Phoenix1111: switch from fluoxetine to vortioxetine

[Phoenix1111]

Hi Everyone,

 

Well i am 36 years old and my journey with antidepressants started at the age of 16 (in 1999) when i started having panic attacks, i had always been a sensitive person and prone to bouts of anxiety as far back as i can remember. The list of medications went from Aropax, Zoloft, Cymbalta, Fluoxetine etc etc and i had tried numerous times basically since i first got put on them at 16 to stop them, i resented the fact that the doctor was telling me i would need them probably for the rest of my life and that i had a "chemical imbalance" which was determined through an extremely flimsy set of written questions, with no science at all backing it up! But unfortunately i was young and naive and this was back when you trusted what your doctor was telling you, so i reluctantly agreed.
 

Every time i tried to come off this medication i would fail spectacularly and end up in severe distress at which point the doctor would use this as "proof i needed medication" when actually this was a withdrawal symptom all along which unfortunately took a lot of pain and anguish and time for me to come to understand, but i am where i am.
I had been on the Fluoxetine for over a decade (can't remember exactly how long) and was tapering off in 2016 (before i knew anything about tapering), anyway i reached a point after a difficult breakup where i had a complete meltdown anxiety wise to the point where it was unbearable and the doctor put me on Mirtazapine where my weight ballooned to the biggest i'd ever been and i am only 155cm tall and since being put on antidepressants have put on close to 30kg! I used to be quite fit and active until this happened.

Anyway at the end of 2017 after being on 15mg of Mirtazapine for a year as well as remaining on the reinstated 20mg of Fluoxetine i began tapering the Mirtazapine because the weight gain was making me even more miserable. The taper was going quite well and i had been tapering for 18months and was down to 0.5mg! and found out my mum needed to have some pretty serious surgery and lost my job which sent me into a spiral and unfortunately because i didn't know any better at the time i reinstated the full 15mg of mirtazapine again  instead of just pushing it up 1mg or something and holding for 6 weeks (which seems to be the magic number for me).
Anyway, after discussing with my doctor we decided to change the 20 mg of Fluoxetine over to 20mg of Vortioxetine after i had done a DNA test which supposedly tells you which medications may work better with your genetic makeup. So now i find myself on a new drug and also still taking the 15mg of Mirtazapine.
The medication change was 10 weeks ago now and 5 days after the switch i did have some vomiting, diarrhea, headache and anxiety which passed but have had a steady stream of side effects including - intermittent Anxiety (sometimes panic), mild vertigo, some headaches, nausea, teariness and feelings of DEEP sorrow, irritability, ruminating thoughts the list goes on and on really but they all seem to pass quite quickly at this stage so i am hoping to power through and hoping that these side effects won't get any worse.
Once i have had a solid period of time where there are no side effects and i feel physically and mentally ready then i will attempt at weaning from the mirtazapine (I wish i could do it immediately so i could finally fit into my old clothes again but alas the evil antidepressant side effects stop this from being a reality right now).

I am being careful to keep a journal of my symptoms and become more aware of what my body is telling me, as well as learning from other people's stories from this website, which are immensely helpful as well as listening to James Moore's youtube channel called "Let's talk withdrawal" which i highly recommend to everyone who needs some encouragement.

So glad to have found Surviving Antidepressants and reading all your experiences, it really helps to know I am not alone through this process  

[Sassenach]

Hello      Phoenix    and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved .

Why did your doctor recommend the switch?

On 10/24/2019 at 7:39 AM, Phoenix1111 said:

The medication change was 10 weeks ago now and 5 days after the switch i did have some vomiting, diarrhea, headache and anxiety which passed but have had a steady stream of side effects including - intermittent Anxiety (sometimes panic), mild vertigo, some headaches, nausea, teariness and feelings of DEEP sorrow, irritability, ruminating thoughts the list goes on and on really but they all seem to pass quite quickly at this stage so i am hoping to power through and hoping that these side effects won't get any worse.

These sound more like W/D symptoms than side effects, please see

dr-joseph-glenmullens-withdrawal-symptom-checklist/

Are your symptoms improving or getting more severe?

A change of drug can cause these symptoms which may be short lived providing the equivalancy dose of the new med is correct.

On 10/24/2019 at 7:39 AM, Phoenix1111 said:

Once i have had a solid period of time where there are no side effects and i feel physically and mentally ready then i will attempt at weaning from the mirtazapine

Please do not decide which A/D to taper without consulting us first.

Are you taking any supplements?

 

On 10/24/2019 at 7:39 AM, Phoenix1111 said:

I am being careful to keep a journal of my symptoms and become more aware of what my body is telling me, as well as learning from other people's stories from this website

You are doing all the right things to help you get through this.

Unfortunately there is no short cut and time is the only healer.

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

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

 

There is whole section on symptoms and self care you cope with W/D.

https://www.survivingantidepressants.org/forum/8-symptoms-and-self-care/

 

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.

 

Again welcome.

 

Sassenach

 

 

 

[Phoenix1111]

Hi Sassenach,

 

Thanks for your reply, since i wrote this i have made the decision to stop the Vortioxetine (the new drug) and just go back to my full dose of Lovan so i can eventually wean off it really slowly. I think it is better for me to stop the new one asap before my brain becomes too dependant on it, This will leave me back where i started a few months ago with just the lovan and mirtazapine in the mix, a third drug is going to overcomplicate an already complex situation and this just feels like the right choice for me.
I will wait a couple of months to make sure my brain is coping ok, i have stopped new meds like this before with no problem it usually becomes more of an issue when i have been taking them for a long time.
Once i feel ready I will start to very slowly wean from the mirtazapine AGAIN i was previously down to 0.5mg before i had a huge meltdown and also before i knew that i need to go especially slow towards the end of a taper. So i will try again while remaining on the Lovan (which i have been on the longest).

 

Thanks again for your help and warm welcome Sassenach  

[Sassenach]

Good luck.

You know where to find us if necessary.

 

Sassenach

[Altostrata]

Welcome, Phoenix.

Please do stay in touch. To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Phoenix1111]

Hi Altostrata,

 

Thanks for the welcome, i have changed my signature as requested.

 

Thanks,

[Phoenix1111]

I have decided to just go back to the 40mg of Lovan and stop the Vortioxetine which i have been on since August. I am already feeling quite scared and anxious since doing this 2 days ago but i have switched others in the past after not being on them for too long and i'm hoping i will be ok soon  

[Phoenix1111]

Hi everyone,

 

I was hoping to get some advice on this. Once everything has settled for me (maybe early in the new year) i would like to try tapering the mirtazapine again.
I had previously been tapering for almost 19months and was down to 0.5mg in July and had a HUGE meltdown, panic etc and because i was not aware about reinstating etc at the time i ended up back on the full 15mg again

I have looked back on my journal notes and i believe when i first started the taper i went straight from 15mg to 7.5mg (obviously not a great idea) but i didn't have any major issues until i got to 0.5mg, so not sure if that is why i crashed and burned or maybe once i got down to the 5mg mark i went too fast on the smaller doses?

My question is will i need to start from scratch at 10% taper from 15mg again since it was only just in July when the dose was put back up? I really don't want to end up crashing and burning but also it just feels like i wasted 19 months of my life for nothing 😡

I have both Mirtazapine and Fluoxetine to eventually wean off of and i'm almost 37 now so i'm guessing any plans i may have had in the future for a family might be out of reach by the time i'm done tapering both meds.  

Any guidance would be great and if i have missed other posts answering the same thing, please point me in the right direction.

 

Thanks

 

[Sassenach]

Copied from tapering as I could not get it to merge.

 

 

Hi everyone,

 

I was hoping to get some advice on this. Once everything has settled for me (maybe early in the new year) i would like to try tapering the mirtazapine again.
I had previously been tapering for almost 19months and was down to 0.5mg in July and had a HUGE meltdown, panic etc and because i was not aware about reinstating etc at the time i ended up back on the full 15mg again

I have looked back on my journal notes and i believe when i first started the taper i went straight from 15mg to 7.5mg (obviously not a great idea) but i didn't have any major issues until i got to 0.5mg, so not sure if that is why i crashed and burned or maybe once i got down to the 5mg mark i went too fast on the smaller doses?

My question is will i need to start from scratch at 10% taper from 15mg again since it was only just in July when the dose was put back up? I really don't want to end up crashing and burning but also it just feels like i wasted 19 months of my life for nothing 😡

I have both Mirtazapine and Fluoxetine to eventually wean off of and i'm almost 37 now so i'm guessing any plans i may have had in the future for a family might be out of reach by the time i'm done tapering both meds.  

Any guidance would be great and if i have missed other posts answering the same thing, please point me in the right direction.

 

Thanks

Edited October 29, 2019 by Sassenach
copied from tapering could not get it to merge

[Sassenach]

Hi Phoenix

 

19 hours ago, Phoenix1111 said:

I have decided to just go back to the 40mg of Lovan and stop the Vortioxetine which i have been on since August.

I hope you will be lucky and not suffer because of this change, but you will have to wait to see what happens before considering any further tapers.

 

6 minutes ago, Sassenach said:

I have looked back on my journal notes and i believe when i first started the taper i went straight from 15mg to 7.5mg (obviously not a great idea) but i didn't have any major issues until i got to 0.5mg, so not sure if that is why i crashed and burned or maybe once i got down to the 5mg mark i went too fast on the smaller doses?

Unfortunately the fact that you did this in the past does not guarantee you can do it again.

Your CNS is in a different state of disarray.

The only way to do it is one day at a time.

If you do not taper more slowly this time it could take even longer.

I know this is not what you are hoping to hear but it is the reality.

We are here to help you get through but cannot control the duration.

 

Sassenach

[Altostrata]

16 hours ago, Phoenix1111 said:

Once everything has settled for me (maybe early in the new year) i would like to try tapering the mirtazapine again.

 

I moved your post here. Please put all your questions about your situation in this one Introductions topic.

 

Let's see how your recent drug change settles out before you make any more plans to reduce mirtazapine.

[Phoenix1111]

Thanks @Sassenach and @Altostrata,

 

I obviously won't be making any further changes for a while.
I just hope i can clear this med i had only been on for 2 months but at the moment i am having some WD symptoms felt sick yesterday and woke up with a headache today  

 

I have been up and down with meds and WD for nearly 20 years now and i honestly feel like i have been in a battle for that long, i'm so tired and honestly don't know how much more fight i have left in me. I almost feel like i was robbed of my life from the age of 17, and i have barely lived because i'm always in a struggle etc.

I know both of you have personal experience and understand this feeling and i'm so grateful that you have taken the time to help me out.  

Thank You

[Altostrata]

Please let us know how you're doing.

[Phoenix1111]

Hi,

 

So at this stage i am doing pretty good so far, i did have a withdrawal headache yesterday and a little bit of anxiety but nothing too severe.
Fingers crossed i get through this one relatively smoothly, only time will tell i guess.
Thanks for looking out for me.

@Altostrata i doubt you have any idea of the magnitude of good you have brought to people's lives through SA, you are an absolute inspiration and a brave, empathic, kick-ass woman!
Please keep doing what your doing, i appreciate you more than you'll ever know  

Thank You

[Altostrata]

Oh, thank you.

[Phoenix1111]

Hi,

 

Just a quick update, i stopped the rest of the Vortioxetine 2 days ago, have had some mild head spins, a bit of diarrhea, and some mild anxiety occasionally but it's mostly been quite mild.
I will continue monitoring symptoms in my personal journal for the next month or two and hope that the brief period of time i took the Vortioxetine wasn't enough to cause too much lasting damage (fingers crossed).

Will keep you updated

[Phoenix1111]

Hi @Sassenach,

 

Just wondering what happens if i do get a delayed withdrawal meltdown in 6 weeks or something from now, do i go back to initial dose or do i reinstate some of the dose?
I'm just freaking out a bit cos i'm scared i'll get hit with it when i least expect it.

 

Thanks

[Sassenach]

Hi Phoenix

 

Do not go back to your preivious dose under any circumstances, it could cause Kindling of your brain.

Do you have any Vortioxetine  left in case you need it?

I cannot suggest a reinstatement dose at present as this changes as the time off the drug increases.

If you feel you have arrived at a point when the symptoms are unbearable just post on here including @Sassenach as above and I will respond asap.

4 hours ago, Phoenix1111 said:

I'm just freaking out a bit cos i'm scared i'll get hit with it when i least expect it.

It is unlikely to hit so quickly but you should not wait too long as symptoms get worse not better when they start.

On 11/6/2019 at 2:28 AM, Phoenix1111 said:

the Vortioxetine wasn't enough to cause too much lasting damage (fingers crossed)

No reason it should cause lasting damage but can cause W/D after even a short period of time.

Keep in touch and look after yourself.

 

Sass

 

[Phoenix1111]

@Sassenach

Thanks so much for replying so quickly. So far i have had a couple of days of withdrawal symptoms, the worst of it so far has tended to last an hour or two then gone away.
I am having some head spins and a bit of anxiety/low mood, i'm just worried about it getting to the point where i can't bear it. I know it's tricky with these drugs cos you think you're past the worst of it and then it can hit again weeks later 10 times worse. 

I do have some Vortioxetine left if necessary

 

[Phoenix1111]

Ok so today the withdrawals have kicked up a notch, felt off balance and had head spins for most of the day as well as sore head, throbbing type of headache pain but it's that distinctive withdrawal headache that i've had in the past. As well as struggling to concentrate and focus my eyes properly on things.
Does this mean it's only going to get worse from here? I'm freaking out and not sure what to do.
I am supposed to see my doctor tomorrow so he can check up on how i'm doing and i'm wondering if i should maybe ask for a 1mg compounding script just incase it gets to be too much? I will ride it out for as long as i can but not sure if it will get worse than this.

@Sassenach any advice?

[Sassenach]

Hi Phoenix

 

My thought are you should not make any further changes and allow your CNS time to settle.

You have had so many changes already this year that any more will only make matters worse.

However I will ask @Altostrata for her input.

 

Sassenach

[Altostrata]

Hello, Phoenix. What times of day do you take your drugs, and their dosages? Do these symptoms get better or worse at any particular times of day?

 

Do you feel any effect from the fluoxetine?

 

Both vortioxetine and fluoxetine are long half-life drugs. As you went off vortioxetine only 8 days ago, you could just now be feeling the effect of the drug changes you made in October. Vortioxetine is ebbing and fluoxetine is ramping up.

 

My guess is your symptoms are from the increase in fluoxetine 8 days ago, combining with the remaining vortioxetine. The combination can be excessively serotonergic. I would cut back to 20mg fluoxetine.

 

This is a little tricky, because you can get symptoms off and on for a bit while the drug content of your body changes. This doesn't mean you're headed for a crash. Try to ride the waves a little longer, keeping an eye on your symptom pattern.

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, with a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

[Greenriver]

I feel your pain. I’m 37 and was put on these drugs at 16 too, despite not being depressed or that anxious. I still pinch myself that this is actually happening. Hope you manage to find some hope and stability. 

[Phoenix1111]

Hi Altostrata,

 

I take the Lovan 40mg at 8pm and the Mirtazapine 15mg at around 9pm every night.
I don't notice much effects from the fluoxetine just withdrawal when i reduce it.
I'm a little hesitant to reduce the Fluoxetine to 20mg since i have been on 40mg for such a long time and i don't want to add to the withdrawals from stopping the Vortioxetine.

If i do cut the Fluoxetine back to 20mg now will that compound my issues or is it still early enough for me to do that? 

Over the weekend i was getting withdrawal headaches at night time for a couple of hours along with some minor head spins. Yesterday and this morning (it's 9:30am where i am) i woke with some mild anxiety.

I am seeing the doctor in a few hours cos he wanted to check up on me, he acknowledges withdrawal to an extent, but once it's down to a low dose or a certain period of time has passed i think he believes it should no longer be an issue (which is obviously bulls**t as we all know). So not really sure what to tell him?
 

[Phoenix1111]

Hi @Greenriver

Thanks for your message. I'm so sorry to hear you have been going through this hell as well, i know how frustrating it is to feel like 20 odd years of your life have been taken from you because of these drugs.

How are you going with your taper, are you coping ok?

[Altostrata]

I am concerned about your high fluoxetine dose overlapping with the vortioxetine. Mirtazapine will also add serotonergicity in combination with these drugs.

 

My intuition is that you are not experiencing withdrawal symptoms, but drug-drug interactions as explained above.

 

Unlikely your doctor will consider this.

[Phoenix1111]

Oh ok, i'm not very knowledgable about drug to drug interactions but the effects i am having are the same to ones i've had before when i have reduced or stopped medication.

I guess only time will tell.

Would you advise that i go down to 20mg of the Fluoxetine tonight @Altostrata?

[Sassenach]

Hi Phoenix

 

Alto is a leading authority on A/D W/D which is why I refered your case.

She does not use phrases like,

13 hours ago, Altostrata said:

The combination can be excessively serotonergic.

lightly.

You are likely to feel a temporary uptick in symptoms when you reduce but it will have two advantages.

1. It will ensure your serotonin levels remain under control.

2. You will have only 20mgs to taper in due course not 40.

Tell your doc. you have been on A/Ds for a long time and you know your own body and want to take it slow.

If he/she does not want to listen just ask for their support with prescriptions and leave it at that.

 

Sassenach

[Phoenix1111]

Ok thanks @Sassenach, i will reduce to 20mgs tonight (i'm due to take it in half an hour).

I guess because of all this hell i am now overly cautious and worried every time i make any changes but i will take yours and Alto's advice.
Thanks

[Greenriver]

17 hours ago, Phoenix1111 said:

Hi @Greenriver

Thanks for your message. I'm so sorry to hear you have been going through this hell as well, i know how frustrating it is to feel like 20 odd years of your life have been taken from you because of these drugs.

How are you going with your taper, are you coping ok?

 

Trying to hang in there. Yea, these drugs rob you of so much. I think some people are way too sensitive to these drugs and get overdosed, so to speak. 

 

Similar to you, I swapped to another drug (Sertraline) from Fluoxetine two weeks ago and I’m starting to regret it. Not sure whether to switch back. Might ask my GP about Citalopram instead as I don’t think the sertaline is agreeing with me. 

[Sassenach]

Good luck Phoenix.

 

Please keep us advised of your progress.

 

Sass

[Altostrata]

No one can examine your nervous system directly, all we can go on is how you feel after making a drug change. Too much fluoxetine is my best guess given current information.

 

A reduction in fluoxetine from 40mg to 20mg might take 10 days for full effect. You can expect your symptoms to fluctuate. Please let us know how you're doing.

[Phoenix1111]

Thanks Alto and Sass,

I just hope it's not anything too severe, i'm not gonna lie i'm pretty scared.

At the moment i'm trying to think of ways to keep myself busy and i'm not working at the moment and probably won't be able to get something til the new year.

[Phoenix1111]

7 hours ago, Greenriver said:

 

Trying to hang in there. Yea, these drugs rob you of so much. I think some people are way too sensitive to these drugs and get overdosed, so to speak. 

 

Similar to you, I swapped to another drug (Sertraline) from Fluoxetine two weeks ago and I’m starting to regret it. Not sure whether to switch back. Might ask my GP about Citalopram instead as I don’t think the sertaline is agreeing with me. 

Do you plan to go off all medications or do you feel like they help you?
Have you asked Alto or Sass for their opinion, maybe they can help you decide what will work best for you?

[Phoenix1111]

On 11/12/2019 at 11:52 AM, Altostrata said:

I am concerned about your high fluoxetine dose overlapping with the vortioxetine. Mirtazapine will also add serotonergicity in combination with these drugs.

 

My intuition is that you are not experiencing withdrawal symptoms, but drug-drug interactions as explained above.

 

Unlikely your doctor will consider this.

Hi Alto,

I have noticed today that i am having a weird feeling of inner shaking (don't know how to describe it), i have had in the past what i now know to be akathisia (years ago when doctor took me off a medication suddenly). I am wondering if it is the beginnings of akathisia? It doesn't feel as severe as i had it years ago but still not pleasant. 
Anything else i could do to help it a bit or is it just something i need to ride out?
I am taking magnesium along with other vitamins i have been on for years now.

Thanks

[Greenriver]

14 hours ago, Phoenix1111 said:

Do you plan to go off all medications or do you feel like they help you?
Have you asked Alto or Sass for their opinion, maybe they can help you decide what will work best for you?

I used to want to get off - that was all I thought about. Now I’m not so sure. My depression has been pretty bad on the lower doses of Prozac (2.8mg) coupled with bad brain fog. I don’t think Prozac ever really agreed with me tbh Sertraline did help me years ago but it doesn’t seem to like me anymore. I just got a script today for Citalopram, so will prob try that at 5mg (low dose) after stabilising back on Prozac. After stabilising on the Citalopram I’ll prob try tapering again. 

 

Go as slowly as possible and use intuition. Sometimes on the higher doses of Prozac (above 10mg) you go can faster than 10%. Personally,  for me, once I got below 7mg, I got seriously punished if I went faster than 10%.