Shmalan: serotonin sensitivity vs SSRI withdrawal

[Shmalan]

@Frogie

Yes, I will try 5% reduction. I might also stop the Atorvastatin then check lipid numbers again in a few months. They are good now. Did you notice any improvements or changes when you stopped?

thanks- Alan

[Shep]

22 minutes ago, Shmalan said:

Yes, I will try 5% reduction. I might also stop the Atorvastatin then check lipid numbers again in a few months.

 

Please only make one of these changes at a time. If there are any problems, you won't be able to know which change caused the problem if you do both at the same time. 

 

Some people hesitate to make abrupt changes during withdrawal. If that's the case, you could reduce the Atorvastatin by 25% a week and see how you do. But if you do, please hold off on tapering any other drug until you see how the Atorvastatin withdrawal goes. 

[Frogie]

@Shmalan

 

@Shepis 100% correct to only make one change at a time. When I got off my statin it was because it was affecting my liver so the dr took me off of it. But that was different circumstances than you.

 

if you want to go off the statin 1st, you could do that relatively quickly and then you could try the 5% drop and see how you do.

[Shmalan]

@Frogie

@Shep

 

Thanks, I appreciate the responses very much. Unfortunately I have to make a decision between the two meds for reduction. I might have to take a couple days to decided

btw my liver numbers (ALT) are high slightly out of range.

[Shmalan]

@Frogie

True, the statin reduction could go relatively quickly. That is a good point. Did you notice a benefit when you went off statin as in feeling in better health?

[Frogie]

8 hours ago, Shmalan said:

@Frogie

True, the statin reduction could go relatively quickly. That is a good point. Did you notice a benefit when you went off statin as in feeling in better health?

The only thing I can say after going off of the statin is my liver no longer hurt. That’s why the dr took me off of it on the first place. I learned to eat better to keep my cholesterol low since.

[Shmalan]

Reduced 5% on July 23 wd symptoms starting to show up

after 9-10 days: more zaps, jolts, restlessness/agitation, dysphoria,etc. I actually had some hope I would feel better. I guess pretty sensitive to dosage changes. The lower the dosage the worse the SXs. If I could find decent dosage for stability, I think I would be willing to hold for several months

[ChessieCat]

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

 

Hopefully the WD symptoms will ease very quickly as the brain adapts to the lower dose.

 

Listen to your body/symptoms.  It's best to not reduce again until the symptoms resolve.  And you might consider making a small reduction next time.

 

18 minutes ago, Shmalan said:

The lower the dosage the worse the SXs.

 

Many members find that the lower their dose gets the slower they need to go, reducing less and/or holding longer.

 

This topic explains why.  The video link in Post #1 is very helpful in understanding this.

 

Why taper paper: dose-occupancy curves

[Shmalan]

@ChessieCat

Thanks for the response and great link! Wow the curve gets steep at the lower doses. Yes I think I may hold for a while- can’t go as fast as am initially wanted. Also the fear of getting WD symptoms seems to cause it’s one symptoms.

[ChessieCat]

Just remember that every reduction, however small, is getting you off the drug.  The aim is to do it in a way that keeps withdrawal symptoms to a minimum so that you can live your life as normally as possible.  There are SA members who have tried to go too fast and it has ended up taking them longer to get off than if they had done a nice, steady taper.  Some have switched drugs and things became worse, and some have added a drug which also needs to be tapered.

 

It's normal to want to get off the drug as quickly as possible.  We can become impatient and frustrated and battle weary, but it is what it is.  It took me 6 years to get off my Pristiq.  I was hoping to be off in 2 years.  And right at the end I decided go down to a really low dose (it seemed really stupid to be taking such a tiny dose!) because I had other health issues I was dealing with.

 

It has nothing to do with how strong or determined we are as a person, but it is about how the brain adapts to getting less of the drug.

[Shmalan]

@ChessieCat  Thanks so much for your response. 6 years is a long time but I assume you are doing much better now that you are off the meds.
 

One problem is that it seems it is possible to have withdrawal and direct side effects from the med  (becoming sensitized to the med) at the same time but hard to tell… I am no longer in a hurry and would happily increase to

a more tolerable dose and stabilize for months but I don’t know if such a dose exists….

[Shmalan]

Hi @Frogie

I have a new batch of meds. The last batch I was using were 10mg. My script was for 3 pills (3x) and I had a 90 day supply, so the has script lasted a long time and was actually past the expiration date (May ‘22) when I finished. I still have 15 pills or so of the old script. New batch is 20mg. Is there a way to go from the old batch to new (like slowly changeover). I know the a percentage active contents of the new pills are different and can adjust for that but I am concerned there may be a difference actual strength in comparison to reported strength (eg old pills stronger ie more active ingredients than reported and new pills weaker etc.). Is there any good advice for these switches. Thanks

[Frogie]

1 hour ago, Shmalan said:

Hi @Frogie

I have a new batch of meds. The last batch I was using were 10mg. My script was for 3 pills (3x) and I had a 90 day supply, so the has script lasted a long time and was actually past the expiration date (May ‘22) when I finished. I still have 15 pills or so of the old script. New batch is 20mg. Is there a way to go from the old batch to new (like slowly changeover). I know the a percentage active contents of the new pills are different and can adjust for that but I am concerned there may be a difference actual strength in comparison to reported strength (eg old pills stronger ie more active ingredients than reported and new pills weaker etc.). Is there any good advice for these switches. Thanks

What you can do is weigh the new tablets again to get a new weight. Then to switch over to the new tablets you would:

 

Week 1: 3/4 old and 1/4 new

Week 2: 1/2 old and 1/2 new

Week 3: 1/4 old and 3/4 new

Week 4: all new

 

Then hold a couple of weeks before you start tapering again.

[Shmalan]

Thanks @Frogie That is what I will do and hope for no new or increased symptoms or sides 

[Frogie]

4 hours ago, Shmalan said:

Thanks @Frogie That is what I will do and hope for no new or increased symptoms or sides 

I hope it goes smoothly for you. Keep me posted.

[Frogie]

@Shmalan

 

How are you doing?

[Shmalan]

Hi @Frogie

I am doing ok. Sorry for the late response; I have not been checking in often. I had CVD in December (Christmas day). The accuse phase wasn’t too bad but afterward I have been in a wave with anxiety, restlessness/agitation and some depression. I have remained at the same dose for the last several months but am wondering if a dosage reduction would be good even though I have not reached a point of stability. Maybe I am one of those that have developed an intolerance to the med and will benefit, at least initially from

a reduction. How have you been?

[Shmalan]

The acute phase not the accuse phase 🤪😀

[Shmalan]

I have been on the same dose for months with minor improvements. Recently, I am using 20mg capsules instead of 10mg which I have had for over a year. I have adjusted accordingly in calculating my dosage but am starting to get minor brain zaps. I wonder how accurate the 10mg and 20mg nominal pills really are? What is the 10mg pills were actually generally higher (10.5mg for instance) and the 20mg pills are actually lower (say 19mg) or vice versa. I could have had a dosage change without trying. If so, I wonder up or down?

[Shep]

10 hours ago, Shmalan said:

Recently, I am using 20mg capsules instead of 10mg which I have had for over a year.

 

Is there an expiration date for the older capsules? 

 

You currently have 6.14 mg/day listed in your signature, as of July 23, 2022. Are you now on a lower dose? If so, please update your signature to reflect your tapering since July 2022. A direct link is here:

 

 Account Settings – Create or Edit a signature

 

 

[Shmalan]

@ShepYes, the older 10mg capsules were several months expired and the 20mg are not. The brain zaps make me thing that I am getting a lower dose with the new capsules even though the old were expired. I reduced down to 6mg almost a year ago but have stayed on this dosage afraid to do anything.  Also not 

taking Zolpidem anymore. Will update.  I have had some minor improvements from a year ago (can read a book now) but still suffering from the med which I think is causing the remaining issues (bad sleep agitation, difficulty relaxing, anxiety,..$

 

[Shep]

@Shmalan What date did you start with the new 20 mg capsules? Did you do a direct switch over to them? 

 

Since it's impossible to know what differences there may be, and since you're having some minor improvements, it may be best to hold for a bit and see if things settle down. 

 

Have there been any other changes? Any life stressors (you don't have to name them), changes in supplements or diet, changes in work stress, family stressors, etc? 

[Shmalan]

@Shep

Thanks for the response. I started the changeover August 4 and slowly worked the new meds in. All new meds as of yesterday. Life stressor: my beloved cat and pal Lucy (15 yo) died at the end of June which was really tough, then in July I got a new kitten from the humane society who is a terror. The tale of 2 cats. At work we have a bunch of new people that I have to help.  I am a little overwhelmed… 

[Shep]

I'm sorry to read about the loss of your beloved cat, @Shmalan. Sounds like you have a lot of things happening in relatively short period of time. Does your new kitten wake you up at night? Are you able to take a day or two of vacation to get away for a bit and relax? 

[Shmalan]

Thanks @Shep.  No I keep the kitten in my bedroom at night. Is her favorite room and where I first put het And I sleep in a cot in the basement 😀. Just a lot of energy and mischief. I

recently went on a vacation to visit family and it was great to see some of them after years. I hope you are doing well and appreciate it.

[Shmalan]

Updated signature. Added 2.5mg melatonin per night (for > 1 year now). I forgot to include. This has really helped with sleep initiation.

 

Still sticking to the 6mg fluoxetine per day for a week or 2 more then I am going to try a reduction: maybe 10%. Hopefully this will result in at least sone initial improvement. 

[Shmalan]

Strange. After a couple of weeks with no zaps, I am

getting some minor brain zaps this afternoon starting at 2pm (I take the fluoxetine at 9:45). I switched making my 6mg dose from expired 10mg capsules to new 20mg capsules in August (half the powder weight to get 6mg). I was hoping to reduce 10% starting next week. I have been on this dose for a looong time and have improved somewhat but not to where I want to be. I expect I will have to eventually get of the med or be on a much lower dosage to avoid all these symptoms. 

[Shep]

@Shmalan I noticed you added in 2.5 mg melatonin a few weeks ago. Was that before or after you made the switch from the expired fluoxetine tablets? Could the melatonin possibly be in play for the uptick of brain zaps? 

 

2.5 mg melatonin is on the high side. How do you feel it's affecting you? Please see:

 

Melatonin for sleep

 

If you feel the melatonin dose may be too high, you could reduce it and see how you do before continuing on with the AD taper. Or you may want to continue holding exactly where you're at to see if the brain zaps fade out again as you adjust to the new 20 mg fluoxetine tablets.  

[Shmalan]

Hi @Shep. Thanks for your response.?I have been taking the 2.5mg of melatonin since August 2022,  it only recently thought to include it. I may stay at the dose I am now for a while longer to be safe but I am looking forward to reducing and hopefully feeling better since I have been on the same dose (theoretically) for so long. 

[Shmalan]

I meant stay at the dose of fluoxetine. I may try going to a lower dose of melatonin since a lower dose may work just as well or better.

[Shep]

@Shmalan Reducing the melatonin a bit sounds like a good idea. Sometimes less is more.

 

Please hold everything else the same, as we recommend only one change at a time. A great post about this is here - The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

 

Please let us know how you do with the reduced melatonin. 

[Shmalan]

Ok thank you @Shep. I will reduce melatonin first. Will read the section on melatonin. Hopefully I wouldn’t need to reduce melatonin only 10 per month. 

[Shep]

27 minutes ago, Shmalan said:

Ok thank you @Shep. I will reduce melatonin first. Will read the section on melatonin. Hopefully I wouldn’t need to reduce melatonin only 10 per month. 

 

Since you've been on melatonin for over a year, you may want to start out with a relatively low rate. You could reduce from 2.5 mg to 2.25 mg and see how you do (which is a 10% reduction). If you don't have a problem, you might be able to up the reduction rate. But please don't rush it if you feel you're benefiting from it. 

 

Are you still getting brain zaps or has that uptick in this symptom faded out? 

[Shmalan]

Well the brain zaps faded out but last 3 days or so. I have been getting them in the afternoon (I take fluoxetine at 9:45). None today so far 2:10PM.