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FeinCara : Ready, optimistic, nervous


FeinCara

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FeinCara

Hi there, fellow Surviving Antidepressants Community Members

 

As weird as this might sound, I'm excited to be here. After many years of feeling I have been surviving but not thriving and suspecting that my antidepressants are part of the problem--or at the very least, preventing me from identifying some of the root problems--I feel like I'm starting to get on track with full recovery at 31 years old. It might be a bit premature to say that but today, with the sun out, and having just gotten the support of my psychiatrist to go ahead with starting to taper off Prozac, I'm hopeful that this is the beginning of me taking charge of my health--mental, physical, and spiritual. I'm currently on Wellbutrin 100 mg and Prozac 20 mg. If you want the long version of my antidepressant backstory: 

 

My Introduction to Prozac

I was first prescribed antidepressants in January 2007 when I was 16 years old. I was about 6 weeks in to an IOP program for eating disorders and I was not responding to treatment. I was severely underweight and was continuing to lose weight despite interventions. I can't remember what psychological symptoms I was experiencing in those six weeks, but I assume they were a mix of the same symptoms I had been experiencing first intermittently then constantly over the preceding 3 years: persistent anxiety, hopelessness, and low self-esteem. Perfectionism was present but was there much longer, probably my whole life, along with some level of anxiety. I was diagnosed with anorexia, depression (probably MDD recurrent or whatever that was in the DSM at the time), and generalized anxiety. I was referred to a psychiatrist in hopes that medication would help increase my motivation to participate in treatment. If my memory is correct (not sure), Prozac was the first medication tried and I did not experience notable side effects at the time. I worked my way up fairly rapidly to 40 mg. Within 2 months, I was admitted to an inpatient hospitalization program and I think my Prozac dose was increased to 60 mg. I was there for 2 weeks and was very successful weight restoring and beginning my emotional and psychological recovery. I continued with recommended psychotherapeutic treatment and was considered to be in full remission by May 2007. I stayed on Prozac and continued to work with the same outpatient psychiatrist. I continued to have perfectionist and social anxiety cognitions and feelings, but they were well-managed and part of this was attributed to my medication. I think I decreased to 40 mg at some point during the next few months and completed high school successfully and with solid emotional stability.

 

Interesting note about my first time being prescribed Prozac: my mom has since shared with me what it was like for her during that first psychiatrist appointment, and that she felt she absolutely did not have a choice--that the doctor was saying I must take medication or I would likely continue to deteriorate, which my mom understood would be a threat to my life. I don't necessarily believe that was incorrect. There is a possibility that Prozac helped save my life. I just think hearing my mom's perspective and considering informed consent and the position parents are in when their children are suffering is really eye-opening.

 

First Round of Withdrawal

In college, I continued to experience low to moderate anxiety but was generally able to manage it effectively. During the summer before my sophomore year (19 years old), I shared with my psychiatrist that I wished to see if I could do alright trying to come off Prozac as I had been stable and coping effectively for a solid 2 years at that point. She agreed and recommended I cut down to 30 mg. I started my sophomore year and did not realize I was having more anxiety than usual until I started having hysterical / paranoid fears of being pregnant despite the extremely low likelihood that that was possible. I took multiple pregnancy tests a day for a few weeks. I finally realized my fear was irrational and expressed to my psychiatrist that my anxiety had become overwhelming and she increased me back to 40 mg. I stayed on this for the rest of college and the next few years and again, enjoyed relative stability with some bouts of increased anxiety and depression intermittently but nothing overwhelming or debilitating.

 

The Middle Years, or, When Becoming a Mental Health Practitioner Leads to Increased Antidepressant Dependence

My memory is fuzzy on when my psychiatrist increased my Prozac to 60 mg. I suspect it was during grad school so it would have been between 2014 and 2016 (I got my MSW to become a therapist--yay giving back! Yay using my empathy to help others! Boo struggling with my unrealistic expectations of myself to not make mistakes as a baby social worker/therapist!). It may have been shortly before actually but like I said, memory is fuzzy. It didn't bother me too much to increase and I had continued my psychotherapy increasing the frequency as needed and dropping back down to 1x every two weeks or every month when things were going well. I remember talking to my psychiatrist this time about worrying that there could be negative effects on my health due to taking Prozac long-term. She assured me there was "no evidence that there are negative effects to taking Prozac long-term and lots of people do and you might just have to be on it for your whole life." I did not love that she gave such a quick and  invalidating answer, but I chose to trust her. I also asked if she had recommendations about other changes I might make to my lifestyle or routine in order to decrease my vulnerability to anxiety and depression. She gave me a handout on "Brain Food" (spoiler alert: eat lots of protein and healthy fats). I have since learned that there are A LOT of other things you can do! Apparently I have this really cool genetic variation that makes exercise super effective in decreasing depression symptoms! But my psychiatrist neither knew nor cared to discuss that possibility! (Yes, that was sarcasm. I have some pent up feelings about the psychiatrist who I trusted for over a decade and who did not really listen to me on multiple occasions).

 

Second Round of Withdrawal

Again when I was 28 years old, I talked to my psychiatrist about wishing to decrease and eventually come off of Prozac. I shared that I had read reports of women needing to stop taking SSRIs when they become pregnant, and that I was hoping to have children in the next 5-10 years, so I figured I should start working on that so I wouldn't have to abruptly stop taking them if I decide to try to get pregnant. My psychiatrist assured me that there's no concern for the health of the baby or the mom if one remains on SSRIs while pregnant. I accepted this and let her know I still wanted to try tapering. She recommended coming down by 20 mg and I pushed back, noting the reaction I had to decreasing 10 mg from 40 mg when I was in college. I tried 50 mg for a few weeks and again experienced seriously increased anxiety. When I asked her about whether this was normal or not, she recommended I just go back on to the 60 mg. She never educated me about the possibility of any withdrawal or discontinuation symptoms, never normalized them, and never challenged my statements that "this must mean I am an anxious mess without Prozac." It genuinely did not occur to me during any of these episodes that perhaps removing Prozac was not unmasking latent anxiety symptoms that would continue indefinitely without Prozac keeping a lid on me. It would be another year before I would start to encounter information that helped me understand these are symptoms of withdrawal, not signs of being unable to function without an SSRI.

 

ADHD onset at 29 years old? Derealization? Did Prozac break my brain?

It may have started sooner, but I noticed my baseline anxiety increasing slowly but surely in early summer 2019 when I was 29 years old. By September, I had noticed other symptoms including difficulty focusing, difficulty organizing my thoughts, and derealization. That probably should have scared me health-wise, but it mostly upset me because it interfered with my performance at work and led to thoughts that I was developing ADHD despite knowing that is not the nature of ADHD. I had just started a new job as a school-based therapist which I thought was the best job possible for me (it did end up being pretty great, and I'm still in the job, I'm just not completely sure it's what I should be doing indefinitely) and desperately wanted to do well and impress my supervisors. I also had a part-time job in which I provided counseling in people's homes. I remember being stuck in traffic driving home from an appointment with a client one day and feeling like my attention was like a telescope and instead of magnifying visual details, it was like I was looking in the wrong end of the telescope, and my consciousness was zooming out further and further into my brain, and what surrounded me became further and further away. It was terrifying and made me feel like my brain was broken. I shared my symptoms with my therapist, who suggested my symptoms could be a sign that my medication was not working as it should and was creating these strange side effects. After experiencing a deeply irrational sadness spiral in the middle of the church at my friend's wedding, I decided I had had enough. Whatever exactly Prozac is intended to do, it was at best failing me and at worst causing me to experience bigger mental health challenges than I already have. I went back to my therapist, who was in the midst of studying functional medicine, and asked for her help trying to taper off Prozac. She agreed and helped me over the next few months get testing to identify some of the underlying issues that contributed to my difficulty with stress and anxiety. We identified that I have the MTHFR gene mutation (both mutation variants. Yahtzee!) as well as leaky gut, vitamin D deficiency, magnesium deficiency, and iron deficiency. Under her advice, I added supplements to address each of these issues and decreased Prozac first by 10 mg for 6 weeks then by another 10 mg in January 2020.

 

It felt successful. I felt pretty okay with some increased mood lability but nothing extreme. I'm really, really grateful to my therapist for being the person who validated my experiences, my concerns with Prozac, and actually helped me work on something I expressed I really wanted. Also for genuinely saving my life when I worked with her through my eating disorder recovery. Shoutout to her :)

 

COVID Strikes

I now suspect that the difficulties I experienced in terms of emotion and mood starting in spring 2020 were not solely due to the arrival of COVID in the US and the ensuing shut-down, but that perhaps there was also withdrawal/discontinuation syndrome. I experienced a lot of anxiety and sleep issues in the first 6 weeks of the pandemic, then a depression set in co-occurring with the anxiety. I was working from home which sucked because I moved back in with my parents so I was living and working in an 8' x 10' room, felt completely ineffective working virtually, and was worried for my clients and my job and my friends and my parents and the world. During that time I attempted to eliminate gluten from my diet as my therapist had noted that my MTHFR gene mutations made it likely that I was gluten intolerant or at least gluten sensitive. It didn't seem to improve my mood or anxiety as hoped, and bread was honestly one of the few things that made me feel pleasure during that time so I went back on gluten in June. Around that time I started seeing a psychiatrist certified in functional medicine. I shared with her that I felt that while my therapist was being super helpful and supportive, and I had gained some important knowledge about my body in the preceding 8 months, decreasing my medication was not going well and I needed the help of a psychiatrist. I shared my background with her and my deep belief that Prozac was not helping the situation. She screened me for depression and noting that I was depressed, advised that I increase back up to 60 mg to stabilize my mood while we wait out the pandemic (remember we thought it would END at some point????) or at least some of the lifestyle situations that I could change in the meantime. I agreed, and we did some extra bloodwork and testing which led to tweaking my supplements and confirmed that I am not gluten intolerant or sensitive. This was a relief! As Oprah would say, I love bread.

 

COVID Summer... and Fall... and Winter. Plus Wellbutrin

I should note that shortly before the pandemic shutdown, I also started working in private practice as a therapist under clinical supervision (I haven't finished my hours to be a fully licensed clinical social worker). It turned out that not only would I be learning to be a private practice therapist doing virtual sessions, but my supervisor was frankly... invalidating and condescending. With the emotional difficulties and stress I was experiencing, this was a bad combination and in my overachieving, perfectionist way, I tried to push through it by just doing everything MORE. This really did not help and I believe it was a big part of how overworked and overwhelmed I starting feeling in October-November 2020. I had felt decent mood-wise and stress-wise by the end of the summer and the start of the school year in September, but the anxiety and depression came back with a vengeance to the point that I was quite hopeless and having passive suicidal thoughts by mid-November. This was really disturbing as I've never had true suicidal thoughts in my life, not even at my lowest points. When I reported this to my psychiatrist, she decided we needed to try something different and prescribed Wellbutrin 100 mg to start. She advised first decreasing Prozac as Wellbutrin would slow down the metabolizing of the Prozac so the effects of both would be intensified. I went down to 40 mg Prozac and added Wellbutrin, and I felt EXCELLENT. Animated, hopeful, productive, focused, really present and mindful in my experiences. It felt so, so good to feel truly good for the first time in a long time. The EXCELLENT feeling tapered off but I really felt genuinely happy for the next few weeks.

 

Around the 2 week mark, I started having a hard time falling asleep. I was having racing thoughts and taking hours to fall asleep or waking up in the middle of the night with my heart and thoughts racing and finding it impossible to go back to sleep. As someone who has needed at the very minimum 8 hours of sleep in order to be functional for my whole adult life, this made work really hard to manage. I reached out to my psychiatrist who scheduled an immediate (expensive) phone call and advised decreasing Wellbutrin to 75 mg. Sleep improved a bit but depression kicked in. We reconvened and she decided to try going back to 100 mg Wellbutrin but lowering Prozac due to their interaction yielding more intense effects of each. I went down to 20 mg of Prozac and stabilized sleep-wise and with depression within about a week. I had spikes of anxiety (up to an 8 on a 1-10 scale, while I had rarely experienced above a 7 before summer 2019) that were at first several times per week then tapered off to once in a while, maybe 2-3 times per month. Psychiatrist advised using L-Theanine as needed when anxiety spiked which honestly works really well--within 10-15 minutes physical symptoms of anxiety completely subside. 

 

Let's Try This Again

I decided in the winter to put in my resignation notice for private practice as both that and my day job are pretty stressful, and I realized I need to prioritize time and energy for my self-care while I make a concerted effort to win my battle with depression, anxiety, and the antidepressants. Within a week of my other job ending, I started to feel like I can mentally and emotionally handle trying again to get off psychotropic meds. I'm seeing my therapist every other week, seeing an integrative nutritionist with eating disorder specialty, and just got the green light from my psychiatrist to start tapering. Her instructions for tapering are different from those on this website, but I'm going to try it her way to start as I'd rather have the support of a medical provider while I do this.

 

I'm planning to use this thread to chronicle this attempt. I'm historically terrible at building habits, so I hope using this site to support what might be the most important goal I've ever had will stick. I'll be recording my doses, symptoms, and other modalities I'm using to manage emotions, stress, and health during this transition here. I'm hopeful, and I'm scared, and I'm so very ready to move on with my life. Something that I didn't write about in the narrative but that really bothers me is I think that meds helped me feel 'better enough' to not address really important challenges I had in my life, specifically around relationships, because I felt okay enough emotionally to keep things moving while being slightly avoidant. One of my deepest fears is that I will not meet someone I fall in love with and will not get married and start a family. I really want that to happen in the near-ish future. I know that the work I have to do in those areas is beyond any medication issues, but my hope is that starting to make this change will help me get real and work hard on what I really want to live a meaningful life. I genuinely welcome and would be so grateful for any words of support you have, and I look forward to doing the same for others.

 

If you really read all this, wow. THANK YOU. 

 

Nothing but positive wishes and prayers for you all on your healing journey.

 

Cara

2007-2019 60 mg Prozac with two attempts to decrease, returned to 60 mg after intense anxiety spikes

November 2019-December 2019 Prozac 50 mg + supplements 

January 2020-June 2020 Prozac 40 mg + supplements

June 2020-December 2020 Prozac 60 mg + supplements

December 2020-January 2021 Prozac 40 mg + Wellbutrin 75 mg + supplements
January 2021-April 2021 Prozac 20 mg + Wellbutrin 100 mg + supplements (Daily: Magnesium glycinate, Omega-3's, Vitamin D, 5-HTP, Feritin, Probiotic; L-theanine PRN)

April 2021-? About to embark on tapering Prozac with psychiatrist's support

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  • Moderator
Gridley

Welcome to SA, FeinCara.  Thanks for completing your signature and congratulations on embarking on your taper.  Using the following link, could you include the supplements you're currently taking?

 

Account Settings – Create or Edit a signature.

 

As you know, we recommend tapering by no more than 10% of your current dose every four weeks.  Some can go faster; many have to go more slowly.

 

Why taper by 10% of my dosage?

 

It is, of course, your choice to taper according to your psychiatrist's schedule rather than our recommended taper.  What type of taper does your psychiatrists suggest?  .Please be aware that almost invariably psychiatrists taper their patients too fast, resulting in withdrawal symptoms that can be long-lasting.  I would also caution you against alternate day tapering, which is favored by many psychiatrists.  This is a terrible way to taper.  Alternate day tapering causes the amount of drug in your blood stream to go up and down, battering your nervous system and making withdrawal worse.

 

This link is specifically about tapering Prozac, including using liquid prescription Prozac, which many members find to be easier and more accurate.  

 

Tips for tapering off fluoxetine (Prozac)

 

Here is some information about withdrawal and the healing process.

 

 

 

When we take psychiatric 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.

 

 

 

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. 

 

 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

 

 

 

 

 

 

 

 

 

 

 

 

  

 

 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg 

Feb. 2021, begin 10%/4 week taper.  Current dose as of Sept 13: 9mg 

Taper is 52% complete.

 

Imipramine 75 mg daily since 1986.  Jan-Sept 2016 tapered to 16mg.  

Held until Aug 2021, tapered for 4 weeks to 14.4mg and holding.  

Taper is 80% complete.  

  

Supplements: omega-3, vitamins C, E and D3, magnesium glycinate, probiotic, zinc, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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FeinCara

Hi Gridley, thanks for your response. I've updated my signature.

 

My psychiatrist's recommendation is to do an alternating dose-- 20-20-10 every 3 days for 2 weeks, then 20-10 every other day for 2 weeks, then 10 daily for 2 weeks at which time I follow up with her. After reading the material you linked to, especially the posts on "Why taper by 10% of my dosage?" and the tips for tapering off fluoxetine, I'm pretty nervous for my psychiatrist's plan. I'm also nervous for the implications of choosing the 10% taper over her plan: whether my psychiatrist will support it or might threaten not to prescribe if I want to go against her recommendation, and the sheet amount of time the 10% taper will require. I can't help but think, but what if I don't need to give years of my life to this? What if it's just prolonging the whole process and I can tolerate the more adverse reactions better if it's going to be a shorter duration? I understand the logic behind recommending it for everyone, and the idea of taking years to do this also fills me with dread. Realizing that I'm stuck trying to make the least risky decision but that this is frankly going to suck for a long time is really hard to accept. I feel incredibly angry at the systems that led to me being on these drugs. I don't want to spend precious years going through this. I'm also honestly intimidated by the complexity of managing the taper itself. 

 

I have a lot to think about, and I definitely don't take it lightly. Thank you for the info, feedback, and support. I'll share an update soon about what I decide.

2007-2019 60 mg Prozac with two attempts to decrease, returned to 60 mg after intense anxiety spikes

November 2019-December 2019 Prozac 50 mg + supplements 

January 2020-June 2020 Prozac 40 mg + supplements

June 2020-December 2020 Prozac 60 mg + supplements

December 2020-January 2021 Prozac 40 mg + Wellbutrin 75 mg + supplements
January 2021-April 2021 Prozac 20 mg + Wellbutrin 100 mg + supplements (Daily: Magnesium glycinate, Omega-3's, Vitamin D, 5-HTP, Feritin, Probiotic; L-theanine PRN)

April 2021-? About to embark on tapering Prozac with psychiatrist's support

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  • Moderator
Gridley

@FeinCara

 

I understand and sympathize with your situation.  As the following link says, it's impossible to know in advance what your reaction will be to your psychiatrist's plan.  It is hard to wrap your head around the sheer time it's going to take.  It took me 3 years and 10 months to go off 20mg of Lexapro.  I did a slightly slower taper than the 10% taper and symptoms were tolerable throughout, though there were a few bad times.  I also understand the problem that your doctor is the source of your drug.  

 

NEVER SKIP DOSES TO TAPER 

 

Would it be possible to talk with your doctor about your concerns?  Or to print off and highlight portions of the links I sent?

 

Keep in mind that any M.D. can prescribe these drugs.

 

It does indeed suck, and I'm sorry you're going through this.


 

Gridley Introduction

 

Lexapro 20 mg since 2004.  Begin Brassmonkey Slide Taper Jan. 2017.   

End 2017 year 1 of taper at 9.25mg 

End 2018 year 2 of taper at 4.1mg

End 2019 year 3 of taper at 1.0mg  

Oct. 30, 2020  Jump to zero from 0.025mg.  Current dose: 0.000mg

3 year, 10 month taper is 100% complete.

 

Ativan 1 mg to 1.875mg 1986-2020, two CT's and reinstatements

Nov. 2020, 7-week Ativan-Valium crossover to 18.75mg 

Feb. 2021, begin 10%/4 week taper.  Current dose as of Sept 13: 9mg 

Taper is 52% complete.

 

Imipramine 75 mg daily since 1986.  Jan-Sept 2016 tapered to 16mg.  

Held until Aug 2021, tapered for 4 weeks to 14.4mg and holding.  

Taper is 80% complete.  

  

Supplements: omega-3, vitamins C, E and D3, magnesium glycinate, probiotic, zinc, melatonin .3mg


I am not a medical professional and this is not medical advice, but simply information based on my own experience, as well as other members who have survived these drugs.

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FeinCara

Hi Gridley,

 

Thanks for your response and your validation :)

 

I've been thinking hard about this and I'm going to go ahead and share some of the materials with highlights with my doctor. I'm also looking into some of the doctors listed on this site but people felt supported by in their withdrawal experience to have backup options.

 

I'm hoping to start my taper in the next few weeks, and I'm working on improving my diet in the meantime using Drew Ramsay's book Eat to Beat Depression and Anxiety as guidance. I'll share my thoughts on the book on SA to let other members know if it ends up being a good resource.

 

I've been rolling around some taper options in my head and I am trying to figure out a rough plan for managing the interaction between Prozac and Wellbutrin as I decrease. I read the links on "Tapering Off Cocktails" and saw that for Wellbutrin and Prozac, the recommendation is to do either Prozac first or "decrease one for a while, then the other for a while, then switch back." I haven't been able to find any posts that share any more specific thoughts on alternating your tapers or how to judge the duration between alternating. Do you know if there are any references to this that I might have missed.

 

Thanks again for your help!

Cara

2007-2019 60 mg Prozac with two attempts to decrease, returned to 60 mg after intense anxiety spikes

November 2019-December 2019 Prozac 50 mg + supplements 

January 2020-June 2020 Prozac 40 mg + supplements

June 2020-December 2020 Prozac 60 mg + supplements

December 2020-January 2021 Prozac 40 mg + Wellbutrin 75 mg + supplements
January 2021-April 2021 Prozac 20 mg + Wellbutrin 100 mg + supplements (Daily: Magnesium glycinate, Omega-3's, Vitamin D, 5-HTP, Feritin, Probiotic; L-theanine PRN)

April 2021-? About to embark on tapering Prozac with psychiatrist's support

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