mva96: hello everyone - 6 months of escitalopram

[mva96]

@ChessieCatYes i think you are right, they kept feeding me damn benzos when i complained about the agitation coming from the prozac, i knew this would happen.

 

I've been taking it for around a month now so i don't think i can just jump off it can I?

 

I've also updated my signature.

 

@GreatfulThank you for your continued support, it a damn nightmare what these drugs can do. I hope you are seeing steady progress in your own recovery journey.

 

@Altostrataid really appreciate your advice on the matter when you have the time. Thank you

 

[Altostrata]

This is what I think:

 

On 9/20/2021 at 5:42 PM, Altostrata said:

But perhaps you won't have withdrawal, or a return of activation from that rather large Prozac dosage that may have been masked by the benzo.

 

When was the last time you changed Prozac dosage?

[mva96]

@Altostrata I was bumped up from 40mg to 60mg about 2 weeks ago, and from 20mg to 40mg about 3 weeks ago. I've been on 20mg for a little over a month now.

 

I've just spoken to my GP as things have been getting extremely bad. She also suggested lowering the prozac, and has also prescribed me lorazapam for if things become unbearable. I will be sure to only use this in emergencies though as im aware it will make it harder to track the symptoms.

 

Do you think lowering from 60mg to 20mg is doable, considering i've only been on those doses for 3 weeks?

 

Thanks again for your help

[Altostrata]

If I were you, I'd immediately go back to 40mg Prozac. Please let us know the effects of this.

 

Avoid taking lorazepam if you can.

 

Your prescribers have gotten you into a pickle.

[mva96]

Hi @Altostrata

 

i know you dislike people going against your advice, but given my situation I feel it is necessary. I didn’t not take any fluoxetine yesterday and noted a dramatically decreased level of restlessness, akathisia and suicidality. For these reasons I plan to drop to 20 mg and hold for the foreseeable future as I expect quite a harsh wave to be part of the trade off for doing this. 
 

If this decision puts you off giving further advice on my thread in the future I completely understand. 
 

Thanks for your help so far. 

[Altostrata]

2 hours ago, mva96 said:

I didn’t not take any fluoxetine yesterday and noted a dramatically decreased level of restlessness, akathisia and suicidality.

 

This is not surprising because, if you recall, I remarked that 60mg Prozac was a very high dosage.

 

I recommended you reduce to 40mg because your increase to 40mg was very recent and reducing more may cause withdrawal symptoms. Because of Prozac's long half-life, you may not feel withdrawal for a month.

 

Our advice is always towards minimizing the risk of withdrawal, but you don't seem to be worried about that, though with your history of severe symptoms, you're probably vulnerable to them. We may not be able to help much if you do get withdrawal symptoms. If you feel you can cope with them, by all means, do it your way.

[ChessieCat]

You might not have read and/or understood the quote that I posted previously.  I will repost it here and try to explain what it means.

 

On 7/3/2011 at 4:11 AM, Altostrata said:

Prozac has the longest half-life of any SSRI. After you take it for a few days, half-life is about 16 days. Fluoxetine itself has a half-life of 2-4 days, but as it is processed, your body creates an active antidepressant metabolite, norfluoxetine, which has a half-life of 7-15 days. So Prozac keeps on extending its half-life as it is metabolized.

According to http://en.wikipedia.org/wiki/Fluoxetine , fluoxetine and norfluoxetine inhibit each other's metabolism, extending the half-life of the drug. Because the half-lives are so long, the full effect of Prozac on the brain may not be felt for several weeks.

 

Most psychiatric drugs have a half life of about 24 hours.  When taking one of these types of drugs it takes about 4 days for the drug to get to full strength in the body and a bit longer (possibly up to a week) for it to register in the brain.

 

Prozac is different.  The effect of reducing to 20mg now (after taking 40mg and then increasing to 60mg) will not be felt until between about 7 to 14/15 days after the reduction.  If you then decided to increase the dose because you realise that you have reduced to much, it will then be the opposite.  The brain and CNS does not like having to coping with yo-yoing the dose.

 

I think it would be much better to do as Alto has suggested and take 40mg Prozac at this time.  This will be a much better and gentler way to reduce the drug quickly, instead of going up and down in your dose trying to find the "right" amount.  Because of the long half life of Prozac every time you make a dose change you then have to wait for it to fully kick in and during that time you may be suffering, either from adverse effect from too much drug or withdrawal symptoms from not enough drug.  You might find that 40mg Prozac is okay.  But if after 2 weeks you still feel activated by the Prozac you could then make another reduction, perhaps from 40mg to 30mg and then wait for another 2 weeks before seeing what effect it has only you.

 

I think about members who have tried to taper their drug too quickly instead of just doing a consistent 10% every 4 week taper.  Sometimes it ends up taking them much longer to get off the drug (and they can suffer during that time and sometimes have ended up on more drug/s) than if they had been patient and stuck to the recommended taper rate.

 

When we are suffering we want the suffering to stop, and we want it to be as soon as possible.

 

Please try to take everything into consideration and make an informed decision about how you are going to reduce Prozac.  If you try to do it too quickly you could be suffering for a very long time, instead of doing it step by step.

 

I suggest you also check out the SERT occupancy graph for Prozac:

 

See Figure 2 (page 4 of the web document):

 

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.161.5.826

 

You will see that when taking higher doses of the drug the difference between 40mg and 60mg is not very much compared to 10mg to 20mg.

 

This topic has  more information and discussion about this:

 

why-taper-sert-transporter-occupancy-studies-show-importance-of-gradual-change-in-plasma-concentration

 

 

 

 

 

 

 

[ChessieCat]

@mva96

 

Just want to draw your attention to Alto liking my post above.

[mva96]

@Altostrata and @ChessieCat  Thank you both for your replies. I apologise for making rash decisions, but having endured akathisia for about 6 months previously I was feeling quite desperate with regards to my situation and having the deal with it again. 
 

I have reduced to 20mg and can’t say I’ve noticed any significant symptoms but as you have both pointed out, it might not be a good few weeks until my brain catches up. The akathisia has almost completely resolved at this dose, I have also been kicked out of my house so that’s another stressor on top of things. 
 

I’ve been through absolute hell and back with withdrawal and other issue so I can probably cope. I won’t be touching the Prozac or lamictal dose for a very, very long time however. 

[Altostrata]

18 minutes ago, mva96 said:

The akathisia has almost completely resolved at this dose

 

This is because you were taking an excessive dosage of Prozac, and it was causing activation.

 

Good to hear you're doing better.

[ChessieCat]

If you do decide to make a dose increase in the Prozac I suggest that you only make tiny incremental increases with time in between in relation to the information I provided about how Prozac works.

 

And remember the idea is not to keep trying to tweak things to get things perfect, it's to get things to a bearable level.  If you make too many changes in short period of time it might end up making things worse.

[Altostrata]

Please don't futz with the fluoxetine dose for a good long while. I doubt any increase is going to be an improvement.

[ChessieCat]

I agree with Alto.  The post I made was just in case mva starting feeling the need to do something.

[mva96]

Loud and clear guys. Will be holding steady on the fluoxetine for the foreseeable future. Thanks again 

[mva96]

Unfortunately I can feel the akathisia slowly starting to return. I know it’s a sticky symptom and struggled to believe I wouldn’t see it again. It’s not as bad as it was at 60mg but still pretty unbearable. 
 

i haven’t had any discernible withdrawals from the Prozac reduction so far. But I’m not going to reduce any further until a month has passed. I’m going to speak to my GP tomorrow and hopefully get some propalonol.  

[Altostrata]

This makes sense because of Prozac's half-life. Your system is only now fully registering the decrease you made 10 days ago.

 

At what time o'clock do you take Prozac, what time o'clock does this symptom appear? How long does it last?

[mva96]

Hi alto thanks for such a speedy response. 
 

I take the Prozac at 1pm everyday. I have felt what I can only describe as ‘flickers’ of akathisia over the past few days. But today has been the first day that the familiar agitation and restlessness has returned. 
 

It started in the evening at around 6pm today. It seems to have past for now but I can still feel the odd sensation in my chest that isn’t agitation. It lasted for about 3 ish hours.  That part is quite hard to really explain but it feels like the stage of aka before it turns into the classic restlessness/agitation. 
 

Thanks for your advice as usual, it’s always appreciated. 

[mva96]

Hi @Altostrata and @ChessieCat  

 

I’ve stayed on the same Prozac and lamictal doses for a while, I don’t really have any intention of reducing but even at 20mgs I feel what I can only describe as mild hypomania. 
 

I find sleep much harder, increased impulsivity and just energy etc. My psychiatrist said it’s ‘mild’ but I could reduce if I wanted too. 
 

just interested to see what you have to say given your experience. Thanks. 
 

 

[ChessieCat]

It sounds like you are still taking too high a dose of Prozac.  You've been on 20mg for at least 3 weeks now, possibly closer to 4.

 

You might find that making a small reduction might help.  If it was me I'd only be reducing to 19mg.  It's better to go by small amounts than to risk reducing too much.   And this is even more necessary with Prozac due to the long half life.

 

This is much my thoughts.  Alto might think differently.

 

Q:  Is there a reason you are taking Prozac at 1pm?

 

If there is no specific reason and if you decide not to increase your Prozac, you could try moving it earlier by 1 hour each day.  Please note that I said if you do not increase the Prozac.  Only one change at a time.  You might find that the activation might not be as bad at night and cause sleep issues.

 

BTW, there is no need to tag me.  Please do not tag me for any reason in the future.  Thank you.

[Altostrata]

I agree with @ChessieCat. Prozac is stimulating for you, it appears you are still taking too much Prozac, you might reduce by 1mg.

 

After you see what that reduction does for at least 2 weeks, you might want to move your dose gradually to an earlier time of day, where it would be less likely to interfere with your sleep. 

[mva96]

Ok thanks guys, I will try to reduce to 19 and see how that goes. 

[Greatful]

@mva96  How are you doing mva96

[mva96]

Hey @Greatful

 

I’m ok ish. Very anhedonic and just feel a bit brain damaged but it’s improving very slowly. The akathisia has completely gone for now which is a relief. 
 

how are things going with you?

[mva96]

Still plugging along at the same doses. Realistically think even with the Prozac it’s going to take at least a year for my brain to recover from the Lexapro, if not longer. 
 

akathisia has totally gone which is great, but a very heavy, thick cognitive fog, anhedonia and malaise seems to have taken its place. Having been off Lexapro for almost 14 months I know this symptom is one that’s slow to improve. 
 

Regardless of that I’m doing ok. Things are hard, but they have been much worse than this. 

[ChessieCat]

4 hours ago, mva96 said:

akathisia has totally gone which is great

 

That's good.

 

4 hours ago, mva96 said:

Regardless of that I’m doing ok. Things are hard, but they have been much worse than this. 

 

This is what I try to explain to members.  It is better to compare how you are currently feeling than to compare how you felt at your best, or how you want to feel.

 

Nonetheless, it is difficult and you still have to get through it.

 

Hang in there.  Not having the akathisia is a huge plus!

[mva96]

Yeah exactly chessie,  I keep reminding myself, this is tough but, I was begging for this level of internal peace when aka was around. 
 

congrats again on completing your taper!
 

 

[mva96]

Not that significant, but thought it was worth mentioning. 
 

About months 3 from my original WD, I developed some sort of facial condition that made me look As though I had just had a stroke. 
 

I still have it now however it’s not very noticeable. My uncle who is a practicing neurologist said it was/is facial palsy, likely from nerve damage. Has seen it in patients using SSRIs before. 

[CasuallyMagical]

Hi I just read all your posts after finding the current one. I was searching for nerve damage. I just hit the sixth month mark off of Prozac. Prozac worked briefly for 6-7 weeks after the first 3-4 weeks of adjusting to the drug. Then I got a paradoxical effect on the drug including akathesia. I stopped fluoxetine after a short taper(unaware of SA or tapering). It took 18-21 days for the  symptoms to start. If it weren’t for my family I’d be homeless. However they too keep telling me to be normal again. My brother has been on a high dose of Zoloft for ten years and even he thinks I’m making it up. 
 

On fluoxetine I could drink coffee like water. Coming off of fluoxetine, caffeine, even in decaf or chocolate, triggered everything. I can’t say what’s right for you but please be aware. 

[mva96]

Hey @CasuallyMagical thanks for giving me a warning about the Prozac. I’m hoping that akathisia doesn’t make a surprise appearance as I’ve already had it for about 8 months then recovered from it. 
 

I agree with you that Prozac is not ideal, I actually preferred being on the Lexapro. The Prozac makes me very impulsive and like you I can drink a lot of caffeine/alcohol if I allow myself. I also feel my emotions are very suppressed. 
 

im sorry you’re going through this, I know how hard it is and it’s even worse when family don’t believe us. 
 

hang in there 

[mva96]

Hope everyone’s having a good Christmas. I’m still cruising along at 20mg Prozac and 50mg Lamictal. 
 

things are definitely improving. I can laugh more and just enjoy life more. 
 

I still have very thick cog fog/anhedonia Which I’d estimate will take at least another year to clear up, but I’m ok with that. 
 

im going to use this stability to work through my PTSD and then VERY slowly taper off both in the future. 
 

hope everyone else is seeing healing

[mva96]

Figured I’d pop in and post another update. 
 

I’m still on 20 Mg Prozac and 50Mg lamictal, my psychiatrist wanted me on 100mg of quetiapine ‘for sleep’ which I immediately refused. 

in terms of symptoms, things continue to improve at a slow rate. My remaining issues are anhedonia and feeling like a part of my brain has literally been fried.  DPDR is there too but it doesn't really bother me anymore. 
 

compared to the level of suffering acute brought, I’m grateful. I don’t plan on tapering for a good couple of years and when I do, it will be very slow. I’d rather take 5 years to get off than experience what I went through again. 
 

hope everyone is seeing some progress and healing. 

 

MVA

[mva96]

Unfortunately I seem to have hit a wave. I've been seeing incredibly slow but consistent improvement since the reinstatement 6 months ago. 

 

However i seem to have picked up a cold, and last night i awoke at 5am with one of the worst headaches i've ever had, very similar to the ones I would get in acute WD.

 

Since then, the clogged up, thick brain fog has returned alongside heavier anhedonia, fatigue and loud tinnitus.  

 

Its not awful, but i would be lying if i wasn't a little frustrated. I had just start to really feel like i had just started making significant progress. Damn the pharmaceutical companies, and bless this website.

 

Hope you are all seeing some progress on this tough journey.

[arbor]

Hi @mva96--how are you doing now?

Sending you healing energy,

Arbor

[mva96]

Hey @arbor

 

I'm doing better thanks, still have some anhedonia, cog fog and mild akathisia, but they are more of a nusiance than anything else. How are you getting on with your recovery?

 

 

 

[arbor]

I'm so glad that you're doing better @mva96.  This is sure up and down, isn't it--

Finally, I'm sensing some progress, so I'm feeling encouraged, trying not to get too far over my skis.

Thinking of you,

Arbor

[mva96]

Its been a while. Generally speaking, things have continued to slowly improve. I still have some residual anhedonia, depression and cog fog which likely would have resolved months ago had I been able to stop drinking.

 

Whilst it's reduced somewhat, the prozac is still very activating and at times I think its made me hypomanic. I'm much more restless, sort of hyper and incredibly impulsive (hence the runaway drinking, and spending for that matter). The cravings to drink are unlike anything i've ever experienced.

 

I've started attending AA recently to help get things under control, I suspect i'll have to start reducing the prozac in the not too distant future to try and get these SX's under control.

 

I'm not sure i'm quite ready to commit to a full blown taper off yet as i'm still quite mentally scarred from the past couple of years, but it would be nice to at least lower to a point where i feel a bit more calm, settled and like myself.

 

Hope everyone else is seeing some progress 🤞