Cjeanr: Prozac bridge information

[Cjeanr]

I successfully tapered off Prozac over a 90 day period ending March 2019. Depression returned so went on Zoloft 25 and Wellbutrin xl 150 with direction to increase to 50 Zoloft. It was great for three days and then debilitating anxiety hit. Doctor switched to me lexapro 5 mg and wanted me to get to 10 mg which I slowly did over 7 weeks and have had anxiety ever since at all doses. Had about three good days at 8.75 before  increasing to 10. 8th day of 10 have had debilitating anxiety and have had to add Ativan to the regime. Try to ride it through but four days ago decreased to 8.75 again and still no relief from anxiety. Doctor wants me to start 10 mg Prozac to replace the lexapro. Is it ok to do this without tapering down? I am thinking I  might like to go off everything again and just try some natural remedies as I have seen here such as magnesium and fish oil. Oh I am also on 60 mg np thyroid. How would the bridging work? I just stop the lexapro 8.75 and go to the 10 mg Prozac the next day? Will I have the crippling  anxiety from starting Prozac and withdrawal from 7 weeks on lexapro?

[Shep]

Hi, Cjeanr.

 

Welcome to Surviving Antidepressants. 

 

Please see this thread on the Prozac Bridge:

 

The Prozac switch or "bridging" with Prozac

 

And here are some more general tapering information links:

 

Why taper by 10% of my dosage?

 

What is withdrawal syndrome?
 
The Windows and Waves Pattern of Stabilization

 

It sounds like you've already done some reading on the site regarding supplements. Yes, fish oil and magnesium are the two we recommend. We don't recommend a lot of supplements, as many members report their nervous systems are simply too fragile to handle them.  Please only add in one supplement at a time and at a small dose. For more, please see:

 

 King of supplements: Omega-3 fatty acids (fish oil)

 

Magnesium, nature's calcium channel blocker

 

 

You may find some helpful information to handle your symptoms here: 

 

Non-drug techniques to cope with emotional symptoms

 

Questions - how often are you taking Ativan? Have you ever taken Ativan or any other benzodiazepine drugs in the past? 

 

Please note that you can become dependent on a benzodiazepine in as little as 2 - 4 weeks, even with periodic use.  

 

Please add Ativan and your thyroid drug to your signature. Also, please update your signature to include the doses for all of the drugs. 

 

A direct link to your signature is here:

 

Account Settings - Create or Update Your Signature

 

I'm not very familiar with the Prozac Bridge, so I'm going to ask for feedback from the moderators who are. In the meantime, please have a read of the links and post any questions you have here in this thread. This is your thread where you can ask questions, post your symptoms, and give updates. 

 

[Altostrata]

Welcome, Cjean.

 

Are you still taking Wellbutrin? What times of day do you take your drugs, with their dosages?

 

How do you feel before and after taking each drug?

 

I would not make any more drug changes before we sort this out. Your doctor does not appear to know what he or she is doing.

[Cjeanr]

No i stopped Wellbutrin cold turkey in January along with the Zoloft and next day immediately started 5 mg lexapro. She wanted me to go to 10 mg but it am highly sensitive to medication so she wanted to start slower. Never was able to adjust to the lexapro. Caused severe anxiety. I asked her if it could be withdrawal from Wellbutrin and she said there is no Wellbutrin withdrawal. What I have researched online shows maybe there is maybe there isn’t. 
 

anyway i could not bear another day of lexapro sure hope took my last 8.75 mg dose yesterday and took 10 mg Prozac today. I don’t feel great but I don’t have the panicky anxiety like yesterday.  What do you recommend?

[Cjeanr]

Sorry for the typos. I took last 8.75 lexapro yesterday and started 10 mg Prozac. I did ask her what do should do if I started feeling withdrawals from lexapro and she said I could take another 10 mg Prozac. If i do that will I have the anxiety come me back. 
 

how I feel right now.  Tightness in chest a little depressed and on edge. 

[Cjeanr]

Oh and no appetite. I’ve lost 20 pounds and b 7 weeks. 

[Altostrata]

You may have been reacting to too-high a dose of Zoloft.

 

Please read questions from the staff carefully and answer them completely.

 

Please let us know how you're doing.

[Cjeanr]

So should I stay on track for now with the Prozac 10 mg. It did seem to calm my anxiety today in that I am not having panic attacks. Do you think I will have withdrawal from the lexapro 8.75 by taking  the Prozac at 10 mg. 
 

I agree the 50 Zoloft was too much for my system but the doctor insisted this is therapeutic dose. I was too scared to take it again. That’s why we stopped and went to lexapro. In hindsight I should have stayed at low doses of all of this stuff regardless of what the therapeutic dose is. I am very sensitive to meds. I can’t drink caffeine. If I take Benadryl I am up all night wired. What would you advise. 
 

by the way what you all do here is a great service. 

[Shep]

Quote

ativan as needed .25 up to 3x a day

 

Cjeanr, this is in your signature. Please also include the date you started taking it. 

[Cjeanr]

So should I stay on track for now with the Prozac 10 mg. It did seem to calm my anxiety today in that I am not having panic attacks. Do you think I will have withdrawal from the lexapro 8.75 by taking  the Prozac at 10 mg. 
 

I agree the 50 Zoloft was too much for my system but the doctor insisted this is therapeutic dose. I was too scared to take it again. That’s why we stopped and went to lexapro. In hindsight I should have stayed at low doses of all of this stuff regardless of what the therapeutic dose is. I am very sensitive to meds. I can’t drink caffeine. If I take Benadryl I am up all night wired. What would you advise. 
 

by the way what you all do here is a great service. 

[Cjeanr]

In response to the question am I still on Wellbutrin no 

 

i read through all the stuff shep sent me regarding Prozac bridging. I could not find dosing equivalent for lexapro to Prozac but did find it in internet. It appears 18 mg lexapro is equivalent to 40 mg Prozac. So if I am taking on 10 mg Prozac I am jumping down to half of the lexapro which will probably give me some withdrawals. It stands to reason I should be taking 20 mg Prozac doesn’t it? Then once I stabilize I can’t start to do a slow taper off the Prozac. 
 

Please let me know as I need to decide this morning what dosage to take. 

[Cjeanr]

Can you send me link for editing signature. 

[Shep]

Just now, Cjeanr said:

Can you send me link for editing signature. 

 

Please click here:

 

Account Settings - Create or Update Your Signature

 

 

 

[Cjeanr]

Thank you dates added. Will I hear back from someone soon regarding what dosage of Prozac I should switch to. If 18 mg lexapro is equal time 40 mg Prozac as my research found should I be taking 20 mg Prozac to be equal to the 8.75 lexapro? I want to stabilize somewhere for awhile and then taper off. 

[Shep]

12 minutes ago, Cjeanr said:

Thank you dates added.

 

Thanks for updating your signature, Cjeanr.

 

Two more Ativan questions -

 

• do you feel comfortable stopping the Ativan? 
• when was the last time you took an Ativan? 

 

13 minutes ago, Cjeanr said:

Will I hear back from someone soon regarding what dosage of Prozac I should switch to.

 

I'm not versed in the Prozac Bridge, so you'd be better off waiting until someone knowledgable in this can work with you. 

 

Please continue to do what you've been doing until Alto has a chance to review your latest notes. 

 

It will help us guide you in your taper if you could start a daily drug and symptoms journal. Please see:

 

Keep daily notes of drug schedule and symptoms to track patterns and progress

 

Please also include:

• any supplements you're taking
• the hours you sleep at night

Please be patient as we gather the information and can help you set up the best game plan going forward. It's really best to do this first, even if it takes a day or two, because erratic changes can cause as much, if not more, nervous system destabilization than holding steady for a couple of days. 

 

You're going to be fine. Let's make sure we have all the information needed to give you the right information on how to proceed from here. 

[Cjeanr]

took a .25 mg Ativan around 12:30am est to see if I could relax and sleep, which did nothing. I was prescribed 45 pills initially and still have about 30 left from the January rx so you can see I have not used them a lot. Am I comfortable stopping them. Yes if I can get relief. 

 

I am feeling worse this morning so I don’t know. I had maybe two hours sleep. I can’t eat. Have lost 20 pounds since January from the side affects of the lexapro or maybe withdrawal from Wellbutrin and I don’t know how much longer I can do this.  I just need to stabilize. Could I be feeling withdrawal from the lexapro already (last dose 8.75 mg March 16) since the Prozac at 10 mg is only covering half the 8.75 of lexapro. I need help fast as I am feeling desperat

Edited March 18, 2020 by Altostrata
removed code

[Cjeanr]

Sheo when will I hear back from someone I am barely hanging on

[Altostrata]

Cj, my guess is you were taking too much Lexapro and now you may be taking too much Prozac.

 

Plus, the direct switch from Lexapro to Prozac was not a good call by your doctor, you might have withdrawal from Lexapro. However, it will take at least 7 days for the Prozac to ramp up to full effect in your system, so we can't tell what's going on yet.

 

You have been taking Prozac only 2 days. Over the last 2 days, how have your symptoms changed? Hang in there, what you're having is a drug reaction. You will get through this, be patient.

[Cjeanr]

Altostrata, I feel terrible. I was not even at the supposed therapeutic dose for lexapro at the end, as I was only taking 8.75 mg. I am on a low dose of Prozac, 10 mg.  The equivalency of 8.75 mg lexapro is 20 mg Prozac. My heart feels like it is jumping out of my chest. I can barely function. I’m resisting taking Ativan to calm down but I might have to. Is that ok? I don’t want to become dependent but I can not function.  I have a friend who is a psychiatrist and I am going to speak with him this evening.  I agree I am probably withdrawing from the lexapro, but shouldn’t the Prozac help with that? My anxiety is getting worse over the last two days, as bad as it was on lexapro. I am mentally exhausted.  I just want off all this crap.

 

have you had any experience with niacin?

[Cjeanr]

Also do you think adding small amount of lexapro back could help

[Altostrata]

"Therapeutic dose" is irrelevant in withdrawal. Very few psychiatrists know anything about withdrawal syndrome, so don't be surprised if your friend says you have relapsed.

 

17 minutes ago, Cjeanr said:

My heart feels like it is jumping out of my chest.

 

Is this a new symptom? When did it start? What time of day does it occur? What time of day do you take Prozac?

 

[Cjeanr]

It happens on and off all day but is at a peak right now. I just took .5 Ativan so hope that calms me down. The anxiety has been a constant since I started all of these medications     I did not have anxiety like this before the meds. Is there a residential center that can help me get off them. 

And i can’t have relapsed if I haven’t been off them right?

[Cjeanr]

I take the Prozac in the am between 6 and 7

[Cjeanr]

Alto, something just occurred to me. If Prozac has a longer half life does that mean it takes longer to get into your system? If that is the case, then doing a direct switch to Prozac is like going cold turkey off lexapro? Which is why cross taper is better?

[Altostrata]

That is correct, when you switch from Lexapro to Prozac, there is a gap of at least a week where Prozac is ramping up.

 

Did you have this same heart symptom when you were taking Lexapro? When did it start? How do you feel before and after taking Prozac?

 

Please read questions from the staff carefully and answer them completely, so we don't have to ask again.

 

How often do you take Ativan? Please try to take it as infrequently as possible. Daily use can cause big problems.

 

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.

 

Some of what psychiatrists say about withdrawal syndrome doesn't make sense. They almost always will call it relapse.

 

[Cjeanr]

God bless you and the others for this service. When i get better I might want to do something like this to help others going thru this. I will speak to you about that when the time comes. 

 

yes i had the same anxiety symptoms when starting and changing doses on the lexapro. In hindsight I should have stayed at the lowest possible dose much longer rather than trying the therapeutic dose my doctor wanted me at. I am very sensitive to medication in general. There were a few days at the end of dosage increase that I felt good but as soon as I increased bam anxiety hit like a hammer. With 10 lexapro it never went away so much bstarted decreased the dose back to 8.75 and still didn’t feel better. That’s when doc suggested Prozac. 
 

in the morning before I take Prozac I feel just a little anxious but as the morning and day progresses it gets worse. I had to take .5 Ativan a while ago because I am exhausted. I got a prescription for 45 .5 mg pills back on January 15 to use as needed but I probably have at least half of those left so I am not abusing them. I’ve used more though the last week or so because I’ve been so miserable but not every day and mostly .25 once a day sometimes twice. Today was the first time I had to take a whole .5 pill. And if the anxiety returns I will probably take one to night so I can sleep as I only got two or three hours last night. 
 

are you saying you want me to post my journal to you here?

 

do you think it’s worth asking the doctor I am speaking to this evening if I should add a small dose of the lexapro back in until the Prozac starts to work in my system and if so how much? Maybe 2.5 or even 1.25?  My doctor of course says it is not necessary yet here I am. If I have to deal with this for another week it will only be with the help of Ativan. 
 

have you been through all this yourself and is that how you have gained so much knowledge?

[Cjeanr]

Revised 24 hours. Didn’t have glasses on when I read the time

March 18 -spent the whole day in bed

630 am: woke up anxious after about three hours of sleep, one hour intervals, took 10 mg Prozac 60 mg np thyroid and multi vitamin

7 am: feeling very anxious and nervously exhausted just need relief can’t go on like this much longer, also a little nauseous 

7:30 am: drank a Stoneyfield probiotic smoothie

8 am: maybe a tiny bit calmer but still anxious

9 am: still anxious feeling hopeless will I ever get better

10:42 am: feeling a little calmer 

11: 17 am: wave of anxiety and down feeling

2:00 pm: very heightened anxiety tried to ride it out, got a peanut butter sandwich to see if it would help to have food in me

3:00 pm: Had to take Ativan .5 to calm down

5:30 pm: pasta for dinner was able to eat a little more than I’ve been able to because I am feeling calm from the Ativan

8:07 pm feeling very relaxed and sleepy, waiting for call 

Spoke to dr Larry said stay on course

10 pm or so, went to sleep.

2:30 am woke up felt ok, little edgy, listened to deep relaxation from DARE which put me back to sleep

5:28 am woke up felt ok little edgy took bath

 

 

Edited March 19, 2020 by Shep
reduced font size

[Shep]

15 hours ago, Cjeanr said:

Altostrata, I feel terrible. I was not even at the supposed therapeutic dose for lexapro at the end, as I was only taking 8.75 mg.

 

14 hours ago, Altostrata said:

"Therapeutic dose" is irrelevant in withdrawal.

 

@Cjeanr I'm going to expand on what Alto wrote here so you can let go of the "therapeutic dose" concept. That comes from the drug companies for the most part because there's no way of measuring your serotonin levels. So the therapeutic dose is an arbitrary number. 

 

At this point, you're dealing with a very destabilized nervous system, which is hyper-reacting to these drugs. So it's possible to get an adverse reaction to even a small dose of a drug that you once were able to tolerate at a higher level. 

 

In other words, it's not about the drug. It's about your traumatized nervous system. Your symptoms will be the best guide to the "right dose," not the "therapeutic dose." This is why we request daily drug and symptoms notes so we can see how you're reacting to the drug. 

 

Hope this helps explain. 

 

P.S. - I reduced the font in your last two posts and hid your first go at the drug and symptoms journal since you re-did it in the next post with a slight change in time. 

 

[Cjeanr]

Thanks shep. With all this being said, will my nervous system calm down eventually and if so how long will that take? Are there some supplements you recommend I start right away to help support it. I haven’t started anything yet.

[Shep]

Please see my first post in this thread regarding fish oil and magnesium. They can be helpful. Please only start one at a time and at a low dose to see how you feel.

 

You may want to wait to add in supplements pending any changes Alto recommends regarding your drugs. It's best to only make one change at a time:

 

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

But you could read over the links and do some research so you know what to get when the time comes. 

 

And yes, your nervous system will eventually calm down. It's been though a lot, so it may take some time, but it will happen. 

[Cjeanr]

Thank you.

[Altostrata]

20 hours ago, Cjeanr said:

yes i had the same anxiety symptoms when starting and changing doses on the lexapro.

 

If you get this hard heartbeat symptom when taking any antidepressant, the dosages you've been taking are too high for you. Too-high dosages may also cause sleeplessness.

 

Did this symptom start during the drug switch in January?

 

Do you feel better or worse after you take Prozac in the morning?

 

How many times have you taken Ativan in the last week? On which days, how many times each day?

 

7 hours ago, Cjeanr said:

60 mg np thyroid and multi vitamin

 

You are taking thyroid medication and a multivitamin at the same time you take Prozac? This creates what's called a confound.

 

Your multivitamin contains B vitamins, which some people find activating. It could be making you feel funny in the morning. Please stop taking your multivitamin.

 

When was your thyroid hormone last adjusted? If you're taking too much thyroid hormone, it can cause nervousness and sleeplessness. Is there a reason you're taking it 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.

 

Yes, please post 24 hours of daily notes at a time in this topic. Be sure to note every time you take Ativan.

 

[Cjeanr]

Drug interaction

Drug Interaction Report

This report displays the potential drug interactions for the following 2 drugs:

• Prozac (fluoxetine)
• NP Thyroid (thyroid desiccated)

Edit list (add/remove drugs)

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• Consumer
• Professional
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Major (0)

 

Moderate (0)

 

Minor (1)

Food (2)

 

Therapeutic Duplication (0)

Interactions between your drugs

Minor

FLUoxetine  thyroid desiccated

Applies to: Prozac (fluoxetine), NP Thyroid (thyroid desiccated)

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed. 

For clinical details see professional interaction data.

Drug and food interactions

Moderate

FLUoxetine  food

Applies to: Prozac (fluoxetine)

Alcohol can increase the nervous system side effects of FLUoxetine such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with FLUoxetine. Do not use more than the recommended dose of FLUoxetine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you. Talk to your doctor or pharmacist if you have any questions or concerns.

Switch to professional interaction data

Moderate

thyroid desiccated food

Applies to: NP Thyroid (thyroid desiccated)

The timing of meals relative to your thyroid desiccated dose can affect absorption of the medication. Therefore, thyroid desiccated should be taken on a consistent schedule with regard to time of day and relation to meals to avoid large fluctuations in blood levels, which may alter its effects. In addition, absorption of thyroid desiccated may be decreased by foods such as soybean flour, cotton seed meal, walnuts, dietary fiber, calcium, and calcium fortified juices. These foods should be avoided within several hours of dosing if possible. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.



When thyroid desiccated is given during continuous enteral nutrition (tube feedings) for more than 7 days, the tube feeding should be interrupted for at least one hour before and one hour after the dose of thyroid desiccated. You may need more frequent blood tests to monitor thyroid desiccated levels.

Switch to professional interaction data

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

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[Cjeanr]

Yes I take the thyroid multivitamin and Prozac at the same time. Is there a better way to take them?

 

i will discontinue the multivitamin for now. Will I be able to resume it soon. 

 

my thyroid was checked within the past year and was fine. I’ve been on this dose for years. In the past two years or so the armor thyroid I was taking was no longer covered by insurance so they switched to np thyroid. 
 

the anxiety symptoms began the last day I took Wellbutrin and Zoloft and continued when I started taking big the lexapro in January. 
 

in the past week I’ve had maybe 4 doses of .25 Ativan and one dose of .5 yesterday afternoon  I took everything this morning at 6:30 and am actually feeling calmer than yesterday with very mild waves but so far without becoming full blown anxiety. Able to get out of bed and showered and dressed. It’s now 1:10 pm est and ok so far.

 

Ive only had three days on the Prozac sure hard to say when I feel worse. Yesterday was all day but worse in afternoon. Tuesday morning was ok but afternoon was tough. Today hopeful that I will not need Ativan. May feel well enough to go for a walk with my husband. Will send you the log for today tomorrow morning. 
 

also trying not to look at news right now. 

[Altostrata]

14 minutes ago, Cjeanr said:

In the past two years or so the armor thyroid I was taking was no longer covered by insurance so they switched to np thyroid. 
 

the anxiety symptoms began the last day I took Wellbutrin and Zoloft and continued when I started taking big the lexapro in January. 

 

When was the switch in thyroid drug>

 

Please post your daily symptom notes in the requested list format.

 

If you're feeling better today, that's a good sign.

 

Please try NOT to take Ativan. It can cause more problems than it solves.

[Cjeanr]

Do you think so? I hope so.