smc123: Reinstate Prozac?

[smc123]

I stopped 10 mg of Prozac cold turkey in 04/2021, after having taken low dosage Prozac and Lexapro off and on for almost 20 years. 
 

While most of my immediate withdrawal symptoms (brain zaps, etc.) have resolved, I have been suffering from insomnia since stopping the Prozac, which seems to have worsened in recent months. I generally don’t have trouble falling asleep, but I often awake in the middle of the night or early morning and can’t go back to sleep. I also am experiencing anxiety, difficulty concentrating, and memory issues. 
 

Since I did not taper off (I wish I had known the importance), I am wondering if it would be beneficial to reinstate Prozac and taper off. If I do reinstate, should I go back to 10 mg?

 

Any advice would be greatly appreciated. I am so glad to have found this site!

[smc123]

Since reading more on this site, I now understand that if I did reinstate, I should start at a very low dose (thinking 0.5 mg?). I am wondering if I’m better off pushing through and staying off completely. Sleep is my only real concern, primarily for general health considerations. All of my other symptoms are mild and manageable. 
 

History:

 

2002 to 2006 - 10 mg Lexapro. Brain zaps withdrawal. 

2006 to 2013 - 5 mg Lexapro. Tapered off, I think. Brain zaps withdrawal. 

2014 to 10/2016 - 10 mg Prozac. Stopped cold turkey - no withdrawal symptoms recalled. Stopped because I was pregnant. 

01/2018 to 04/2021 - 10 mg Prozac. Stopped cold turkey. 

 

Edited November 22, 2021 by Kiasofia
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[Kiasofia]

Welcome @smc123

I'm relieved you have found us and have learned about what to consider for reinstatement. Perhaps you read this:

About reinstating and stabilizing to stop withdrawal symptoms

 

We advise no more than 0.5- 1mg to start with. However, ideally reinstatement should be as soon as possible and ideally within 3 months of quitting. After that it's even harder to decide if it is worth the try. If you can find other ways to deal with the insomnia, it might be worth finding non-drug techniques to cope instead. Many find using a sleeping mask helps to lessen morning anxiety and early wakening.

Tips to help sleep -- so many of us have that awful withdrawal insomnia

Waking with panic or anxiety -- managing the morning cortisol spike

 

Important topics about symptoms

 

I found this post helpful to understand how these drugs actually work and why healing takes time:

How Psychiatric Drugs Remodel Your Brain

 

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

The Windows and Waves Pattern of Stabilization

 

 

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

 

Keep it simple, slow and stable

 

Aside from a high quality fish oil and magnesium, be careful with supplements. Your central nervous system (CNS) has become sensitized from psychiatric drug use and can react unpredictably. Alcohol, caffeine, nicotine and other mind altering substances can make the condition worse.

Important topics about tests, supplements, treatments, diet

 

Take some time to read the information I have provided and then we can take it from there.

 

Please stay in touch and let us know how you are doing.

Edited November 22, 2021 by Kiasofia

[smc123]

Thank you so very much for this response and the information! This is extremely helpful. I appreciate your time and help! 
 

History:

 

2002 to 2006 - 10 mg Lexapro. Brain zaps withdrawal. 

2006 to 2013 - 5 mg Lexapro. Tapered off, I think. Brain zaps withdrawal. 

2014 to 10/2016 - 10 mg Prozac. Stopped cold turkey - no withdrawal symptoms recalled. Stopped because I was pregnant. 

01/2018 to 04/2021 - 10 mg Prozac. Stopped cold turkey. 

Edited November 24, 2021 by Kiasofia
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[Kiasofia]

I hope the information can help you make a decision and cope with your symptoms.

 

I also highly recommend reading  Anatomy of an Epidemic by Robert Whitaker as well as A straight talking introduction to psychiatric drugs by Joanna Moncrieff to better understand these drugs and their effects. The Council for Evidence based Psychiatry also has a lot of good information.

 

Just a small thing, could you change the font of your signature so it's the same size as mine?

 

This is your Introductory topic, where you can ask questions and connect with other members.  If you need any advice specific to you and your situation, please ask it here. Otherwise, feel free to join discussions on other threads. To make sure I or someone sees your question, tag them by writing @ and then start typing their username. A drop down menu will appear. Click on their username and it will turn blue.

 

Best wishes for your recovery❤️

[smc123]

On 11/23/2021 at 8:02 PM, smc123 said:

@Kiasofia@Altostrata

Thank you very much for the resources. I have continued to research extensively since my last post.

 

My insomnia seems to be progressively worsening (staying asleep as opposed to falling asleep is my main problem). I have now been off Fluoxetine for 9 months, since going cold turkey. This past week, after a terrible 2-week spell of insomnia, I ended up in the ER following dizziness, body shaking, and heart palpitations. I was prescribed Ativan, of which I took one pill due to the emergency situation and was able to sleep for 11 hours.

 

I have since followed up with a primary care doctor and discussed my plan to continue to try to manage the insomnia through melatonin (more regular use and reduced dosage) and other non-prescription methods. However, I also had the doctor prescribe me 0.5mg of fluoxetine, should I decide to ultimately reinstate.

 

At this point, I am scared for my future, my job, etc. The thought of facing this insomnia potentially for years, is mentally daunting, to say the least. I know there is no guarantee that reinstatement would work, particularly at how far out I am from stopping my medication. However, I am wondering if anyone has experienced success (anecdotally) with reinstating at a very small dose (0.5 mg, in my case) this long after cessation. I realize you cannot say for certain what the best course of action is and that only I can decide; however, I would appreciate any insight you all may have from the countless stories you have seen. I have tried searching the boards here to answer this question, but have not had much luck.

 

Thank you tremendously for your help.

 

(Additionally, I have tried reducing the font size in my signature, but I can't figure out how to do it. Apologies.)

[Kiasofia]

Hi @smc123

Yes, there are many who have had a successful  reinstatement many months after quitting. There are also those who have reinstated successfully over a year after quitting. Since we don't know how a person will react it is suggested to start low (usually 1mg for prozac. One might need to increase beyond 1mg to get relief, but one is less likely to react badly to a low dose reinstatement than a normal dose. If you react badly to 1mg (or 0.5mg), stop immediately. If you don't notice anything, wait two weeks and then consider another small increase.

 

I know it's a hard decision to make. Do let us know what you decide and how you are doing either way.

[smc123]

@kiasofia

Thank you so much for the information. This is helpful to know in working towards making a decision. You are right - it is certainly not an easy one. I greatly appreciate you taking the time to answer my questions and for the assistance you've provided. I will keep you posted. Best regards.

[Lauren90]

Hi! Did you end up reinstating? How are you doing? 

[smc123]

Hi! Thanks so much for asking and I apologize for the delayed response.

 

I did not end up reinstating, but I will be honest that I still consider it. My insomnia has improved (I can often sleep 7-8 hours now, which used to never happen) but I do still struggle with it. My main reasons for considering reinstatement are the insomnia as well as my continued anxiety. When I was on Prozac (10mg) (and previously Lexapro - 5mg), I always felt good. It felt like it took the edge off my anxiety and quite honestly, I felt like a better version of myself. My reason for stopping was that I didn’t want to be on SSRIs forever if not needed, particularly in the event of long-term negative effects into older age. Then I stopped without tapering and all the bad symptoms began. I thought I would be ok without SSRIs and I am “managing,” but I do wonder if my quality of life would be improved if I went back to a low dose of Prozac. I recognize the medication could cause problems down the road particularly in older age and that rekindling is a risk, which are the reasons I haven’t yet done so. But it’s been 2 years since I stopped and while my condition has improved somewhat, I still feel much worse off than when I was on the low-dose SSRI. 

 

For the insomnia, I will share what has helped me. I did CBT for Insomnia therapy for several months, and strategies I learned from that definitely helped (e.g., getting out of bed to read when not sleeping and not lying in bed awake for hours, to help re-associate the bed with sleeping). Overall, I feel that my insomnia is highly linked with cortisol and a hyperactive nervous system. It seems that alcohol and phone use before bed both exacerbate these (more on that below). When I can’t sleep, it usually feels physiological rather than mental (it’s like I’m on the verge of sleep and not consciously thinking of anything but it feels like there’s cortisol or adrenaline inside that just won’t let me fall completely asleep). Every night before bed I take 1 mg melatonin, 1 Swanson Anti-Stress Formula (Lactium), and often one 200 mg L-Theanine (the latter two I read can help manage cortisol levels and this combo seems to help me fall asleep). I also take Integrative Therapeutics Cortisol Manager when needed. I usually take this after I have a really bad night’s sleep because it seems that going without sleep further increases the cortisol, making sleep even more difficult. I also take either 10 mg Doxyalamine Succinate (Unisom) or 5 mg Cyclobenzaprine (muscle relaxant) when the other more natural options don’t work to fall or stay asleep. I don’t take these every day and try to alternate them, to try to avoid becoming dependent and building up tolerance. Ideally, I’d like to stop the Unisom and Cyclobenzaprine, but for now, I believe the benefits of occasional use for my health outweigh the risks.

 

I have found that alcohol (any more than one drink at this point) and phone use right before bed both are major triggers of my insomnia. If I drink, I often wake up in the middle of the night and can’t fall back asleep, even with the sleep aids mentioned above. This is far more than the disrupted sleep I used to experience from alcohol prior to SSRI discontinuation and also feels related to a hypersensitized nervous system, as discussed on this site. Reading on my phone before bed even in “dark mode” often makes it difficult to fall asleep, so I try to avoid that as much as possible. 

 

As far as the anxiety, I try to manage this with exercise, breathing techniques, and cognitive strategies (learned through prior therapy), but it is definitely still a struggle. These things help somewhat but the anxiety always feels like it’s right under the surface and I’m constantly fighting it. That part felt much easier on the Prozac. I felt like I could breathe freer, I wasn’t as easily agitated, and my brain wasn’t constantly overthinking and ruminating like it does now. It also makes me wonder how much of the anxiety is a part of me that the SSRIs helped “treat,” and how much of it is now a symptom of discontinuing the SSRIs without tapering. 

 

I would still be very interested to hear of anyone who has had success at reinstating a low-dose SSRI (either after coming off a low or higher dose SSRI). Or success stories of anyone staying off and feeling 100% “good” at some point. I have read some success stories on these boards, but most seem to be more about improving and coping rather than feeling fully “cured” at some point. I don’t know if fully cured is even possible. I certainly wish I had never started SSRIs to begin with, but the fact is that I’m here now and wonder if it would better just to be on a low-dose SSRI forever than deal with this diminished quality of life and constant struggle from here on out. I don’t mean to be negative but just sharing my thoughts. 

 

I remain so thankful to have found this site and to not feel so alone in this journey because of it.