Shmalan: serotonin sensitivity vs SSRI withdrawal

[Shmalan]

Hello @Moment19 .

 

Thanks for your response! I appreciate it. I rely on what I read at this site a lot as I don’t know any people in person who have an understanding of this.

It looks like you did a big reduction at the end 10mg to 5 to 0, congratulations on being off the med for 8 months! The last 10mg are tough. Do you now regret taking trazadone? Or did you find that it helped out overall? I guess taking new meds means more taper.  You bring up very good points- rumination around being in WD and mental health and fitness. Do you have a regular exercise schedule? Any cardio or strength training. I have gotten sedentary the last few months but have been walking 1/2 hour almost every day. With spring coming I am trying to get in shape for all the yard work I have planned.

 

Yes, it is difficult to figure out how to taper all the way. Too fast? Too slow? “Is it just the depression coming back?” Then there is not only WD but side effect of the med(s) that can develop. 
Plus general mental health and fitness. I am glad things have improved for you. Very nice to hear from you.

[Shmalan]

Shmalan’s State of the Taper Address
Monday Feb 28 thru Thurs March 3 not great due to less quality sleep. Although Wednesday was not too bad this is after a pretty good period of about 10 days. Thursday was the worst with respect to nervousness and agitation which, as I have mentioned before is typically worst in the late afternoon 6 or so hours after fluoxetine dose (peak plasma).  <Last night and today, Friday March 4 have been pretty good.>
 

I have always considered  this nervousness/ agitation as direct side effect of the med which I remember from when I first took it back when I was much younger. The key difference is back then it was more of an energetic enthusiastic (although sometimes jittery) feeling, now it is an unpleasant shaky restlessness. All that to say I don’t consider this necessarily a WD symptom and therefore more incentive to reduce dose.

 

However, since reducing I have noticed occasion very minor potential withdrawal symptoms. These don’t concern me at present, but due to the long half life of the med it could take 2-3 months (more) to reach a new steady state. Therefore, “out of an abundance of caution” and after reading several histories of fast tapers, I am planning on  sticking with the current 6.8mg for another 2 - 4 weeks, although I could change my mind at any time.

[Moment19]

@Shmalan

 

Sorry for the late response. Great to hear from you mate. 

 

The taper was a little fast. I wish I had gotten my hands on the tablet form earlier. At the time the smallest capsule they prescribed was 10mg fluoxetine. Later when I was in the middle of serious WD symptoms I tried reinstating with 5mg tablets that I would break up into smaller doses (By that time reinstating wasn't working and I was in it for the long haul). I didn't see the extreme WD symptoms for about 2-4 months. But once it had rolled through my system I was left with an extremely sensitive nervous system, extreme headaches, blurry vision, insomnia and bad ringing ears. 

 

From my own experience I would recommend tapering down using the tablet form so you can microdose all the way down and hopefully avoid PAWS as much as possible. Trazadone was an interesting ride. I wasn't sleeping and the over the counter sleep meds that usually work for me were not anymore. The trazadone would put me out but like I said I would wake the next morning feeling like I didn't sleep at all. This could also have just been symptoms of the withdrawal but I was excited to get away from the trazadone. I am a major advocate for using supplements to help with the nervous system but they are supplements to the real work. Which in my opinion is learning how to work with your brain through this difficult time instead of fight it. 

 

I still experience windows and waves but they seem to be much more often now and not as prolonged. Usually a few days of a window and then 5-14 days of waves currently. 

 

I have tried to keep up my fitness. I try and hit the weights 3-4 times a week and I was adding in a mile run at the beginning. I have gotten away from that and I want to start running again. I used to play collegiate soccer. I am no where near how fit I was before I took the medication and even when I was on it that was the main reason because I was so tired all the time. I had been through a 2 year spout of extreme anxiety that I didn't realize at the time was my nervous system and brain trying to recover but instead I took fluoxetine to get any source of energy. But I have noticed I have to learn to have compassion with myself when I am in a wave and really fatigued. I have to not resist the thoughts that my brain is throwing up in an attempt for it to help and fix things. I just try and do a little exercise and not chase after the thoughts. I have noticed this has been major in moving my recovery along. 

 

I hope this help mate!

 

[Shmalan]

Going to insert daily notes for a few days since I have been in 6.8mg fluoxetine for 6 weeks. Then hopefully decide whether to reduce, stay at same dose or even possibly up dose (?). Apologize for the multi day data dump

 
Thursday March 10

-420 AM wake: 

-slightly shaky 

-6:30 breakfast + 2 cups half caff coffee

-10:00 snack and 6.8mg Fluoxetine

-12:15 lunch and 40mg Atorvastatin 

-afternoon slight anxiousness/restlessness 

-6PM improvement In symptoms 

-630 PN dinner good appetite

-1020 PM Sleep (until 4AM with one wake up for 20min)

 

Friday  March 11

-400 AM wake: 

-minor very slight brain/body zap type symptoms 

-6:30 breakfast + 2 cups half caff coffee

- later AM no more zaps

-9:50 snack and 6.8mg Fluoxetine

-12:15 lunch and 40mg Atorvastatin 

-afternoon minor anxiousness/restlessness 

-by 7Pm improvement In symptoms 

-7PM dinner good appetite

-Difficulty sleeping 

-1145PM take 2/3 Benedryl 

~12:45 AM asleep until 305AM then off and on doze till 5:35 AM

The Benadryl was an experiment 

Saturday March 12

-535AM  wake: 

-Benedryl hangover agitation

-6:46breakfast + 2 cups half caff coffee

- Some improvement

-9:30 snack and 6.8mg Fluoxetine

-1 PM lunch and 40mg Atorvastatin 

-afternoon better

-7PM dinner good appetite

-1020 PM Sleep (until 525AM not bad)

 

Sunday  March 13

-525AM wake: 

-6:45breakfast + 2 cups half caff coffee

-doing ok

-10:00 snack and 6.8mg Fluoxetine

-1:15 PM lunch and 40mg Atorvastatin 

-afternoon increase in anxiousness/restlessness 

-slightly better by evening

-7PM dinner appetite ok

-Difficulty sleeping 

-1045 sleep (til 505)

 

Monday March 14

-505 AM wake: 

-minor shakiness/weakness with anxiousness/restlessness 

-6:00 breakfast + 2 cups half caff coffee

-10:10snack and 6.8mg Fluoxetine

-12:25 lunch and 40mg Atorvastatin 

-afternoon increase in anxiousness/restlessness but reduced shakiness and weak feeling

-by 630Pm much improved symptoms

-645 dinner good appetite

-10:20 PM sleep (until 6AM unusually long sleep period) 3 relatively good nights

 

Tuesday March 15

-6AM wake: 

-some very slight brain/body zap type symptoms (I think I get these zaps after waking from longer sleep they usually last a few minutes)

-some shakiness/weakness

-6:00breakfast + 2 cups half caff coffee

-10:05 snack and 6.8mg Fluoxetine

-12:15 lunch and 40mg Atorvastatin 

-afternoon slight anxiousness/restlessness but less weakness/shakiness 

-by 5PM improvements in symptoms

-630dinner good appetite

-8PM increase in nervousness and restlessness

-Difficulty sleeping 

-1139 light sleep

-around 2AM wake bathroom break

-around 230AM back to sleep (light

Until 420AM

(Bad sleep. Maybe anxious about upcoming overnight sleep titration study Wednesday 16)

[Shmalan]

Note Shakiness/weakness = hands slightly trembling, legs shaky in shower, adrenaline  tend to get in

 

Restlessness/agitation refers to energetic in an unpleasant way wanting to keep moving, jittery I associate this as a side effect of Fluoxetine but unsure

[Shmalan]

Wednesday March 16 (Sleep study today)

420 wake

early restlessness and agitation 

630 breakfast

10 AM snack and 6.8mg fluoxetine 

some reduction in symptoms by 12 noon

12:15 PM lunch 

afternoon symptoms of agitation and restlessness  continue to improve 

Evening very good (comparatively best in a while)

7PM Dinner - very good appetite

8PM arrive at sleep lab

10:30 to bed with wires and CPAP attached

1215-1245 sleep

115 AM restroom break

1:30 AM take 5mg Zolpidem (1st time in over a month but desperate to sleep so I don’t have to do this again)

2AM - 430 sleep 

530 AM leave sleep

 

Thursday March 17

430 wake

530 leave sleep lab

Very tired and unwell feeling but not sleepy

800 breakfast

950 AM snack and 6.8mg fluoxetine 

12:40 PM lunch 40mg Atorvastatin 

afternoon increase in restlessness and agitation and some depression

645Dinner - appetite not very good

11PM sleep wake up twice for 10-20 minutes

545 Am wake

 

Friday March 18

545 AM wake

Very tired and a little shaky even though sleep was ok

630 breakfast

945AM snack and 6.8mg fluoxetine 

12:20PM lunch 40mg Atorvastatin 

afternoon increase in restlessness and agitation less weakness and tiredness

evening some reduction in restlessness and agitation

7 dinner appetite good

1030 sleep with one 20 min wake up

605 AM wake

 

Saturday March 19

605 AM wake

Ok except some lower back pain

745 breakfast

10 am snack and 6.8mg fluoxetine 

12:45 lunch 40mg Atorvastatin and 1 Ibuprofen

afternoon gardening

evening some depression and tiredness

7 dinner appetite good

later depression

1030 sleep with one 10 min wake up

355 AM wake

355-545 light dozing

 

Sunday

wake 545

630 breakfast

Am weakness and shakiness

10 AM snack and 6.8 mg fluoxetine 

1230 lunch 40mg Atorvastatin 

afternoon restless and agitated but less weak and shaky

3PM some improvement 

[Shmalan]

I have been on 6.8mg Fluoxetine for over 6 weeks. It is time to decide on another 10% reduction.  Thinking about dropping to 6.12mg/day I am not sure if I can say I am “ stabilized” as too much up and down but some improvements in sleep (generally). My theory is that I currently have more side effects than WD but could very well be wrong.

@Frogie do you have any ideas or opinions on this? I can answer any questions since the daily notes are kind of repetitive and boring. Thanks

[Frogie]

@Shmalan

 

Maybe try a 5% taper and see how you do with that in 5-7 days. If you are ok, you could taper another 5%. That may relieve some of your symptoms.

[Shmalan]

Ok thanks. A little safer probably.

[Frogie]

@Shmalan

 

I think if might be safer at this point to make sure you don't get worse.

[Shmalan]

Thanks @Frogie. 
I waited a day now am trying the 5% reduction (6.46mg) as of yesterday. I will try for 5-7 days to see how it goes before reducing more. I assume I should wait 5-7 days also before chickening out an going back to previous dose if things appear to be worse. Had a pretty good day yesterday then a less than optimal sleep ( but still >4 hours so not horrible), but I have cycled in and out of good sleep on previous doses also. Will see how things are after  a few days. Thanks for the suggestion.

[Frogie]

@Shmalan

 

If you have tapered 10% total, I would hold for at least 3-4 weeks to see how you are doing.

 

If you do get worse you can go up the 5% and hold to see how the symptoms go.

 

If you are getting more than 4 hours of sleep a night, in wd, you are getting really good sleep.

 

Please keep me posted so I know how you are doing.

[Shmalan]

Hi @Frogie

Thanks for the help. How are you? Are you ready for spring yard work season?
 

I recently reduced  5% from 6.8mg to 6.46mg I think I may stick to for a couple of weeks just in case before continuing with the next 5%. This will give me more time to see the effects since I have ups and downs even on a constant dose.

 

Yes, 4 hours of sleep is not to bad, sometimes I get more which is great. Also I will be prescribed a CPAP machine soon after a sleep study. Hopefully that will help with quality. 
 

[Frogie]

@Shmalan

 

I think a 5% taper with at least 2-3 week hold sounds like a really smart idea. Then you will know how you feel. If you feel ok, you could taper another 5% at that time.

 

I would take 4 solid hours of sleep any day. You are lucky you are getting that much. If you have sleep apnea, a CPAP machine will certainly help you then.

 

We did yard work today, I'm done and it's only just beginning ha, ha.

 

Hope you enjoy your weekend!

[Shmalan]

Thanks @Frogie

Enjoy your weekend! It is nice and warm here in KS. I will be planting some snap peas this tomorrow. Have been laying around too long so going to ease into yard work this year…

[Frogie]

@Shmalan

 

I've laid around too much this winter too, now I'm paying the price by doing yard work today. But's it's done.

 

Snap peas sound wonderful! We don't have anywhere to put a garden, so I just have my bushes and roses.

[Shmalan]

Hi @Frogie,

How are things?

I recently (Monday March 21) reduced dose of Fluoxetine 5% from 6.8mg to 6.46mg. I had hoped to see more improvements but I guess with the long half-life it takes a while, weeks maybe to notice an effect.

Yesterday and today are not great (sleep, agitation fatigue) but I have had days like this all throughout the process at previous higher dosages  mixed with better days, so not sure if anything is dose related. What is your impression? Thanks

[Frogie]

@Shmalan

 

I'm glad you did a small taper. That's a wise decision.

 

You are correct, you may not feel the taper for a few days because of the long 1/2 life of Fluoxetine. But hopefully, you won't have much of a reaction.

 

Sleep affects everyone that I know during this process. Just do the best you can and take naps and rest when you are able. That's the best self care you can do for yourself.

 

Keep me posted.

[Shmalan]

Thanks @Frogie.

Yes, that is what I figure too (sleep affecting everyone in this process). I guess it is no cause for panic or go back to previous dose since I had sleep issues with higher doses also. Thanks for the help. Its great to be able to run ideas past another who is been through all the tapered and withdrawal and side effects.

[Frogie]

@Shmalan

 

You are very welcome. Glad I can help. I think this is a great site where everyone has been through it all and we can all share our own experiences.

 

I think you are going to regain your sleep. It may take a while, but just do lots of self care in between😊

[Shmalan]

Hi @Frogie

i reduced my dosage 5% to 6.46mg Fluoxetine. In the last week or so sleep has deteriorated from what it was before the reduction although I have had bad sleep periods in the past on higher doses as well. I don’t know if this is a sign to go back to the previous dose of 6.8mg, a partial increase, or stay at the current dosage and wait  for body and mind to slowly adjust. What would you do? Thanks for the help.

[Frogie]

@Shmalan

 

Fluoxetine can take a couple of weeks to reach fully in your body because it has such a long half life in your system.

 

I would guess, if it were me, that you are going through a little wave perhaps and it just coincides with recent taper.

 

Maybe try a little melatonin and see if that might help with your sleep.

 

Hopefully it will straighten itself out soon.

 

Keep me posted.

[Shmalan]

Thank you @Frogie. You are probably right. Daylight savings time didn’t help either. I will stick with this dosage. It had been a couple weeks since the dosage reduction, so maybe I try an additional few days to a week or 2 especially due to to the long half life

[Shmalan]

Also, I have a Zolpidem prn script that I hardly ever use. I did use 5mg when I had my sleep study last month because I needed sleep results that night then I am thinking about getting rid of this med (disposing of)  so that I don’t have to think about it on sleepless nights but not sure if these are useful to have around. 

[Frogie]

@Shmalan

 

Be careful with the Zolpidem, you can become dependent on it in a couple of weeks, even using it as needed.

 

I think if you hold a couple more weeks, you should start to see some improvement.

[ChessieCat]

 

On 2/6/2022 at 9:47 AM, ChessieCat said:

Here is an example of an updose I did whilst tapering Pristiq.  This was a 4 day period and I did not go back to the "original" dose.

 

29/12/15	75
30/12/15	67.5
31/12/15	67.5
01/01/16	70

 

21 hours ago, Shmalan said:

Thanks for this example, do you remember and mind sharing why, in this case you chose to increase to 70mg and not closer to the 75mg dose? Did the withdrawal of symptoms improve? 

 

Because it is better to make small increases.

 

The following post shows that going up to 70mg was enough.  Going back to 75mg might have also worked but my aim was to get off the drug and by going back to 75mg (which was not necessary in my case) would have added more time to me getting my dose lower.  My initial goal when I got to SA was to get my dose to 50mg because of the mild serotonin syndrome.  But after what I learned here I decided to keep going and see how low a dose I could get to and I got all the way off!

 

On 1/1/2016 at 4:20 PM, ChessieCat said:

Will fess up to waking up this morning feeling yuck which I put down to a couple of physical days and not sleeping well last night.  However it wasn't long before I realised my ears were "blocked" and then got a headache.  I tried sleeping it off after taking some Dimetapp but it didn't seem to work so I ended up taking an additional 2.5mg Pristiq and a couple of paracetamol and going back for some more sleep.  I have woken up feeling so much better.  I also realised when I stopped to think about it that I had been feeling a bit stressy and was shallow breathing since about lunchtime yesterday.  That has gone too.

 

[Shmalan]

Thanks @ChessieCat

for the great explanation!

[Shmalan]

@Frogie

Hey, I hope you are doing well. I have not updated for a while as no big change. Still on the same dose with still a lot of ups and downs.  Hoped improvement would be faster but know it can be a long process especially with external stressors.

 

I still wonder with SSRI and fluoxetine in particular if I have developed a growing intolerance to the med itself (in addition to withdrawal). I have basically been on these for 30+ years. 
 

take care and have a great weekend.

[methuselah]

4 hours ago, Shmalan said:

still wonder with SSRI and fluoxetine in particular if I have developed a growing intolerance to the med itself (in addition to withdrawal). I have basically been on these for 30+ years. 

hey @Shmalan  I’m in a similar spot.  I’ve been on some version of an ssri for 25 years.  I had some acute w/d symptoms hit on thanksgiving, I guess due to expired liquid, and i never really stabilized from that event despite switch to brand name Prozac.  
 

i wondered if that event and the following months of symptoms was in fact withdrawl, or serotonin syndrome, or side effects, some sort of paradoxical reaction, and on and on wayyyy too much.  I still wonder about it, but not as much.  What stopped me from constantly agonizing about what was happening was making the choice to slowly taper off.  Alto suggested based on my symptoms, I was maybe dealing with too much Prozac so side effects or a reaction  from that.  Either way, I was just sick of sitting in limbo so I dropped from 10 to 9.5 mg.  Honestly, 3 weeks after the drop I still  feel like sh-t most of the time with some windows, but I’m just gonna keep going down.  Like you, at least my theory is, I’m probably dealing with some form of a paradoxical reaction to the drug and withdrawal in parallel, that’s my best guess. 
 

This whole thing has taken over my life and I just can’t live like this anymore without taking appropriate action.  Only direction is down for me.  I’ll wait another week or for a better semblance of stability after the last drop then drop 2.5% every few weeks or a month or whatever.  In my situation, it seemed like if I was going to wait to feel good to taper from a position of strength, I’d be waiting forever.

 

best of luck!

 

M

[Shmalan]

Hi @methuselah

Thanks for you response. Yes this can be an all consuming thing. Hope your symptoms improve as you go down on dose. It is good you have made a choice. I was waiting for WD normal before reducing again but am not sure how stable that is.

Difficult to know what is a side effect vs withdrawal sometimes similar. Then a psychiatrist might say it was depression relapse. Good luck reducing the dosage.

[Shmalan]

Still holding at 6.46mg of Fluoxetine every day. I have some good periods but overall still getting side adverse effects from the drug ( or is it WD).

The curious thing is that I had tapered from 40mg peak to 10 mg every other day (before finding this site) 5mg per day ave. Then Oct 2021 I increased to 7.5mg per day (10mg and 5 mg alternating) to counteract brain zaps I was getting during a fairly mild illness.

 

Within a day or 2 I started to get restlessness and agitation. These symptoms did not “go away with treatment” and by December I knew I had to reduce. Luckily I found this site and bought a scale and made the dosage 7.5mg every day. I have been slowly tapering since.

 

The puzzling thing is I got these primary symptoms restlessness and agitation (also sleep issues) after dosage increase. Maybe a kindling effect. I had a fairly decent January on 7mg. Still with symptoms now.

Typical day: wake around 5am (or earlier) usually with nasty cortisol spike (sometimes shaky weakness). Slight improvement by late am. Take fluoxetine every day at 10AM, typically mood and symptoms improves for a while but by late afternoon there is an increase in restlessness/ agitation which usually gets better by evening (6 - 8 Pm

Not sure what to do at this point reduce another 10% to get off this  med which the body brain may not be handling as well at 50+ yo (assuming symptoms are continued adverse effects),hold for longer and work on non med self care or up dose to reach a more stable dose (assuming these are now withdrawal effects from the recent taper.

 

Any suggestions would be much appreciated.

[Shep]

On 6/13/2022 at 9:55 AM, Shmalan said:

Typical day: wake around 5am (or earlier) usually with nasty cortisol spike (sometimes shaky weakness). Slight improvement by late am. Take fluoxetine every day at 10AM, typically mood and symptoms improves for a while but by late afternoon there is an increase in restlessness/ agitation which usually gets better by evening (6 - 8 Pm

 

 

How much sleep are you getting, Shmalan? 

 

On 6/13/2022 at 9:55 AM, Shmalan said:

Not sure what to do at this point reduce another 10% to get off this  med which the body brain may not be handling as well at 50+ yo (assuming symptoms are continued adverse effects),hold for longer and work on non med self care or up dose to reach a more stable dose (assuming these are now withdrawal effects from the recent taper.

 

Since you've been at the 6.46 mg since March, I'm not sure I'd updose. If you do increase, try a very small increase because your nervous system may hyper-react to a larger amount of this drug. The further out you are from a reduction, the more your body has adjusted to that lower dose. 

 

Instead of reducing by 10%, why not try a smaller reduction of 3 or 5%? Have you read about the Brassmonkey Slide taper? 

 

The Brassmonkey Slide Method of Micro-tapering

 

This method of tapering may be gentler on your nervous system because it involves much smaller reductions spaced out weekly instead of a larger monthly reduction. 

 

On 6/13/2022 at 9:55 AM, Shmalan said:

I have some good periods but overall still getting side adverse effects from the drug ( or is it WD).

 

On 6/13/2022 at 9:55 AM, Shmalan said:

Take fluoxetine every day at 10AM, typically mood and symptoms improves for a while but by late afternoon there is an increase in restlessness/ agitation which usually gets better by evening (6 - 8 Pm

 

I don't think you're having side effects or an adverse reaction. The fact that you feel better after you take the drug until late in the afternoon sounds like you're tolerating the drug okay, but you're having the typical waves and partial windows throughout the day. 

 

I get a very strong vibe that you're also dealing with battle fatigue from feeling crummy for so long, which is understandable. Check out the link to the Brassmonkey Slide and see if you think that might be a good way to go. 

 

Also, make sure you're eating healthy, avoiding sugar, caffeine and alcohol, drinking plenty of water throughout the day. And also getting a gentle walk outside each day, if possible. 

 

[Shmalan]

@Shep

Thanks so much for your response! 
I get about 4-6 1/2 hours of sleep per night of varying quality. Occasionally, I have nights where it is hard to sleep at all. I also recently got a CPAP machine for sleep apnea which I have not integrated yet as it takes a while to get used to and I have not yet set aside a week or 2 of really bad sleep to get used to.
 

Another problem is that several months ago Doc gave me prescription of Zolpidem which I would take occasionally on nights I couldn’t sleep (1 to 3 times per month). I am thinking about stopping all together as the uneven prn dosing causes downstream symptom ripples and I don’t want to take regularly

 

yes, you are probably right about not adverse effects and getting battle fatigue.  I will check out the link to brassmonkey’s slide. I think I have gotten sensitive to any dosage change. (Been on SSRIs for more than 30 years). The idea to upside is because It seems I was doing better on 7mg in January but that was also a much less stressful period. So maybe not so much dose related.

thank you for the help!

 

[Shmalan]

@Frogie

Hi Frogie, I hope you are doing well. I am updating since it has been a while. Still stuck on 6.46mg. No big improvements but am considering a dose reduction again. Maybe it would even help with the nervousness and agitation I  get from the med (although I guess that could be prolonged WD ?? , or a psych doc may say depression recurrence/relapse) I am interested in your thoughts on reduction.
 

Also, I am considering reducing my Atorvastatin as I have seen it can cause neuro sides. But I guess this site is not “surviving statins” so just throwing that out there.

 

thanks

[Shmalan]

Re Statins I read from the American College of Cardiology “Statin Intolerance: Not a Myth” under neurological and psychological effects a “risk of suicide, aggressive behavior” also risk of depressive disorder, severe irritability, insomnia,. I think I am going to talk to doc about reducing dose or stopping (fwiw)

[Frogie]

@Shmalan

 

You've been on that dose for quite a while. Would you be comfortable doing a 5% taper and see how you do? That might be a good starting point. It takes 7-10 days for it to reach full stability in your system.

 

I think you can just stop the Atorvastatin. I didn't taper off mine and did fine.

 

Let me know what you think about this.