RichB: looking to taper off SSRIs

[RichB]

Hi-

I am new here and have been on SSRI's since around 1990! Diagnosed with unipolar depression.

 

Diagnosis Depression: Prozac from 1990-1999, Prozac stopped working, then various SSRI's through 2001, several hospitalizations and ECT.

Older tricyclics and depakote 2001-2003; Effexor, Cymbalta, Zoloft, Zyprexa, Luvox and others the past 20 years, another few hospitalizations, then back to Prozac, Wellbutrin and Zyprexa, not working very well. Recently was self-medicating with kratom, low doses but quit Aug. 2020. I don't want to be addicted to anything.

 

Never tried to get off these meds, but now (soon) is the time. I fear their long-term damage and am not benefitting from them.

I've developed a swallowing disorder the dysphagia specialist suggests (cannot be proven) could be the result of long-term use of psych meds causing neurological damage. I'm 62 and I want to get back to a more functioning self.

I exercise daily and have begun meditating, diet and physical fitness are good.

 

I am here to learn from others about tapering and other ways to manage depression besides meds. I am scared to get off the meds, scared I will always be depressed. It's hard to be optimistic and hopeful.

 

Also, how do I get my meds history as part of my signature/profile?

Thanks!

Rich in Ga.

Edited September 30, 2020 by Gridley

[Gridley]

Welcome to SA, RichB.  We're happy to help you taper off these drugs. It's very good that you came here before tapering so we can help you with a safe taper.  We have many members who have successfully tapered off these drugs and are doing fine.  Take a look at our "Success Stories" forum on our main page.

 

To give members the best information, we ask them to summarize their medication history in a signature -- drugs, doses, dates, and discontinuations & reinstatements, in the last 12-24 months particularly.  Use this link and when you've finished, press "save."  Please include the present drugs you're on and dose and when you started these drugs.  If Wellbutrin is one of your current drugs, please indicate the form of wellbutrin you're taking: immediate release, sustained release, or extended release.

 

Account Settings – Create or Edit a signature.

 

Since you've been on and off so many drugs over the last years, it's very likely that much of what the doctors have been diagnosing as depression is actually withdrawal (which doctors don't believe exists).  Depression is a common withdrawal symptom.

 

What is withdrawal syndrome.

 

Daily Checklist of Antidepressant Withdrawal Symptoms (PDF) 

 

If I'm reading your post correctly, you're currently on Prozac, Wellbutrin and Zyprexa (please correct me if I'm wrong).  We recommend tapering only one drug at a time.  Otherwise, if problems arise, you won't know the cause.  We recommend tapering the more activating drug first, leaving the sedating or neutral drugs in place to act as a buffer to be tapered later.  SSRI's like Prozac are activating.  Antipsychotics like Zyprexa are sedating.  Wellbutrin can be activating or neutral depending on the person.  So it would be a choice between tapering the Prozac or the Wellbutrin first.  Do you have a preference? Can you tell if the Wellbutrin is activating (stimulating)?

 

Taking multiple psych drugs? Which drug to taper first?

 

We recommend tapering no faster than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The following links are specifically about tapering Prozac and Wellbutrin (though you'd only be tapering one of them at a time).  The links include information on how to obtain the nonstandard doses you'll need for your 10% taper.  Prozac comes in a prescription liquid and would likely be the easiest way to taper this drug.  

 

Tips for tapering off fluoxetine (Prozac)

 

Tips for tapering off buproprion (Wellbutrin, SR, XR, XL)

 

We recommend non-drug tenchiques to help cope with life.  Take a look at the liks in the following link and see which you think might be helpful to you.

 

Non-drug techniques to cope

 

Here is a link on dealing with depression.

How I am coping with depression - Symptoms and self-care ...

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

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 asks questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

Edited September 30, 2020 by Gridley

[RichB]

Thanks Gridley for the intro and helpful links/information!

My psychiatrist recently took me off a low dose (2.5mg) of Zyprexa, suspecting it was contributing to my swallowing disorder. 2nd day off, not feeling so good, but bearable. I might be experiencing withdrawal still from quitting kratom 3 weeks ago, feeling more depression. I'm hoping it will improve soon.

 

I don't know if my psychiatrist would be agreeable to helping me taper off my meds. I haven't asked him yet.

 

I was looking into a doctor of Integrative or Functional Medicine possibly, to help me with tapering and lifestyle changes. Could be expensive though! 

Has anyone tried different types of physicians, besides the psychiatrist, to coordinate a taper?

 

I agree with your taper advice. My next step is try to get my psychiatrist on board.

I think I find the Wellbutrin slightly stimulating, am taking 200mg now. I will add to my signature to show dosages too.

 

Thanks for the welcome! This site has been very helpful the past couple weeks before I registered.

Rich

[Gridley]

1 hour ago, RichB said:

I don't know if my psychiatrist would be agreeable to helping me taper off my meds. I haven't asked him yet.

 

I was looking into a doctor of Integrative or Functional Medicine possibly, to help me with tapering and lifestyle changes. Could be expensive though! 

Has anyone tried different types of physicians, besides the psychiatrist, to coordinate a taper?

 

Of course, it would be good to have your psychiatrist on board.  Unfortunately, the vast majority of psychiatrists know nothing about safe tapering and almost invariably taper their patients too fast.    They also don't believe in withdrawal.  That's why this site exists. 

British psychiatry is ahead of the U.S. in recognizing withdrawal, and these two links might be helpful to you if your psychiatrist is open to reading them.

 

Major milestone: Royal College releases new guidance on stopping antidepressants

 

And here is the leaflet from Royal College of Psychiatry website: 

 

Stopping antidepressants

 

I don't know how knowledgeable an integrative or functional doctor would be about tapering or withdrawal.  They might be more open to new information about these drugs.  I'd think they might be more helpful with lifestyle changes than tapering.

 

Since you just quit the Zyprexa and might be experiencing withdrawal from it and also the kratom, I'd suggest waiting to taper until you see how you're feeling from these two changes.  With multiple drugs, we recommend a holding period of 2-3 months between drug tapers so you can be in as stable a position as possible when you begin your taper. 

Edited September 30, 2020 by Gridley

[RichB]

More good info, thanks. I can try to get that leaflet from Royal College of Psychiatry to my psychiatrist. I will discuss tapering with him at my next appointment.

I agree I should wait until I am somewhat stabilized from coming off the kratom (3 weeks) and Zyprexa. I don't feel too badly, still able to do my exercise and function.

 

I can feel overwhelmed, so I lower my standards as far as how much I expect to do in a day. Somedays it's just morning exercise and making it to the grocery store. I used to be able to work full-time, do my workouts 3-4 times a week, do other activities. I don't know if I'll ever be able to return to such functioning, as that was 20 years ago. But I do hope for better functioning than I have the past decade or so, especially being able to work more without getting overwhelmed. I help care for my elderly Mom right now, as we share a house. I also help with the house and pet care.

 

I also returned to school in 2018 to update and learn new CAD, computer-aided drafting/3D modeling skills. The challenge of classes and assignments has kept my brain "sharp" (I guess) and improved my confidence. It also gives my day structure. I can finish that diploma program next semester. I am also looking for another part-time job, haven't worked in a few months.

 

Another question: Can you mix the prozac capsule in water, then take the small doses needed when tapering, by syringing out and drinking certain amounts from the water solution? I'm not doing it yet,  was just wondering.

 

Congratulations on your taper, Gridley!

Thanks-

Rich

[Gridley]

@RichB

 

Making your own liquid with Prozac is commonly done.  The following instructions are from the link I provided earlier, "Tips for Tapering Fluoxetine (Prozac)."

 

Making your own Prozac liquid 
Prozac is one of the few psychiatric medications with a long history of do-it-yourself dilution in water or juice. Mixed in cranberry juice, it's been called "Cranzac."

My own personal preference would be to dilute it with water, to avoid any degradation that might be caused by sugar or acid in the juice. Also, it will be easier to see how well the Prozac is dissolved in water. (There may be particles swirling around, that's the filler in the Prozac capsule that doesn't dissolve.)

Your Prozac solution may be a little bitter -- just swallow it quickly. You might want to chase it with a little fruit juice.

For very gradual tapering, for example, you can dissolve a 10mg capsule or orally dispersible tablet in 10mL of water to make a solution with 1mg Prozac in 1mg of water. To take 1mg Prozac, use an oral syringe to take out 1mL.

Refrigerated, it's supposed to be stable for 14 days. From a pharmaceutical technician manual

Using a liquid can be a very precise way to taper.

 

Using a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

For example, if you are taking more than 10mg Prozac per day, you could get your prescription filled in 10mg capsules and take part of your daily dosage in a 10mg capsule and the rest in liquid.

 

If your doctor prescribes liquid and tablets or capsules at the same time, most likely, he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

[RichB]

I'm back. I am beginning a taper of my Prozac dosage which is currently 60mg. I take three 20mg caps. I am going to dissolve one cap in water, as suggested in the instructions you linked me too.

I am going to reduce by 5mg and hold for at least a month, see how that goes. So I'm taking 55mg Prozac daily.

I knew I would come back to this forum when I was ready to taper. I've referred several people here too; it is very informative!

Thanks!

[Dejavu]

Hey @RichB, glad you're back. Good luck with your taper! 

[DiscJockey]

Hi @RichB I am the same as you, use to exercise 3-4 times a week, caregiver for my parents and pets. Now, I still exercise but gently. If I push too hard I can go into a terrible wave that will last a couple weeks. Still work full time, luckily part from home and onsite. I had to take a medical disability leave last summer because I went into terrible wds from Paxil, it was debilitating! Just sending good vibes your way. I am currently in a wave right now from doing a 2% drop of the Paxil 2 weeks ago. I am hoping it will pass.

[RichB]

9 hours ago, DiscJockey said:

Hi @RichB I am the same as you, use to exercise 3-4 times a week, caregiver for my parents and pets. Now, I still exercise but gently. If I push too hard I can go into a terrible wave that will last a couple weeks. Still work full time, luckily part from home and onsite. I had to take a medical disability leave last summer because I went into terrible wds from Paxil, it was debilitating! Just sending good vibes your way. I am currently in a wave right now from doing a 2% drop of the Paxil 2 weeks ago. I am hoping it will pass.

Thanks DiscJockey. Still doing my morning walks or indoor bike/rowing. My goal is to be working again pretty soon, in addition to maintaining good health. That's a drag that the Paxil w/d's were debilitating. I'm trying to do my Prozac tapering smoothly. Yes, I hope your low wave passes soon. You'll ride it out.

Thanks for the good vibes!

Rich