mooki24: introduction - weaning off fluvoxamine / Luvox

[mooki24]

Hi there,

 

I'm new to the forum and wanted to say hi.

 

I've been on Fluvoxamine for 16 years. I've also been on lots of other medication due to a traumatic event that happened a few years ago which caused a lot of stress. So I've been on benzos, migraine blockers, vertigo tablets, other antidepressants / anxiety tablets, etc. 

 

However currently I'm only on Fluvoxamine and trying to get off it.

 

I was in hospital for the recent taper and felt okay during it, however since I've gotten out I've had extreme headaches, vertigo, lethargy, sore eyes and irritability. This makes me think the taper was way too quick and am so grateful to find this forum.

 

I was due to go back into hospital this week to taper from 50mg to 0mg however I've decided to cancel that after reading the information on this site. I'll wait for the current side effects to subside before considering any further drop.

 

Very grateful for all the good information here! 

[Gridley]

Welcome to SA, Mooki24.

 

Yes, that was a very fast taper.  Unfortunately, doctors invariably taper their patients far too fast, causing the withdrawal symptoms you're now experiencing.  You're wise to hold off on any further taper until your withdrawal symptoms subside.  This may take some time, so please be patient.

 

We recommend tapering no more than 10% of you current dose every four weeks.  

 

Why taper by 10% of my dosage?

 

This link is specifically about tapering fluvoxamine, including how to get the smaller nonstandard doses you'll need for your 10% taper.

 

Tips for tapering off Luvox (fluvoxamine)

 

So that you have a better understanding of what you're experiencing, here is some information on withdrawal and healing.  The symptoms you describe are typical withdrawal symptoms.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

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.  

 

These explain the healing process really well:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

   On 8/30/2011 at 2:28 PM,  Rhiannon said: 

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

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 (glycinate is a good form) 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) 

 

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.

 

 

 

 

 

 

 

[mooki24]

Just wanted to post an update.

 

I'm still struggling. The headaches aren't as regular but still have dizziness and irritability. When I first started tapering I felt pretty numb and even had trouble crying. However now I'm very anxious and cry about everything. I can't make decisions and *everything* seems stressful. At times I've felt suicidal.

 

Still not even considering dropping down any further. Just wondering if this will ever end. Going to go hug my dog 😞🐾

[Gridley]

5 minutes ago, mooki24 said:

 

Still not even considering dropping down any further. Just wondering if this will ever end. Going to go hug my dog

That is wise to hold where you are.  Your taper was very fast, and your system needs to catch up to the changes dosage.  Yes, it will end but it will take some time.

 

Have you tried the magnesium and omegas I suggested in my first post to you?

 

Good idea to hug your dog--and it's good sign that the headaches aren't as regular.  Healing is taking place even if you're no aware of it.

[mooki24]

Thank you so much responding Gridley, its nice to hear advice from someone who understands what this is like. 

 

I've been taking magnesium and fish oils but not as regularly as I should be, so will make more of an effort there.

 

Migraine has been back the last few days. Really starting to consider going back up in dosage, maybe to 100mg.

 

Is there any advice on this on the site? 

[mooki24]

Still struggling with withdrawal symptoms.

 

List of symptoms over the past few days:

- Headache

- Low energy / oversleeping

- Teary and sensitive

- Dizziness

- Very negative self talk

- Rumination

- Irritable and snappy

- Generally just feel sick all over

 

I’ve withdrawn from my friends because I feel I'm too grumpy / unstable to be around. They don't get it.

 

I wish I could just jump out of my body for a day and get a break from this! 

 

Really keen to hear advice on what to do. 

 

It's been 3 months since any dose changes. Do I stick this out or go up a bit in dosage just to get through?

[Gridley]

2 hours ago, mooki24 said:

Do I stick this out or go up a bit in dosage just to get through?

 

You might consider a small updose, like 5mg more.  I wouldn't go all the way back up to 100mg.  Your system is sensitized from your fast taper and updosing too much could be destabilizing.  Are you on the immediate release or extended release?  The link in my first post  contains instruction on how to get small doses.

 

Tips for tapering off Luvox (fluvoxamine) 

 

 

 

[mooki24]

12 hours ago, Gridley said:

 

You might consider a small updose, like 5mg more.  I wouldn't go all the way back up to 100mg.  Your system is sensitized from your fast taper and updosing too much could be destabilizing.  Are you on the immediate release or extended release?  The link in my first post  contains instruction on how to get small doses.

 

Tips for tapering off Luvox (fluvoxamine) 

 

 

 

 

I've read the posts but still can't figure out if I'm on immediate release or extended release tablets. The posts state that extended release tablets have beads in them (mine do not), so would that mean I'm on immediate release?

 

Would It be okay to go up to 75g? Or would that be too much? It's the easiest way as I can just cut tablets in half. I don't trust making a water version myself.

 

On a side note, I went to a new doctor today. As expected, they believe the withdrawal symptoms should have subsided after 4 weeks and that this is probably my depression returning. They believe I may have chronic fatigue syndrome. 

 

Made me feel pretty hopeless

[ChessieCat]

1 hour ago, mooki24 said:

but still can't figure out if I'm on immediate release or extended release tablets.

 

You could contact your pharmacist.  They should be able to tell if it is immediate or extended.  You don't need to tell them why you are asking (ie that you are tapering).  If they ask, just say something about you wanting to know how the drug works.

 

Another option would be to take a photo of the box and/or packet and post it here.  You would need to remove/cover any information which identifies you, your location and/or your doctor.

 

Or, do a search for Luvox and click on Images.  You will see pictures of Luvox boxes as well as pictures of tablets.  You could then right click on the image and click on Copy Image Location.  Then in a post here click in the reply box and Ctrl +V which will paste the link here.

[mooki24]

1 hour ago, ChessieCat said:

Or, do a search for Luvox and click on Images.  You will see pictures of Luvox boxes as well as pictures of tablets.  You could then right click on the image and click on Copy Image Location.  Then in a post here click in the reply box and Ctrl +V which will paste the link here.

 

Thank you for your reply @ChessieCat.

 

I've found some images on the web as well as a pamphlet (attached). Nothing mentions immediate or extended release unfortunately. 

 

Does anyone know? Otherwise I'll contact my pharmacist 

Fluvoxamine.pdf

[ChessieCat]

According to the information in Post #1 of the Tips for Tapering Fluvoxamine:

 

tablets are immediate release

 

capsules are extended release

 

  

On 10/18/2013 at 7:55 AM, Altostrata said:

From official FDA prescribing information http://www.drugs.com/pro/fluvoxamine.html

Fluvoxamine (immediate release) comes in 25, 50, and 100mg tablets. It is available as a generic. Its half-life is about 15.6 hours.
 
Luvox CR or generic fluvoxamine ER comes in 100mg or 150mg extended-release capsules. Per http://www.drugs.com/pro/luvox-cr.html

 

[Gridley]

6 hours ago, mooki24 said:

75g? Or would that be too much?

75 would be too much.  Could you get 25mg immediate release?  Then you could cut the tablets into quarters giving you a 6 1/4mg updose which would be fine.  

 

6 hours ago, mooki24 said:

As expected, they believe the withdrawal symptoms should have subsided after 4 weeks and that this is probably my depression returning. They believe I may have chronic fatigue syndrome. 

 

Made me feel pretty hopeless

The know nothing about withdrawal.  Don't pay any attention to them.

[Altostrata]

Hello, mooki. It seems you have withdrawal syndrome from tapering too fast from 175mg to 50mg. How have your symptoms changed in the last 2 months?

 

Those are immediate-release Luvox tablets. You can break them in half.

 

If you had Luvox liquid, you could titrate more gradually. Can you get the Luvox prescription liquid? Ask your pharmacist, if yes, get the item number for your doctor to order.

 

 

 

[mooki24]

On 5/26/2020 at 9:25 PM, Gridley said:

75 would be too much.  Could you get 25mg immediate release?  Then you could cut the tablets into quarters giving you a 6 1/4mg updose which would be fine.  

 

Can you explain why it'd be too much? 

 

I can ask my doctor for 25mg tablets but he will ask why. I'm not sure he will understand.

 

I'm sleeping and crying most days, I feel so low and barely functioning. I'm worried a quarter of a 25mg tablet won't be enough.

[mooki24]

On 5/27/2020 at 1:47 AM, Altostrata said:

Hello, mooki. It seems you have withdrawal syndrome from tapering too fast from 175mg to 50mg. How have your symptoms changed in the last 2 months?

 

They haven't changed much at all. There was a 2 week period of intense anxiety recently, however that has subsided. My headaches have lowered a little bit. But apart from that not much has changed. I keep a diary of my symptoms as suggested on this site.

 

On 5/27/2020 at 1:47 AM, Altostrata said:

Those are immediate-release Luvox tablets. You can break them in half.

 

Yes correct, I do this at the moment with 100mg tablets (to get 50mg). That's why I thought it'd be easier to do 75mg as I could split the tablets myself and save the exhausting of seeing my doctor. Also I'm currently interstate and won't be able to see my doctor for another two weeks 😣

 

On 5/27/2020 at 1:47 AM, Altostrata said:

If you had Luvox liquid, you could titrate more gradually. Can you get the Luvox prescription liquid? Ask your pharmacist, if yes, get the item number for your doctor to order.

 

Thank you, I'll check with my pharmacist. I can't see my doctor for another two weeks but I'm worried about asking for this. I'm worried they'll be confused and say no

[mooki24]

Update: I have a phone booking with another doctor tomorrow as I'm getting desperate. Will ask about Luvox liquid and / or 25mg tablets (that I can cut into quarters). However I'm worried the conversation will go into the usual "you should see your psychiatrist, this is your depression returning" etc etc.

[ChessieCat]

Please see this topic:  how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

A suggestion:  write down what you want to say and rehearse it.  An idea of how to say what you want is "I would like to try this".

 

[mooki24]

5 hours ago, ChessieCat said:

Please see this topic:  how-to-talk-to-a-doctor-about-tapering-and-withdrawal-what-to-expect

 

A suggestion:  write down what you want to say and rehearse it.  An idea of how to say what you want is "I would like to try this".

 

 

Thank you, I'm rehearsing my script tonight.

 

This may be a stupid question but what is the difference between the liquid and a compounded liquid?

 

Is the latter just more concentrated?

 

[Gridley]

10 hours ago, mooki24 said:

 

Can you explain why it'd be too much? 

You system has gotten used to the lower dose of 50mg. Jumping back up to 75 would be a very large increase and could overwhelm your system and destabilize you further.  The reason why I wanted you to get the 25mg tablets is you could easily cut them into quarters.

[mooki24]

12 minutes ago, Gridley said:

You system has gotten used to the lower dose of 50mg. Jumping back up to 75 would be a very large increase and could overwhelm your system and destabilize you further.  The reason why I wanted you to get the 25mg tablets is you could easily cut them into quarters.

 

Thanks Gridley, ChessieCat and Alostrata for getting me through the last few days with your insights and advice.

 

I'll ask for liquid fluvoxamine and / or 25mg tablets tomorrow. Fingers crossed I don't come out with a "diagnosis" for bipolar or chronic fatigue *eye roll*

 

Will update soon! 😊

[Altostrata]

For background, please review Tips for tapering off Luvox (fluvoxamine)

 

If liquid Luvox is available, tapering with it would be vastly easier. Ideally, you'd cross over to liquid gradually with a mixture of tablets and liquid.

 

I would not ask the doctor for permission to taper, but firmly and calmly request assistance in tapering.

[mooki24]

Hi everyone, quick update.

 

After a phone call with the doctor and a lot of research and running around, I was finally able to get a compounded prescription for 55mg!

 

I got 30 days worth to start with which was quite expensive but that's okay.

 

I asked about liquid form but the doctor didn't quite understand and then I got confused also. The information on this site is very helpful however I still don't quite understand the concept of getting a liquid prescribed and how to measure it out. I'll continue reading the site - hopefully I'll feel more stable soon and can understand things better - and then ask for liquid next time.

 

Thanks again for all your help and will update soon 😊

 

 

[mooki24]

It's been 2 weeks since I've increased from 50mg to 55mg. 

 

I still feel horrible. Very irritable. Anxious, headachey and have eye pain (like my head is stuck in a vice). 

 

Also very lethargic and feeling very depressed. Couldn't get out of bed yesterday and felt very, very sad. Lots of negative self talk. 

 

Any advice would be appreciated. I worry that I really am just very depressed.

 

[Gridley]

5 hours ago, mooki24 said:

 

I still feel horrible. Very irritable. Anxious, headachey and have eye pain (like my head is stuck in a vice). 

 

Those are common withdrawal symptoms.

 

Is there any improvement at all since you went up to 55mg?  Are you worse than when you were on 50?

 

 

 

[mooki24]

16 hours ago, Gridley said:

Those are common withdrawal symptoms.

 

Is there any improvement at all since you went up to 55mg?  Are you worse than when you were on 50?

 

 

 

 

I'd say maybe an extremely small improvement since the change - barely noticeable. 

 

I'm not worse - it's about the same with bad days here and there.

 

Would it be okay to go up further? I'm so miserable and it's been 6 months of this 😕 

 

[Gridley]

1 hour ago, mooki24 said:

 

Would it be okay to go up further?

I'd suggest you hold another week at 55 and then  let's reevaluate.  It takes a while for things to settle down with a reinstatement.

[mooki24]

Will do. Thanks @Gridley, you are so wonderful for all the support you provide!

[mooki24]

Hi @Gridley and anyone else reading,

 

The last 3 days have been quite hard. I feel so depressed, lethargic and beaten.

 

I have one weeks worth of tablets left (at 55mg) and am due to see my doctor in 3 days to reevaluate. 

 

Can I please seek assistance on whether to increase again or not? 

 

I've read some commentary on a SSRI withdrawal Facebook group where some people talk about the need to be completely off the medication before they start truly healing. Is there any truth to this? 

[Gridley]

1 hour ago, mooki24 said:

Can I please seek assistance on whether to increase again or not? 

 

I've read some commentary on a SSRI withdrawal Facebook group where some people talk about the need to be completely off the medication before they start truly healing. Is there any truth to this? 

You could increase to 60.

 

Regarding the commentary, no, that is not true.  As you reduce your drug burden and your brain begins the process of taking control again (instead of the drug) you are healing.  One example in the case of SSRI's is that as you get lower in dosage, the neurotransmitters that have been put out of commission by the drug begin to come back on line and function again, as your brain moves back toward its natural nondrugged state.  Healing does increase when you're completely off the drug, but it begins as you lower the dosage.

Edited June 23, 2020 by Gridley

[mooki24]

1 hour ago, Gridley said:

You could increase to 60.

 

Regarding the commentary, no, that is not true.  As you reduce your drug burden and your brain begins the process of taking control again (instead of the drug) you are healing.  One example in the case of SSRI's is that as you get lower in dosage, the neurotransmitters that have been put out of commission by the drug begin to come back on line and function again, as your brain moves back toward its natural nondrugged state.  Healing does increase when you're completely off the drug, but it begins as you lower the dosage

 

Okay thanks @Gridley for writing that out, that makes sense. 

 

With regards to going to 60, whilst I'm still not stable, is this still recommended instead of going to 75? The jump from 50 to 55 didn't seem to have much effect, what would an additional 5 do vs 20?

[Gridley]

4 hours ago, mooki24 said:

what would an additional 5 do vs 20?

 

It's better to updose incrementally to avoid overshooting what your system can handle and thereby overwhelming it.  If you updose too high, it can destabilize you further.  60 might be just right.  If not, after giving it time to work, you can go a little higher.

 

Remember that the goal of updosing/reinstatement isn't to feel perfect but rather to make withdrawal symptoms tolerable.

[mooki24]

14 hours ago, Gridley said:

 

It's better to updose incrementally to avoid overshooting what your system can handle and thereby overwhelming it.  If you updose too high, it can destabilize you further.  60 might be just right.  If not, after giving it time to work, you can go a little higher.

 

Remember that the goal of updosing/reinstatement isn't to feel perfect but rather to make withdrawal symptoms tolerable.

 

Ah thanks for the explanation, that makes sense.

 

However, I don't want to tolerate these symptoms anymore, I just want to feel happy again. I'm worried 5mg won't do anything. I just want to go up to 100mg or something normal to feel well again. Feel like I'm going crazy.

 

This sucks. 

[ChessieCat]

31 minutes ago, mooki24 said:

I just want to go up to 100mg or something normal to feel well again.

 

We have members here who, in desperation, have reinstated/updosed too high a dose and things become much worse for them.

 

Your drug signature states that you have been on 50mg since 24th February 2020 and updosed 2nd June .  During the time that you have been on the lower dose your brain has been slowly adapting to not getting as much of the drug.  As Gridley stated, it is better to increase slowly than to take too much.

 

  

On 8/31/2011 at 5:28 AM, Rhiannon said:

This is something I posted somewhere else and then saved. I know it's all stuff I've said before, but it bears repeating and further discussion. A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

 

That's not what happens with medications that alter neurotransmitter function, we are learning. What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain. So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along).

 

It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

 

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

 

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected.

 

Edited June 24, 2020 by ChessieCat

[ChessieCat]

Post #1 relates to updosing as well as reinstatement:

 

About reinstating and stabilizing to reduce withdrawal symptoms

[DataGuy]

@ChessieCat and @Gridley are right. Reinstating a large amount could 1) undo some progress you made and 2) actually make you feel worse because your system has been sensitized. It is much better to updose slowly and incrementally. Your system needs stability and you don't want to rock it with overly rapid changes in opposite directions. We all hope it makes you feel better, but you have to guard against the fact that it may not, especially since you've been at this lower dose for so long. 

[Gridley]

4 hours ago, mooki24 said:

I'm worried 5mg won't do anything. I just want to go up to 100mg or something normal to feel well again. Feel like I'm going crazy.

Mooki, 

 

I understand your wish to feel normal again.  We all do.  It's very important to remember that more is not better with an updose.  More can make you worse than you already are for the reasons ChessieCat, DataGuy and I have explained.  Your system is very sensitized right now.  It's also very important to make changes slowly and not do something based on desperation.    The only way to know if 5mg will do anything is to try it and see what happens.