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Fluctibelle

Fluctibelle: Don´t know what to do

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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 by Shep
added username to title

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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.

 

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.

 

 

 

 

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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

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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 by Gridley

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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

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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 by Gridley

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Fluctibelle

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

Thank you very much!

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