Strategist: Buspirone and fluoxetine taper advice, PSSD

[Strategist]

Hi all,

 

My story:

 

I am a 33 yo male. Family history of depression in maternal grandparents and sister. First started on 20mg paxil in 2006 due to what was diagnosed as anxiety & depression when transitioning to college. The medication seemed to have helped almost immediately - I became more calm and the bottom didn't seem to be falling out. I continued paxil for 2 years and then decided to quit cold turkey in 2008. I was fortunate in experiencing only one very unpleasant week of withdrawal symptoms including brain zaps, insomnia, panic, and tremulousness after abruptly discontinuing paxil. 

 

In May of 2014 I was started on 20mg fluoxetine during another major life stress event. Again, the medication seemed to prevent the bottom from falling out. Over the next several years I had only one major mood disturbance: in February of 2016 I experienced substantial anxiety and moderate sexual dysfunction during the start of a new relationship. Psychiatrist subsequently prescribed 0.5 mg ativan as needed, 100mg wellbutrin daily, and viagra as needed in February of 2016. For two months thereafter I took wellbutrin daily, ativan very sparingly, and viagra once. As my relationship grew, my anxiety diminished and sexual function returned to baseline so I stopped taking wellbutrin, ativan, and viagra without incident in April of 2016 but continued taking my 20mg daily fluoxetine.

 

In January of 2019 I decreased from 20mg -> 10mg fluoxetine without incident. I have been taking 10mg of fluoxetine for the past several years and doing quite well - able to manage a difficult breakup, multiple major life transitions, and a very demanding & stressful job. In June of 2021, I decided to stop my fluoxetine altogether (with the support of my psychiatrist). I tapered by taking 10mg of fluoxetine every other day, then every third day over the period of 4 weeks with my last pill on July 17 2021. Several weeks later I experienced mild and intermittent increased anxiety, tearfulness, diarrhea, and tremulousness which resolved in two weeks. Approximately 6-8 weeks after my last pill of fluoxetine I began to notice sexual dysfunction (decreased libido and inability to establish an erection with a new partner). It was at this time that I first learned about PSSD and the mere discovery of this disability and all of the literature and reports of permanent, enduring dysfunction sent me into a tailspin of which I had never before experienced.

 

My psychiatrist thought I was experiencing rebound anxiety, depression, and obsessional thinking. However, he humored me with the possibility of PSSD and prescribed buspirone. I have been taking 7.5mg of buspirone BID since 10/22/2021. I didn't appreciate any substantial improvement on this medication and my anxiety, obsessive thinking, and depression regarding PSSD became unbearable to the point where my psychiatrist recommended restarting fluoxetine 10mg daily to see if it would help with the mood changes as well as the sexual dysfunction as I didn't have any noticeable dysfunction while previously on any SSRI. To summarize, I have now been taking 7.5mg buspirone BID since 10/22/201 and 10mg fluoxetine since restarting it on 11/13/21. While my mood has moderately improved, my sexual dysfunction has seemingly worsened which has caused significant distress. 

 

From what I have gathered here and elsewhere, most people that are fortunate enough to make a recovery from PSSD seem to do so by stopping all of their psychotropic medication and patiently waiting. I am writing to ask for your help with the following questions:

 

1) If the only potential solution to PSSD is to rid my body of these drugs and let the healing begin, I am eager to do this as quickly as possible (as I have seen some here have suffered through many years of enduring sexual dysfunction before noticing improvement and others elsewhere with PSSD indefinitely). Please let me know if this is the correct framework of thinking, and if so, at what rate should I taper each medication keeping in mind that I am eager to regain sexual function as soon as possible. 

2) Should I taper both buspirone and fluoxetine together or separately? If separately, which should I taper first?

3) How do you distinguish between rebound depression & anxiety or other mood disturbance and withdrawal patterns including PSSD? 

4) What recommendations do you have for the management of ongoing anxiety & depressive disorders in those that decide to stop their medication because they cannot live with side effects including PSSD?

 

Please let me know if you would like me to clarify any of the above, and thank you in advance for your consideration. I am amazed by the great community here and the wealth of advice and encouragement for all of those suffering.

 

[Kiasofia]

Welcome @Strategist

I am sorry you are going through this and are suffering, but relieved you have found us. Thank you for creating your drug signature.

 

Starting and stopping psychiatric drugs is bad for the central nervous system (CNS). Each time we start and stop it becomes more and more sensitized. The risk of a bad reaction to restarting the drug or starting other drugs or supplements increases. Taking the drug every other day (or every third day) is the same as starting and stopping many many times. So it is not a good tapering method. Thankfully restarting Fluoxetine has gone well.

 

Your taper from fluoxetine was faster than we recommend and triggered withdrawal symptoms:

What is withdrawal syndrome?

Dr. Joseph Glenmullen's withdrawal symptom checklist

 

About PSSD:

Post-SSRI sexual dysfunction (PSSD)

 

About tapering:

Why taper by 10% of my dosage?

NEVER SKIP DOSES TO TAPER

Tips for tapering off buspirone (Buspar)
Tips for tapering off fluoxetine (Prozac)

Taking multiple psych drugs? Which drug to taper first?

 

About anxiety and depression:

Withdrawal or relapse? Or something else?

Bona Fide Emotional Pain or Clinical Depression? Are ANY Psychiatric Conditions Real?

Non-drug techniques to cope with emotional symptoms

 

About dealing with doctors:

How to talk to a doctor about tapering and withdrawal? What to expect?

 

I've given you quite a bit of information here.  Please read through it, and we will take it from there.

 

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.

 

We're glad you found your way here.

 

Edited December 31, 2021 by Kiasofia