Cjeanr: Prozac bridge information

[Cjeanr]

March 25

6:07 am 10 mg Prozac 30 mg np thyroid anxious shaky headache

6:32 am 100 mg magnesium

All morning feeling tense,  little anxiety, depressed. Confused as to whether I am withdrawing or adjusting to Prozac. Maybe both

11:30 am ate apple

Feeling cooped up, rainy gloomy day

12:30 pm cheese sandwich

2:00 pm Took 50 mg magnesium

Maybe felt a tiny bit better, not quite as anxious, not great

4:30 wave but passed just general stimulated feeling, jittery like I had caffeine

Just hanging out with it trying to breathe with it

7:00 pm dinner small piece salmon and some veggies. Added butter to try to fatten it up. I’m still losing weight due to loss of appetite

Noticed this evening an absence of what I’ve been feeling, I suppose this was a window? It lasted throughout the evening up until going to bed. Could I be starting to adjust to the Prozac?

9 pm took 100 mg magnesium, total 250 mg today.  Watched some tv, got sleepy did sleep meditation around 10 pm. 

Noticed I was sweaty in middle of night

4:45 am woke up, headache, slightly jittery, tried to get back to sleep

5:20 am morning meditation either had a very deep meditation or went back to sleep for an hour - feel somewhat relaxed

6:22 am took 10 mg Prozac

6:58 am feeling slightly activated little jittery

7:22 took 30 mg np thyroid

[Cjeanr]

March 26

 

6:22 am took 10 mg Prozac

6:58 am feeling slightly activated little jittery

7:22 took 30 mg np thyroid

7:38 am 100 mg magnesium took epsom salt bath

8:12 am hands shaky

930 am ate cheese sandwich 

Hanging out all morning, feeling a lot less anxiety but still a little jittery

10 am video appt with foot doctor re foot pain

1:15 pm a little jittery but still better than past days. Don’t want to get optimistic yet. Could the magnesium be helping?

1:30 pm had a disappointing conversation with new doc who said you don’t need to taper off Prozac due to long half life! Scratch that doc. She also wanted me to do genesight testing. Not sure if I want to go through with it now, especially if my goal is to eventually come off the Prozac after I stabilize my nervous system - this is just so confusing and so much different and conflicting information

2:30 pm 50mmg magnesium

3;00 pm primary care doc called and does not want me to lower dose of np thyroid since we cant do follow up blood work right now, so tomorrow back on 60 mg.  Will take sheps advice though and take it an hour apart from Prozac 

3;3pm feel a little shaky just ate an apple

Afternoon started feeling more anxious. Did a weird meditation that sort of freaked me out and felt a bit panicky. 

Got email from doctor who told me she would help me taper when ready so felt a little better about her.  She will prescribe liquid. Need to find a compounding pharmacy that will fill rx.

7 pm dinner chicken sausage. Filled me up but forced myself to eat another cheese sandwich for protein and calories. Still losing weight

Think I need to snack on nuts or something during the day to keep blood sugar up and avoid shaky feeling

8 pm 100mmg magnesium. Got into bed. Watched tv. Feeling very tense and anxious 

12 am Listen to sleep meditation. Could not sleep. Put on sleep music, maybe drifted In and out a few hours 

4:40 am up feel tense and anxious heavy chest shallow breathing  feeling discouraged

5 am meditated

5:30 am 100 mg magnesium

6:30 am 10 mg Prozac

7:30 am back to 60 mg np thyroid

[Cjeanr]

March 26

 

6:22 am took 10 mg Prozac

6:58 am feeling slightly activated little jittery

7:22 took 30 mg np thyroid

7:38 am 100 mg magnesium took epsom salt bath

8:12 am hands shaky

930 am ate cheese sandwich 

Hanging out all morning, feeling a lot less anxiety but still a little jittery

10 am video appt with foot doctor re foot pain

1:15 pm a little jittery but still better than past days. Don’t want to get optimistic yet. Could the magnesium be helping?

1:30 pm had a disappointing conversation with new doc who said you don’t need to taper off Prozac due to long half life! Scratch that doc. She also wanted me to do genesight testing. Not sure if I want to go through with it now, especially if my goal is to eventually come off the Prozac after I stabilize my nervous system - this is just so confusing and so much different and conflicting information

2:30 pm 50mmg magnesium

3;00 pm primary care doc called and does not want me to lower dose of np thyroid since we cant do follow up blood work right now, so tomorrow back on 60 mg.  Will take sheps advice though and take it an hour apart from Prozac 

3;3pm feel a little shaky just ate an apple

Afternoon started feeling more anxious. Did a weird meditation that sort of freaked me out and felt a bit panicky. 

Got email from doctor who told me she would help me taper when ready so felt a little better about her.  She will prescribe liquid. Need to find a compounding pharmacy that will fill rx.

7 pm dinner chicken sausage. Filled me up but forced myself to eat another cheese sandwich for protein and calories. Still losing weight

Think I need to snack on nuts or something during the day to keep blood sugar up and avoid shaky feeling

8 pm 100mmg magnesium. Got into bed. Watched tv. Feeling very tense and anxious 

12 am Listen to sleep meditation. Could not sleep. Put on sleep music, maybe drifted In and out a few hours 

4:40 am up feel tense and anxious heavy chest shallow breathing  feeling discouraged

5 am meditated

5:30 am 100 mg magnesium

6:30 am 10 mg Prozac

7:30 am back to 60 mg np thyroid

[Altostrata]

8 hours ago, Cjeanr said:

Got email from doctor who told me she would help me taper when ready so felt a little better about her.  She will prescribe liquid. Need to find a compounding pharmacy that will fill rx.

 

Which doctor is this? You don't need a compounding pharmacy, your regular pharmacy can fill a prescription for fluoxetine liquid.

 

There is no reason to pay for a Genesight test.

 

Please keep gradually moving the thyroid drug later in the day, until you're taking it at noon. Please keep posting your daily notes, they're very helpful.

[Cjeanr]

This is the new doctor I had a phone appt with this week.  Have had a horrible morning today but feeling a little better now. I hope I get some sleep tonight because last night was terrible.  Had 200 mg magnesium so far today.

 

The thing that actual interests me in the gene test is the lmethylfolate piece. do you know anything about this?

 

i will continue posting. 
 

 

[Altostrata]

The MTHFR piece is not relevant, either, as genetic variations are common and most are perfectly normal. There is no known way to "correct" them other than to take B vitamin supplements in extreme cases.

 

Any MTHFR issues you might have can be resolved by eating lots of fresh leafy green vegetables, which are packed with natural folate. Green veggies good for neurological healing, period.

 

So you don't need to spend money on an MTHFR test, just eat veggies.

 

Magnesium is most effective taken in small doses throughout the day.

[Cjeanr]

The issue is I have no appetite still and what I do want to eat is bland food not leafy greens. So it’s hard to get enough in me to make a difference. 
 

Question on the Prozac liquid. What strength should it be ordered in or does that not matter since you measure it. Does the liquid work faster than the capsules since it is directly going into the system? Will I feel more of a kick with liquid due to faster delivery?

[Cjeanr]

On the magnesium doses, so split the 100mg to 50s and take through the day?

[Cjeanr]

March 27

Will this ever end?

6:30 am 10 mg Prozac

7:30 am back to 60 mg np thyroid

Contacted a cbt therapist to see about video appts. I need help

Feeling very anxious and tense all morning, so tempted to take an ativan but resisting temptation so far. Haven’t had one since Monday’s.25 mg in morning 

10 am oatmeal with butter and a few cashews very full - weight stable from yesterday

Working on finding a therapist 

Not a great morning...

Handful of cashews to keep blood sugar stable

2 pm 100 mg magnesium

started to feel a bit better in the afternoon and through the evening.

7 pm dinner, hamburger pattie and broccoli

Felt pretty good this evening

Read a little of The Magnesium Miracle by dr Dean. Interesting. I can’t get tested, but I’m sure I am not getting enough. No plans to megadose though

9 pm 100mmg magnesium

Got into bed around 10, watched a little tv, did a sleep meditation

4 am woke up did another sleep meditation, 

5 am 50 mg magnesium - going to split the magnesium into smaller more frequent doses

listened to relaxing music, drifted back to sleep even had a dream

6:10 am woke up from dream, trying to work on separating body sensations from anxiety ie just because my heart skipped a beat doesn’t mean anxiety is coming back 

630 am 10 mg Prozac

Listening to Tara brach webinar

830 am np thyroid 60 mg

[Shep]

22 hours ago, Cjeanr said:

6:30 am 10 mg Prozac

7:30 am back to 60 mg np thyroid

 

22 hours ago, Cjeanr said:

630 am 10 mg Prozac

Listening to Tara brach webinar

830 am np thyroid 60 mg

 

Please post how you feel before and after taking Prozac (especially before you take the thyroid drug). 

 

If you don't feel any different, that's okay, but please let us know. 

 

 

[Cjeanr]

March 28

 

630 am 10 mg Prozac

Listening to Tara brach webinar

830 am np thyroid 60 mg

9mam still in bed trying to get motivated to get up, meditate and get dressed for the day

10;30 50 mg magnesium breakfast cheese sandwich finally up

11 am meditated

Feel low level anxiety or jittery feeling, allowing it in hopefully breakfast will help stabilize blood sugar a bit

Staying pretty calm morning and afternoon. 

Had a shock. My aunt contracted corona virus and passed away. I’m very shocked and sad, but so far not in a panic. She was 98 and lived a full life.  She was a world traveler, a talented artist and a fun loving person. She will be missed.

2 pm50 mg magnesium

Had a pretty good afternoon actually

Started to feel a bit depressed late afternoon

6;30 pm dinner salmon and cauliflower rice still can eat so little

50mmg magnesium

7:30 pm got very sleepy -magnesium? Felt anxious and tense

Watched some tv went to bed, listened to Tara brach

10mpm listened to sleep meditation, but had a rough night. Waking up with anxiety and fear frequently over corona situation, my aunt, worry about my dad.  

6:20 am 10 mg Prozac- I know you are wondering why I have not started tapering. I feel I need to stabilize on this for a while. With the current situation in the world I am reluctant to make any changes yet, but I will when I am ready. I want off these drugs, I’m just not sure right now is the time. Already too much anxiety inducing events don’t want to add another one.

6:30 am 10mmg Prozac meditated had hard time relaxing 50 mg magnesium 

Did a mindful movement guided meditation 

7:0 am still tense anxious

8:43 am 60 mg np thyroid

Still heightened fear and anxiety trying to ride it out. How to deal with the fear out there right now?

[Cjeanr]

I’m not sure if I felt any different or not, especially today on this heightened alert. So much bad news...my aunt dying, my daughters friends mother in a coma with corona, my friends daughter with corona, it’s all so scary right now, and my dad in hospice.  I’m worried about my family, myself and the world.  

[Shep]

I'm sorry you're having to deal with so much sickness with friends and family, Cjeanr. These are scary times. 

 

But even in the midst of this, you're reporting some calm times: 

 

19 hours ago, Cjeanr said:

Staying pretty calm morning and afternoon. 

Had a shock. My aunt contracted corona virus and passed away. I’m very shocked and sad, but so far not in a panic. She was 98 and lived a full life.  She was a world traveler, a talented artist and a fun loving person. She will be missed.

2 pm50 mg magnesium

Had a pretty good afternoon actually

 

 

Listening to Tara Brach is an excellent way to cope through this. 

 

[Cjeanr]

March 29

 

6:30 am 10mmg Prozac meditated had hard time relaxing 50 mg magnesium

Did a mindful movement guided meditation 

Still feel anxious and tense

8:43 am 60 mg np thyroid

Still heightened fear and anxiety trying to ride it out

9 am ate cheese sandwich

Anxious morning

10:30 am 50 mg magnesium

12 pm ate orange

Anxious undercurrent this afternoon

Forced myself to do a light yoga class did ok

Felt depressed

3:30 50 mg magnesium

Went outside on balcony and sat in sun. 

Snacked on some cashews

Felt a little better

6 pm dinner barely could eat a half a small chicken breast. Forced myself to eat broccoli cauliflower and carrots

Put together grocery shopping list for delivery including leafy greens 

Worked on an anxiety workbook seven week cbt course

8;30 pm 50 mg magnesium

10 pm went to bed read a bit watched a little tv

10;15 50 mg magnesium total today so far  250mg 

Did sleep meditation

Woke up intermittently with some unease, listened to more relaxation and 

Meditation through the night

6 am woke up feeling low grade anxiety 50 mg magnesium

Meditated

Had a little anxiety during meditation let it in breathed through it

6:30 10 mg Prozac 

Some anxiety 

7;50 sleepy

8:20 am got up showered

8:38 am 60 mg np thyroid maybe heart palp 

 

 

[Shep]

A couple of suggestions:

• You may want to take the magnesium at the same times of the day every day. 
• You may want to eat breakfast when you wake up and take your first drug instead of waiting two or three hours. Some of the early morning anxiety may actually be due in part from low blood sugar from not eating since the prior day. 

[Cjeanr]

Good suggestions. 

[Cjeanr]

Sorry i have been out of touch this week. I haven’t had anything new to report until now.  I got the results of my genetic tests back. SSRIs are apparently not good drugs for me and additionally I have high serum levels of Prozac in my system even at 10 mg dose. So now I want to start a taper but I am wondering if I should just decrease to half for a few weeks then half of that. My doctor wants me to try Effexor or prestiq but I honestly am scared and just want off everything. The anxiety is still horrible at 10 mg. I have read because of the longer half life of Prozac the withdrawal is not as bad but wanted your thoughts. I know in the past you have said take it down 10 % at a time but with the high serum level right now I don’t know if that will affect how I feel at all or if I need more of a decrease?

[Altostrata]

Interesting, but none of those results are meaningful for tapering, though they may explain any adverse reactions you've had.

 

We still advise tapering Prozac by 10% per month, especially with your long history of withdrawal syndromes.

 

As far as substituting Effexor or Pristiq, that's something we'd never advise anyone to do. Both of those drugs are much more difficult to taper than Prozac.

 

Your doctor may be concerned about maintaining you on drugs to avoid "relapse." If your intention is to switch drugs for treatment of a putative psychiatric disorder, that's between you and your doctor. We don't do that here, as we do not diagnose or treat psychiatric disorders.

 

What we do is help people go off drugs if they've decided to take responsibility for their lives without the effects of drugs. That choice is up to you.

[Cjeanr]

I’m not so sure now that my withdrawal history is actually withdrawal or bad reactions to SSRIs as the genetic testing showed. I am concerned about the high serum levels of Prozac and that a ten percent decrease isn’t enough. And with the bad reaction I am having to the Prozac the thought of ten more months of this reaction is very depressing. 

[Altostrata]

The blood serum level of Prozac is not relevant. What is relevant is that it seems the amount you're taking is too much for you.

 

We've been talking about this for a long time.

On 3/17/2020 at 4:09 PM, Altostrata said:

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

....

 

On 3/18/2020 at 11:09 AM, Altostrata said:

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

....

 

We have been urging you to reduce Prozac for almost 2 months. When you reduce the dosage, generally adverse effects also reduce.

 

Even so, we recommend you reduce by 10% so you don't add withdrawal syndrome to your problems. Are you able to get a prescription for liquid Prozac from your doctor?

 

What we do here is help people minimize their drugs. Are you looking to find a good drug for you? We don't do that. We don't treat psychiatric disorders.

 

If you believe you need to take 10mg Prozac for a psychiatric disorder despite the adverse effects, you may be better off  with your doctor's solution. You can do that. We won't be involved any more. Good luck.

[Cjeanr]

I appear to be able to get the liquid Prozac and also a tablet form versus a capsule.  Remember I have only been on the Prozac 10 mg three weeks today.  Knowing that, do you still recommend 10 percent  reduction per month for three weeks usage? know you are frustrated with me, but I am very scared.  I have a video call with my psych thurs and will get whichever you recommend, liquid or tablet. But I do not want to take 10 mg ever again, can I start by taking some of the beads out of the 10 mg capsule right away?

[Altostrata]

Prozac capsules do not contain beads, they are filled with powder. The most convenient method to adjust Prozac dosage is with liquid titration.

 

We are going on the assumption you also have some form of SSRI withdrawal syndrome from whatever happened in early 2019. It appears your doctor might have been trying to treat Prozac withdrawal syndrome with too-high doses of Zoloft, Wellbutrin, Lexapro, and now Prozac again, which caused adverse reactions on top of withdrawal syndrome.

 

Your nervous system got sensitized from drug changes. It is possible that had your doctor reinstated a lower dose of Prozac (or any other SSRI), you might have had relief of withdrawal syndrome without the adverse effect of too much SSRI.

 

A decrease of 1mg is a trial decrease. It happens to be 10%. We need to see what effect it has before reducing further.  It could be you feel better at 9mg. It could be you'd feel better at 3mg. The only way to get there is to lower the dose slowly -- we usually do this by 10% per step -- and observe what happens. Your nervous system is the guide.

 

If 10mg Prozac is too strong for you, you should be feeling better as you lower the dose. Adverse effects tend to be dosage-related.

 

We don't treat psychiatric problems here, we counsel people about how to minimize drugs in a way that they don't get withdrawal symptoms.

[Cjeanr]

ok So here’s an update. I am going to start tapering. I’ve had enough of this.  The first psychiatrist, true to form, said just stop taking it, it’s self tapering.  The best she would do I take a 10 mg every other day! I know this is wrong.

 

The second psychiatrist is willing to put me on a taper, but her idea is reduce by 10% of current dose each week, which I also know is wrong. She found a compounding pharmacy that will make up the capsules. I told her I wanted a slower taper, but she wants me to give her the taper schedule I want. I believe based on what you told me it would look like this:

1st month 9 mg

2nd month 8.1 mg

3rd month 7.29 mg

4th month 6.57 mg

5th month 5.9 mg

6th month 5.3 mg

7th month 4.8 mg

8th month 4.3 mg

9th month 3.9 mg

10th month 3.5 mg

11th month 3.1 mg

12th month 3.16

13th month 2.85

14th month 2.5

15th month 2.25

16th month 2

17th month 1.8

18th 1.6

19th 1.4

20 1.3

21 1.2

22 1

etc

 

will it really take me two years to come off 1 mg of Prozac that I’ve been taking this time around for four weeks? And with how activated I am, can my initial decrease be enough so I don’t have the anxiety? 
 

 

[Shep]

11 hours ago, Cjeanr said:

will it really take me two years to come off 1 mg of Prozac that I’ve been taking this time around for four weeks? And with how activated I am, can my initial decrease be enough so I don’t have the anxiety? 

 

I'm assuming you mean will it take two years to come off 10 mg of Prozac (not 1 mg)? 

 

Please see Alto's post here:

 

On 4/7/2020 at 8:37 PM, Altostrata said:

A decrease of 1mg is a trial decrease. It happens to be 10%. We need to see what effect it has before reducing further.  It could be you feel better at 9mg. It could be you'd feel better at 3mg. The only way to get there is to lower the dose slowly -- we usually do this by 10% per step -- and observe what happens. Your nervous system is the guide.

 

We really can't give you any more detailed advice then this. Make the first reduction, 10% or less, and then see how you feel. 

 

Even if it does take two years to taper off, if the higher dose is causing problems, then you'll feel better as you reduce. 

 

That doesn't mean you need to taper faster, though. A too rapid taper can cause as much, if not more, symptoms than slowly reducing and allowing your nervous system to adjust along the way. 

[Cjeanr]

Shep I am having feelings that I would be better off dead. I don’t know if the Prozac is causing this. If it is the thought of taking it for even one more day is scaring the crap out of me. If suicidal ideation is a side affect of the drug, how can I even contemplate tapering and continuing to take it.  

[Cjeanr]

Yes 10 mg 

[Altostrata]

For some people, SSRIs cause negative thoughts. Those are just thoughts. Wave them away as much as you can.

 

As stated before, adverse effects tend to decrease with a decrease in dosage. That is why we're recommending you lower the dosage.

 

You do not need to get capsules compounded, Prozac comes in a liquid form.

 

17 hours ago, Cjeanr said:

she wants me to give her the taper schedule I want.

 

First, I would ask for a prescription for Prozac liquid. Tell her you intend to reduce by 10% per month calculated on the last dosage so you can find the lowest effective dose, a hyperbolic reduction based on this study. She doesn't need to see the entire schedule.

 

You might tell her Prozac may be treating underlying withdrawal syndrome from your drug changes last year and you want to be especially careful while reducing.

 

 

[Cjeanr]

She has told me that in speaking with various psychiatrists and pharmacists, using the pills is what she came up with as the best approach. Do you think I will need to stay on each decrease for a whole month? I can’t live feeling this way. I skipped my dose today because I was scared to take it. I feel miserable, deep depression, haven’t slept.

Also because the liquid is 20 mg it is too complicated to figure dosage.

[Cjeanr]

What is confusing me is what you mean by lowest effective dose.  And the things I am feeling are feelings....deep depression and anxiety.  

[Cjeanr]

I am probably going to have to take this into my own hands and start either weighing out the powder in each capsule or making the liquid myself if I can’t get a prescribed to order it for me.  Do you know of any psychiatrists who are on board with the slow taper measure that I can work with, even via zoom or Skype during these times. I want to get this right. Also any scales you recommend for precise measuring of dosages?

[Altostrata]

I am trying to address the adverse reaction you may feel from taking too much Prozac.

 

Reducing the dose probably will reduce the activation and doomy thoughts, if they are adverse effects of the drug.

 

You may not want to go off Prozac completely as it might be compensating for withdrawal syndrome from going off Prozac back in 2019. If you can feel better at the lowest effective dose, you may want to stabilize on that for some months before going off completely. Or, you can continue to take it however long you want.

 

We do not offer psychiatric or psychotherapeutic care here. If you feel you need to take psychiatric drugs for a psychiatric  condition, please see a physician.

 

The reason this site exists is because people can't find doctors to help them. That is why we have do-it-yourself information such as Tips for tapering off Prozac (fluoxetine), which you should have read thoroughly.

 

Many people have tapered by making a liquid from the powder in a Prozac capsule. Any doctor can prescribe the liquid, it doesn't have to be a psychiatrist. Why can't you get a prescription for the liquid?

[Cjeanr]

I understand what you are saying.  But do I have to live like this for months on end until I find a lower dose? 

[Cjeanr]

Good good news. The original psychiatrist read the article and she has agreed to prescribe the liquid.  I will need dosing information, since I believe it’s 20 mg in 5ml correct? How do I convert that if that is the case?

[Altostrata]

Adverse effects should decrease as you decrease the dosage.

 

1mL of the liquid will contain 4mg Prozac. For 10mg Prozac, you'd take 2.5mL of the liquid.

 

Be sure to ask the pharmacist for a 5mL and a smaller 2mL or 1mL oral syringe, which will come in handy later on.

[Cjeanr]

Thank you. So if my first decrease is to 9 mg, how many ml is that of the liquid? Is there a chart somewhere?

[Altostrata]

Write this down: If 1mL of the liquid contains 4mg Prozac,  each 0.25mL contains 1mg Prozac.

 

9mg is 2.25mL of the liquid. You'll probably want to learn to use a calculator. Keep daily notes of all your drug doses and symptoms.