khoff4488: tapering fluoxetine

[khoff4488]

Hi all. This is my third go around with tapering. I was originally put on Paroxetine by a GP back in 2012 following some very stressful and traumatic things that happened. The upstart side effects were unpleasant but after they passed I actually had a fairly positive experience with it. Got back to normal fairly quickly. Tapered off far too quickly on the advice of a different GP. Went back on a year later when anxiety returned. Startup side effects were quite a bit worse. But got back to normal. Tapered off a couple years later.

 

Which brings us to late 2020. Pandemic burnout was probably the biggest factor but I had a panic attack waking up from a dream (which is when I get 90% of the mine) and just couldn't shake it. I spiraled over the next week or so and made an appointment to see my GP. I explained that the startup side effects got progressively worse on Paroxetine so I would like to try something else so she put me on 10mg Fluoxetine and I got scheduled to see a psychiatrist and put on a waitlist for a psychologist. As I increased my dose i developed severe DPDR. Just acknowledging the fact that I exist or thinking about any of the hundred existential thoughts that would pop into my head would send me into a panic.  My anxiety ebbed and flowed but never really got better so we upped to 40. I noticed a pretty big increase in my brain fog and DPDR going up to 40. That's when i started to suspect it was making it worse. Over the coming months my anxiety symptoms started to ease. My DPDR did start to ease but plateaued which after conferring with my psychiatrist, we decided to reduce the dose and see what happened. Within a few days I noticed a decrease in my DPDR. Since then I've been fairly aggressively tapering off using tablets and now home-made liquid. I do feel terrible at times. But Ive found it to be worth it getting my reality back. I'm still in some state of dissociation 24/7. But it's getting better. I just fear that I won't know it when it comes. Its been so long since I've felt like i wasnt in a dream. My withdrawal effects can change drastically over the course of a day. Trying to sleep is the hardest as my brain darts all over the place. 

 

But I have a wonderful support system in my girlfriend, family, along with my psychiatrist and therapist. Just taking it one step and sometimes one hour at a time. 

[Erell]

Hello @khoff4488, 

Welcome on SA.

Thank you for your signature : it will help us to see your history at a glance. 
Do you take supplements ? Please include them too.

 

It's good news that you see a decrease in side effects as you decrease the dose. However, the drops you make are much faster and wider than we recommend.
On SA, we suggest no more than a 10% drop every 4-6 weeks. I invite you to read these links to better understand this suggestion:

 

1. why-taper-by-10-of-my-dosage

2. how-psychiatric-drugs-remodel-your-brain

 

You can also present this document to your psychiatrist: it is the new official guidelines in the United Kingdom (document published by the Royal College of Psychiatrists). These recommendations also advocate slow and progressive tapering.
stopping-antidepressant

What is your current symptom pattern ?
If you feel that your symptoms are manageable, now that you are at a low-dose, I would suggest taking a break for a few months to allow your nervous system to do its job of regulating and finding some stability after all these changes.

 

You're not the only one who reports side effects that get worse every time you restart an antidepressant. Some hypothesize that repeated exposure to these molecules can lead to hypersensitivity of the nervous system. If your goal is to get off medication, I would recommend to try to find tools and practices that helps you to live with your emotions.
You might find ideas in our symptoms and selfcare section.

Ok kohff, that's quite a lot of reading for a first message : I leave you with this information, keep us updated.

 

Take care .

 

 

[khoff4488]

Thank you for your reply and thoughts. I'll update my signature in the morning as I can't seem to find a way to edit it on mobile. I take fish oil, a multivitamin, and apple cider vinager. Ive tried a couple types of magnesium but i don't like how it makes me feel. I also have a Xanax prescription but I rarely take it. 

 

I think your suggestion of sticking where I'm at for a bit to let myself regulate is a good one. I've been going pretty hard on trying to get off as everytime I go down on dose my head clears a little bit more. It was like pulling teeth just to get them to prescribe me tablets so I could break them in half. I also need to order myself a better syringe. I think I'll do that right now. 

 

Currently my symptoms are flushing, dpdr episodes, rushes of anxious energy especially in the evenings, constant tinnitus, headaches, anxiety, and stomach issues. Lately every evening I start with anxious energy and my face and neck flush and get hot and I get pretty anxious. 

 

During the day I just have a general unreal and spacey feeling. 

 

It is my current goal to get off of all meds and deal with my emotions as I've spent the last year or so in therapy learning to do.

[ChessieCat]

Hi khoff and welcome from me too,

 

Some helpful links:

 

Dr Joseph Glenmullen's WD Symptoms Checklist

 

Non-drug techniques to cope

 

Please read Post #1 of this topic which explains how to get non standard doses of fluoxetine:

 

Tips for tapering off fluoxetine (Prozac)

 

Stability

 

WDnormal

 

And Brassmonkey talks more about it here:

 

tao-of-the-brassmonkey

 

AND
 

On 4/28/2017 at 4:03 AM, brassmonkey said:

 

AAF: Acknowledge, Accept, Float.  It's what you have to do when nothing else works, and can be a very powerful tool in coping with anxiety.  The neuroemotional anxiety many of us feel during WD is directly caused by the drugs and their chemical reactions in the brain.  Making it so there is nothing we can do about them.  They won't respond to other drugs, relaxation techniques and the like.  They do, however, react very well to being ignored.  That's the concept behind AAF.  Acknowledge, get to know the feeling involved, explore them.  Accept, These feelings are a part of you and they aren't going anywhere fast. Float, let the feeling float off as you get on with your life as best as you can.  It's a well documented fact that the more you feed in to anxiety the worse it gets.  What starts as generalized neuroemotinal anxiety can be easily blown into a full fledged panic attack just by thinking about it.

 

I often liken it to an unwanted house guest.  At first you talk to them, have conversations, communicate with them.  After a while you figure out that they aren't leaving and there is nothing you can do to get rid of them.  So you go on about your day, working around them until they get bored and leave.

 

It can take some practice, but AAF really does work.  I hope you give it a try.

 

 

[khoff4488]

Thank you @ChessieCat. That checklist is very thorough. I had made myself something very basic on a notepad but this is way better. That thread about tapering off of Fluoxetine is actually where i learned about making my own liquid in the first place. 

 

Ive been staying at 2.5mg for the last bit and feeling a bit more level. Just still spacey and episodes of agitation and dpdr. I live with my brother and his kids and as much as I love them they can be kind of a nightmare for me when I'm having a hard time and they are being rambunctious.

[ChessieCat]

Dr Joseph Glenmullen's Withdrawal Symptoms

 

If you go to the above link, in Post #1 there are PDF printable and computer versions for ONE MONTH of the same WD symptom list where you can also rate your symptoms if you wish.

[khoff4488]

Thank you very much. Also apologies for tagging you. I didn't notice your request until now. 

 

Felt very flushed and like I had low blood pressure today. Odd feeling. Also noticing when I get frustrated it just sticks with me for hours. Like I'm amped up. Have to breath and relax. But more clear headed. Still sticking at 2.5. I have an appointment with my psychiatrist in the morning. 

[khoff4488]

Wanted to update as I've been really struggling the last couple days. It's been a very stressful few months and I think it's caught up to me. My grandmother passed away in February and My father passed away on the first of May. That hit me really hard. I found this site and started following the 10% rule as I got lower because the withdrawal was getting bad. Everything seemed to be ok for the most part. I went down from 1.6 to 1.46 in mid May. But this past weekend I went to my girlfriend's parents house for dinner and was having a hard time with my vision there. Couldn't focus on anything it seemed. On the way back home I got very anxious. That night I could not stop sweating and I woke up several times. Since then I've been anxious, flushed, vision blurred and hard to read things, nauseous, and pretty constant tinnitus. Weird thing is my depersonalization is basically gone, which was why I started to get off of prozac in the first place. I also quit smoking around mid to late May as well so I think i've just been putting too much on my nervous system. I'm going to stick at 1.46 for a while and hopefully I level back out. I feel terrible right now. I slept well last night though so that's encouraging even though all i want to do right now is go back to sleep. 

[ChessieCat]

4 hours ago, khoff4488 said:

so I think i've just been putting too much on my nervous system

 

I am sorry for the losses that you have experienced this year.  These alone are placing a great stress on your body.

 

You also quit smoking at the same time you made a reduction.

 

When we experience added stresses it is better not to make a reduction.  So even if the only change was to quit smoking it would have been better not to reduce you Prozac as well.

 

Prozac has a very long half life and it can take 2-3 weeks and sometimes longer for withdrawal symptoms to appear.

 

Even though your symptoms seem to have worsened it sounds like you are managing them okay so I don't think that increasing the Prozac by a tiny amount is worthwhile, simply because it would take so long to build back up in your system.

 

4 hours ago, khoff4488 said:

I slept well last night

 

It is good that you are able to sleep.

 

I realise that this is a difficult time for you, but please try to use non drug ways to relax.

 

4 hours ago, khoff4488 said:

I'm going to stick at 1.46 for a while

 

Yes that is a good idea.  If it was me I would not evening be thinking about reducing again for at least another 3 months and possibly longer.

 

You might also consider only making a small reduction next time.  This may help to reduce any anxiety you might get about reducing.  Anxiety can cause symptoms similar to withdrawal.

 

[khoff4488]

Thank you Chessie. I think that's the plan. I just overdid it and I need to give my body a chance to regroup. The last few days have been pretty good. But today started off well and then around dinner time I got a rush of energy and got really flushed and anxious. Not as bad as when I posted but annoying. Going to try and sleep this off. I expect this will be the norm for a while. 

[ChessieCat]

That's good that you have noticed some improvement.  Just be careful not to overdo things when you feel good.

 

SA encourages members to learn and use non drug coping techniques.  I find that I can now recognise faster when my anxiety is starting and it is becoming more second nature to use the coping skills I have learned.

 

 with emotional symptoms

[khoff4488]

Had another rough night. Preceded by vision changes in the evening. Seems to be my precursor. Hot and flushed. Sweating. Anxiety. Can't think straight. Very tired today and my face just feels hot internally. Not so much on the skin.  Luckily have a long weekend. My windows are pretty good though. Seem to last a good few days. 

 

I also discovered coffee is a no go for now. Decided to give it a try and made some very low caffeine coffee and it made me extremely agitated. No problem giving that up for a while. 

[khoff4488]

This wave seems to just keep going. Nauseous all day today. Feel hot internally but no fever. Headache. Low mood and weird vision. I've never had a wave be this bad for this long. I really did a number on myself didn't I.

[khoff4488]

So last night I ended up taking  .25mg of Xanax. I generally try and avoid doing that but I was pretty bad. I think a lot of my symptoms from the last couple days are just really bad anxiety. I'm feeling a bit better today. Just spacey. But good to tamp down the anxiety and more importantly know what it is so I can deal with it better. 

[ChessieCat]

3 hours ago, khoff4488 said:

So last night I ended up taking  .25mg of Xanax.

 

How often do you take this?

 

When was the last time you took it?

 

The reason I am asking is that taking benzos occasionally can actually cause/contribute to anxiety.

[khoff4488]

I actually don't remember the last time I took it. It's very rare. This is the first time I've taken it this year for sure. 

[khoff4488]

It's starting to get pretty intense at times. If I were to try and updose,  what would you recommend? I'm worried this is because of a drop I did a while ago and updosing back to say 2mg won't have any effect. 

[ChessieCat]

On 6/14/2022 at 8:47 AM, ChessieCat said:

I am sorry for the losses that you have experienced this year.  These alone are placing a great stress on your body.

 

You also quit smoking at the same time you made a reduction.

 

When we experience added stresses it is better not to make a reduction.  So even if the only change was to quit smoking it would have been better not to reduce you Prozac as well.

 

Please remind yourself of this.  I think what you are experiencing is grief from your losses which you state below hit you really hard.  Your father's death was only 2 months ago.  Sometimes we can be numb for a while after the loss and then the numbness wears off, life goes back to normal (but people don't check in on you like they did at the start, you are not busy with things that need to be done after a death) but the person/people is/are no longer there.  I lost my father unexpectedly from a heart attack when I was 19 and my husband died after a long illness when I was 40, so I am speaking from personal experience.

 

If it was me, I would not be updosing the fluoxetine and definitely not to 2mg.  If you do decide to increase do it by tiny increments and wait at least 3 weeks after an updose before reassessing.

 

On 6/14/2022 at 4:26 AM, khoff4488 said:

My grandmother passed away in February and My father passed away on the first of May. That hit me really hard.

[ChessieCat]

You might benefit from some grief counselling.

[khoff4488]

I think you might be right. That's something I hadn't really considered.

I've been lucky not to lose too many people in my life until now and I've lost two of the biggest back to back. I'm sorry for your losses. It's absolutely terrible. 

 

I am feeling better after laying down with my migraine mask. Once again proving its just anxiety. I have an appointment with my therapist tomorrow. I will ask her about grief counseling.

[ChessieCat]

Thank you for your commiserations.  It's amazing what an impact things like this can have on our lives.  Unfortunately my daughters have been impacted by their father's death like I was mine, except for them they were about 10 years younger than I was, so I am fortunate to have more memories than they do.

 

During my taper I tried to not immediately think that any worsening was caused by withdrawal symptoms.  I would be a detective and try to think of what other things might have caused it.  For example something as simple as having a few nights of poor sleep can make things worse, but that is not a good enough reason to increase the AD.

 

17 minutes ago, khoff4488 said:

I have an appointment with my therapist tomorrow. I will ask her about grief counseling.

 

I am pleased to read this.

 

You might find this helpful:

 

I have found relaxation techniques very helpful too.  It isn't going to stop the external stress from happening but it can help to reduce the impact of that stress on your body.

 

With the relaxation I think it is better to do short periods of it throughout the day, regardless of whether you feel you need to do it.  Think of it like an old fashioned kettle on stove, the sort with the whistle.  If you keep turning the heat on and off the whistle will never blow because the steam won't build up.  Relaxation techniques work in a similar way.  You probably won't get rid of the stress completely but you keep bringing it down a bit so that it doesn't get to the build up.

 

I now find that I more quickly pick up when I am starting to feel "different" (tired, confused, anxious etc) and it's second nature now to do some sort of non drug technique (self talk, breathing exercise, get up and look at something different) to cope with whatever it is that is happening.

[khoff4488]

6 minutes ago, ChessieCat said:

 

During my taper I tried to not immediately think that any worsening was caused by withdrawal symptoms.  I would be a detective and try to think of what other things might have caused it. 

 

This is something I absolutely need to do. Getting off of fluoxetine has been such a big thing that I think that I'm too quick to attribute any problem I'm having to it's affects. Case in point. It's hard to tell what's what. It's not like withdrawal sends me a text saying hey it's me right now. Although that would be helpful. 

 

I have so much happening in my life right now that's hitting me while I'm starting to not have that numbing layer of meds and shock. Thank you for the relaxation tips and the perspective. I appreciate you Chessie.

[khoff4488]

I also need to do the "get up and look at something different". When I start to feel bad the doom scrolling starts and I convince myself I'm going going to lose my new job and end up in a hospital and be this way for years. 

[ChessieCat]

You are welcome.  I'm glad that some of what I have posted is helpful.

 

Have you seen this topic?  Check out the last one in the topic which I quoted today, but most/all of the posts are good.

 

Best of SA - Favourite advice and insights

[ChessieCat]

Just now, khoff4488 said:

"get up and look at something different"

 

It's funny that you say this, because it is one of things that Brassmonkey said in the post that I mentioned above.

[ChessieCat]

2 minutes ago, khoff4488 said:

I convince myself I'm going going to lose my new job and end up in a hospital and be this way for years. 

 

See this post:

 

best-of-sa-favourite-advice-and-insights

 

[khoff4488]

Had a really nice conversation with my therapist. Your thoughts came up and she agreed wholeheartedly. My girlfriend also agreed so it was something I was obviously missing. We focused on my grief and are probably going to for the time being unless something else comes up. I helped my mother pick out a box for my dad's ashes. It's a fairly simple one made of nice wood. He would have really liked it. Actually he probably would prefer a coffee can. He'd think that's hilarious.

 

I had a window where I felt almost completely normal today. It's been so long that it felt kind of weird. But no anxiety spirals. Also no withdrawal podcasts or videos so probably some connection there. 

[ChessieCat]

38 minutes ago, khoff4488 said:

Actually he probably would prefer a coffee can. He'd think that's hilarious.

 

I have literally just finished sending this via PM to another member:

 

My dad was a cabinet maker and was very particular but was very serious and couldn't laugh at himself or the mistakes he made, but he did laugh sometimes.  He did beautiful workmanship.  After we were being driven away from the crematorium my mum said that he was probably lying in the coffin and checking out the bad joins and knots in the timber.

 

40 minutes ago, khoff4488 said:

I had a window where I felt almost completely normal today. It's been so long that it felt kind of weird. But no anxiety spirals.

 

This is good.  You might write it down somewhere so that you can remind yourself of it.  When we get dumped by a wave it can sometimes be hard to remember that there were times we did feel better, like when you are sick with a flu some of the symptoms aren't as bad on day 3 as they were on days 1 and 2, but because you still feel awful you don't notice the improvement.

[khoff4488]

Absolutely going to write it down. It's going in my nightly symptom journal for this very purpose. So I can look back and see I feel good sometimes. 

 

That's really funny. My dad was a civilian contractor who built ships for the US Navy his whole life. He wrote in very blocky, legible handwriting because they are trained to write a certain way in drafting. We made sure to pick the best, most legible engraving we could find. He'd be furious if you couldn't read it. He did quite a bit of woodworking too. I've got a lifetime of tools to sort out. 

[khoff4488]

Little update. I've been doing quite a bit better. Still have some baseline DP/DR from the small dose of fluox im on but it's improving. Still having some weird emotions and stuff but nothing too crazy. Also pretty constant visual snow and tinnitus but they aren't very bothersome. I still have these episodes of really bad flushing, nausea, and headaches that i described before which I'm kind of just discovering might actually be migraines. I had kind of just assumed they were withdrawal waves, and they might be to some extent. I've had ocular migraines for a long time but they don't really cause me much discomfort other than seeing colors. These can be quite bad. I had one on saturday after being out with my girlfriend all afternoon. Had a heavy meal and walked probably a half mile to another shop so one of those might have triggered something. It is getting warm around here now too. Ill have to document when they happen and see if theres some connection i can make. Basically just something I need to be aware of and not feed into when they are happening. Still holding at 1.46 but I'm planning on making a 5% drop probably beginning of next month if things stay as they are. 

[khoff4488]

Little update. Went to 1.4 on 8/15. Had a really bad day a week after that. Then 2 weeks later another couple bad days but not as bad. Now 3 weeks and change having another few bad days. Flu feeling and negative thinking along with heightened dpdr. Was feeling ready to make a reduction and glad I did it but think I'll hold again but longer and then might try an even smaller drop of 1% or 2% and see how I do. Seems like it's going to be a long road getting off of this last little bit. 

[ChessieCat]

Fluoxetine has a very long half life so it may take 2-3 weeks for symptoms to appear, whereas with drugs with shorter half life symptoms might be felt within the first week after a reduction.

[khoff4488]

Yeah that's what I've noticed everytime I make a reduction that it comes in weekly waves. Follows what I've read about it and it's active metabolite. 

 

I remember back when I was on Paxil if I forgot to take it for even an hour I would get dizzy. That was honestly easier to get off of. 

[khoff4488]

Wanted to come back and give an update. Having an anxious day today. I've been holding at 1.38 using homemade liquid since October 5. Previous to that I tried to use the sliding scale of tapering and did a 1% decrease a week but only made it two weeks into my planned 4 weeks. It concerns me that a 1% decrease could cause such a strong reaction so I'm just holding until I feel better. Which i do at times. 

 

There are times when my windows feel almost completely normal.  My dpdr is mostly just a feeling now. It still comes back as visual on occasion but mostly it's just an ever-present feeling that something is "off". Especially at night when I'm tired. 

 

I have these episodes of what I can only describe as my brain rearranging where I feel way worse for a day or two and then my symptoms are improved or changed after. This happens every couple months.  I had one of those a few days ago. My visual stuff is greatly improved but now my main symptoms are headaches, nausea, and heightened anxiety. Also a lack of motivation and just feeling weird. 

 

Still grieving my dad and grandmother. Also split from my girlfriend because of all this last month which is relieving in some ways and sad in others. It's hard to know what's what. Probably all of it. Just taking things one day at a time.

 

I've thought about getting another psychiatrist but I don't know what they would do for me. Hope everyone had a good holiday.