MontanaMan: Delayed withdrawal or adverse reaction? Need guidance

[MontanaMan]

22 year old male,  this is my first post here, but I have been lurking here for awhile and have read many other peoples experiences... 
History of mild depression, anxiety, cannabis use had a overall great life and had no reason to take ssris
Jan 2017 (17 years old)- Prozac 10 mg by family doctor for a single panic attack and some anxiety. This didn’t do much, maybe lifted my mood artificially for a few months
May 2018 rapid taper, had no withdrawal besides some anhedonia and felt pretty good through the summer
October 2018: reinstated 10 mg Prozac had a cycle of some anxiety which isn’t uncommon for that time of year, could have either been delayed withdrawal or just seasonal 
December 2018: began taking the legal supplement Kratom (partial opiate agonist, serotonin receptor agonist) for back pain. Soon started taking it every day
Jan 2019: upped to 20 mg prozac 
August 2019: upped to 40 mg prozac 
Through 2020 I slowly worked up to my maximum dose of Kratom being 25 grams per day (a moderately high dose)
September 2020: had a serotonin syndrome like reaction from the double whammy on my serotonin system of Prozac and Kratom. I dropped my dose instantly by 10 grams ( to 15 gpd) this ended the serotonin syndrome like effects but left extreme anxiety and depression. 
Sept 2020- January 2021: tapered my Kratom dose ton 7 grams per day, had a tough time but it was bearable, I had good and bad days 

Jan 2021: my doctor suggested I switch to lexapro because the Prozac “wasn’t working” so he put me on 10 mg per day (under half of the equivalent dose of Prozac which I had been taking) and told me no need to cross taper.

Feb 2021: Had some mild accutes in the first 2 weeks (anxiety, trouble sleeping) which subsided

march 2021: had a mild window, felt better than I had felt in months 

may 2021: window slowly transformed into extreme fatigue, weakness, horrible internal agitation (not akathesia more like a sick disgusting uncomfortable feeling in my body), insatiable appetite and thirst crushing depression and low self esteem like I’ve never had before etc. At the time I thought it was from either the Kratom taper or lexapro adverse reaction, I now suspect it was delayed withdrawl) the majority of days were absolutely terrible then I would have some days where I randomly felt pretty good, almost manic

summer 2021: continued tapering Kratom,

had a pretty brutal time with withdrawals

sept 2021: had a window all fall (not complete remission of symptoms but I felt better, much much less internal agitation, and had much more goodish days) which I think was a combination of moving to Montana for school and doing a bunch of fun new stuff, and possibly from taking a supplement for gut health which contained grapefruit seed extract which enhances absorption of ssris 

december 2021: window ends and symptoms went back to almost as bad as they were in the summer, this exactly coincided with both me stopping the grapefruit seed supplement and also going home for Christmas break and going from occupied with fun stuff to being very bored 

Jan 2022: continued terrible symptoms 

February 2022: complete my Kratom taper at 0.8 grams per day (from 25), continued terrible symptoms but slightly more clear headed after getting off Kratom 

March 2022: continued terrible symptoms but had a week long window while I was in a fishing trip in California (possibly triggered by the warm weather and fun stuff) 

April 2022: continued terrible symptoms, feeling very frustrated, seemingly little progress 

may 2022: I decide the best course of action is to try to go back on the Prozac because I was on it for the longest and at the highest dose (I thought it could be an adverse reaction from the lexapro, or Prozac specific wd). I also had a fainting incident that was related to that internal agitation feeling I have had since I cut and switched to lexapro.  I requested to be put on 20 mg Prozac (about the equivalent to the dose of lexapro I had been taking) my doctor agreed to give me Prozac but refused to give me the 20 mg equivalent dose because he said it didn’t work last time and said I would be fine taking 10 mg. 
May 2022: within days of switching to 10 mg Prozac my worst symptoms alleviated, I felt more clear headed and less depressed, but much more anxious (this was a welcome change, and an overall improvement) this improvement continued into a window in which I haven’t felt as good since the beginning of this all. I still was/am depressed (but not nearly as bad)  and have more anxiety/ocd but overall I don’t feel sick, brain dead, and internally agitated I don’t feel 100% but I feel like I can actually enjoy my life. 
June 2022: I am greatful for the improvement, but I know if it is too good to be true then it probably is. I am expecting this window to end with a crash of delayed withdrawl a month, two months or three months out. I don’t understand how I could feel better by further dropping my ssri dose unless it was an adverse reaction to lexapro which I find unlikely at this point. I spent much of June worrying about this 

July 2022: it’s now July and I have been worrying a lot about what to do, either wait it out and see if it was a bad reaction to lexapro and see if delayed withdrawals come. Or see if I should go up to 20 mg Prozac (the equivalent of the dose of lexapro I was taking) and not run the risk of letting my CNS get out of wack. It could totally be in my head because I’m worrying but I feel like symptoms have been starting to come back the last few days. I feel like the odds of this window lasting and not turning into an even worse wave than before I cut aren’t great. The internal agitation/sick/brain dead feeling have been gone since a few days after the drop, my fear is that coming back far worse. I can deal with regular depression and anxiety but this crushing agitation and sick feeling paired with the depression is my greatest fear
 

should I see if I can go up on the Prozac? 
should I wait? 
has anyone else had similar experiences? 

Has anyone else felt better after a drop only for delayed withdrawl to come? 

 

 

 

 

 

[MontanaMan]

Delayed withdrawal? Not sure what to do, need guidance

 

22 year old male, first ever post but long time lurker
History of mild depression, anxiety, cannabis use had a overall great life and had no reason to take ssris
Jan 2017 (17 years old)- Prozac 10 mg by family doctor for a single panic attack and some anxiety. This didn’t do much, maybe lifted my mood artificially for a few months
May 2018 rapid taper, had no withdrawal besides some anhedonia and felt pretty good through the summer
October 2018: reinstated 10 mg Prozac had a cycle of some anxiety which isn’t uncommon for that time of year, could have either been delayed withdrawal or just seasonal 
Jan 2019: upped to 20 mg prozac 
March 2019: upper to 30 mg
August 2019: upped to 40 mg prozac
September 2020: had a strange reaction/poop out reaction from the double whammy on my serotonin system of Prozac and Kratom. This left me with extreme anxiety and depression. 
January 2021: lexapro 10 mg, my doctor suggested switching to lexapro because the 40 mg of Prozac “wasn’t working”. He prescribed lexapro 10 mg (under half of the equivalent dose to Prozac which I had been taking) and told me no need to cross taper just switch right over 
Feb 2021: one month on lexapro I had some sleep issues and anxiety from accute withdrawl of the Prozac 
March 2021 : I actually started feeling better than I had in months, accutes let up, I thought I was turning the corner, this window lasted 2 months.
May 2021: this window slowly transformed into what I think is delayed withdrawal or an adverse reaction to lexapro

terrible symptoms throughout the summer 

sept - December 2021: window that coincided with me moving to Montana for school and taking a supplement for gut health which contained grapefruit seed extract that enhances absorption of ssris. 
December 2021: came home for Christmas and stopped taking the supplement, back to the terrible symptoms within 2 days 

Jan - March 2022: terrible unrelenting symptoms except for one week when I was on a fishing trip

April 2022 10 mg Prozac, Switched to Prozac thinking it was an adverse reaction to lexapro or Prozac specific wd, doctor refused to put me on 20 mg Prozac (the equivalent to the 10 mg lexapro dose) because “it didn’t work last time” 

May 2022: days after dropping/switching, An unexplained window started, my worst symptoms are gone and my depression is significantly better, I start thinking that my symptoms were because of lexapro 

June 2022: window continued, feeling too good to be true (not completely depression free but feeling better than I had since I switched/dropped from lexapro to Prozac) and starting to worry about delayed withdrawl 

July: currently reading about other people’s experience having delayed withdrawal after a window and consequently being unable to stabilize, I can’t wrap my head around why I would feel better after cutting my dose by 50% unless it was an adverse reaction to lexapro or delayed withdrawl is coming 

 

I am wondering whether I should wait it out and see if withdrawl comes or just see if I can go up to 20 mg Prozac (the equivalent to the lexapro dose I was taking before the drop) and not risk going into withdrawl and CNS destabilizing. However I also worry that trying to do think could cause some adverse reaction since I’m feeling better right now. I’m still feeling better but I feel like symptoms could be creeping back in already, but it could also be because I’m worrying non-stop about it 

 

its all just so confusing and I know nobody can make the decision for me but I am just looking for advice

 

Edited July 3, 2022 by ChessieCat
added Intro topic title before merging with intro topic

[MontanaMan]

Update: after doing more research on this site I realize that it was classic delayed Prozac withdrawal that gave me my horrible symptoms. But those symptoms did not include any anxiety/Cortisol type symptoms, they were all crushing depression, extreme fatigue, overeating, feeling sick physically. I think this may be because both Kratom and Prozac are 5 ht2c antagonists which increase dopemine and norepinephrine. Since switching back to the Prozac, this crushing fatigue, depression, and sick feeling have lifted, but anxiety, early waking, lack of appetite have took its place. At first this was preferable because I felt improved. But in the days since writing the initial post, my anxiety has been ramping up significantly and I’m starting to feel more withdrawl symptoms like bad brain fog and slight dizziness. I could deal with how I feel at the moment but I know it could continually worsen over the next weeks and I’m not sure what to do, Increase Prozac, stay at Prozac 10 mg and see what happens, switch back to lexapro (it’s only been 2 1/2 months since I switched) 

[getofflex]

Hello, and welcome to SA.  We are a volunteer-run community of people who have been or are getting off of psychiatric drugs.  What is you goal here - is it to get off of psychiatric drugs?  It sounds to me like overall, you are doing better on the Prozac than on the Lexapro.  Let me give you some basic info, then discuss your situation after than.  

 

Can you please be more specific and detailed about your recent drugs? In the last line of your drug sig, did you mean to say "April 2022"?  Please correct this if so.

 

It would be especially helpful to have the details of your drugs in a concise vertical list (no symptoms), only drug names, specific dates (as best you can say for example early March if you don't recall the day) and dosages of each medication decrease or increase.  Use this format:

 

Drug name: date, dose, date, dose, date, dose…

Drug name: date, dose, date, dose, date, dose…

Etcetera

 

Please read the link below for instructions.  This will allow us to give you the best guidance.  Thank you.  

 

 

How to List Drug History in Signature

 

Here is some important information about how these drugs actually work.  This explains why we get symptoms from going off of these medications, and why it's so important to taper slowly and carefully, and be very cautious about changing our drugs and doses: 

 

How Psychiatric Drugs Remodel Your Brain

 

 

This helps you understand what withdrawal syndrome is: 

 

Video on Recovery from Psych Drugs

 

Windows and Waves Pattern of Stabilization

 

 

Here is a link with checklists of common WD symptoms: 

 

Dr Joseph Glenmullen Withdrawal Symptom Checklists

 

 

Here are some techniques to cope with symptoms: 

 

Non Drug Ways to Cope with Withdrawal Symptoms

 

Stability is really important when we are tapering off psych meds.  Please read the link about stability:

 

Keep It Simple, Slow, and Stable

 

 

We don't suggest many supplements, but 2 that many of us find helpful are magnesium and omega-3 fish oil. Here are the links for info about those. It is suggested to add one at a time, and start with a low dose to see how it affects you. 

Magnesium

Omega 3 Fish Oil

 

It sounds to me as if your nervous system is destabilized from the various drug changes and tapers you have done in the past 2 years.  Unless you are having an adverse reaction to Prozac, I would suggest staying on the Prozac 10 mg, and not go up to 20 mg prozac.  Doing so would put you at risk of further sensitizing your nervous system and destabilizing it, which would just make your situation worse.  The trap a lot of people fall into, is they feel bad, and they keep changing drugs and doses to try to fix it, and they usually end up just making their situation even worse.  This is because the more we jump around on drugs and different doses, the more confused our brains become.  If you checked our my second link on how these drugs remodel the brain, you will see why.  And the doctors don't help, because the vast majority have no true knowledge of withdrawal from these drugs, and how much they change our nervous systems.  I understand you are having anxiety on the Prozac, but this could be a combination of things:  1) your nervous system being destabilized from the several recent drug changes, as well as 2) the fact that you are anxious about the future, and getting hit with another wave.  I suggest you work on trying not to project in the future, and worry about what will happen.  Anxiety tends to feed on itself, and get worse, and go into a downward spiral.  

[MontanaMan]

Hello, 

I appreciate your response and apologize for not getting back to you. Yes my long term goal is to ultimately get off meds, currently my goal is to stabilize enough before I go back to university in mid august, from there I will hold then start a slow taper. The reason I switched from lexapro to Prozac back in April is because of the terrible physical symptoms I was having on lexapro, aswell as the fact that Prozac is easier to taper (I looked into the SA Prozac bridge guide) but instead of giving me the equivalent dose I was given essentially a 50% cut. This caused me to have a good window for 2 months then delayed withdrawl symptoms hit around the time I made this post. anxiety, total lack of appetite, temperature sensitivity, night sweats, dizziness and disorientation,etc. This was not simply anxiety but very much withdrawal symptoms. I went to the doctor 2 days before you responded and she upped my Prozac dose to 20mg. However I saw from the Prozac bridge guide that you should go up slowly so instead of going straight to 20mg I went up to 15 mg, and I’ve held there for around 9 days. After a few days on the increased dose I had a slight decrease in anxiety (still pretty bad though)  and near full elimination of wd symptoms like temp sensitivity and dizziness and disorientation, and my appetite has returned. I have been having a lot of ups and downs in terms of my mood, in general feeling anxious in the morning and afternoon but feeling better at night. But also having a couple days were a felt good most of the day aswell as terrible most of the day. Last night I also had a panic attack that woke me up at 3 in the morning following a bad dream about my situation. I have a lot of fears that I messed myself up and won’t be stable going back to university, which makes my anxiety worse obviously. Should I hold at 15 mg? Go up? 

[getofflex]

8 hours ago, MontanaMan said:

I appreciate your response and apologize for not getting back to you. Yes my long term goal is to ultimately get off meds, currently my goal is to stabilize enough before I go back to university in mid august, from there I will hold then start a slow taper.

This sounds like a wise and prudent plan.  

 

8 hours ago, MontanaMan said:

I went up to 15 mg, and I’ve held there for around 9 days. After a few days on the increased dose I had a slight decrease in anxiety (still pretty bad though)  and near full elimination of wd symptoms like temp sensitivity and dizziness and disorientation, and my appetite has returned. I have been having a lot of ups and downs in terms of my mood, in general feeling anxious in the morning and afternoon but feeling better at night. But also having a couple days were a felt good most of the day aswell as terrible most of the day. Last night I also had a panic attack that woke me up at 3 in the morning following a bad dream about my situation. I have a lot of fears that I messed myself up and won’t be stable going back to university, which makes my anxiety worse obviously. Should I hold at 15 mg? Go up? 

It's good that you feel overall better on the 15 mg than on the 10 mg.  It takes about a week for the updose to become steady state in your body and register with your brain, but it can take a month or two for the new dose to become fully effective.  Therefore, I suggest you do not change the dose again at this time. If I were you, I would hold at the 15 mg. Prozac for a long time - at least several months. Please realize that this may not eliminate all symptoms, but it should make them more bearable.  You may still have windows and waves - please don't change your dose if you end up in wave, it's better to just ride it out. 

 

when you are stable, and feel you are ready to begin tapering, then you can try a reduction as described below.  

 

 Why Taper by 10% of my Dosage  

 

Tips for Tapering Prozac

 

Stability

[MontanaMan]

the last 2 days I have been feeling worse in terms of anxiety. I haven’t felt better at night like I usually do. I’m quite scared it’s going to get worse. Do you think this is just a wave? If it does get worse should I go back down to 10 mg? Not sure if it’s the Prozac causing the anxiety or just from withdrawal/sensitization. I’m not going to make any impulsive descions but not sure what to do if this continues. Hopefully it stabilizes because this is pretty bad. 

[ChessieCat]

2 hours ago, MontanaMan said:

the last 2 days I have been feeling worse in terms of anxiety.

 

2 hours ago, MontanaMan said:

Not sure if it’s the Prozac causing the anxiety

 

April 2022: drop lexapro and added 10 mg Prozac 

July 7: 15 mg Prozac 

 

For most psychiatric drugs it takes about 4 days for a dose to get to full level/strength in the blood and a bit longer for it to register in the brain. 

 

HOWEVER Prozac has a very long half life.

 

You increased the dose from 10mg to 15mg on 7 July which is about 10 days ago.  If you look at the following you will understand that the drug is still increasing to full strength.  See what I have highlighted in red in the quote.

 

On 7/3/2011 at 4:11 AM, Altostrata said:

Prozac has the longest half-life of any SSRI. After you take it for a few days, half-life is about 16 days. Fluoxetine itself has a half-life of 2-4 days, but as it is processed, your body creates an active antidepressant metabolite, norfluoxetine, which has a half-life of 7-15 days. So Prozac keeps on extending its half-life as it is metabolized.

According to http://en.wikipedia.org/wiki/Fluoxetine , fluoxetine and norfluoxetine inhibit each other's metabolism, extending the half-life of the drug. Because the half-lives are so long, the full effect of Prozac on the brain may not be felt for several weeks.

fluoxetine (1-6 days) ---> norfluoxetine (up to 16 days) ---> other metabolites

 

 

 

2 hours ago, MontanaMan said:

If it does get worse should I go back down to 10 mg?

 

I'm assuming that you increased from 10mg because you felt that it wasn't enough.  It would seem from what you have noticed with the timeline of when the increase in anxiety occurred that 15mg is too much.  You could try going to 12.5mg, however it will take a couple of weeks before you can tell the effect of the decrease so you will need to be patient.  It's going to take time to reverse the effect of the increase and then more time to know if 12.5mg is the dose that works for you.

 

Post #1 of this topic explains how to get non standard doses:

 

Tips for tapering off fluoxetine (Prozac)

[MontanaMan]

Thanks for the reply. I increased from 10 to 15 mg because I was starting to have delayed withdrawl symptoms from dropping the lexapro and was trying to take into account this information 

 A significant characteristic of Lexapro is that milligram for milligram, it is much stronger than other SSRIs.Chemically, Lexapro is a variation of Celexa; the molecule was re-engineered to be patentable as Celexa's patent was about to expire. The streamlined molecule is a more potent SSRI, 2 to 4 times stronger than others. 

so I was trying to compensate for the 50% drop in dosage from the lexapro and subsequent withdrawals. Which is why I’m not sure if the anxiety is from the Prozac or the wd from lexapro. I’m not sure if I should stay at 15 mg or drop to 12.5. Seems I’m stuck between a rock and a hard place. The question is what is the bigger risk, the wd symptoms from the 50% drop in dosage or the 15 mg possibly being too much. 

[ChessieCat]

4 hours ago, ChessieCat said:

You increased the dose from 10mg to 15mg on 7 July which is about 10 days ago.  If you look at the following you will understand that the drug is still increasing to full strength. 

 

You made a 50% increase in the Prozac.  And I explained my reason for going to 12.5mg.

 

The timing fits with the Prozac dose building up in your system and it still hasn't got to full strength yet.

 

And you stopped the Lexapro in April, no date supplied, so it is at least 2.5 months or possible even 3 since you were taking whatever dose of Lexapro that you last took so your brain will have made adaptations during that time.

[MontanaMan]

I understand. You dont think it could be the lexapro withdrawal taking full effect rather than being caused by the Prozac? If you were me would you drop the dose now or wait to see if I’m just in a wave? 

[Altostrata]

21 hours ago, MontanaMan said:

I increased from 10 to 15 mg because I was starting to have delayed withdrawl symptoms from dropping the lexapro

 

What were these symptoms?