Leland: Hello! Panic Attacks and Prozac taper gone awry

[Leland]

Hey, my name's Leland. 

 

Last May, 2020, I started having Panic Attacks due to life stress, COVID fears, and unhealthy lifestyle habits. After a week of bad anxiety, DP/DR, I was prescribed 10 MG Prozac. The first week was managable, so I increased to 20 MG. Did all kinds of research on the drug to assuage my fears, but my side effects were pretty minimal. Panic attacks continued once a week or so, but began to slowly weaken. After one bad day in late July 2020, my doctor and I increased my dose to 30 MG. After a few weeks of this I felt pretty calm again. For the next few months, my anxiety was hit or miss, but I stopped having panic attacks, and I learned to live with the anxiety that would creep up, so largely that went away as well. I felt pretty detached and foggy with the medicine, but very calm, so it was worth it. 

 

This spring, I had gone 7 or so months without a panic attack, so I decided to taper off. My doctor recommended dropping 10 MG every 2-4 weeks, so I chose 4 weeks. Went from 30 to 20, then to 10 on May 8. On June 1 I took my last 10 MG pill. Immediately I felt withdrawal symptoms. Brain zaps, fatigue, body and head aches, and a feeling like I was underwater. Did some research on my own and found this site! Decided after 5 week of symptoms to talk to my doctor about reinstating and tapering again, from 5 MG. Before I received the liquid medicine, I went on a vacation with family and drank, a lot. Came back to California having new and severe anxiety attacks (not panic attacks, since I gained the skills to stop them from becoming panic). New feelings of DP/DR came from the anxiety. Took my first reinstated dose of 3 MG on July 30. The next week was full of dizziness, anxiety, DP/DR, aches. Came to an understanding with my Psychiatrist that binge drinking while having Withdrawal Symptoms led to my anxiety outburst. Increased to 5 MG liquid on August 7. Since then, my anxiety has lessened some, but I still have daily feelings of feeling underwater, occasional anxiety outbursts, and fatigue. Have cut my drinking by 85%, now only 2 beers per week. Sleeping well, eating well and exercising, walking to lessen my anxiety. 

 

Ultimately, I'm staying on 5 MG liquid for several more weeks before doing the 10% taper. Withdrawal symptoms *seem* better, definitely no more brain zaps. But it's hard to tell with all my new anxiety symptoms. 

 

I want to calm my anxiety holistically, instead of increasing my prozac back up to 10 or 20 MGs. The medicine really worked for me, but I want to be able to remove it from my life eventually as well. Will continue to take care of myself everyday, and hope both the medicine and anxiety symptoms even themselves out over time. 

 

Excited to have found this site!

[getofflex]

Hello, and welcome to SA.  We are a peer owned and run forum of people who have been or are getting off of psychiatric drugs.  Unfortunately, few doctors know how to properly taper their patients off psych drugs.  Your doctor tapered you off way too fast.  We suggest a 10% per month taper.  

 

Can you please give us specific information about your drug history for all drugs you are on and have been on, especially for the past 18-24 months?  It would be especially helpful to have the details of your drugs in a concise list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Please read the link below for instructions.  This will allow us to give you the best guidance.  

 

How to List Drug History in Signature

 

Here is some information about how these drugs actually work.  This explains why it is important to taper off very slowly and cautiously.

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

 Video on Recovery from Psych Drugs

 

What is Happening in Your Brain

 

What is Withdrawal Syndrome?

 

 

Also, as we are recovering, we suggest keeping things slow, simple, and stable. This is extremely important. 

 

Keep it Simple, Slow, and Stable

 

 

When we recover, there may be times of feeling OK mixed in with times of feeling bad.  This is called windows and waves.

 

Windows and Waves Pattern of Stabilization

 

Here are some techniques to cope with symptoms, especially the anxiety: 

 

Acknowledge, Accept, Float

 

Change the Channel

 

Audio:  First Aid for Panic (4 minutes)
 

CBT Course:  An Introductory Self-Help Course in Cognitive Behaviour Therapy
 

Audio:  How to Recover from Anxiety - Dr Claire Weekes
 

Anxiety Stuff - all kinds of stuff about anxiety attacks and things that help ...

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

 

Omega 3 Fish Oil

 

22 hours ago, Leland said:

Ultimately, I'm staying on 5 MG liquid for several more weeks before doing the 10% taper. Withdrawal symptoms *seem* better, definitely no more brain zaps

 

My suggestion would be to stay on 5 mg for at least several months.  It takes a long time for your nervous system to stabilize after a too fast taper.  In the long run, you will actually recover fast this way than rushing the taper.  

 

22 hours ago, Leland said:

I want to calm my anxiety holistically, instead of increasing my prozac back up to 10 or 20 MGs

 

This is great.  There are many ways to cope with anxiety besides a chemical.  Anyway the drug mostly serves to just cover up the symptoms, and doesn't get a the root cause of the anxiety.  

 

I've given you quite a bit of information here.  I hope you find it helpful and useful - I think you will.  Hang in there, and be patient - healing from this takes time and patience.  Healing will happen, as long as you take proper care of yourself. 

[getofflex]

I wanted to add that drinking any alcohol during psych med withdrawal has a likelihood of making your symptoms worse.  We suggest you avoid all alcohol.  

 

22 hours ago, Leland said:

Increased to 5 MG liquid on August 7. Since then, my anxiety has lessened some, but I still have daily feelings of feeling underwater, occasional anxiety outbursts, and fatigue

It takes a bare minimum of a week to feel the effects of a reinstatement, and can take a couple of months for the reinstatement to fully settle.  Hopefully, things will continue to improve.  It may not totally resolve all the WD, but it should reduce the symptom severity.  

[Leland]

Thanks for the reply getofflex. Hopefully my new signature shows up!

 

I'm going to continue on the 5 mg, unfortunately my pharmacy has to 2-week order liquid prozac everytime I request it, so my next batch won't come until I'm out of my current amount. So I either have to skip a few days, or increase to 10, and I'd rather not increase my dosage. I'm probably in for a few more days of withdrawal before I get my next batch of liquid, but I learned my lesson. Order earlier next time. 

[Altostrata]

5 hours ago, Leland said:

So I either have to skip a few days, or increase to 10, and I'd rather not increase my dosage. I'm probably in for a few more days of withdrawal before I get my next batch of liquid, but I learned my lesson.

 

This is not a good plan, @Leland We do not recommend skipping doses or taking withdrawal symptoms lightly, they could get a lot worse and more permanent than you can imagine. Read this for other options Tips for tapering off fluoxetine (Prozac)

 

Do you think any other pharmacies in the San Francisco Bay Area might have liquid fluoxetine on hand?

[Leland]

Possibly, but I'm down to two days of medicine left and I'm very busy this weekend. I don't see what choice I have. 

[Leland]

What i do have is some remaining 10 mg pills. Do you have recommendations for dissolving those to carry me through the next week? 

[getofflex]

this link will tell you how you can do that. 
 

https://www.survivingantidepressants.org/topic/759-tips-for-tapering-off-prozac-fluoxetine/page/3/?tab=comments#comment-535813

 

[Leland]

Thanks for that link. My psychiatrist was able to find me 20 mg/5 ml liquid right away, so I'm able to take that for the next few days until my 5 mg/5 ml comes in. Crisis averted this time. I'll check in in a few weeks with an update on symptoms. 

[getofflex]

That’s wonderful.  I’m glad to hear that. It sounds like a good plan. Be sure you take 1.25 ml of the liquid for your 5 mg dose.  

[Heath]

@Leland I ran in to that with my liquid prescription. My pharmacy couldn’t get it and I got comfortable with them always having it and hadn’t been stockpiling so I almost got in a pickle. 
 

Most pharmacies in US will fill a monthly script at 3 weeks. Some big chain pharmacies will start calling you at 2 weeks to fill it because they want you business. 

 

If you can call 2 weeks in advance and explain to your pharmacy that you need that medicine on your script date and can’t wait 2 weeks they should order for it to be there on time. That’s what I had to do with my pharmacy 👍

 

[Leland]

Okay so an update on my symptoms. 

 

I am having waves of severe anxiety daily at this point. Symptoms are light-headedness, dizziness, depersonalization, stomach aches, headaches, and a feeling of tension. Some days the waves last for hours and are debilitating. At no point are they becoming Panic Attacks, because I don't react to any symptom with fear, but I am definitely frustrated. It's fair to say the anxiety began as a symptom of the withdrawal, but it's more difficult to treat this anxiety when I don't feel calm or rested in between anxiety attacks like I did when I was taking the medicine. My nervous system is damaged, and I didn't do it any favors by binge drinking back in July. Does anyone have any suggestions? Happy to provide more clarity on my symptoms. 

[getofflex]

I'm sorry to hear that you are having the waves of intense anxiety throughout the day.  Have you tried the magnesium and/or the omega 3 fish oil?  Check the links in my first post for info on how to introduce these.  Magnesium is calming for many of us.  I can certainly understand why you would be frustrated.  Our nervous systems are incredibly complex, and they are intricately tied to every other system in our body, so it takes a very long time to heal from this.  

 

Are you taking your 5 mg liquid prozac every day at the same time?  Are you completely avoiding alcohol and other mind altering substances?  These things are important. If you are doing these things, then all you can do is take care of yourself the best you can every day.  Have you looked at the link for non drug coping techniques?  

 

Are you having any other symptoms besides the anxiety? How is your sleep and your eating?  Are you able to function in your day to day life? 

 

It takes at least several weeks, and up to a couple of months for a reinstatement to completely settle in your system. It is highly frustrating, but often the only thing we can do is wait for our system to heal, which requires massive amounts of patience.  You might try, if you are physically able, to take a 30 minute walk each day.  I believe that this helps me a lot with anxiety.  Many people have good luck with medication.  I use prayer and my faith in God to give me peace.  Here is a link on meditation.  

 

Meditation for Stressed Out Nervous System

 

Hang in there, and keep us posted on how you are doing.  I know this is really hard, and its very frustrating that it takes so long to get better.  

[Leland]

Hey thanks for the reply, I appreciate the support. 

 

Yes I'm taking my medicine everyday at 4 pm, I am avoiding drinking and do not take other drugs. I walk and meditate everyday, as well as other therapeutic activities like reading, exercise, playing the piano, doing a puzzle, etc. Some days like today I feel calmer and more in control, and I am very grateful for these moments. I have no other symptoms other than generic withdrawal symptoms like brain fog and fatigue. I am sleeping and eating quite well lately, which has been helping. 

 

I will continue to be patient and forgiving to myself in the meantime, and I will try the magnesium/fish oil! 

[getofflex]

This is great Leland.  It sounds like you are doing everything right.  I'm glad you are having a window today!  Let us know how the magnesium and fish oil go.  

[Leland]

Hello! Things were getting better until Thanksgiving, when I had a panic attack. Since then my anxiety has been bad and very slow to settle. I had anxiety attacks every day for 2 weeks after, and still occasional ones through New Years. 

 

I had previously decided to start tapering from 5 mg at the end of December, so I did that. Anxiety didn't get worse, but I felt foggier and a stiffer headache that could have been withdrawal. January was a tough month of stress, loneliness, having covid. 

 

I had a couple beers at a friend's birthday, and that set off my anxiety again. Last 10 days I've had anxiety attacks everyday. Decided to hold at 4.5 mg in February and stop drinking altogether. I need stability in my life if I am going to pull through this. 

 

Should I continue to hold at 4.5 in March? Or would continuing to taper 10% strengthen my central nervous system and allow my anxiety to finally heal. Thanks for your support!

[SonSetFree]

Hi Leland sorry to hear you are having trouble.  When exactly did you have Covid?  Did you notice the symptoms got worse after?   For me I got Covid around Christmas Day and had a huge wave come 5 days in, followed by a bigger wave about 3-4 weeks later.  I am still in that wave. 

[Leland]

I had it for about 7 days starting 1/17. It was a very mild case, i just had a lot of anxiety about it, since COVID is a scary thing. Still trying to recover from that anxious week. Don't think my current symptoms are sickness related, but it would make sense for them to be. Hope you recover soon!

[Patient2022]

Hi, just stopping by to say all the best with the taper. It’s good to see others on a similar journey. 

[Leland]

Hello Hello

 

So on March 2, I tapered 10% down to 4.05 MG Prozac. I've been having mostly brain fog, headaches, and afternoon anxiety (not attacks) as symptoms. I had *one* drink last Friday, and made my weekend feel very tense and uncomfortable, so I have finally decided to cut out all alcohol. For at least the rest of 2022, and potentially beyond that. For a long time, I've read here to avoid all alcohol, but I always figured doing it in moderation was fine. I love beer and wine! So I drank a bit over the past few months. During months with dosage hold it was mostly fine, but my anxiety never got better, and I would sometimes slip from 1 to 3 drinks, which always made me feel terrible. So now, I'm done. 

 

My follow up to alcohol is coffee. I LOVE coffee and would really prefer to not cut it out. I have been drinking 1 cup every 4 days for a little while, and most days it's fine. Just some light headedness and energy, but it hasn't made my anxiety any worse, and I don't notice any increase in WD symptoms unless I drink coffee on back to back days, or 1 every 2 days. I'll be careful not to do that. 

 

Ultimately my question is, is it safe to drink 1 coffee every 4 days while I taper? I've also thought about waiting the first two weeks of a tapering month, then having a cup or two near the end of the month once my body has adjusted to the new dose. I'm willing to be patient and at this point, do whatever it takes to heal properly. 

 

Thank you all for your support! Very grateful for this site. 

[Heath]

@Leland I am afraid there is not a truthful answer to your question . For one we are all different and second there is not much logic reasoning in what happens when we taper.  

You sound like me with the caffeine and nicotine. I will say this truth for me is when there is instability in cns then it’s a big NO for any stimulant . 
 

And we could say logically when we are stable it would be ok. But that would be a huge risk in life as we know it for just something we don’t really need. I am saying this to myself also👍
 

I would put that caffeine and alcohol in same boat as life stresses or any other drug. During tapering process we are very sensitive. 

I am not condemning at all , I am right there with you! It’s tough ! 

I read through your posts. Looks like you have been doing pretty good, that’s great !

[Leland]

Hello again, 

 

Am curious if my liquid solution of Prozac can overheat? I left it in a hot car trunk this afternoon while at Yosemite. Came back, and the color was clearer instead of its usual milky. Put it in the fridge for a bit until the color came back.

 

Asking because I took my normal dose and immediately felt bad symptoms like shaking, tension. Wondering if the solution got screwed up somehow? Feels like symptoms of taking too high a dose, but I took my normal dose. 

[brassmonkey]

The very high temperatures of a car trunk can destroy any of the drugs we work with in a matter of hours. It will render them very unstable and unpredictable. It is not a good idea to use them after such exposure.

[Leland]

Thanks. I don't really have a choice until I can get a refill in a few days, but that's good to know for the future. 

[Leland]

Hello. I went to the pharmacy and picked up fresh Prozac, and will not be making the mistake of leaving it in a hot car again. 

 

I have a question about stabilization. I've been on 4.05 since the beginning of March. I had lots of withdrawal symptoms in March, but fewer in April and even fewer in May. In fact the last week I felt pretty good. I am still having occasional waves, about a week of mild/moderate symptoms of dissociation, tension, etc. My question is, is it possible to have windows and waves after you reach stabilization on a dose? Or should they be gone? My assumption was that stabilization means your day to day changes are very minor (which is me now), but that you can still have overarching cycles of feeling good and bad, until you ultimately heal. 

 

Hopefully this question makes sense, please let me know if you need clarification. 

[ChessieCat]

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

[Leland]

Thanks ChessieCat. Just a heads up that the first link isn't opening for me. 

 

I've read Brass Monkey's checklist many times, it's incredibly helpful. I have been having minor symptoms, but feel mostly the same each day, so it's fair to say I've reached stability. Question answered!

[ChessieCat]

1 hour ago, Leland said:

Just a heads up that the first link isn't opening for me. 

 

Thanks.  Another member had the same issue.  It might be the device you are using or the settings.  I am using a desk top computer and it opens in the internet browser; previously it used to ask me to download it.

 

You can find it here but you might have to save it and then view the PDF.

 

dr-joseph-glenmullens-withdrawal-symptom-checklist

[Leland]

Excellent, downloading it worked. Thanks again!

[Leland]

Good morning, 

 

As of today, I've been holding at 4.05 mg since March 2. I've really stabilized nicely, or at least something close to it. I feel less sensitive to food and stress. My anxiety is pretty low. Just feeling some dissociation and anhedonia, but mostly in the background. 

 

So my question is, if I were to hold at my dose for a LONG time (6 to 12 more months), how much better would I end up feeling? I would expect that my body would continue healing and fully adjust to my current dose. But it's possible that some amount of the drug being in my system still makes withdrawal harder. Just curious what you all think. 

 

This isn't to say I'm against tapering, but my last two drops of 10% were met with pretty stiff withdrawal symptoms. Yes, I was drinking occasionally then, and eating more sugar, so I likely had more inflammation. That's done away with now, as I've been sober and sugar free since March. I'm happy doing smaller tapers, and will have to eventually anyway. 

 

Thank you for your time. 

[ChessieCat]

If you find that a 10% reduction is too much then you reduce by less.  If you are nervous about making a reduction or you are not sure but think that you are ready to start tapering again, you can always make a tiny reduction as a test.

 

Be aware that Prozac has a very long half life and it can take several weeks before the dose change is fully recognised by the brain so it will be important to hold for at least 4 weeks after a reduction.  It is important to listen to your body/symptoms and not reduce again until you are stable.

 

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

[Leland]

Hello,

 

Update: I had held at 4.05 mg for 8 months, and I got quite stable. I felt some lingering day to day physical anxiety but nothing overwhelming. I was feeling flashes of feeling GOOD again. So I decided to taper. 

 

I started one week ago taking 4 mg in TWO syringes: one full 3 ML syringe, and one full 1 ML syringe.  the purpose for this is that I can more accurately measure my dose as I go down by 0.1 mg each time. My original 5 MG syringe was too big to make cuts that small. Three days ago I started feeling withdrawal again. I have been having periods since Thursday of tension, nervous system agitation, and stiff headache. Nothing too painful, like I'd felt back in March, but certainly uncomfortable, and pretty surprising for a drop of only .05 mg. Maybe the change to two syringes is having an effect. 

 

In any case, it's still early, and I'm going to try to wait out the symptoms rather than go back and take 4.05 mg on my old syringe. I'll update my signature with my new dose. 

 

I'm also taking: 840 mg Magnesium everyday (7 tablets of 120 mg), 4000 mg Seriphos serine, 700 mg Sulforaphane, and 2400 mg NAC. So I'm supplement loaded up. I'm not drinking, not drinking coffee, and avoiding as much sugar as possible. I feel mentally prepared for this long taper. I hope that my body feels the same. 

 

[ChessieCat]

I suggest that you double check that you are measuring your dose correctly and getting the planned dose.

 

Prozac has a very long half life and it can take 2-3 weeks for the dose change to register in the brain.

 

It is not unusual to feel withdrawal symptoms after making a reduction.  The aim is to keep them to a minimum and symptoms which are bearable and you can live with.

 

If after 4 weeks from the reduction you don't feel stable, hold for longer. 

[Leland]

Thanks for your response, 

 

I am being incredibly careful measuring the dose. I switched to two syringes to more accurately read a 0.10 mg drop each time I taper. Right now for 4 mg, I fill one 3 ml syringe (right to the line), and one 1 ml syringe (right to the line). Not to mention removing air bubbles, and cleaning any extra liquid off the outside of the syringe. I'm also taking the dose around the same time each day within an hour. 

 

So I have no idea. You say prozac can take 2-3 weeks to show symptoms, but I'm feeling symptoms after 5 days. 

[ChessieCat]

8 hours ago, Leland said:

You say prozac can take 2-3 weeks to show symptoms

 

No, that is not what I said.

 

20 hours ago, ChessieCat said:

Prozac has a very long half life and it can take 2-3 weeks for the dose change to register in the brain.

 

You might experience withdrawal symptoms at anytime after a reduction.  There is not set rule about how it occurs.  Some members find that there is a pattern to their symptoms after a reduction, but it might not always be the same; the symptoms might be slightly different and when they appear might change.

 

I found it helpful to understand why we get withdrawal symptoms (see the things at the bottom of this post) and learn and use non drug techniques to help me cope with them.  When we understand them then we are not as scared of them; if we get anxious and worried about the symptoms we can make things worse because we add fear.  If you can tolerate the symptoms then it is better to learn to accept them for what they are, your brain getting used to getting less of the drug.  I used to remind myself that my brain was just making the necessary changes that it needed to make which is why I was getting some symptoms; I'd think oh that is just a withdrawal symptom, I made a reduction a few days ago so I know what it is and why it is happening.  The important thing is to not make another reduction until you are stable; you listen to your body/symptoms not the calendar.

 

Non-drug techniques to cope with emotional symptoms

 

I found the Rubik's cube analogy in this video really helpful:

 

Video:  Healing From Antidepressants - Patterns of Recovery

 

On 8/31/2011 at 5:28 AM, Rhiannon said:

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

 

AND

  

On 12/27/2015 at 6:37 AM, Altostrata said:

Basically- you have a building where the MAJOR steel structures are [...] to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were [...] to rebuild the tower - WHILE people were coming and going and [...] to work in the building!  You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while [...] is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves.  The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made. 

 

 

[Leland]

Ok I see, thanks for clarifying. I made a pretty small drop, so hopefully the withdrawal symptoms ease before too long. I would like to continue tapering if possible!