ktp: weaning from 4yrs 50mg Pristiq

[Gridley]

2 hours ago, ktp said:

so far i'm just skipping doses

 

We strongly advise against skipping doses. The brain craves stability.

The rule of 3KIS: Keep it simple. Keep it slow. Keep it stable.

Skipping doses is equivalent to reducing your dose by 50%.  Skipping days is NOT recommended by SA.  SA recommends tapering by 10% of the previous dose followed by a hold of about 4 weeks to allow the brain to adapt to not getting as much of the drug.

 

Skipping Days vs Every Day Dosing Graph

 

The half-lives of almost all psychiatric drugs are too short for this to make any sense. It causes the amount of the medication in your bloodstream to go up and down, battering your nervous system, and makes withdrawal worse.

 

[ktp]

> The half-lives of almost all psychiatric drugs are too short for this to make any sense.

thank you for good advice, but like I said, this is Prozac (with a half life > 7 days).  

 

any other great tips for prozac weaning?  I hear there's liquid or I can make my own from tabs or caps.  I'd most prefer to count beads from in a cap but my caps are just powder so liquid seems smart.  thanks again!

Edited July 13, 2019 by ktp

[ChessieCat]

From Post #1 of this topic Tips for tapering off Prozac (fluoxetine)

 

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

 

Is Prozac "self-tapering"?
Because of its very long half-life, Prozac has the reputation of being "self-tapering," meaning it requires only a short taper. However, some people do suffer withdrawal from Prozac, just as severe as other SSRIs. Because of the long half-life, withdrawal symptoms simply take longer to appear.

We suggest starting out with a slow taper of 10% per month for a couple of months; if no withdrawal symptoms appear, rate of taper may be increased -- but slow down if withdrawal symptoms arise.

Reduce by 10% per month to start
The 10% rule holds for Prozac, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

See Why taper by 10% of my dosage?

 

 

[ktp]

thank you.  If you can suffer through reading my sig you'll see I've been thoroughly convincedd of the need to keep reductions to <=10%/month, and with prozac maybe even slower, as I won't see the effect of a change for what could be quite a while.  I'll very soon be down to 10mg/day, smallest cap available, and it will be time for liquid.  anyone who happens to read this have tips re dealing with liquid prozac?  I can probably make my own from 20mg caps cheapest but no problem getting it over the Rx counter and further diluting.  ooh looky, after a few dilutions this is almost like homeopathy 😉

 

thank you again ChessieCat!

[Altostrata]

When you skip doses of Prozac to taper, you are still causing fluctuation of the level of the drug in your bloodstream and nervous system. Symptoms from this can become more severe as you go lower in dosage.

 

You can do this the way you want, but don't count on us to be able to dig you out if things go south. We're not miracle workers.

 

Quote

20190712

 

You have a very complicated way of displaying dates. What does the "20" stand for?

[ktp]

thanks for your reply.

20190712 means 2019 July 12.  in order for sorting, sorry that's so unclear.  

I'm well aware of the desire to keep dosage consistent, but I'm also aware that prozac has a half-life > 10 days so at this point varying dosages goes completely unnoticed.  But that's also why today's question in the Syringes thread: What's the solvent used to make liquid prozac?   

I see no point in trying to measure tiny amounts of liquid when further dilution would easily eliminate all the problems with trying to measure microliters.

[ktp]

 20190902 first day of liquid.  was skipping each 3rd day using 20mg caps so 13.3mg/day.  first batch of liquid is 13 20mg caps in 100ml water.   Using 5ml luer-lock syringes, 120ml amber glass bottle (same as the commercial product) with luer-lock cap and a F-F adapter to connect to syringe.  Dumped 13 20mg caps of AUROBINO-manufactured fluoxetine powder into 100ml water and shook it up, got two distinct layers of precipitate.  [May try adding ethanol and or glycerin to achieve solubility but no progress acquiring either glycerin or ethanol, doing without.  you can't buy ethanol at a drug store well not mine anyway. pharmacist says there's glycerin on aisle 12 but nobody can find it]   for today, my first dose of 13.0mg, I shook up my 260mg/100ml mixture and measured out 5ml.  it tastes bitter like drugs.  Planning to stick with this dose for the whole 100ml or 20 doses before making a cut

What are the ingredients in fluoxetine oral solution? Active ingredient: fluoxetine hydrochloride Inactive ingredients: 0.23% alcohol, benzoic acid, spearmint flavor, glycerin, purified water, and sucrose.

[ktp]

20190921 first day of 12mg via liquid made from 12 20mg caps in 100ml water.  (this is a 7.7% reduction after 20 days)

plan is to do the same thing again after 20 more 5ml (12mg) doses (8.4% reduction)

[ktp]

20200210 back to 9mg due to daily anxiety starting when I started Linisopril 10mg for high blood pressure.  pattern at 8mg is too-early awake, I try to entertain my brain with TV & Email, feel better within an hour of taking the prozac again.  So having read a lot about the efficacy curves it makes a lot of sense to decrease size and frequency of reductions.  the curve from 0mg to first effective dose is really really steep.  Gonna get through this.   

[ktp]

(See my sig for years of gory details.)  briefly, I've been taking antidepressants since 2009.  After a horribly failed venlafaxine taper in 2014, I switched to 10mg Prozac late 2016 ("easier to wean due to long half life" they said).  28Nov2016 I was rid of venlafaxine and taking 10mg prozac.  Still feeling anxious a couple weeks later, upped prozac to 20mg 15Jan2017, felt pretty good and after 2 more years I started weaning off prozac March2019 (first I noticed I was fine with missing an occasional dose, then made it a habit and skipped one day a week; 2 mos later I was skipping every 3rd day (NOT RECOMMENDED, EVEN WITH LONG-HALFLIFE PROZAC!!!) and was wonderfully stable.  Switched to liquid 2Sep102019, taking 13mg.   next few reductions...

20190921 12mg (7.7% reduction in 20days).  

20191010 11mg (8.3%/20days) 

20191031 10mg (9.1%/20days) 

20191124 9mg (10.0%/24 days)

20191213 8.5mg (5.6%/20 days) 

20191231 8mg (5.9%/20days) 

20190115 routine checkup revealed hypertension started Lisinopril and doubled statin per cardiologist.  (any chance this high BP is due to prozac weaning??)

20200120 anxious, made another 20-day batch of 8mg.  still anxious.  

20200208 back to 9mg after daily anxiety starting about 1/18.

20200212 back to 10mg prozac cap daily.  anxiety still there but seems to clear within an hour of drugs. 

20200221 still anxy 2 hrs after 10mg, added another 1mg and mucho better. 

20200223 11mg and still anxious, seeking advice, please, as i'm feeling a bit irrational.  Also should mention I am losing weight after starting Lisinopril.  that was nice at first but now i'm 10 pounds lighter after just a month, no change in diet.

Should i go back to 12,13,14,15, 20mg? Is Lisinopril a factor in this renewed anxiety?

  

recent reading is discouraging, research is more & more indicative of permanent brain changes and unlikelihood of successful weaning.  a pointer to a success story would be wonderful, are there any? 

[Please don't admonish me (already got plenty thank you;-) about my early dose-skipping; it was actually accidental at first and it encouraged me to try weaning again.  I stopped that routine as soon as I gathered the tools to do liquid.  I do NOT recommend skipping doses even with super-slow prozac.  thank you for any advice you can offer! 

 

 

[ktp]

https://www.survivingantidepressants.org/topic/7562-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

has the main chunk of advice I wanted to find: reinstatement by minimal amounts.  Well based in common sense and experience, I'll follow this guide and make any increments in 1mg amounts, no more than 1mg / week per Alto's advice.  

 

btw i'm 

I'm still curious about whether to blame my new hypertension on my prozac weaning.   "funny" how the BP goes back to normal at about an hour after I take my prozac.  (i take all at the same time: [11mg prozac, 87mg aspirin, 40mg atorvastatin (up from 20mg 1/18 or so), 20mg Lisinopril (new 1/18/2020)] about 9am upon return from dog walk.)

also read some nasty stuff here about too much statin causing too-low cholesterol.

does anybody reading have remarkable Lisinopril experience?

 

[Altostrata]

ktp, I moved your new posts here, to update your Intro topic.

 

Please explain more about your sensation of anxiety.

 

What times of day do you take your drugs, with their dosages? Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. You can post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right.

 

Please put ALL your drugs in the Drug Interactions Checker https://www.drugs.com/drug_interactions.php
and copy and paste the results or a link to them in this topic.

[ktp]

Alto, thank you for moving my content to where it belongs.  (I couldn't find it;-)

Drug interaction worksheet:  https://www.drugs.com/interactions-check.php?drug_list=1115-0,276-0,243-13622,1476-0 

Drug list: I take all of these...

prozac 10mg            long term, recently raised to 10 after seeing anxiety at 8mg.

atorvastatin 40mg   doubled mid-january per cardiologist

aspirin 81mg            long term

lisinopril 20mg         Rx'd mid January by cardiologist.

...first thing in the morning about 7am every day.

and since mid january I've been experiencing elevated anxiety, holding breath, tight stomach, impending doom, can't think clearly, constantly checking on my mental state, general undirected agitation makes me want to jump through my skin.  not yet at the level of needing xanax (haven't' touched that Rx in years) but close.  Best solution so far has been to take another 1mg after dog walk, and miraculously I feel much better within an hour.  did that a few times, raised dose to 9mg then 10mg and as of 

Much better is great, but what should I do to get back to "so comfortable I want to resume my weaning"?  I got down to 8mg and thought i was doing fine, then along came the hypertension (maybe caused by prozac weaning?) and cardiologist and more drugs.  these 3 all happened about the same time, so i don't really know my trouble is not enough prozac, could be too much statin or lisinopril is not the right drug for me or what can a stable brain come up with for this? 

18 jan 2020 Rx'd lisinopril 20mg (ACE inhibitor for hypertension)

18 jan 2020 Rx'd atorvastatin doubled to 40mg

started seeing anxiety, assumed prozac dose too low, held at 8mg, it just got worse.

Feb 8 2020 increased prozac from 8mg to 9mg.

Feb 12 2020 increased prozac from 9mg to 10mg.

Feb 16 ?        10mg at 7a, still anxious, add 1mg at 9am, better.

Feb 22          increased prozac to 11mg.  still anxious at 9am but afraid to make a move.

 

 

 

[ktp]

some data...

2/24/2020
00:00     can't go to sleep, but staying in bed okay with tv and phone for distraction from too fast brain. 2 hrs sleep
7am    10mg prozac 81mg aspirin.  delaying statin and lisinopril to see if any effect.
8am    back from dog walk, anxious lonely pit in stomach not quite impending doom but close.  reading @ SA...
830am    couldn't sit, took 1mg prozac liquid.  eating oatmeal.  i keep losing weight too fast now 182 was 195 on 2/1
930       haircut,shower.  pretty anxy, almost can't stay in the shower.
1145    lunch date nice burrito and still anxy but much less so.  
1300    mini golf with stef, outdoors and no pressure.  feels pretty good.
1600    strawb shake and feeling better.
1800    187lb dressed no statin no lisinopril.  slight headache doesn't feel like BP.
8pm     went to bed slept til 
2/25/2020
1am      now wide awake again after retire at 8p.  email, water, toast.  brain is churning with no fodder.
3am    same bit, trying bed again, on and off dozing
7am     11mg prozac 81mg aspirin skip statin skip lisinopril 181.0 weight loss would be great if deliberate
9am       oatmeal w raisins & berries.  still anxious.  should I try adding another mg of prozac?

[ktp]

02/25 continued

10am    sought psych referral from doc; took a dose of CalM but can't tell if it helped.
1100    dog park 2 hrs, spoke with cardiologist nurse who said her doc said double the lisinopril not gonna happen.  
1200    not a trace of anxiety
1500    more dog play, tacos.
1900    pasta salmon pesto yum!  bp 155/93 61 after eating.
2200      bed, tired, anx small
2/26/2020
0300    awake but not jumping thru skin.  anx mild but awake til
0700    11mg prozac 81 mg aspirin 3rd day no statin no lisinopril.  can't tell if it's helping or not!
0800    visit Grace in kaiser burn unit. busy, a bit anxious but sitting mostly.
1000    battery shop, dog park, driving range
1600    home, feeling pretty good but what to do?
1420    call from Stanford Psychiatry, offering med analysis, i declined, they don't do any talk but offerred a counseling pointer.
2000    shower, bed, tired
2/27/2020
0645    toss & turn most ofs the night with occassional dozing.  anxiety, can't relax 182lb bp 162/117
0655    11mg prozac 81mg aspirin.
0800    reinstated referral to Stanford Psych, i'll get a phone eval on 3/13 and an appt ~ 5 weeks.
0930    still anxious after long dog walk.  CalM, oatmeal...
1027    bp 157/87 p70, calmer but still out there.

1105    add 1mg prozac!

Edited February 27, 2020 by ktp
dup data b4 2/25; 2/27 1105 1mg prozac experiment

[ktp]

got a referral to stanford psychiatry, will get a phone eval on 3/13 also on waiting list.  secy says at least 5 weeks before real appointment.  for counseling they suggested "feeling good institute" onto which i'm glomming today.

[ktp]

more data...

1105    1mg prozac makes total of 12mg today.
1305    feeling a little better, i can sit here.
1800      back from tacos, dogs, goodwill, more dogs, feeling much better.  
1900    normal pasta supper, pretty calm.  edgy but not crazy.
2100    bed.  actually slept most of the night, 
2/28/2020
0600    slept pretty well, not exactly calm but not freaking out, way better. 11mg prozac 81mg aspirin.
0700    dog, just a bit jagged.
0800    added 1mg prozac; oatmeal w berries, coffee.  shoulda skipped the coffee but feet on the ground i think
0905    bp 139/98 p79
1230    pbj
1400    dogs, tacos, 3rd, 24hr
1900    tv pasta chicken feeling pretty good.
2/29/2020
0700    mildly jagged but ok.  11mg prozac & 81mg aspirin.
0900     add 1mg prozac, 12 seems to be better than 11.  oatmeal, coffee.
1230    pbj 
03/01/2020
0300    why awake?  staying abed but anxy, dozing
0743    12mg prozac 81mg aspirin mildly anxy 185lb 184/113 61
0830    dog
1257    184/113 61 right arm
1258    117/91 63 left arm
2030    bed, tired
03/02/2020
0300    awake, lost phone! freakout 0330 found it but no more sleep just read on phone.
0730     12mg prozac 81mg aspirin 20mg atorvastatin 10mg lisinopril; dog.
0830    too many figs ha.  
0930    anxious but tired, need sleep.

[ktp]

more diary data; still anxious 3/4...

1600    back from gym dog tacos more dog, sleep deprived, clogged brain needs a rest. nap ~1hr
2030    tv sucks go to bed.  
03/03/2020
0630    wow, slept better.  still anxious.  sore from gym 🙂
0700    12mg prozac, 81aspirin, 10mg lisinopril, 20mg atorvastatin.  out w dog.
0845    oatmeal berries raisins, CalM 
03/04/2020
0200    awake and anxious.  email,etc til 730 some dozing.
0700    out for dog walk, still anxious, feeling overheated.
0900    12mg prozac, 10mg lisinopril, 20mg atorvastatin, 81aspirin.  155/104 69
0910    oatmeal berries raisins no coffee

[ktp]

stanford psych doesn't do any counseling, so they referred me to FeelingGoodInstitute Mountain View.  arranged a 15min intro call; doc who called says...

1) no insurance accepted

2) intake interview $800

3) 50 min counsel $500

4) parroted the switch to Prozac and quit CT; "weaning? you must be sensitive".

four strikes against this one.

[ktp]

diary continued

03/06/2020
0230    awake anxious reading dozing
0700    12mg prozac 81aspirin 10Lisinopril 20Atorvastatin bp 186/109 63
0830    back from longish walk bp 157/107 73.  got lisinopril Rx doubled.  got appt to see cardio psychologist.
1100    drive to arcata 
03/07/2020
0400    awake anxious reading dozing.
1133    159/96
03/08/2020 
1031    159/98 60 
1739     154/98 83  
03/09/2020 
0701    166/100 58
0800    fairly calm, slept better, minimal awake time.  sinus is clear, helps a lot!
1902    161/100 60    
03/10/2020
0625    160/98 70
03/11/2020 
0757    152/90 52 slept pretty well. 🙂
0830    12mg prozac 81aspirin 10Lisinopril 20Atorvastatin no CalM, anxiety 0
1306    148/95 53
03/12/2020
03/13/2020 
0724    158/96 59 12mg prozac 81aspirin 10Lisinopril 20Atorvastatin anx3.  bad sleep 3rd day zombie
20200315 0736 178/103 61 same drugs + CalM
20200316 0900 increase prozac +1mg: 13mgProzac 81Aspirin 10Lisinopril 20Atorvastatin anx3.
20200316 2040 anx1
20200317 0800 slept better, clear sinus.
20200317 1134 159/97 61 13mgProzac 81Aspirin 10Lisinopril 20Atorvastatin anx2
 20200317 1635 157/102 63 'normal' headache behind left eye, anx0
20200318 0915 13mgProzac 81Aspirin 10Lisinopril 40Atorvastatin (doubled per cardiologist) anx3.

 

Edited March 18, 2020 by ktp
extraneous irrelevant garbage removed