Fluctibelle: Don´t know what to do

[Fluctibelle]

Dear reader,

 

after taking Prozac (40mg) for almost 15 years I started my (maybe) fourth trial to taper...on 5mg crash came and I fell into a horrible condition I never felt before (infernal ruminating, anxiety, obsessive thoughts, irrational thoughts and feelings, paralysed, deper- and derealization, mood swings and a lot of further weird and agonizing symptoms - my life came to stop)...reinstating the drug does not help as before...only a new medication with quetiapine (200mg) brought a little relief. Since the acute phasis in last September 18 -January 19 a wave and window pattern start with overall only 4-8 days with feeling almost normal in 2019. Now I am back in a terrible wave, started with anhedonia, very bad indescridable feelings like deepest depression, like almost dead and weird thoughts, acompanied by deper- and derealization. So, I really don´t now what to do - I am on 23mg Prozac and 187,5mg Quetiapine and feel very very bad. Looking back throug 2019 makes me feel very hopeless...I don´t think that I can stand another year like this.

Can you give me an advice how to handle the situation? Maybe I need to taper the Prozac after its poopout... to help my nervous system heal? Maybe prozac is actually inhibit a healing after poopout...? I am lost...

 

I will be very glad for every little advice...

 

Thanks for reading an excuse my low english skills...

All the Best,

Mary

Edited December 17, 2019 by Shep
added username to title

[Gridley]

Welcome to SA, Fluctibelle.  I'm sorry you're experiencing these difficult symptoms.  Your English is fine.

 

Three factors seem to be contributing to your condition.  First, your system is kindled, which mean in a very sensitized state often caused by multiple attempts to taper.  Second, though you didn't specify how fast you tapered, likely it was too fast, resulting in withdrawal from Prozac.  Third, if the Prozac is in poopout, that will be a very strong factor (further explanation of poopout is later in this post).

 

As a general rule, we recommend tapering no faster than 10% of tour current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The symptoms you describe are typical antidepressant withdrawal symptoms.  The fact that you're getting some windows is an encouraging sign of healing.

 

What is withdrawal syndrome.

 

Glenmullen’s withdrawal symptom list.

 

The Windows and Waves Pattern of Stabilization

 

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

 

If you are in poopout, it likely is a good idea to taper the Prozac.  Brassmonkey, one of our moderators, wrote the following about poopout:

 

 

"Although acute WD and Poopout are related they are not the same thing.  Acute WD is a severe case of WD Symptoms while Poopout is the body tolerating the effects of the drug, trying to work around them, and causing WD symptoms by doing so.  The harder the body rejects the medication the more severe the symptoms.  

 

It all stems from the body being a self-correcting homeostatic organism. It's designed to work with a specific balance of neurotransmitters and will do anything in its power to maintain that balance.  Taking an AD causes some the receptors for a specific neurotransmitter to stop working which floods the body with that NT and supposedly makes us feel better because of the excess. After a while the body finds ways around this and works to regain homeostasis.  When the struggle for control that ensues becomes acute it is known as Tachyphylaxis, or Poopout.  In order to "cure" it, there must be a clear winner, leaving two options. Updose or taper.  

 

Once Poopout has set in it is going to continue to grow worse, no matter what. To Updose would just be buying a little time. By Updosing the drug is declared the winner, the symptoms subside somewhat, and you move on, but the body continues to fight.  This could last from a few months to a year or so, but in the end, things will go down hill again and leave a person in the same or worse situation and at a higher dosage, which would require a longer taper. To hold during poopout would only prolong the struggle and might make things worse as the body continues its fight for control. 

 

When it comes to Poopout the only way out it down.  If a person tapers, the body is declared the winner, repair work is started on the body and the symptoms subside.  BUT, it takes a long time to undo the physical changes the drug has made, and the presence of the drug is required to maintain those changes while the changes are being repaired. Thereby necessitating a long slow taper."

 

The link to the whole essay is here.  

 

Tachyphylaxis or As It’s Lovingly Known “Poopout”

 

Normally it's best to begin a taper when you are in stable condition.  Poopout is an exception.  Because your system is very sensitized, it may be advisable to taper more slowly than 10% every four weeks.  You could try 5%.  Here are two other tapering alternatives.

 

A micro-taper is the gentlest way to come off these drugs. 

 

Micro-taper instead of 10% or 5% decreases

 

The Brassmonkey Slide is a way of making micro-taper reductions weekly, as opposed to a larger reduction once a month. 

 

The Brassmonkey Slide Method of Micro-tapering

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Only add in one at a time and at a low dose in case you do experience problems.

 

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

 

 

 

 

[Fluctibelle]

Dear Gridley,

 

Thank you very much for your informative response and the links!

The informations about poopout are making me very sad because it sounds like a neverending suffering... I am not sure if prozac is poopout in my case...within the last 15 years I tried 3 times to taper...after strong withdrawl symptoms came I took prozac again and within 2 month I felt normal again. after the fourth taper 2018 this does not work..maybe this is a sign for popout? 

so shall I try to taper the prozac again?

 

Thanks a lot!

Best

[Gridley]

1 hour ago, Fluctibelle said:

after the fourth taper 2018 this does not work..maybe this is a sign for popout? 

so shall I try to taper the prozac again?

The fact that you're getting windows is an argument that you're not in poopout.  Your fourth reinstatement not working could be due to kindling, your body becoming sensitized from the previous taper attempts.  Things that work in the past don't always continue to work.  
  

I would hold and wait until you're more stable before tapering.

 

 Two questions, please:  

1. How fast was your last taper?  

2. You got down to 5mg and crashed and then reinstated to 40mg, correct?

Edited December 15, 2019 by Gridley

[Fluctibelle]

Thank you!

1. Fourth taper started 01/2016 - jumped from 40mg on 30mg and hold this one year, 01/2017 jumped on 20mg and hold this till 10/2017 - on 20mg first problems started but they were manageable, than I went very fast= 10/2017 on 10mg and 05/2018 on 5mg (took 10mg tabs every second day).

2. 09/2018 I crashed....went up on 30mg - but it was like the brain does not want it anymore, cause I got „brain shaking“ - a symptom I formally known from tapers, not from updosing.... but I hold the dose. There was almost constant misery with small windows in the evening till february, than it got a little better, some okay days, some with strong symptoms...

 

I thought prozac does not really helped me anymore and tapered till 05/2019 down to 18mg... in 08/2019 I suddenly got very bad, strong mood swings with aggression and depression, early awakenings with panic and doom - so I dose up to 23mg.

 

Sorry for the long answer, I hope it is clear..

 

Best

[Gridley]

43 minutes ago, Fluctibelle said:

but it was like the brain does not want it anymore,

 

Here's what I think has happened.   On this last taper, though you went slowly at the beginning, you went fast at the end, which resulted in withdrawal symptoms.  Withdrawal symptoms increase on a fast taper as you get to the low doses (from 10mg on down) So part of what you're experiencing is simple withdrawal.  

 

The second factor is that during the time of your almost 2-year taper (10/2016 to 9/2018) your brain became accustomed to the lower doses.  When you updosed to 30mg, it was too much for your system and overwhelmed it--what you called "not wanting it any more-- causing further destabilization.  When updosing we always recommend a very small updose, something like 1-2mg.  I think these two factors are the cause of your symptoms, not poopout.  

 

What you need now is stability.  I know your symptoms are difficult, but I suggest you hold where you are at 23mg  and make no further changes for several months.  Over that time your system should slowly return to a more stable condition (and you'll feel better, slowly).  At that point you can begin a slow taper of the Prozac as I described earlier.

 

 

Edited December 15, 2019 by Gridley

[Fluctibelle]

Your answer helps me very much. now I will stay on this dose hoping for a stabilization.

Thank you very much!

[Fluctibelle]

Dear All,

 

after staying on my dosage I saw some little improvements and had 3-4 one-day-windows in which I felt almost normal! 

at  15th of march I started to taper 6,5mg from 187,5mg Quetiapin, it is less than 5 percentage...after 17 days some strange new symptoms arrived I did not have before: Wake up at 4:00 in the night with horrible feelings and panikattack... now I feel destroyed, could this small amount of reducing make such symptoms??

For me it seems so...could it be that I am not able to taper smallest amounts of Quetiapin?

Doctors gave it to me during my prozac crash one year ago.. it helped nothing but I cannot taper it now. So I stucked with two medications that don t help me...

 

I am full of fears and make the dosage change undone today, hoping that the terrible nights got better..

 

hoping very much that someone can explain what was going on with me.

 

Thanks a lot

Mary

[Fluctibelle]

Hello everybody,

 

unfortunately I feel very very bad and it doesn‘t seem to get better. I really don‘t know whats going on with me, guessed symptoms got better in january, but after tapering only a small amount of quetiapine (6,5mg) everything got worse... I reinstated one week ago. 

I take my daily quetiapine as follows:

08:00 - 37,5mg fast release

14:00 - 25mg fast release

16:00 - 100mg extended release

22:00 - 25mg fast release

after tapering 6,5 mg from morning dose symptoms got worse after a some days

Could this due to my kindled nervous system?

Or is this maybe another wave after prozac my prozac crash?

 

I have horrible obsessive irrational thougts and anxiety 24/7 , yesterdas evening I got a window but it does not last for long. I am so desperated about the fact that all symptoms are so intensed...what can I do, shall I just wait??

 

Thank you very very much for any response!

Mary

[Altostrata]

Hello, Fluctibelle.

 

What is your daily drug schedule, with all your drugs and their dosages? Why are you taking the 25mg quetiapine doses twice a day?

 

Do your symptoms follow any daily 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, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

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.

[Fluctibelle]

Dear Altostrata,  

 

thank you very much for your response!!

 

1. I have splitted the Quetiapine doses due to the change from extendet release to slow release (before I took 150mg extendet release once a day, then I separated 50mg of it on two doses of slow release).

 

2. Since my Prozac Crash 09/2018 my symptom pattern is quit stable with horrific feelings in the early morning till around 11a.m. and mostly a better condition in the evening hours.

 

see below for my daily drug and symptom schedule:

 

6 a.m. Woke with anxiety and bumping heart
8 a.m. Took 23mg Prozac & 37,5 mg Quetiapin (slow release)
- feel very bad during morning hours (depressive mood, high anxiety, mood swings, ruminating thoughts and other odd feelings I can‘t describe, feel overwhelmed from everything, hypersensitive, every thought generate bad feelings;
09:00 breakfast helps a little, but strong anxiety and tension, thoughts tend to be obsessive, derealisation, afraid of taking a shower but don‘t know why..
11:35 a.m. after doing some homework slowly feeling a little better, 
12:35 p.m. Ate lunch, feel a bit more stable
2 p.m. Took 25mg Quetiapine (fast release)
3 p.m. feel more stable especially if I can distract my mind with homework or walks in the forrest

 

5 p.m. took 100mg Quetiapin extended release
6 p.m. Anxiety got higher, strange emotions hit me very suddenly (fear, pain, some other strange ones I cannot describe); belly felt bad and swollen
7 p.m. dinner, slowly improvement of all symptoms
8 p.m. feel almost normal, relaxed, thoughts have stopped
10 p.m. 25mg Quetiapine
10:30 p.m. fall asleep

4 a.m. wake up with bumping heart, very intense dreams, very bad feeling of doom, desperated...

Edited March 13, 2020 by Altostrata
reduced font size

[Altostrata]

Why do you take Prozac at the same time you take quetiapine in the morning?

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

[Fluctibelle]

Doctors gave it to me in acute prozac withdrawal 09/2018. They put me on quetiapine morning and evening dose to treat the 24/7 anxiety and tension. I did not change it since then. 

 

The results of the drug interaction check:

Using QUEtiapine together with FLUoxetine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitaminsand herbs. Do not stop using any medications without first talking to your doctor.

 

I did a cardio check soon before, everything was allright.

[Fluctibelle]

Dear all,

can someone please tell me if it is possible that tapering off only 6,5mg Quetiapine from 187,5mg made me feel so worse...? I made it undone two weeks ago but still feel bad...

I am ill since 19 month after my failed prozac tapering...I had severe waves and a few windows. I am not able to stabilize despite taking all those terrible meds...

and can’t get rid of even small amounts of quetiapine..

 

Can someone please give me an advise how to act?

 

Thanks a lot

Mary

[Fluctibelle]

Hello, 

I need desperately any advices. I could not get stable since my Prozac crash 2018. Since two month I got worse. Every morning horrible feelings of dread and doom. Intrusive memorys (often old dreams), obsessive thinking, irrational thoughts, anxiety, tension and Derealisation/Depersonalisation... I loose myself completely, have not feel like myself since so many month...with the exception of some short windows. 

 

During afternoon I often feel a bit better and the evenings are often okay, not normal but bearable.

I take :

8:00 a.m. 23mg Prozac, 37,5mg Quetiapine

2:00 p.m. 25mg Quetiapine

5:00 p.m. 100mg Quetiapine retard version

10:00 p.m. 25mg Quetiapine 

 

I take Quetiapine like this because I initially took 200mg of it in retard version... after changing it into fast release version I spread the doses over the day.

 

Can someone please give me an advice why I do not get any better over so many month?

 

Thanks a lot!

Maria

[mstimc]

Hi Fluctibelle

 

High anxiety and intrusive thinking is very common in the morning.  Even after being off my meds for more than 10 years, I still have days when I wake up very anxious.  Unfortunately, morning anxiety can set the tone for the rest of the day, leading to heightened emotions for the rest of the day.  This prolongs your recovery.  One thing that may work is as soon as you wake up, look around your room and find five things, then concentrate on them and describe them in detail in your mind.  What are they?  What are they made of?  What do they do or what function do they serve?  If you find your mind wandering to negative thoughts, that's okay--just bring yourself back to describing those five things.  The object is to prevent the intrusive thinking before it has a chance to take control.  Good luck!

[Fluctibelle]

Hello Mstimc,

 

thank you for your response! I will try it!

it is very hard for me to hold on cause I hold for so many month and nothing changed it even got worse... I feel caught in an ongoing trauma.

nothing really helps, it s hell everyday again...

and I don t know if I should change my meds or hold to find little relief...

 

all the best for you

 

Maria

[mstimc]

Hi Maria

 

Switching medications is not something I know I lot about so I'll let other members or moderators comment on that. 

 

I struggled with intrusive and persistent negative thoughts for many months during withdrawal so I know what you're going through.  I know it seems like it never gets better but if you can do just one or two positive behavioral practices a day, even for a few minutes, they will slowly begin to ease.   Did you have any low-energy hobbies or exercises you liked before your symptoms?  Anything you can do to distract your thinking patterns and give you some relief?  I think a big hindrance to recovery is not giving ourselves permission to do something enjoyable.   Anxiety is jealous and selfish and it doesn't want  you to do anything but pay attention to it and do what it tells you.  That is very difficult to overcome but you can do it a little at a time.

 

 

 

 

 

 

[Fluctibelle]

Hi Tim,

 

thank you for answering me! I am sorry that you went through the same process... it seems so endless and even if I feel better a few moments it comes back again. I do some things like walking in the forrest and running two times a week but if the nasty irrational thoughts are very intense it seems like nothing helps and everything I do is making it worse. 

Yes you are absolutely right - giving myself the permission to do enjoyable things is not as easy. I will work on it every day again

 

Thanks a lot

 

[mstimc]

My first window lasted just a few minutes.  Our son was playing in his junior high school jazz band and I just let myself enjoy seeing him play and do something he loves.  The window only lasted about 20 minutes but I hung onto that when things were really bad.  If you can feel better for just a few moments, then you know you can recover.

 

Also, don't work on it too hard.  A very common mistake is to try coping so hard, it just adds to the anxiety, especially if you think you are somehow failing at it.  The feelings will come whether you want them to or not.  For now, the best thing may be for you to accept them and not try to fight, but to allow yourself to feel anxious while also telling yourself they are only feelings and not reality, and they will pass one day.   Its miserable and so difficult to believe you can recovwer, but you can and will!