electron, tapering off prozac

[Altostrata]

electron, it looks to me like you've been reducing by a steady .2mg lately.

 

.2mg is a larger proportion of 1mg (20%) than it is of 2mg (10%). You are now decreasing by greater than 20% of your dosage.

 

I suggest you either hold until these symptoms go away or updose a bit and stabilize. Then decrease by no more than 5%-10% of your current dosage.

 

These will get to be very small amounts. You may need to dilute the Prozac liquid further so you can take out the proper amount with your oral syringe.

[electron]

Alto, do you know why withdrawal works this way? Surely the brain just notices the actual decrease in the amount of the drug rather than the decrease as a percentage. I understand this is the way it is but do you know why?

[Altostrata]

The brain recognizes "abrupt" and "gradual." The percentage calculations are to help you keep to a systematic, gradual reduction. Once you find a system that works for your brain, keep to it!

[strawberry17]

As I'm at the same place as Electron more or less, how does one "dilute" the liquid Prozac to get the accurate doses?

[Altostrata]

I believe you can add water to the Prozac liquid to get a new dilution ratio.

[electron]

Strawberry, how long does it usually take you to stabilise after a reduction? I've been at my current dose for four weeks now and still don't feel ready to reduce.

[strawberry17]

Electron it's a funny thing, I've tapered a lot lot slower than you, and my withdrawals have pretty benign, almost non existent, until now!! It's since I got below the 1ml level it's all gone horribly wrong for me, so I'm staying at this level until I feel right again, it's really thrown me off balance. I am amazed that such teeny tiny amounts of a drug can make such a difference.

[electron]

I feel exactly the same. It's been five weeks now and I feel worse now than the past month. So frustrating!

[electron]

Hi guys,

 

I wanted to update you on my situation and get some advice if possible. Towards the end of last year I was reducing as normal and didn't run into any problems. I finished college and began to start looking for jobs. I felt under a lot of pressure at this point to come of my meds and began to reduce in shorter intervals. I found that I was going too quickly and so reinstated by a small amount in two steps. Two weeks after the reinstatement I had very bad symptoms that I had not experienced before, including racing heart, nausea, dizziness, blurred vision. After a few days these subsided but I was left in a sensitized state and the blurred vision remained along with brain fog.

 

After 3-1/2 months, I felt stable and as if my symptoms were due to taking the meds and would decrease as I reduced them. I did another reduction and two weeks later experienced very strong symptoms just as when I had reinstated. I now feel very destabilised with a very sensitive nervous system, brain zaps, etc. I wondered if anyone else feels like this or could offer me any advice about what to do next. As my nervous system is sensitive I also feel as if taking the meds themselves are causing further destabilisation / prevention of healing.

[bubble]

Hello Electron and thank you for the update. It's much appreciated. 

 

Others will be able to say more but what it seems to me is that your reinstatement after you realised you were going too fast might have been too much for your sensitized CNS. You are talking about that period when you were going from 0.80 to 0.76 to 0.72 and then back to 0.74?

 

Others will probably see more, the only thing that I can see is that you were reducing by 0.02 instead of in percentages but this seems so small a dose that it looks like micro-taper to me and the holds were around 30 days or even longer. It's just that things get particularly tricky at lowest doses so despite the fact that you were going so small and slow, it seems your CNS is simply not happy. 

 

Maybe even smaller cuts and longer holds would help? It seems that your signature hasn't been updated after 16/04 so I can't see what's been happening since April till now. 

 

At the moment I can't find a chart which shows what happens with ADs in our system at the lowest dosages but will post it when I find it

 

I think it will explain a lot.

 

Hope others have other insights. That's just my take on things.

 

best,

bubble

[electron]

Hi bubble. Thanks for the reply. I meant when I went from 0.64 ml to 0.62 ml and back up. I've remained on the same dose since 16/04. The main reason I can think of for why it takes so long to stabilise is the long half life of fluoxetine. According to the Wikipedia page one of its active components can have a half life of around 16 days. Its just amazing that such a small change can have such a large effect over such a long time.

 

The chart sounds interesting. Does it show half lives / medication levels of different ADs?

 

Thanks,

electron

[Petunia]

Hi electron,

You have been tapering very slowly and carefully, its difficult to understand what may have caused an increase in your symptoms.  My feeling is that it may not be directly related to dosage, but more generally the nervous system sensitivity, combined with the change in your life situation of finishing college and looking for work.  This is a major life transition and can increase stress. Increased life stress can cause a wave of symptoms, or increased symptoms.

 

What symptoms are you having now?  Is there a pattern to them?

 

In general, we suggest that when symptoms increase, you hold your dose until they subside, which is what you have been doing.

 

Are you working now?  What is your diet like?  Do you get regular exercise? Do you have supportive relationships? Have you experienced any other stressful life events?

 

As my nervous system is sensitive I also feel as if taking the meds themselves are causing further destabilisation / prevention of healing.

 

Its unlikely that you are suddenly having an adverse reaction to a medication which you have been tapering so carefully.  Even when people are doing a slow, careful taper, recovery happens in a window and wave type pattern which is sometimes not related to dose changes, it can be confusing.

 

Read through our symptoms and self care section, especially the topics pinned at the top:

 

http://survivingantidepressants.org/index.php?/forum/8-symptoms-and-self-care/

 

Here is the link to the charts Bubble mentioned:

 

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

Petu.

 

 

[DrugSlave]

Electron,

 

I replied to your post on my intro thread. You seemed to be tapering at a good and slow rate. I'm surprised that you had a bad reaction when you decreased from 0.64ml to 0.63ml after holding for 3 months. I updosed slowly around the same time frame when you were updosing and didn't have any problems. Updosing too fast can create adverse reactions though. I did experience that once. If you have been destabilized, updosing can be very tricky.

 

You know the long half-life of Prozac is supposed to make it easier to withdraw from, not more difficult. I take Effexor which has a relatively short half-life. Some people advocate switching to Prozac since it has a longer half-life. I'm sorry that you are having a tough time with it.

 

I just discovered an email posted from Dr. Richard C. Shelton a few days ago on this site. Some people don't like what he has to say but I think he might be on to something. The post is here about a quarter of the way down the first page: http://survivingantidepressants.org/index.php?/topic/368-papers-about-prolonged-antidepressant-withdrawal-syndrome/?hl=%2Bpapers+%2Babout+%2Bprolonged

 

Here is a segment of the email: "First, let's acknowledge one thing: there is a great deal of variability in response, with a lot of people experiencing bad symptoms and others little at all, but almost all resolve; that is, except for a very small group, where the symptoms become persistent..........There appear to be lots of variation in this reaction in people who develop persistent symptoms, but one salient feature that seems almost invariably present: They become intensely afraid during the experience. People may describe this in different ways, but the way the brain is reacting is an exaggeration of what the brain does during threat. The physical symptoms are consistent with that.

So the "threat" systems are "turned on" and don't "turn off" easily. This can happen in a few ways, but has to occur pretty fast.

In fact, it is a normal response. Think of a mouse living in a field somewhere. If there is an acute threat that occurs (e.g., chased by a cat) and the mouse escapes, the mouse's brain has to remember that and react. There are a couple of ways to do that. One is to synthesize proteins to "remember." That, actually, is slow (but happens). The second is to actually do something to the genes controlling the system itself: to induce chemical modifications to the genes or the supporting structure to activate some genes and inactivate others. The net effect is for the system to stay "on" so to speak. However, in this situation, it is purely adaptive.

Going by the principle, then, that people vary in their response, some people seem particularly prone to have this to occur. That is why when people are exposed to a life threatening situation, some go on to develop post-traumatic stress disorder, and others don't. Now, one important thing is that most people develop trauma related symptoms immediately after an event (e.g., insomnia, dreams of the event, anxiety, etc., etc.). In the normal situation, these symptoms resolve within a month. But some people develop long-standing responses, in which the system is turned "on" and they can't turn it "off." I think that is what is at play here.

People might ask, "why then do I still have some of the same symptoms?" The answer is related to the longer-term synthesis of new proteins. What happens is that the brain activates the pathways associated with that symptom (e.g., electrical sensations in the body), and it stays on. It is like a kind of memory, so to speak. But one that reactivates the sensations.

That is the basic story. The question, then, is what's next? There are a few ways to potentially deal with the problem. First, you could use something to directly suppress the symptoms - really not great, but often effective. Drugs related to Valium (e.g., Xanax) activate neurons related to a chemical in the brain called gamma amino butyric acid (GABA). That is an inhibitory transmitter, which can suppress the symptoms. However, it only works when it is present, and the body adapts to it with time, producing physical dependency - not ideal.

Another way is to use another serotonin uptake inhibitor antidepressant (probably one with a long half life). Most people don't want to do that since they believe that the first one was toxic (which, as I've described, is untrue). Serotonin is a regulatory chemical in the body, and in the stress-emotional system its primary role is inhibitory. So, it suppresses the activity of the neurons that are "turned on," suppressing the symptoms. In most (but not all) people that will work. It is an acceptible alternative.

Given that the mechanism involves "memory," then information processing is important. So, certain forms of cognitive behavioral therapy seem to be effective in reducing the symptoms, at least to a manageable degree. I like that option. It has to start with several ideas - your brain has not actually been "damaged;" the symptoms are not life-threatening; etc. However, a good cognitive therapy may be able to help.

A lot of therapists say they do cognitive therapy; however, most who do so are not really compent at the treatment. I'd advise going to the Center for Cognitive Therapy website at the University of Pennsylvania (http://www.uphs.upenn.edu/psycct/). There is a referral list at the bottom of the page (it goes to this site:http://www.uphs.upen...rral/states.htm, where you can look up your state to try to find a therapist). If you have the choice, someone that specializes in anxiety disorders is the place to start.

Best of luck,

Richard C. Shelton, M.D.
James G. Blakemore Research Professor
Department of Psychiatry
Vanderbilt University School of Medicine "

[DrugSlave]

I have read books from 2 different authors who have very similar theories to what Dr.Shelton is saying. Neither of them talk about withdrawal specifically, but they talk about persistent health problems including depression. All 3 of these health care professionals say the same thing: The symptoms you are experiencing have caused your brain or mind-body to "turn on" pathways that cause the symptoms. Either your genes have been upregulated or neural connections have been strengthened or proteins synthesized to hold memories. The symptoms have been hard wired into your system. It is then difficult to turn them back off.

 

The other 2 authors are: 

 

Dr. John Sarno   http://www.healingbackpain.com/treatment.html

Dr.Joe Dispenza    http://www.youaretheplacebo.com/about/

[electron]

Hey guys, thanks for the replies, they are very helpful.

Petu, I agree, stress could be having a large impact on my symptoms. It's hard to tell as I have been through stressful times before and not had any problems. At the moment my symptoms are varying in type and intensity but include dry mouth, anxiety in the morning, nausea, electric head/brain zaps, palpitations. I have been working all this year and generally have a healthy gluten-free diet. I have also started walking home from work which takes the best part of an hour each day. I've had no other stressful events. As I am otherwise healthy, this worries me due to the length of time I have been experiencing these symptoms.

DS, I mostly agree with what Dr Shelton is saying there. I do indeed feel like my nervous system is stuck in a heightened stress response state. I'm wondering whether this will resolve itself or I will need to take some sort of medication to help with this.

[Altostrata]

It was I who corresponded with Dr. Shelton. On one hand, he admits that prolonged withdrawal syndrome exists, which to me is the value of that correspondence.

 

On the other hand, I believe the reasons he puts forward for it -- anything but adverse effects from the drugs themselves -- are typical nonsense from psychiatrists who have been desperately seeking a biological basis for depression for many years.

 

Supposedly "brain circuits" (the new fad that's replaced "chemical imbalance") get reinforced. Yes, but they can get unreinforced. That's what brain plasticity is all about.

 

Contrary to the theoretical dysregulation of whatever in mood disorders, the dysregulation of the nervous system wrought by psychiatric drugs is real. Our bodies tend to repair themselves, they want to get back to normal functioning. When it comes to a complex web like the nervous system and endocrine functioning, this can be very gradual and take quite a while.

 

Withdrawal syndrome is not a mood disorder and those cockamamie theories of mood disorders cannot be applied to it.

[LexAnger]

Can't agree more with alto!

My symptoms like seeing bright lights and panic attacks always come up in middle of sleep w/o any dreams which wakes me up. My needling and pins always appear just a few minutes after I start dosing and subside within hours even I am most focused on the pain during the dosing period. Even with the most intensive work distraction or doing my favorite shopping with my mind fully occupied, the pain won't go away if the hours from dosing is not long enough.

[electron]

Hi guys,

 

So after 7 months I have resumed my withdrawal. I have been prescribed propranolol which has had a very beneficial effect on my side effects and withdrawal symptoms. It seems to have eliminated the dysautonomia-like symptoms such as rapid heart rate, nausea, weakness etc making withdrawal possible again without taking time off work. I have been taking a slow release version meaning I just need one capsule per day.

[Petunia]

Thanks for the update electron, I'm glad the propranolol is helping.  If you decide to stop taking it, you will need to taper, please see:

 

Tapering Beta Blockers or Alpha Blockers

 

[electron]

Petu,

 

Thanks for the link. I wonder if many other people have experienced what I have been experiencing regarding nervous system symptoms. To me it feels very separate from actual withdrawal symptoms and feels like some sort of defence mechanism used by the body in that many of the symptoms feel 'fight-or-flight' related. I guess this is why the BBs help as they suppress the sympathetic nervous system and the effects of adrenaline. Thanks also for the links in your signature - very helpful.

[Altostrata]

We see those sorts of symptoms all the time!

[electron]

Hi guys,

 

Does anyone know if a tolerance is developed while taking beta blockers and/or they start losing their effectiveness?

 

Thanks