Hernamoeg Fluoxetine tapering

[Hernamoeg]

Hello to you all, and thanks in advance for your reading.

 

I am new tho this website and also to the withdrawal world.

I am thinking to start the tapering of fluoxetine (I have been taking a doses of 60 mg daily for more than 15 years) although I am too scared to begin with it. 

My doctor has already diminished this doses to 40 mg, but unfortunately, does not know how to help me in the process.

I am also taking mirtazapine and two type of benzos (alprazolam and clonazepam).

I  would like to join a support group that is dealing with the tapering of the fluoxetine mentioned above.

 

Best wishes for all and thank you again!!!

[Altostrata]

Welcome, @Hernamoeg

 

How do you feel having reduced fluoxetine from 60mg to 40mg?

 

Why are you also taking mirtazapine, alprazolam, and clonazepam?

 

Why did you choose to go off fluoxetine? See Tips for tapering off fluoxetine (Prozac)

 

To help us out, follow these instructions Please put your drug and withdrawal history in your signature You may need to use a computer to do this.

[Hernamoeg]

Hello and thank you very much for your interest!

 

I will try to answer your questions as best I can.

 

-  As for my feelings and sensations related to the reduction of fluoxetine and the choosing to go off,  I have not been able to start the tapering of fluoxetine yet. It scares me too much. I take it since I were twenty-something and I am now 55, as I told you in the introductory post, I think.

On this matter my GP and my psychiatrist have decided for me and against my will (or to to be more accurate, they have not consulted it or asked about my fears and possible adverse effects of this tapering.  I have told them about the recommended 10% reduction to begin with but have not obtained any answer or explanation on their part).

 

- In relation with the mirtazapine taking, they have prescribed it for my anorexia nervosa. Apparentely, so they say,  both drugs, fluoxetine and mirtazapine, are some kind of antagonists (¿?) in the pursuing of increasing my appetite and weight, which is (for them and should be to me) the primary goal now in my attempt of recovery, since I am suffering from cachexia at the moment. I am very confused since it is true that I am far below my normal weight and in a risky health condition.

 

- And concerning the alprazolam and clonazepam, I suffer from general anxiety disorder and it does hurt a lot! But I am sure you know all about it.

 

Thanks again and always my best wishes for you and all of the benzobuddies. If I can be of any help to anyone I will do it with my best heart and will.

 

 

Edited August 21, 2021 by Hernamoeg

[Altostrata]

Did you not reduce your fluoxetine dose from 60mg to 40mg?

 

When did your problem with eating start?

 

What effect do you feel from mirtazapine?

[Hernamoeg]

 

 

Hello and thanks again for your quick email, Altostrata!

 

In response to your questions,

 

- No, I have not reduced the fluoxetine from 60 mg to 40 mg daily (yet!?). I am too afraid (I could not stand the reappearance of my fiercest enemy: bulimia nervosa, the nightly binge eating and purging (vomiting and laxatives). I still have still too vivid a memory of that hell and prefer dying of consumption. I am aware this statement sounds too drastic and dramatic, but I can't help feeling this way. And the proposed tapering does not follow your advice nor the Ashton's criteria (10% reduction).

 

- My problem with eating started when I was around fifteen. I was always-since birth- a petite, quite thin child and have never weighed more than 50 kg (and this only during my bulimia years), approximately 36 kg now (do not know exactly). I have never been able to get completely rid of this aversion to putting on weight and can't remember a period of my life without worrying about it since then. This condition and the depression have accompanied me all this time and prevented me from having a truly liberated feeling and the fulfilling of many of my projects and dreams. They have also frustrated or ruined many of my career prospects and relationships.  The depression and eating problem have been there some way or another throughout 40 years now!!!

 

- It is too soon to say, but I seem to sleep a little bit better (wake up only twice during the night, and fall asleep easier and earlier). I seem to look a bit calmer, too (so they say) but, for example, my restless tremor of hands and legs has not subsided and I do not really feel that "relaxed".

I am very vigilant of my food intake in fact, as mirtazapine is supposed to increase my appetite. It is true that when I look at myself in the mirror I see a skeleton lately and I am very ashamed of my body. But the alternative to putting on weight as soon as I can (my doctors keep repeating it) is checking in in a psychiatrist hospital unit where I would be surveilled at all times, my movements and activities -even my phone calls- restricted. I would - could- not allow this intrusion in my life, not at 55 as I am now. 

 

Best wishes,

 

(I have followed your suggestion and written my signature. I am very sorry I can't be more precise. My memory is failing me as my cognition functions -attention and concentration along the capacity to remember have deteriorated severely since the reappearance of my anorexia-. It has been a year now and I have not been able to work since then, I even lost my job six months ago now).

[Hernamoeg]

Hi to everyone, dear fighters and survivors of antidepressants, dear fellow buddies,

 

I am feeling terrible, my anxiety and fear have reached a new peak and I find myself crying and inconsolable all day long. Anguish, irritability, loneliness, the incomprehension and passiveness on the part of my 20 year companion are not the best friends I could get at this precise moment!

 

It has barely a month and a half been since I started mirtazapine and I am already putting on weight as my appetite seems to be increasing hourly, daily. I can't stand it. Not without this feeling of guilt, not without this horrible fear coming from my anorexic syndrome. I feel the need to lose this weight rapidly no matter the way, no matter what I would have to endure and the prospects ahead (very bad ones, indeed).

 

My body is changing. Anybody who has suffered from anorexia knows how it feels. The loss of control, the spiteful body image. Doctors, family and friends want me, urge me to put on weight. As I said, it is my very life which is at risk, but I can't come to terms with this new body I see in the mirror.  I seem to notice - I do not need any proof- every new gram that I am putting on without even weighing myself - and I am panicking- .

I am scared of not being able to stop this developing process (increased appetite, eating more, putting on weight, I can feel it, I can see it in my face, legs, waist ...).

Does it ever stop or will I go on like this if I keep on taking this drug?

Too quick a change. I do not say I do not need it but I can't help feeling this guilt, this terrible despair and I am completely alone in this process.

I hate this new self that is emerging! I´m desperate as I feel the need to quit mirtazapine before it is too late. I am suffering terribly as anorexia still reigns over all my emotions, feelings and thoughts. She is the queen, the great mediator, the great interpreter and leiv motiv of my whole life. I had thought it would be easier. How wrong I was!

 

Forget about the sweat (I always wake up sweating profusely, which I never did) and the severe constipation I am suffering from since I started (a month ago) taking the drug. Forget even the better sleep I am getting from the pill.

It is the gaining of weight what is putting me off, what seems intolerable and the source of my acute emotional pain.

 

I apologize beforehand, this might not be the place to write about this condition. Is anyone there to offer any support, any suggestion, any advice, please? Will I experience any discontinuation feeling after only one month approximately of starting with the pill?

At this very moment I feel if there is any withdrawal effect (I suppose it is too soon to notice !?) it would be preferable to this fear of putting on weight so rapidly. I am ashamed of my body weight gain (and also of the skeleton that lurks behind, the one I was just two weeks ago). I can't find a way out of this vicious circle, it resembles an inescapable catch-22).

 

Thank you and sorry again!

Best wishes

Bless you all!

[Hernamoeg]

Hi to all  buddy survivors. You are a great help, a model and also a valuable source of consolation and companionship for me! I I can't thank you enough for being there!

 

The tapering I mentioned in the title (from 60 mg of fluoxetine to 40 mg daily) was prescribed by the doctors treating my depression without any consultation about the rate of the tapering and without been given any information on the withdrawal symptoms. The reason they alluded for this rapid and sudden reduction is the introduction of a new antidepressant (mirtazapine). I do not need to say they have not heard about the Ashton Manual nor about the risks of this unexpected and unwanted reduction.

 

All in all, it was not my decision and I found myself forced to accept it. They say round here that "hell is full of good intentions". I do not want to find myself crossing that river with Dante. And the mirtazapine has onset a quick weight gain I find myself incapable of dealing with emotionally (nor does my anorexic condition). It has been only a month and a half since I started taking this new drug and I find myself crying all the time, hiding from the world, despising myself and my body, feeling so scared, suffering such psychological pain that I had to stop it (from one day to the next!, yes) and I find myself in a hurry to lose the weight I have gained as quick as I can, no matter the consequences).

 

As I wrote in a previous post, I have not been able to start yet with the fluoxetine tapering as I find it too brusque a reduction and I am also too frightened of the withdrawal symptoms. Is there any other way to do it? I am supposed to take two capsules of fluoxetine in the morning now instead of the three I am used to since I was quite young.

 

Thanks again and my best wishes to you all!

[Go2zero]

Hi Hernamoeg,

 

I merged both new threads you opened to this thread. There is only one thread allowed per member. It is important to have all your information together. So please only post here and do not open new threads. Thank you!

[Hernamoeg]

I am so sorry, Go2Zero!

Thank you very much for your correction. I am finding it a bit difficult to getting used to the site. How  could I -or just anybody- read all the posts and replies I write so that they (with luck) could follow my story and perhaps offer any kind of help or support? I will correspond, of course, I appreciate so much every little bit of advice, encouragement, recommendation. You are a great lot.

 

Best wishes! And thank you!

 

 

[Go2zero]

Hi Hernamoeg,

 

Welcome again to this site. This is your peronal thread. You can post all your questions, updates, remarks and so on in THIS thread. All members can read this and react on it. The moderators check all posts, so one of them will answer if appropriate. 

 

Sometimes it may happen that we miss a post. In such a case you can tag a moderator (after a while). Here is an example how I tag you:  @Hernamoeg 

 

You can react to other members as well. You can find all threads of yourself and other members in the forum:   "introductions and updates"

[Hernamoeg]

I feel the need to write a new post and I am doing it here not to interfere with any other forum or thread although still doubting if this is the right place to do it. Do not want to commit the same mistake again!

 

I have read it is advisable to start tapering down one of the two benzos I take before doing the same thing with fluoxetine. Is this the correct path?

 

If so, tapering alprazolam is proving to be a nightmare. Yesterday was my worst day in weeks, crying and panicking, trembling and in desperate anguish all they long after quitting my morning dose of the damned drug.

As stated I am currently taking three mg (morning-afternoon-evening -to get some -very bad-sleep-).

Could not do anything, could not sit or stand still, could not perform any activity, could not take care of my mother as I should, could not even breath, tried everything, exercise, walking, browsing through the Internet, music, relaxation, deep breathing... A distorted face, acute stomach pain, almost vomit what I managed to eat, swollen eyes from the crying in desperation, the only result of my poor attempts.

Had to do what I did not want and is against the manual and recommendations, I did not only reinstate the doses, I twice the one prescribed at the end, the anguish overwhelming,  I felt and feel a failure, so frustrated, could not turn to anyone for help, could not even hide my anxiety although I tried, too evident, too patent. I woke up four times yesterday night in spite of the alprazolam renewed and increased dose. Got up finally at four in the morning. I am so afraid! Please, help!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Go2zero]

2 hours ago, Hernamoeg said:

I feel the need to write a new post and I am doing it here not to interfere with any other forum or thread although still doubting if this is the right place to do it. Do not want to commit the same mistake again!

 

Yes, this is the right and ONLY place to ask these questions. So will be all your information and posts in 1 place.

 

2 hours ago, Hernamoeg said:

I have read it is advisable to start tapering down one of the two benzos I take before doing the same thing with fluoxetine. Is this the correct path?

It is always best to taper only 1 med at a time. When WD symptoms occur it is much easier to find out what is causing it when tapering only 1 drug at a time. Furthermore many drugs influence each other. So tapering more than 1 drug at a time may cause more WD symptoms.

 

2 hours ago, Hernamoeg said:

If so, tapering alprazolam is proving to be a nightmare. Yesterday was my worst day in weeks, crying and panicking, trembling and in desperate anguish all they long after quitting my morning dose of the damned drug.

You write that you are taking 3 mg now. How much have you tapered in mg?  We advise to taper not more than 10% of the last taken dosage every 4-6 weeks.

 

https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/

 

https://www.survivingantidepressants.org/topic/22958-never-skip-doses-to-taper/

 

 

[Shep]

On 8/22/2021 at 1:41 AM, Hernamoeg said:

- My problem with eating started when I was around fifteen. I was always-since birth- a petite, quite thin child and have never weighed more than 50 kg (and this only during my bulimia years), approximately 36 kg now (do not know exactly). I have never been able to get completely rid of this aversion to putting on weight and can't remember a period of my life without worrying about it since then.

 

Thank you for telling us your story. Since you're 55 now and started psychiatric drugs in 1979, you would have been 13 at the time, which means you were already on drugs that affect appetite when you developed eating problems. These drugs are notorious for causing all sorts of problems with food cravings, and doctors blame patients, not the drugs. Hopefully coming off the drugs will take away one of the variables that can cause eating problems and you'll feel better and able to handle the other variables. Early childhood trauma can play a large role in so many of these types of problems. Please be kind to yourself and find ways of self-soothing and distracting to get you through. Best to deal with this one variable at a time, one step at a time so it's not so overwhelming. 

 

On 8/22/2021 at 1:41 AM, Hernamoeg said:

My memory is failing me as my cognition functions -attention and concentration along the capacity to remember have deteriorated severely since the reappearance of my anorexia-. It has been a year now and I have not been able to work since then, I even lost my job six months ago now).

 

Do you remember if you had any drug changes around the time of the reappearance of your anorexia? 

 

5 hours ago, Hernamoeg said:

I have read it is advisable to start tapering down one of the two benzos I take before doing the same thing with fluoxetine. Is this the correct path?

 

If so, tapering alprazolam is proving to be a nightmare. Yesterday was my worst day in weeks, crying and panicking, trembling and in desperate anguish all they long after quitting my morning dose of the damned drug.

 

When was your last alprazolam reduction? Please stop tapering for now. Let's set up a game plan for your entire drug cocktail first. You may be getting interdose withdrawal from not having a morning dose of alprazolam, so tweaking when you take each of your drugs may help. But let's get more information before making any changes. 

 

Please list the times of day you are taking each of your psychiatric drugs and the dose. Also list any other types of medications, including over-the-counter medications, and any supplements. 

 

 

[Hernamoeg]

Thank you very much for your quick answers and advice. Deeply grateful to both of you: Shep and Go2zero.

 

In response to your question, Go2zero, I did not taper the 10% of alprazolam recommended, I just skip the morning dose (three doses a day, 1 mg each; morning-afternoon-evening). Great error on my part. I should have cut the pill in half at the least but went bold and therefore, now I can see, the terrible consequences. Never again. Too painful a withdrawal (or whatever name this experience may be called) to bare.

But yes, I understand I should taper only one of the drugs I am taking. Below I will list the ones I am on at the moment.

 

And about your comments, dear Shep, I can't remember having ever reduced the alprazolam doses. In fact, I did increase them from one to three mg. When? It was long ago, I am very bad at remembering dates and find it impossible what all of you seem to recall so easily, stating the exact date and dose and the beginning and ending of each and every drug you took or take!!!!!!! I simply can't!.)

 

As for my anorexia, I had never thought about the possible  influence of the drugs I started taking when I was barely a child (had to quit school and lost a year of tuition -one of many subsequent ones of my life). It brings on a new light on the possible causes of its onset. Thank you very much for your insight.

 

No, there were not any medication changes around the time of my renewed anorexia episode. I started losing  interest in food and weight, I restricted my diet, I skipped meals and ate when nobody was looking...It was my doctor who made me realize what was happening again!

But it is true there were two important changes in my life during that period: the starting of a new job and with it a very stressful period of my life. The other one was the accident (two falls, broken hip) and illness (stroke) of my mum and my assuming the role of the only person to take care of her. Also quite an stressful event.

 

And here is the list of medicines I'm on right now:

 

- Morning:

•   1 mg alprazolam
•   2 mg clonazepam
•   60 mg fluoxetine

- Afternoon:

• 1 mg alprazolam
• 2 mg clonazepam

- Evening:

• 1 mg alprazolam
• 2 mg clonazepam
• 15 mg mirtazapine

 

Thank you again and again!!!!

[Altostrata]

14 hours ago, Hernamoeg said:

I have read it is advisable to start tapering down one of the two benzos I take before doing the same thing with fluoxetine. Is this the correct path?

 

 

We would never advise this! How have you changed your benzo doses? Have you deliberately made yourself sick by arbitrarily reducing the benzos?

 

We need to know what times o'clock that you take each of your drugs, with their dosages. Taking benzos inconsistently can cause bad symptoms. Your memory and cognition problems may well be due to the benzos. It's possible some of your other symptoms also are due to the benzos. But benzo changes need to be made carefully.

 

On 8/23/2021 at 9:51 PM, Hernamoeg said:

It has barely a month and a half been since I started mirtazapine and I am already putting on weight as my appetite seems to be increasing hourly, daily. I can't stand it. Not without this feeling of guilt, not without this horrible fear coming from my anorexic syndrome. I feel the need to lose this weight rapidly no matter the way, no matter what I would have to endure and the prospects ahead (very bad ones, indeed).

 

I do not understand what's going on here. You originally said you were dangerously underweight. Gaining weight is a very common result from taking mirtazapine, yet now you are feeling guilty about it and want to go off your drugs. You need to speak to your doctors and therapist about this and your unusual fears of dying of consumption. We do not treat anorexia nervosa, bulimia, guilt, or depression here.

 

What we do here is help people taper off drugs if they choose. 60mg Prozac is a high dose, with mirtazapine added and the benzodiazepines you're taking all day long, you are taking a lot of psychiatric drugs.

 

However, we will not talk you into reducing Prozac or the benzos. It sounds like you're psychologically dependent on Prozac (and maybe the benzos, too), with all kinds of reasons why you don't want to go off. If you don't want to go off, you'll have to discuss this with your doctor.

 

If you want to reduce the Prozac more slowly, you'll have to convince your doctors to help you or otherwise find a way to reduce your dose on your own. We have no way to convince your doctors to do anything.

 

It sounds like you are not ready to voluntarily taper off anything. If you want help with tapering information, please let us know.

 

 

[Shep]

22 hours ago, Hernamoeg said:

Morning:

•   1 mg alprazolam
•   2 mg clonazepam
•   60 mg fluoxetine

- Afternoon:

• 1 mg alprazolam
• 2 mg clonazepam

- Evening:

• 1 mg alprazolam
• 2 mg clonazepam
• 15 mg mirtazapine

 

Please read at least the first post in this thread, as it explains the concepts of "brakes and accelerators" and how to know which drug to taper first:

 

Taking multiple psych drugs? Which drug to taper first?

 

It will help us to know your symptoms within the context of when you take your drugs. After you've posted a few days of daily notes, we can help you set up a game plan for coming off. Please also include:

• in addition to your psychiatric drugs, any other drug, over-the-counter medication, and supplements you are taking, including the dose.
• the number of hours your sleep each night

Here is an explanation and example of what we need: 

 

On 9/27/2016 at 2:49 PM, Altostrata said:

In the course of discussion in your Introductions forum topic, you may be asked to keep notes on paper of your daily symptom pattern, including when you take your drugs, their dosages, and any symptoms. We ask this because there may be something we can do to reduce the symptoms.

 

What we need to see for every single day over several days is what symptoms you get before and after you take your drugs. If you're not taking any drugs and have withdrawal symptoms, we still need to see your symptom pattern throughout the day:

 

The time of day, dosage, and severity of symptoms are essential information. Include

 

- Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:
 

Example:

DATE:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

 

[Hernamoeg]

Responding Altostrata,

Sorry, sorry, sorry! That’s all I can say! Please forgive me, please, do not let me by myself.

I have committed all the possible mistakes, I am confused, lost, scared,  new to tapering and feeling very low, lower now; I could not stop the tears after reading you. Do not, please, leave me alone, I beg you!

About the fluoxetine tapering I quote from the Ashton Manual: “…Antidepressant drugs should also be tapered slowly since they too can cause a withdrawal reaction (euphemistically labelled "antidepressant discontinuation reaction" by psychiatrists). If you are taking an antidepressant drug as well as a benzodiazepine it is best to complete the benzodiazepine withdrawal before starting to taper the antidepressant…”.

I  thought this to be the right procedure.

On my skipping a Xanax dose, no, nothing deliberate here, I really thought I could manage, how stupid of me! I did not expect that horrible pain and the suffering I had to endure all day long from the skipping of my morning dose of the alprazolam. I thought I could do it, and, yes, I was completely wrong!

As for my current doses, I will copy the ones I posted on my thread:

Morning:

• ·         1mg alprazolam.

• ·         2 mg clonazepam

• ·         60 mg fluoxetine

Afternoon:

• ·         1mg alprazolam.

• ·         2 mg clonazepam

Evening:

• ·         1mg alprazolam.

• ·         2 mg clonazepam

• ·         15 mg mirtazapine

• ·         (40 mg omeprazole -forgot this time I wrote this down; I am not really sure it is relevant information.)

As for my anorexia:  Sorry again, I just felt the need to explain the reason of the introduction of the mirtazapine. I am not looking for help for my anorexia, I know this is not the right place. I just wanted you to have the whole picture of my situation, context, and condition. Anorexia nervosa is very complex to manage. It is not just me; you know you are putting yourself on risk and at the same time you find it almost impossible to tolerate the weight gain. I will not dwell on this. I just would like you to know that it is very dangerous and complicated to cure a condition. It has proven to be one of the most lethal and most resistant to any kind of alleviation of all the mental illnesses (I do not like the term). Unfortunately, it is also one of the most difficult for people to understand and accept. 

And just to finish, please, do help me to find the way to reduce my fluoxetine and benzos intake. I even bought the precision scale some of the fellow survivors recommend and YES! I need and want to gradually taper off them, I certainly do, please help me do it the right way, please!!!!!!! My doctors do not offer any help. There is not help around. Do not know the way, can't find the way out! Yes, I do need your help, I badly need your help!

Thank you very much and, as always, my best wishes!

In response to Shep, thank you so much for your advice and help. I will write down the diary you suggest each and every day. You come as a blessing at my rescue. As for my sleep pattern, I mostly sleep just four hours per night, nothing during the day.

[Altostrata]

We need to know your actual drug schedule, with times o'clock for each dose and the amount of each dose. "Morning, afternoon, and evening" is not sufficient.

 

If you are not taking your drugs at the same times each day, you need to do this or we cannot even begin to understand your symptom pattern.