Addax: 30 years with Fluoxetine and tapering

[Addax]

So this doctor wasn't completely clueless and pretty much just listen to my symptoms, acknowledged he was aware of discontinuation syndrome/withdrawal from SSRIs. He even said he knew there was some risk to reinstating... So I was kind of surprised. Even before I said it he asked if I had been prescribed the Wellbutrin to counter the fatigue and weight gain side effects of Prozac. So he seemed to know stuff.

 

His recommendation was to not reinstate prozac, stay at my current prozac dose, and based on my exhaustion, depressed mood and apathy add a small amount of Wellbutrin. He then asked what I wanted to do. I asked if he would just write a script for 75 mg tabs of Wellbutrin.

 

I still haven't decided what I'm going to do. I won't reinstate any Prozac. I'm too nervous about that back firing. As far as the Wellbutrin,

I honestly don't know how much to reinstate... 1/4 tab 2x/day? Less?

[Altostrata]

Interesting. Is this a psychiatrist? Does he know anything about tapering?

 

I don't know about adding Wellbutrin. It does tend to be stimulating. For a lot of people, that would be a bad thing.

 

Perhaps your body is just tired from drug changes. Are you getting some sun each day?

[Addax]

He wasn't a psychiatrist. I suspect I wouldn't be able to get in to see a psychiatrist before the end of October unless I was suicidal. He initially seemed concerned that I'd stopped taking Wellbutrin until I explained I'd tapered off, and he seemed surprised that I'd been tapering prozac for a year. He did not seem surprised when I quickly explained how I came to be on it and unable to get off it. That being said the entire appointment couldn't have taken longer than 5 or 10 minutes so it wasn't a very in-depth conversation. I'm not sure he's a permanent doctor at the practice.

 

I know Wellbutrin can be activating, but my fatigue has become nearly debilitating and I'm desperate. I get plenty of sun, but I have not been active... Too tired and just want to sleep... Exhaustion. Sometimes my heart pounds like I just climbed a flight of steps. It feels like exhaustion. But sleeping and not getting things done then cause me to become anxious and depressed. So I lay there tired, restless, anxious, and depressed... It's crazy making, really.

 

my hope is that since this was my only attempt to taper it my system may be less likely to freakout than if I were going to reinstate Prozac.

 

Any suggestion about an amount to reinstate with?

[Addax]

Well this just sucks. Akathisia has kicked in pretty hard this morning. I don't really understand what's going on. I haven't made any changes and I haven't reinstated anything as of yet.

 

I can't continue like this. Not now anyway. It's been over a month now. I wasn't going to reinstate any prozac, but the Akathasia has me thinking otherwise. I'll try and wait till Sunday to see if there is any improvement... But I feel like I'm kind of losing my battle right now.

 

Alto, I know it's up to me whether to reinstate prozac and or wellbutrin, but are you able to recommend an amount to reinstate if I do? It would be a dose to maintain me through the spring probably, when things will have calmed down and I will have completed what I'm currently working on.

 

I was thinking: 10mg prozac and 18.75 wellbutrin twice a day (1/4 of 75mg tablet).

[Meimeiquest]

Are you looking for a dose to stay on permanently?

[Addax]

To stay on till things settle down and I'm able to take some down time. Several months at least.

[Altostrata]

I'm sorry I can't say what will work, Addax. I would move in terms of perhaps 0.5mg Prozac or 5mg Wellbutrin to get a feel for what might work.

[Addax]

Thank you, Alto.  So much.

[cymbaltawithdrawal5600]

Please forgive me if I don't have all of your information straight, I have a hard time reading back in people's threads lately.

 

You found SA in April and from the looks of it wanted to get off your meds quite quickly, thinking you wanted to get the withdrawal part over with as soon as possible (you said you were fighting impatience). If you go back and read the beginning of your thread you were commended for taking a slower approach. What I cannot figure out is why you pretty nearly jumped off the wellbutrin. At a 10% reduction of the last dose you would be nowhere near close to being off that drug at this point. The purpose of that is to let your system gradually get used to a reduction in BOTH drugs, which have been propping you up for some time now. But you took one of the supports away and now I think you have upset the delicate equliibrium your system was in.

 

Your post in Symptoms (which I think should be here in your thread) about Jekyll/Hyde shows that you are experiencing high cortisol levels as a result of autonomic nervous system upset, i.e. withdrawal syndrome. The high cortisol effects are worse in the morning and day and gradually level off in the afternoon and evening. And then start the same thing over every day for who knows how long in any individual case. Once it starts, and you attempt to manipulate it with your drug dosages and supplements, you tend to make it worse. The 3KIS topics explain what you need to do, from when you first got here. A slow taper is a slow taper, not changing dosages every few months just because you want to get off the drugs. It is controlled and deliberate. You have to keep track of your daily symptoms and look for long patterns because dose changes don't show up that quickly. You came off 150 mg wellbutrin in 2 years and jumped the last half of that just since April. It is just now catching up with you.

 

Wellbutrin is activating in a fashion yet you want to add it back in when you are suffering from the agitation of cortisol. Not such a good idea if you ask me. Now is the time (I think) for you to stop everything and wait for your system to stabilize. Trying to beat it into submission with drugs so you can get what you need to get accomplished in your life is apt not to work. Did you ever stop drinking caffeine? That is definitely a must when cortisol is raging. Remember I said something about using other means to combat sleepiness? Think of the sleepiness you are experiencing as your body's backlash to wellbutrin dosing. The only way to get out from under it is to let your body adjust on its own, not by adding in more wellbutrin.

 

Anyhow, this is all well-meaning advice. You may have the mods delete it if you wish. I don't mean it to sound harsh, I am just not a very soft person when I see people on these boards go against the best advice they are apt to get anywhere, do what they want, and then have it hit them like a ton of bricks. Then they want to mess with the drugs or add a supplement to fix what has happened and it doesn't work. I hear the panic in their voices and I hurt for them. This is one condiition which has to be managed very delicately.

 

So it took a year after my CT to hit autonomic nervous system instability. I thought I was ok. Got thrown into high cortisol and brutal insomnia and all of the other goodies of the emotional variety. So I did another CT of my own: not one drop of caffiene since then. No OTC or any drugs of any kind, not even a tylenol for headache and I've suffered thru some bad ones from crying. Eat 3 meals a day. One walk nearly every day. Rest in bed from 10 pm to 6:30 am. Drink as much water as I can. Religiously take 300 mg magnesium every day as it is calming and stopped the heart palpitations. It is almost a year later since I have done this and I get 6-7 hours sleep a night, the horrific thoughts are gone. I am massively depressed and anhedonic but it occasionally lifts. It is what I have to go through because of what happened to me.

 

I hope you feel better and can figure out what to do. If it were me, knowing what I know now, I wouldn't add in any more drugs and I would stop tapering the prozac for a long time, maybe a year, and see if you stabilize. You are too valuable of a person to lose yourself in this mess. I'm rooting for you!

[Addax]

CW-

I read what you wrote twice trying to figure out what it was you thought might have me wanting an admin to delete it. Candidness and honesty may sting, but it has to be appreciated. You will have to pardon me if I come off as a little defensive. I got the sense you think I'm making dose changes on a whim, and I don't know why you think that.

 

What I cannot figure out is why you pretty nearly jumped off the wellbutrin. At a 10% reduction of the last dose you would be nowhere near close to being off that drug at this point. The purpose of that is to let your system gradually get used to a reduction in BOTH drugs, which have been propping you up for some time now. But you took one of the supports away and now I think you have upset the delicate equliibrium your system was in.

I followed the recommended 25-50% cuts noted in the Wellbutrin tappering thread that most people seem to be able to tolerate, while holding and Prozac tappering. It was going well with only mild fatigue as a symptom. Until the end of the Wellbutrin tapper anyway. The thread was only recently updated to suggest a tapper slower than 25 or 50% might be warranted in some cases.

 

A slow taper is a slow taper, not changing dosages every few months just because you want to get off the drugs. It is controlled and deliberate.

I know this. Hence my hold on prozac for 5 months and subsequent 10% cut after feeling stable after the Wellbutrin tapper was done. Again, the Wellbutrin tapper was done per recommendation in the Wellbutrin tapper thread in conjunction with how I was feeling. I haven't changed dosages beyond a slight updose after my 1st prozac cut felt too destabilizing. I'm confused about why it might seem that I have been changing doses every few months.

 

Wellbutrin is activating in a fashion yet you want to add it back in when you are suffering from the agitation of cortisol. Not such a good idea if you ask me. Now is the time (I think) for you to stop everything and wait for your system to stabilize. Trying to beat it into submission with drugs so you can get what you need to get accomplished in your life is apt not to work.

I'm not trying to beat anything into submission and I've not made any changes. It's not that I WANT to reinstate Wellbutrin. But I don't want to feel the way I have been either. When I'm so exhausted and feel as if I'll be exhausted forever, can't get my work done, am too tired to do much of anything and simply want to sleep, I welcome the idea of the activation Wellbutrin may cause. Hell, I fantisize about it. When I feel the Akathisia, anxiety and my heart pounding I want the relative calm I think prozac might bring. Of course I realize neither of those reactions are guaranteed.

 

I know reinstating can backfire. People remind me in my thread every time I've brought up reinstatement... but it's comforting to have information, like Alto provided, so that I feel I have options "just in case." There's something reassuring to me about having a back-up plan even if I never use it. It helps me to feel less trapped in my symptoms if I know there's a possible out. Having dose recommendations is comforting for me... To me I have a planned fire escape in case my brain yells 'fire', otherwise I could panic and just leap from the window.

 

Did you ever stop drinking caffeine? That is definitely a must when cortisol is raging.

I cut back my caffein considerably, but as I felt fatigued I stopped cutting it back any further for awhile.

 

Think of the sleepiness you are experiencing as your body's backlash to wellbutrin dosing. The only way to get out from under it is to let your body adjust on its own, not by adding in more wellbutrin.

I know, but the fatigue interferes with work I need to get done. I understand I could make sacrifices in my life and accept that opportunities may have to be by passed over. It would be inaccurate to say I can't do those things... It simply comes down to my unwillingness to. The repercussions would not only effect me. This is why I panic when I feel unable to get things done.

 

Anyhow, this is all well-meaning advice. You may have the mods delete it if you wish. I don't mean it to sound harsh, I am just not a very soft person when I see people on these boards go against the best advice they are apt to get anywhere, do what they want, and then have it hit them like a ton of bricks.

I'm not sure why you think I've gone against anyone's advice here and done what I wanted. I take everyone's advice and encouragement to heart, and have followed it. I also seek out information and read and ask, and consider everything. If I didn't listen to the advice here or do the reading and asking I would have reinstated the Wellbutrin weeks ago and updosed my Prozac. I've done neither. It's enough for me right now just to know I have the option.

 

 

I hope you feel better and can figure out what to do. If it were me, knowing what I know now, I wouldn't add in any more drugs and I would stop tapering the prozac for a long time, maybe a year, and see if you stabilize. You are too valuable of a person to lose yourself in this mess. I'm rooting for you!

Thank you CW.

[cymbaltawithdrawal5600]

Oh dear, your message does sound defensive and rightly so. My message to you was out of concern after I read of your question and description about cortisol in Symptoms and your asking for a recommendation for a dose to add back in the Wellbutrin. You remember my failed volunteer job? Well one of the ladies told me I should never be around people and I think maybe that is the case here as I seem to be very heavy handed. I don't think there is any way to save this but I'll try.

 

I should have read your thread more thoroughly and am doing so now. When people first come here for help. some of the first messages of help they get are from the Admins: Alto, Rhi. I an only at the point in your thread, after having gotten advice from them, where you are encouraged to follow a slow taper and you agree. I haven't found any mention where it was suggested a fast taper off Wellbutrin was recommended for any reason, even in the tapering Wellbutrin thread, only that some people get away with it.

 

The thing that triggered my concern was this: you originally were given Wellbutrin to combat sleepiness from Prozac but that is not all that the drug does. But you still want it to do that in spite of the fact that you sound like you are starting to feel the effects of autonomic nervous system instability. The worst thing to happen as a result of this is brutal withdrawal insomnia, which is due to so much cortisol raging.  Adding and subtracting drugs and changing doses seems to trigger this.

 

Anyhow, I was only trying to help. I always get a funny feeling when backup plans involve drugs instead of lifestyle changes. When the drugs stop working in ways you are accustomed to (and they most certainly do) the only thing that seems to work is to stop relying on them to do the trick.

 

I meant you no ill will and I really think I'd better think twice about posting any well-meaning comments in the future. WD is hard enough without my ham fisted commentary. And my wd itself may be causing my inability to express compassion. I am miserable and stuck in my misery. I only want good for people no matter how it may sound.

 

I always think it is a good idea for people to go back and read the comments from the Admins when they first got to this site. the comments here and after are an example. I don't know if I'll be able to keep reading your thread in time for you to see it but I am curious to know why you jumped off so quickly. But you really don't have to say.

 

Good luck to you and don't pay me any attention. My sig says it all: I don't know crap about tapering except what I read here.

[Petunia]

Hi Addax,

I just managed to catch up with your thread.  First I want to say I'm sorry you lost your dog, expected or not, its still a huge loss and something which will take time to adjust to.  I'm sure this is adding to the stress on your NS and playing a part in the way you are feeling. It can be devastating to lose a beloved pet.

 

As I've been reading through the posts, my opinion has been swaying from one side to the other, there are so many good reasons for not changing anything, but I also hear your desperation to get some control back over your ability to function so that you can save your project, its obvious how important it is to you.

 

I understand how it can feel helpful to believe we actually have options, whether we use them or not, it does give a sense of some kind of control and ease the panic a little, like as if we have a safety net to fall into if it ever gets bad enough.  I used to feel that way about my little bottle of xanax I kept in the fridge.  I hardly ever took any, but just knowing it was there was comforting.  For me, that's gone now, its no longer an option. My erratic drug and supplement taking pushed me to a point where it got very bad for a long time and I fell into my safety net once too often, but like you, there was something I had to get done, it felt like a survival issue, and in a way it was, I'm sure that it's set my recovery back a lot, but for me, there wasn't any other option I was willing to take.

 

We all have to live our own lives, be responsible for our decisions and live with the consequences, which can often be difficult because much of the time we don't know what they will be, but having some information and hearing about the experiences of others can help.

 

I honestly don't have any opinion about what you should do because I don't know what's at stake, or what it means to you.  But I noticed this: 

 

 

I cut back my caffein considerably, but as I felt fatigued I stopped cutting it back any further for awhile.

 

 

Caffeine is a stimulant and can stay in the body for up to 14 hours, it can make us feel more awake and energized but in a sensitized nervous system, it can have paradoxical effects.  If you are having cortisol mornings, then adding caffeine is probably making your symptoms worse,  adding to the stress/anxiety response and then increasing the level of exhaustion as the day progresses.  I notice this pattern in myself every day.  My mornings/days have my body tense and anxious with the cortisol fueled fight/flight response, then it subsides and leaves me relieved, but exhausted with very little motivation to do anything but rest.

 

I sadly gave up caffeine completely, and it continues to be difficult, I used to love the pleasure of those first few sips of coffee in the morning, for me, it was like a sacred ritual which was always worth getting out of bed for. 

 

But now, if I have any caffeine, even weak tea, in the morning, it makes the cortisol symptoms worse.  If I have any in the afternoon, I don't sleep.

 

You might find that giving up caffeine completely helps a little with lowering morning anxiety and afternoon exhaustion.  The energy we get from caffeine is a false energy, it ends up taking more than it gives.  It effects the action of several neurotransmitters and decreases blood flow in the brain, not a good thing when we are trying to promote stability and healing.

 

See Caffeine and the CNS

 

If you decide to reinstate a little Wellbutrin, as Alto suggested, please go with less, not more, but I would probably try giving up the caffeine first.

 

Petu.

 

 

[Addax]

CW-

I tried to temper my response post with explaining that I may "sound" defensive.  Without inflection I knew it would come across as defensive, when in fact I was just explaining any misconceptions.  I didn't actually feel like I was on the defense, nor did I feel like you were heavy handed.  I didn't question the fact that you were concerned and trying to help.  Not at all.  And I know there is no ill will.  

 

Given my current state and recent writings about desperation and reinstatement I don't blame you or anyone for thinking I was just going to start tweaking dosages.  I've THOUGHT about tweaking dosages, believe me.  So maybe you jumped the gun a little when you didn't read my entire thread.  Worse things have happened, and reading someones 5 month long thread is not easy task.  I'm guessing you responded to the urgency I've been conveying with your own urgency.  We're human and that happens.  

 

I wish I didn't see reinstatement as an escape route and that I could hold out for a window.  It's just with each day of lost work I become more and more desperate.  

 

I've seen your contributions in other places and they include good insights, support, and wise words... I still think that lady that told you you shouldn't work around people is wrong. Very wrong.  

 

I jumped off Wellbutrine quickly after reading that it was a weaker antidepressant and that people have been able to tolerate larger cuts.  The first few cuts I made went well and there were improvements in the form of relief from some minor side effects, so I kept going with the larger cuts.  I thought the short half-life meant that if there were going to be bad w/d symptoms associated with the steep decrease that I would feel them pretty quickly... apparently not.  It took a few weeks to catch up with me. Rhi even warned me, but  I attributed some evolving side effects to an error I'd made making my prozac solution.  

 

I'm sorry you feel so miserable. I truly wish you didn't.  I wish we didn't.  WD is a horrible, horrible beast, 2nd only to big Pharm and the drugs themselves.  Maybe it even comes in a nose a head those.  

[Addax]

Petu- 

 

I appreciate you going through my thread.  It's been a very difficult time of late.  I have a great deal at stake right now and w/d seems to be getting the better of me.  The cycle you wrote about, yeah, that's me too.  It's actually gotten a little bit worse in the last couple of days.  I tried to allow myself to do nothing all weekend, but ended up ruminating about everything I'm not doing and winding myself up more.  

 

I am giving up caffeine. I thought I was doing okay with the small amount, but you and CW have made me rethink this again and I do really need to cut it out completely. It's difficult because I get very tired and end up with a pretty bad headache during the first few days without coffee, so I have to time it right.  

 

There's a big part of me that wants to reinstate a small amount.  I need to function and my inability to do so is making me feel hopeless.  Till yesterday I thought it was enough to have a plan.  Today I feel like I need to use it  :'(. 

 

I had my prescriptions refilled and am considering trying a small reinstatement after I get done weening off coffee completely.  My morning coffee really is like a wonderful, sacred ritual.  That's a perfect description.  

 

Thank you Petu.

[rapunzel2]

just wanted to let you know I'm following your thread and thinking of you. I hope it will get better soon!

[mammaP]

 

  My morning coffee really is like a wonderful, sacred ritual.  That's a perfect description.  

 

Thank you Petu.

I was just the same with my coffee, I had just one cup of real coffee per day, first thing in the morning and

I felt like I couldn't  do without it. I loved that coffee! Then it suddenly hit me like a bolt out of the blue that

it might be affecting me, and Petu very gently told me off , she was absolutely right!    I gave up the

full caffeine and started having the same make but decaff and it's fine. I felt so much better after I gave it

up and not too much withdrawal either.  

 

Today has been a very bad day for me with awful symptoms and no sleep at all last night. Reading this

has just made me realise why, I went out with my grandson for lunch and they didn't have any decaff, then later

had a bottle of coke which was totally reckless of me!  I didn't think of the caffeine in it   I'm glad I dropped

by your thread now because I was a bit worried about why I felt so bad and thought I was going into a 

nasty wave! 

 

I hope you feel the benefit of cutting the caffeine, I know I did. 

[Addax]

Alto, Rhi, Petu, Bubble, CW, Andy, MammaP, Repunzel, Hudgens, I want to thank everyone for their support over the last month or so. What a horrible time it's been. I was sure I was losing my mind. The desperation that accompanied my experience is hard to explain. I don't think I would have made it through this last... Wave? Huge-gigantic-horribleness? if not for you guys dropping by my thread and writing, sharing, supporting, and advising. I am sincerely grateful.

 

So it seems the last wave has brought me to a new set of steps which will hopefully bring me to a landing with a window. I am not in a window, but markedly improved.... Without having reinstated anything.

 

I have some brain fog and mild headach, so I'll write more later... I just mostly really wanted to thank you all.

[Altostrata]

So good to hear, Addax.

[rapunzel2]

I am not in a window, but markedly improved.... Without having reinstated anything.

Yay!!!!!!!!! I'm so glad! especially that things are improving without reinstating. it seems that if you hold things constant for long enough time, then the brain finally adjusts!

[bubble]

that's what we were hoping (and believing) to hear

 

very happy for you and believe and hope thing will continue to improve 

[Rhiannon]

Glad to hear you're getting a bit of relief at last. Hang in there! There will still be ups and downs but over time the ups will gain on the downs.

 

I'd recommend giving yourself some healing time before making another cut in the Prozac, since you just came completely off Wellbutrin. Give your CNS time to recover from that big change. I'd hold for two or three months, and longer if you don't notice significant stabilization in that time frame.

[Addax]

Thank you Rhi. Unfortunately things took a bad turn and I ended up in a very dark place. By Wednesday I simply couldn't stand it and updosed from 8.5 to 10mg. I thought of a smaller increase but just the idea of making the liquid solution overwhelmed me. So I'm at 10mg and will stay here for several months. I did not reinstate Wellbutrin, as so many have pointed out it might not be wise due to the anxiety I was experiencing.

 

I'm not out of the woods. I know that. But here's something VERY interesting that I think explains this recent horrible down turn:

 

I had never thought to check the interactions of Prozac and Wellbutrin. I did. And I clicked on the "professional" tab. While I was aware that at higher doses the combination increases risk of seizures, I was not at all aware the Wellbutrin causes an increase in plasma levels of Fluoxetine. How much of an increase, I don't know. This took me back to those charts of dose vs plasma levels of the SSRI, etc in that article.

Here's the link

http://www.drugs.com/drug-interactions/prozac-with-wellbutrin-1115-648-440-203.html?professional=1

 

The link talks about case studies and big jumps in plasma levels of other ADs when combined with Wellbutrin. Kinda freaked me out.

 

If I'm conceptualizing this correctly, as I was making those large cuts in Wellbutrin, I was indirectly making "cuts" in my prozac dose... Possibly pretty big cuts.

[Meimeiquest]

Having taken both of them (separately), I think Wellbutrin inhibits a key CYP450 enzyme that metabolizes Prozac. Sorry I didn't think about that. I believe .i had problems coming off Wellbutrin related to the Same thing...a year ago...hopefully it will be in your past soon as well.

[rapunzel2]

that does make total sense! phew.... you just have to be a scientist to figure all out what's happening!

I hope the reinstatement helps and you will feel better soon!

[crazykatie]

Hey Addax,

 

Hope you're getting a bit more stable. I had to reinstate my wellbutrin 150 mg though. I was taking 450 mg. In addition, I take 40 mg of prozac. I think the Prozac helps me more with that depression n the wellbutrin gives me an increased level of energy. Wellbutrin is similar to a stimulant.

 

I know it sucks going backwards. I feel like it will be years before I will be med free. However, look at it this way; you are taking small doses. Not large doses. So there isn't as much weaning time wise. I feel angry with myself for reinstating but I also can't do everything at once. I just hold out hope that these side effects n after effects will decrease someday. A good day is a good day. Gotta enjoy it!!

 

Hugs

[Addax]

Thank you repunzel, crazykatie, and meimeiquest for stopping by. 

 

It's been almost a week since I reinstated to 10 mg of prozac.  I wish I could say that I'm feeling enormously better.  I have to admit that I'm so disappointed in myself for giving in and keep trying to remind myself that am still 30 milligrams from where I started just over a year ago with prozac (and 50 mg from my all time high dose). I held out for over a month.  I'm just not quite as strong as some of you are.   

 

I still wish I had understood the increased plasma level of Fluoxetine caused by the Wellbutrin before I started making those larger cuts... 

 

As it stands now, Cortisol is my biggest enemy and feelings of depression my biggest obstacle.  The fatigue is still there, but maybe not quite as pronounced. I know it's only been a week since i up-dosed, but I guess I was anticipating more significant improvements at this point.  I'm not asking for normal at this point.  Just functional. 

 

I did see a pdoc last week.  He was not at all helpful and I'm pretty sure had no real clue about tapering or discontinuation syndrome, etc., but he did say this; that he and his colleague felt it was highly irresponsible of the doctors I've seen to have kept me on Prozac for so many years.  So there's that. 

 

meimeiquest: What were some of the problems you had during your withdrawal from Wellbutrin? Were you tired?

[Meimeiquest]

Thank you repunzel, crazykatie, and meimeiquest

 

meimeiquest: What were some of the problems you had during your withdrawal from Wellbutrin? Were you tired?

Yes, fatigue and weight gain would be entirely expected. I did those, but I was also manic, over-stimulated, whatever. Dizzy, unable to think clearly, insomnia, gall bladder pain, extreme cortisol reactions..had watery diarrhea many times a day for three days, then accidentally took a 200mg instead of 100mg dose and it stopped, and I went manic. Once I got down to about 50 mg it was a more normal taper experience. Very depressed about four months off. I had really nice pdocs who really tried to make me comfortable...which means I was on a lot of meds. That definitely impacted things...I dropped 1/3 of the Wellbutrin two weeks after coming off Zyprexa because I was freaking crazy. It was definitely the most tumultuous taper for me.

 

Please don't feel bad about reinstating..I just wish it was helping more and faster. I reinstated a benzo while tapering Zyprexa. First of all, success is entirely how you define it. I don't know if I would have started tapering if I knew what it would be like at this stage of life. It doesn't mix well with raising teenagers, but I am making it and my pharmaceutical house of cards has collapsed and there is no going back. But as you move forward you learn more about yourself, more about withdrawing (now you know more about the liver than you probably ever wanted to know), and build your own personal toolbox of what helps you. You'll be fine and you are learning every day.

[Addax]

It's been a week since I updosed to 10mg and I haven't felt improvements . I'm not planning on doing it now, but I can't help but wonder if I would need to increase to a higher dose to compensate for the increase in the plasma level of fluoxetine Wellbutrin was causing.

 

At what point do I say, " up dosing didn't work to alleviate withdrawal? I've seen varying accounts of reinstatement alleviating withdrawal symptoms anywhere from 24 hrs to the 6-7 weeks it took for the drug to work in the first place.

 

When reinstating doesn't work or there is a bad reaction, is this kindling?

[Altostrata]

Kindling is usually activation from a drug. It doesn't sound like you have that.

 

Have there been any changes in your symptoms at all?

[Addax]

I'm feeling very activated. Agitated/restless, muscle tension, very fatigued, nauseous, and anxious. But with all that I have barely moved from my sofa in 2 weeks. It's been almost two weeks since my updose. Pretty much non-functional.

 

I forgot to take anything yesterday. I was kind of feeling better. Took prozac today and definitley felt an increase in the above mentioned symptoms.

 

I don't know what to do.

[mammaP]

Sorry you are feeling so bad Addax,  It is awful not knowing what to do and there is the urge to do something,

anything, in a desperate attempt to control what is happening. This will get better, it really will. 

[Rhiannon]

I'm sorry you're struggling and suffering so much. :-(

 

Please consider the things I have been saying about stabilizing. You just came off Wellbutrin quite fast, much faster than I would have advised. I would expect it to take many months to fully stabilize after that, even without the fluoxetine interaction that you discovered, and of course that has aggravated things.

 

I wish we had some kind of solution for you. Patience and time are the only things that consistently seem to work in this kind of situation. Adding fluoxetine doesn't seem to be helping, I'm so sorry.

 

The only thing I can think of might be to try a very small amount of Wellbutrin, say 2-5 mg, and see if you get any improvement or resolution of your symptoms. I suspect you're suffering withdrawal from coming off of it too fast. It's true that in general it's stimulating, but in withdrawal drugs can have paradoxical effects, and low doses have not been studied at all. Overall there are very few things we have found that really help people other than time and stabilizing and reducing stress, but one thing that does seem to help when people are in withdrawal from coming off something too fast is a very small amount of whatever that drug was. 

 

Unfortunately it's a crapshoot. Probably the best thing now is to just change absolutely nothing and to arrange your life so that you can take care of yourself and reduce stress. But the one other thing that I would consider in your shoes, and would suggest if you were my own daughter, would be to try just a very small amount of Wellbutrin (again, 2-5 mg, no more!) and give it a week and see if things change in any obvious way. It can be hard to tell of course because you've reached that point where things are going to keep changing up and down regardless of what you do or don't do.

 

I realize that my advice about Wellbutrin tends to not be the same as Alto's, and I'm sorry about that. I just haven't had the same experience with it that she has. I treat it the same as any other AD and just as cautiously.

[Meimeiquest]

I am no expert at all, except I have had SSRI withdrawal and Wellbutri withdrawal. Your symptoms were mine when I was tapering Wellbutrin. But that doesn't necessarily mean you would feel the same.

[Addax]

The nausea has passed, but the fatigue/depression, muscle tension and trembling remain. I feel physically weak as well. Still unable to get things done. It feels like my life is crumbling...

 

Rhi, I thought about adding a small amount of Wellbutrin, but it doesn't disolved well at all so I have no idea how much I'm actually getting. I tried it for a couple days but gave up when it wouldn't disolve.

 

I reached out to two doctors recommended on this site. One said he didn't know what to tell me as he's not known anyone to be on Prozac as long as I have been, nor at the high dose I'd been on for such an extended period. The other doctor said he wouldn't have advised me to try tappering and sees tappering successfully as unlikely for me given how long I've been taking Prozac. He recommended I updose to 20mg and stay there... Permanently if it works. A third doctor has told me I should go back to what was working prior to tappering: 20mg prozac, 150mg Wellbutrin.

 

So that's where I'm at. No idea where to go from here.

[Meimeiquest]

Do you have immediate release Wellbutrin? It is a bit cloudy from inactive ingredients, but the actual drug dissolves, by many people's experience, and according to the package insert. But SR will not dissolve. I am sorry you are having such a hard time.

[Rhiannon]

Addax, I agree with your doctors that long use and probably to some extent high doses do make recovery and growing a new, healthy brain more challenging. But I don't agree that it can't be done. If I can do this well, at my age, after 20 years on psych meds, with multiple CTs and changes, and as sick as I was when I started to taper four and a half years ago--well, I doubt that I am some huge exception to what's possible for humans.

 

I do think that I would never be able to do this fast, though. Your brain has designed itself to function in the presence of those drugs, and you need to give it time to redesign itself, and that is just not something that it can do quickly. Remember, our brains have never encountered anything like these drugs before, in evolution, so they don't have any kind of built-in mechanisms for recovery. They just sort of improvise and experiment, overshoot and undershoot, I suspect; at least that's what it feels like and sounds like. That's why it's best to make only very small changes at a time, and allow lots of time for adjustment.

 

As far as what to do right now, though, I can't offer anything other than what I've already said, plus the usual: read through the Symptoms and Self Care section for ideas about how to cope, and get all the support you can, and take it easy in your life. You may need to change what you do and what you expect from yourself for a while.

 

It's possible that a small increase in Prozac might help, I would probably try that if I were in your shoes, although I think I would probably try the small dose of Wellbutrin first, personally, since that's the last thing you came off. Those are the only things I would do drug-wise personally. If you do decide to take psych meds again, definitely start at lower doses than the ones suggested by the docs. You're sensitized now and there's no telling how it will go. Better to start very low and slowly increment up as you see how your body responds.