Cjeanr: Prozac bridge information

[Altostrata]

On 3/21/2020 at 4:28 AM, Cjeanr said:

....On another not4, I am started to worry about the weight loss.  I can not eat much and this has been going on two months. I have now lost about 21 pounds since being on the lexapro and now day five of Prozac. Have you heard of appetite suppression going on this long?  

 

This is an indication the dosages of the SSRIs were too high for you. They can induce a low-level activation that suppresses appetite.

 

Shep and I are looking at your daily notes to see if maybe 10mg Prozac might be too much. Has your appetite changed at all since you switched to Prozac?

 

As Shep said, add butter to your diet, it will help you maintain weight, plus it is delicious. Enjoy whatever you can while you go through this rough patch.

 

1 hour ago, Cjeanr said:

FYI, I have made an apt to see a holistic psychiatrist who can help me deal with these symptoms naturally and when the time is right help me taper off. 

 

I hope this psychiatrist understands psychiatric drug adverse effects and withdrawal symptoms because such doctors are very hard to find, even among holistic practitioners. Please let us know what you find out.

[Cjeanr]

Appetite has not changed since switch to Prozac. I did add butter to oatmeal this morning.  Will try to get more veggies in too.  

[Cjeanr]

I will. I have an apt with her tomorrow via tele appt.

I will also ask if she thinks the dosage is too high. 

[Cjeanr]

I also just started having terrible pain in the bottom of my left foot today. Any correlation?

[Cjeanr]

March 23

6:03 am 10 mg Prozac 60 mg np thyroid

I’ve noticed I feel wired on Prozac, my eyes wide open and I’m wide awake. It is definitely stimulating for me.

7:19 am .25 mg Ativan, just needed some relief from this tight chest and shallow breathing

10 am breakfast, small bowl,oatmeal with butter

11 am Didn’t feel like ativan was doing much, but definitely felt calmer today. Was able to breathe easier, and deal with the issues in the world better.  Able to engage with others (virtually)

Noticed today severe pain in bottom of left foot.  Could that be related?

5:20 starting to feel a little tense again, so I guess the Ativan is wearing off.  Want to try to avoid it tonight. Looks like Magnesium May have been delivered along with epsom salt so will try that and see if I feel calmer.  

7:00 pm dinner one chicken thigh, one piece broccoli, one piece cauliflower one baby carrot. Completely full. Actually felt ok after eating. Maybe tension I felt at 5;20 was low blood sugar since I hadn’t eaten since 10?

8:3o pm took 50mmg magnesium (came in 100mmg tabs, recommended dose is 2 tabs) could not really cut it any smaller, got into bed. Despite having so little sleep last night I don’t feel tired, but I hope to get some decent hours tonight. Will listen to a new sleep meditation.

10Pm fell asleep to sleep meditation

3:30 am woke up little tense listened to sleep meditation again went back to sleep

5:11 am up little tense chest tight

6:30 am 10 mg Prozac 60 mg np thyroid - start of week 2

Took bath, foot still hurts can’t put any weight on it

 

[Shep]

4 minutes ago, Cjeanr said:

6:03 am 10 mg Prozac 60 mg np thyroid

I’ve noticed I feel wired on Prozac, my eyes wide open and I’m wide awake. It is definitely stimulating for me.

 

It may be time to start reducing this drug. 

 

Please post your thoughts on this. 

 

4 minutes ago, Cjeanr said:

Maybe tension I felt at 5;20 was low blood sugar since I hadn’t eaten since 10?

 

It sounds like you're treating the stimulation from too high a dose of Prozac and the anxiety from low blood sugar by taking an Ativan. 

 

Instead of taking an Ativan, please eat something first. 

 

Having a small, high protein, low sugar breakfast should be your goal every day. A lot of low blood sugar symptoms are withdrawal symptoms, so please eat. 

 

6 minutes ago, Cjeanr said:

Took bath, foot still hurts can’t put any weight on it

 

Pain can be a symptom of withdrawal, but did you injure yourself?

 

[Cjeanr]

I have a video appt today with the new psychiatrist. I will ask her about reducing.  Regarding my foot, I did not injure myself.

 

I will eat something now. I do feel a bit shaky.  

[Cjeanr]

Regarding reducing.  The equivalent dose of Prozac I am currently on, 10 mg, is half of the equivalent dose of the lexapro I was on, 8.75. If that reduction was a week ago could I be experiencing withdrawal from lexapro and if so by reducing Prozac even more wont that make withdrawal worse?  

[Shep]

44 minutes ago, Cjeanr said:

Regarding reducing.  The equivalent dose of Prozac I am currently on, 10 mg, is half of the equivalent dose of the lexapro I was on, 8.75. If that reduction was a week ago could I be experiencing withdrawal from lexapro and if so by reducing Prozac even more wont that make withdrawal worse?  

 

You bring up a good point. I'm going to repost something Alto wrote a few days ago:

 

On 3/18/2020 at 2:09 PM, Altostrata said:

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.

 

So it really depends. Yes, Lexapro is a much more potent drug than Prozac, but if you're sensitive to even small doses, you'll have to weigh withdrawal symptoms against adverse reaction symptoms. 

 

You might want to hold where you're at a few more days and work with your diet (i.e. eating breakfast and healthy meals and snacks throughout the day, as you're able). And see if you get some improvements. 

 

But if the Prozac continues to be overly stimulating, you may want to consider a small reduction. 

[Cjeanr]

ok, I will also discuss with doctor today and see what she thinks. 

[Cjeanr]

Had initial consult with psychiatrist. She will send recommendations and summary later. She wants me to stay consistent at 10 mg Prozac and cut thyroid to 30 mg and see how I do.  She is going to do genetic testing to see what is best drug for me.  She feels that the direct switch from Wellbutrin and Zoloft to lexapro is probably partially causing the anxiety I am having, either by withdrawal or having too much in my system. She would have done a taper and then started lexapro.  She believes in as few drugs as possible at the lowest dose possible. I have follow up in two weeks.

[Altostrata]

Very few doctors have a clue about drug withdrawal or adverse effects.

 

Yes, too much thyroid hormone can be stimulating. How long have you been taking 60mcg np?

 

If you have been taking 60mcg np steadily for a long time, it is unlikely it is causing you to feel activated after you take it in the morning. It has a half-life of weeks and you are at steady-state -- your system probably doesn't feel small daily variations.

 

If you reduce the thyroid hormone, it will be weeks before you can tell if that relieved the activation.

 

Your taking the Prozac with the thyroid hormone is a confounding factor. We can test whether it's the thyroid hormone causing the stimulation or the Prozac by gradually moving the Prozac dosing away from the thyroid. Can you move the Prozac an hour later each day, until you are taking it at noon?

 

Please post daily notes while you are doing this, we need to track your symptom pattern throughout the process. Please minimize the Ativan, it influences your symptom pattern.

 

8 hours ago, Cjeanr said:

Regarding reducing.  The equivalent dose of Prozac I am currently on, 10 mg, is half of the equivalent dose of the lexapro I was on, 8.75. If that reduction was a week ago could I be experiencing withdrawal from lexapro and if so by reducing Prozac even more wont that make withdrawal worse?  

 

Milligram for milligram, Lexapro is several times stronger than Prozac.

 

No matter what the dosage equivalence, if your body is telling you 10mg Prozac is too stimulating, it is too stimulating.

[Cjeanr]

If I dose the Prozac any later I will be up all night. I can maybe take the thyroid later, though. Does that work?  This doctor seemed to know a little more about withdrawal and did agree that I should never have been switched directly from Wellbutrin and Zoloft to lexapro. My first doctor said there is no withdrawal from Wellbutrin, but I don’t believe that.

 

i have a compounding problem now. My dad is being put into hospice. I am hoping this doesn’t add to my anxiety.

[Cjeanr]

Np thyroid about two years, prior to that armor thyroid for many years.

[Cjeanr]

Another question.  Since my dads situation is going to put more stress on me, what are your thoughts about vistiril? My first doc offered it to me but it scared me because usually if I take Benadryl, I get wired, but this is a different antihistamine than Benadryl, correct? Do people have the paradoxical affect with it like I have with Benadryl?

[Altostrata]

If the Prozac you take in the morning will keep you up all night, it is too much Prozac.

 

Are you using Prozac liquid? If so, you can easily reduce it by 1mg. Then you can see if the activation eases.

 

1 hour ago, Cjeanr said:

Np thyroid about two years, prior to that armor thyroid for many years.

 

Your thyroid dosing has been the same for 2 years? Have you had any adverse effects from it before?

 

It's far more likely that the Prozac is activating. This psychiatrist may be better than others, but she's got a blind spot when it comes to adverse effects of antidepressants.

 

Why would you want to take Vistiril? It's another psychotropic drug that will require tapering.

 

Strongly advise you to learn stress management techniques rather than adding drugs. As this is a site for going off drugs, we can't help you mix a cocktail, that's your doctor's job.

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Ways to cope with daily anxiety

 

Dealing With Emotional Spirals

 

Shame, guilt, regret, and self-criticism

[Cjeanr]

i don’t want to take vistiril, I’m just trying to figure out a non benzo way to handle this extra anxiety of my dad going into hospice. I will talk to the new doc about lowering dose and getting liquid form.  As it is, taking the Prozac first thing in the morning makes sleep difficult, so you are right, I think I need less.

[Cjeanr]

Sorry for the multiple questions.  She is also recommending omega fish oil with 800mmg of epa of higher as well as vitamin d (my blood work shows me very low on d) and l methylfolate 5 mg. What are your thoughts on these recommendations in terms of  my situation.  She does agree that my current anxious state could be the result of withdrawal. Anyway, your thoughts on these supplements are appreciated. And should they be taken at the same time of day as my other meds (morning) or at different times? She did not give me any guidance there.  

[Cjeanr]

March 24

6:30 am 10 mg Prozac 60 mg np thyroid starting week 2 prozac

Took bath, foot still hurts can’t put any weight on it

Dropped a little more weight, about 2 ounces

7:04 morning meditation

8 am yogurt smoothie

Feeling stimulated

10:30 am had a cheese sandwich to get some protein in

12 pm feeling a little anxious fast heart rate not terrible 

Trying to breathe and relax

12:38 feeling anxious, maybe a little about upcoming appointment with new doctor at 1 pm

1 pm dr waggel - wants me to cut np thyroid to 30 and stay stable on Prozac for now at 10 mg. Will do genetic testing to see what best drug is for me. Not sure if I will go on any of it, and then taper off that, or taper off Prozac, but we will see what results say.

Sent her all blood work I’ve had done for past year

Feel little less anxious after the call. She thinks she can help me.  I hope so.

3:30 pm just found out my dad is being put in hospice. Feeling very overwhelmed sad and trying not to have an anxiety attack. Have no control of anything around me.

5;35 pm just trying to breathe 

6:30 pm dinner mostly protein

Feeling very wired this evening like I had coffee

9:30 pm went into bedroom, not sleepy at all. Took 100mmg magnesium to see if I could relax a little.  

Magnesium did seem to help calm me

Fell asleep

2:30 am woke up feeling anxious listened to sleep meditation

535 am woke up feeling anxious listen to relaxation audio and meditate

6:07 am 0 mg Prozac 30 mg np thyroid anxious shaky headache

[Shep]

12 hours ago, Cjeanr said:

Sorry for the multiple questions.  She is also recommending omega fish oil with 800mmg of epa of higher as well as vitamin d (my blood work shows me very low on d) and l methylfolate 5 mg. What are your thoughts on these recommendations in terms of  my situation.  She does agree that my current anxious state could be the result of withdrawal. Anyway, your thoughts on these supplements are appreciated. And should they be taken at the same time of day as my other meds (morning) or at different times? She did not give me any guidance there.  

 

Please see: 

 

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

 

Vitamin D3 (cholecalciferol or calcitriol)

 

Folic acid, folate, L-methylfolate, and Deplin (vitamin B9)

 

Many people find vitamin D to be stimulating, which may make you feel worse. 

 

I wouldn't add these in while you're making drug changes. One change at a time. 

 

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

 

Please use the search feature. You'll be able to do a lot of this research on your own without waiting for a mod to come by. If you do research and still have questions, please post your questions. 

 

1 hour ago, Cjeanr said:

Took bath, foot still hurts can’t put any weight on it

 

Is your foot swollen? Do you have arthritis or any other underlying medical condition? 

 

15 hours ago, Altostrata said:

Your taking the Prozac with the thyroid hormone is a confounding factor. We can test whether it's the thyroid hormone causing the stimulation or the Prozac by gradually moving the Prozac dosing away from the thyroid. Can you move the Prozac an hour later each day, until you are taking it at noon?

 

14 hours ago, Cjeanr said:

If I dose the Prozac any later I will be up all night. I can maybe take the thyroid later, though. Does that work?

 

It would be best to separate these two drugs first before making changes, so you know which drug to make the change to.

 

But it looks like you've already reduced the thyroid drug. It takes 4 days for your nervous system to notice a change and several weeks for it to adjust.

 

Just my take on it, but I'd want to know which drug to make the change to before reducing. Since you only took the reduced dose one day, you could go back to your regular thyroid drug dose today. 

 

If you wish to separate the drugs, you would move one of them apart by one hour per day. The next day, move it another hour. This will give your nervous system time to adjust to the change more gradually. 

 

Could you take one of these drugs at 6 am and one of them at 9 am? Would that work? 

 

13 hours ago, Cjeanr said:

i don’t want to take vistiril, I’m just trying to figure out a non benzo way to handle this extra anxiety of my dad going into hospice.

 

I'm sorry you have to deal with this on top of withdrawal. Please talk to the staff at your dad's hospice. They likely know of support groups you could join. It may have to be an online group, due to the shutdown with the corona virus, but it may be very helpful to talk to others about this aspect of your life. They won't understand withdrawal, but they do understand grieving. 

 

[Cjeanr]

So to be clear you are saying for example, take the Prozac at 6 am and then the thyroid at 9? And not to lower the dose to 30?  
 

Right now I have added the magnesium, so I will hold off on adding the other supplements for now.

 

based on my time table, with January 21 or so being the last day of Wellbutrin and Zoloft, and if I am withdrawing from the Wellbutrin, plus the switch to lexapro and then Prozac a week and a day ago, how much longer do you think this will continue. How long to stabilize on the Prozac if doctor doesn’t not want me to decrease Prozac dosage?

[Shep]

1 minute ago, Cjeanr said:

So to be clear you are saying for example, take the Prozac at 6 am and then the thyroid at 9? And not to lower the dose to 30?  

 

Yes, you are correct.

 

You may want to make the move gradually, just one hour a day. This gradual move is gentlest on your nervous system.

 

1 minute ago, Cjeanr said:

Right now I have added the magnesium, so I will hold off on adding the other supplements for now.

 

Sounds good.

 

2 minutes ago, Cjeanr said:

based on my time table, with January 21 or so being the last day of Wellbutrin and Zoloft, and if I am withdrawing from the Wellbutrin, plus the switch to lexapro and then Prozac a week and a day ago, how much longer do you think this will continue. How long to stabilize on the Prozac if doctor doesn’t not want me to decrease Prozac dosage?

 

Your symptoms are going to be your guide. 

 

Here are some helpful tips for talking to a doctor:

 

How do you talk to a doctor about tapering and withdrawal?

 

A couple of videos that demonstrate talking to a doctor: 

 

 

On 3/30/2015 at 4:57 PM, Lilu said:

Withdrawal Dialogues - Doctor's Visit Pt. 1 - typical

 

https://www.youtube.com/watch?v=iwZuvo_au1M

 

Withdrawal Dialogues - Doctor's Visit Pt. 2 - a keeper

 

https://www.youtube.com/watch?v=AF2vmb8XbHw

 

 

[Cjeanr]

Shep I read through all the links you sent me.  I’m still not clear about if I should take the l methylfolate or not? Looks like at 5 mg a definite no, but how about a low dose.  

[Cjeanr]

Antidepressant discontinuation syndrome is a set of symptoms that can occur after an abrupt cessation (or marked reduction in dose) of an antidepressant medication that was taken continuously for at least 1 month. Symptoms generally begin within 2-4 days and typically include specific sensory, somatic, and cognitive-emotional manifestations. Frequently reported sensory and somatic symptoms include flashes of lights, "electric shock" sensations, nausea, and hyperresponsivity to noises or lights. Nonspecific anxiety and feelings of dread may also be reported. Symptoms are alleviated by restarting the same medication or starting a different medication that has a similar mechanism of action - for example, discontinuation symptoms after withdrawal from a serotonin-norepinephrine reuptake inhibitor may be alleviated by starting a tricyclic antidepressant. To qualify as antidepressant discontinuation syndrome, the symptoms should not have been present before the antidepressant dosage was reduced and are not better explained by another mental disorder (e.g., manic or hypomanic episode, substance intoxication, substance withdrawal, somatic symptom disorder).

Ok so i am obviously feeling the non specific anxiety and dread from the Wellbutrin/Zoloft but was put in lexapro directly from that, and now Prozac, both of which are SSRI.  Is this saying to try the tricyclics antidepressant and then once stable taper off that?

[Cjeanr]

Also on the dosage of fish oil, the one the doc recommends is 2000 mg in two pills with 800 epa and 600 days per 2 caps. I would start with 1 to see if I tolerate, but do you think that is an ok starting dose and what is the best time to take that?

[Altostrata]

Sounds like a good way to start fish oil, be sure to take it several hours away from other drugs so you can see if it causes a reaction.

 

You can add in the other supplements after you get the potential adverse reaction from Prozac settled.

 

4 hours ago, Cjeanr said:

How long to stabilize on the Prozac if doctor doesn’t not want me to decrease Prozac dosage?

 

If you are having an adverse reaction to Prozac, you will not stabilize on it.

 

Rather than asking permission to reduce dosage, I would make a very clear request for the liquid so you can "personalize" the dosage. Otherwise, you can make a liquid from a Prozac capsule, instructions here

 

It looks like this psychiatrist is trying to treat you for depression, which means she truly is not paying attention to adverse effects or withdrawal symptoms. It's long been established that SSRIs such as Prozac can be activating if dosed too high -- this is called "SSRI activation syndrome."

 

Whether you're having withdrawal from Wellbutrin or Zoloft, we can't say. Symptoms can be the same. What you need to do is clear away the adverse reaction to Prozac to see if it's helping at all.

 

It may very well be you'll feel better at 5mg Prozac.

 

I am sorry your father is going into hospice. This must be a sad time for you and your family. Feeling grief and anxiety in this situation is a natural reaction to a natural event, the approaching loss of a loved one. You have no control over it. This is not a disease requiring a drug. As Shep suggested, finding people in similar situations and sharing your feelings will be more constructive than adding a drug, which will come with its own adverse effects and complications and eventually need to be tapered.

[Cjeanr]

Thanks. Don’t see a link for instructions. 

[Cjeanr]

And is from 10mg to 5 mg Prozac too big of a dose reduction?

[Altostrata]

Oops, here is link Tips for tapering off Prozac (fluoxetine)

 

You've been taking 10mg Prozac only since March 17. You should be able to reduce it fairly quickly. However, our suggestion is to try an initial reduction to 9mg. Your reaction will indicate whether reduction is the correct route.

[Cjeanr]

Thank you.  I think I read that you used magnesium during withdrawal. How much did you use daily and how did you take it? Pill or liquid? I started Monday night with 50mmg, then last night 100mmg, this morning 100 mg, but starting to feeling shaky again so want to take some more.

[Altostrata]

See https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Magnesium may help, but don't count on it compensating for too much Prozac. If the Prozac is too activating, I would reduce it sooner rather than later.

 

Why are you reluctant to try a reduction in Prozac?

[Cjeanr]

I’m not reluctant, I want to. I’m waiting to hear from the new psych to see if she will write me a compounding rx  and have contacted a local compounding pharmacy to see if they will fill it.  Her philosophy is as few medications and as low a dose as possible.  We are doing genetic testing to see if I am not a good metabolizer, and if so what might be better to switch to and then taper off of.  What’s weird is I took this drug for 23 years no issues..  

[Cjeanr]

I’m not reluctant, I want to. I’m waiting to hear from the new psych to see if she will write me a compounding rx  and have contacted a local compounding pharmacy to see if they will fill it.  Her philosophy is as few medications and as low a dose as possible.  We are doing genetic testing to see if I am not a good metabolizer, and if so what might be better to switch to and then taper off of.  What’s weird is I took this drug for 23 years no issues..  and on the magnesium, yes I am dividing my doses during the day. Had 100mmg this morning and will take another shortly, maybe 50, and then more at bedtime. 

[Cjeanr]

I have a 30 minute telephone appt with my doctor tomorrow at 13 pm to discuss taking dosage down.  But had a weird thing happen just now, where there was just an absense of the feelings I have been having. Is this a window?

[Erell]

10 hours ago, Cjeanr said:

I have a 30 minute telephone appt with my doctor tomorrow at 13 pm to discuss taking dosage down.  But had a weird thing happen just now, where there was just an absense of the feelings I have been having. Is this a window?

 

Hello, 

 

waves and windows : this is just a metaphor to illustrate the fact that WD is all about ups and downs. 

If you had a moment without symptoms, yes you can call it a window,  and that's a great news.

More will come

 

Take care ❤️

 

[Cjeanr]

I look forward to more. It was a weird feeling and I was almost looking for the feelings of anxiety. But it lasted into the evening..just this absence of what has been present for two months.