that my slow stabilization may be partly a consequence of my simply being on one AD or another most of the time for the past 33 years?

[manymoretodays]

I'd stay put a little longer before tapering further, if it were me.  Give it a whole 6 weeks this time or until you have a whole week of being where you were before the last taper.

Does that make sense?? 

 

You do have times without the blurry vision don't you?  I mean already.  I know you've had to  use corrective eye-wear, and have had some significant changes, but  I would sure hope that the blurriness becomes a thing of the past, someday though.

 

I've always thought you might be going a bit fast with the Prozac.  And I just don't think that there is any real value to rushing to the finish line so to speak.

 

4 minutes ago, Edmunds said:

Do you think that my slow stabilization may be partly a consequence of my simply being on one AD or another most of the time for the past 33 years?

 

I don't think that your stabilization is particularly slow Edmunds.   You are brilliant.......shining through the internets!

 

I do wish sometimes I could go back in time some 30 plus years for me now.  And that I would not have been so trusting and all.  Eh, what fun would that be though?  Sometimes, it just is what it is.

 

You are right where you are now.

 

L, P, H, and G,

mmt

 ❤️

[Edmunds]

Thanks @manymoretodays That was a warm and encouraging message. I appreciate it.

 

My blurry vision is the same every day, though it isn't severe. The more aggravating problem has been esophoria (double vision). I'm continuing my quest for just the right glasses to correct it properly.

 

I'm in a pretty miserable state today, so thinking about holding at 1.8 mg of fluoxetine for 6 weeks, then at 1.62 for another 6 weeks, and on from there far into next year feels so discouraging, especially since I have had no significant windows in many months.