rd57: Need help getting off fluoxetine!

[ChessieCat]

7 hours ago, rd57 said:

even when I don't take CBD the problems I've mentioned are still there. 

 

Q:  How long do you not take it for?  If it is only a few days to a week, that might not be long enough.

[rd57]

11 minutes ago, ChessieCat said:

 

Q:  How long do you not take it for?  If it is only a few days to a week, that might not be long enough.

 

I've not taken it for around a week at a time but after doing some research, it seems as though there is no definitive answer on when it has been 'completely' eliminated from the bloodstream.   

[ChessieCat]

If it affects the brain then it could take longer.  When tapering a psychiatric drug the recommended hold after a reduction is 4 weeks to allow the brain to adapt to not getting as much of the drug.

[rd57]

12 hours ago, ChessieCat said:

If it affects the brain then it could take longer.  When tapering a psychiatric drug the recommended hold after a reduction is 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

All of these withdrawal problems started when I began the taper, so isn't there a clear cause-effect here? I also always use a broad- rather than a full-spectrum CBD as I find that the compounds present in the latter but not the former can be somewhat overstimulating. 

[rd57]

Since I am currently on 17.82mg, which I started in March 2022, and these withdrawal symptoms have been exacerbated by this drop, wouldn't it make more sense to return to the previous 18mg dosage that I started in August 2021? I appreciate that I'm in a wave right now but, to me, it makes no sense to carry on with the current dosage since things haven't gotten better since. 

 

[ChessieCat]

No you do not return to the last dose that you were on before the drug.  It has been just over 3 months since you were taking 18mg and during that time the brain will have made some adaptations to the lower dose.

 

Q:  Have you missed any doses, are you measuring accurately, have you been sick, any extra stressors (relationship, financial, work, death of loved ones or pet), drinking alcohol, overdoing exercise/physical activity, consuming caffeinated beverages (eg energy drinks), staying up late regularly?

 

Q:  Are your symptoms bearable?  If yes, then hold on your dose.

 

If no, then increasing by a tiny amount might help, but not back to the previous dose.  It is better to increase by small increments than to risk taking too much.  The issue with fluoxetine is that it has a very long half life so if you take too much it can be several weeks before you get the full effect of the dose increase.  And then if you decrease again it will take about the same amount of time in reverse.

 

Personally, because you made such a small decrease I think it might be better to hold on your current dose.

 

And please understand that there will most likely be times during your taper when you do experience withdrawal symptoms and discomfort.  The aim is to keep them to a minimum.  AND to use non drug coping techniques to get through those times and not think of the drug as being a quick fix.

 

Non-drug techniques to cope

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

SA's taper rate is no more than 10% of the current dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.  But it is also important to listen to your body/symptoms and taper according to those, and holding for longer/reducing by less if/when needed.

 

[rd57]

6 hours ago, ChessieCat said:

No you do not return to the last dose that you were on before the drug.  It has been just over 3 months since you were taking 18mg and during that time the brain will have made some adaptations to the lower dose.

I'm sorry, you'll have to help me understand why it isn't the best idea to return to the dosage before the current one. Really, when the side effects started from the original drop in August 2021 from 20 to 18mg and my nervous system became over-sensitive but didn't return to normal after a few months, I should have returned to the 20mg dosage. The drop from 18 to 17.82mg a few months ago was obviously too much, and resulted in the exacerbation of the already-present side effects, namely the over-sensitive nervous system. 

Obviously people's tolerance to their side effects varies, but this nervous system oversensitivity is impacting the basics of my daily living. 

 

 

6 hours ago, ChessieCat said:

Q:  Have you missed any doses, are you measuring accurately, have you been sick, any extra stressors (relationship, financial, work, death of loved ones or pet), drinking alcohol, overdoing exercise/physical activity, consuming caffeinated beverages (eg energy drinks), staying up late regularly?

I've never missed a dose, I use a precise scale to measure the fluoxetine (reads in 0.001g increments with accuracy of +/- 0.005g), and I very recently quit my job, which of course has added to my stress load but note that the over-sensitive nervous system is there regardless of any stress. 

 

 

6 hours ago, ChessieCat said:

Q:  Are your symptoms bearable?  If yes, then hold on your dose.

The vast majority of the symptoms are quite tolerable but the over-sensitive nervous system isn't. I've had this problem now for around a year with literally no sign of improvement, in fact it's gotten worse and my career will soon require I do daily travelling, which unfortunately does not reconcile with the over-sensitivity. 

 

 

PS, thank you for all of your advice so far, I really appreciate it!

 

[ChessieCat]

6 hours ago, rd57 said:

I'm sorry, you'll have to help me understand why it isn't the best idea to return to the dosage before the current one.

 

I DID provide the explanation:

 

13 hours ago, ChessieCat said:

It has been just over 3 months since you were taking 18mg and during that time the brain will have made some adaptations to the lower dose.

 

SA generally suggests only making small increases and doing it gradually, and with fluoxetine's long half life it would have to be even more gradual.

 

It's also important to understand that the effect of changing doses on your nervous system is cumulative.  We have SA members who gone on/off drug/s and up/down doses and don't have any issues, then one day they do the same thing they have done previously and it doesn't work the same way.

 

6 hours ago, rd57 said:

my nervous system became over-sensitive

 

It's generally even more important not to increase by too much when your nervous system has been sensitised.

[methuselah]

You may want to drop the CBD (probably taper it if possible and dependent on dosing frequency) as it impacts the liver enzymes that metabolize prozac.  i tried cbd a while back, also on prozac, and reacted negatively after several days of consistent use.  i can't recall if it inhibits the cyp2D6 enzyme of cyp3a4, may be both.  I ran a google search to try to find specifics but there's a lot of info out there and it's a little cloudy.  Wish, i could  be of more help.

 

 

[ChessieCat]

From https://reference.medscape.com/drug-interactionchecker

 

• fluoxetine + cannabidiol

  fluoxetine will increase the level or effect of cannabidiol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP2C19 inhibitor.

• cannabidiol + fluoxetine

  cannabidiol will increase the level or effect of fluoxetine by decreasing metabolism. Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit CYP2C9 activity. Consider reducing the dose when concomitantly using CYP2C9 substrates.

[ChessieCat]

From https://academic.oup.com/rheumatology/article/59/1/249/5540352?login=false

 

Fluoxetine is metabolized in the liver by CYP2D6 and CYP2C9. Cannabidiol inhibits CYP2D6 and CYP2C9 in vitro. This interaction has yet to be reported in humans; however, until more is known caution is advised because concomitant use could increase serum levels and the risk of adverse effects.

[rd57]

Hi all, quick update + advice needed:

 

Been doing really well as I’ve taken up meditation and my nervous system has repaired itself enough for me to get back into the gym + swimming.

 

However, these past two weeks have been some of the worst that I can remember. It may be due to overdoing it a bit, but I know what to expect when this happens, and usually the side effects subside within a few days. The side effects that I’m getting now largely resemble those I had when I was changing between sertraline and fluoxetine (see earlier posts), and when I dropped from 20mg fluoxetine to 18mg in August 2021.

 

I’ve noticed that these symptoms have largely begun from around when the fluoxetine manufacturer had changed - it seems the capsule size is smaller than before.

 

The way that I’ve been measuring my dosage is:

• When I first tapered by an amount, I took 30 capsules, calculated the average weight and then created new capsules with the new tapered amount.
• Since the manufacturer hadn’t changed since then, I’ve been measuring out that same tapered amount/ mg for all subsequent doses without calculating the average weight of the original/ full capsules before I begin, and I’ve not had any problems using this method.

 

Could it be that the average amount of fluoxetine in the new capsules is different and I now need to get the average weight of the new capsules and then calculate the tapered amount?

 

[rd57]

Hi all,

 

I’m preparing to reduce my fluoxetine but unsure as to how much to reduce by. The last drop I made was 1% which was around a year ago so should I make a 1% drop initially and then adjust accordingly, i.e. increase if symptoms don’t show/ are tolerable etc. or go for a 10% reduction?

[LostInCanada]

@rd57hey, I saw your post under the brassmonkey slide. I would definitely hold till the symptoms settle. Because of the long half life of fluoxetine, it takes a bit if time for the symptoms to show up. I see in your thread you had issues with a manufacturer change. Me too and the company I use seems pretty inconsistent with pill weight so I averaged the pills as well. I got the pharmacy to put the manufacturer on my file so that I avoid problems. Looks like the moderator you had hasn't been on for some time. Unfortunately alot of the mods have had health and withdrawal issues as well.  Wishing you well with your taper. 👍

[rd57]

On 7/8/2023 at 4:42 PM, LostInCanada said:

@rd57hey, I saw your post under the brassmonkey slide. I would definitely hold till the symptoms settle. Because of the long half life of fluoxetine, it takes a bit if time for the symptoms to show up. I see in your thread you had issues with a manufacturer change. Me too and the company I use seems pretty inconsistent with pill weight so I averaged the pills as well. I got the pharmacy to put the manufacturer on my file so that I avoid problems. Looks like the moderator you had hasn't been on for some time. Unfortunately alot of the mods have had health and withdrawal issues as well.  Wishing you well with your taper. 👍

Thanks for the reply, will hold:)