Stone: Tapering problem - please help - a bit urgent

[bubble]

Stone, I know you are struggling with which of the two courses to take.

 

If I may help, I think you won't make a mistake with either decision as long as you stick with it. You obviously need a higher dose than 1.25.You might get it both with increasing citalopram or bridging with Prozac as Alto suggests.

 

Also, any course will take some time for the symptoms to subside.Hope this helps.

[stone]

Hi Alto and thanks, first I should clear something up, I was not on 2.5mg Citalopram I was on 1.25mg. I still feel a bit better today, thanks. No headache either, 10mg might have been ok. Did you read that I had decided to re-instate the Citalopram today at 1.5mg already? So, I have aleady taken that dose today. I feel I am now committed to that because I have already messed my brain up enough as it is.

 

I understand what you were saying but going from 1.25mg Citalopram to 10mg of Fluoxetine seems a big jump, a big jump I was seriously considering doing too, like I say I was 50/50 about the whole thing and deciding what to do was very hard. I very nearly kept on with the 10mg Fluoxetine but from the day I started taking Fluoxetine I had second thoughts about it.

 

If before I had ever started weaning from ADs, I had known about the "bridging" thing I might well have done it but it just seems a bit late when I was down to 1.25mg Citalopram. To go from 1.25mg to 10mg isn't bridging so much as it is taking nearly 10x the amount of something and then starting to wean again... when? At least that is the kind of thought processes that lead me back to "the Devil I know".

 

Maybe it would have been better to do start with 5mg of Prozac and stick with that, maybe even go up to 10mg, but when I started the Fluoxetine I was in a panic, not thinking or planning, just jumping at a full dose of 20mg and basically scrapping the whole weaning thing and deciding I was wrong to have ever even begun weaning in the first place. It was a panicked rash thing and I regretted it.

 

I really didn't think the Fluoxetine could be working so soon and put my improvement down to some kind of placebo effect, the moment I decided to "do something" about how I felt (the something was to take the Fluoxetine) I started to feel better, I believe that thought of "here I am doing something to help myself" may have brought about an improvement in itself.

 

I am still not convinced I have done the right thing, especially as you don't seem to think so...but I felt I had to decide today and I couldn't keep taking 10mg while being unable to decide without effectively "locking myself into" Fluoxetine for considerable time. 

[stone]

Stone, I know you are struggling with which of the two courses to take.

 

If I may help, I think you won't make a mistake with either decision as long as you stick with it. You obviously need a higher dose than 1.25.You might get it both with increasing citalopram or bridging with Prozac as Alto suggests.

 

Also, any course will take some time for the symptoms to subside.Hope this helps.

 

 

Thanks bubble, if I could go back in time three days I think I would have started on 5mg Fluoxtine in order to deal with side-effects and for bridging, but as I explained it was a panicked, muddled decision, where I was basically scrapping the whole weaning thing and deciding it was all a terrible idea in the first place, I wasn't thinking straight. 

 

Given that I took 1.5mg of Citalopram today, is it too late to start on 5mg of Fluoxetine do you think? Basically changing my mind again! lol (not lol really, the whole thing has been an agony of indecision).

 

I like the sound of bridging, it was just never part of the thought process that lead me to take the Fluoxetine.

 

PS

Now I think about it, I may be a candidate for bridging because I have got down to low doses of Citalopram a few times before and always had to up the dose again. I seem to be very sensitive to the last bit, though I have never micro-tapered in the past.

[stone]

I feel inclined towards taking 5mg Fluoxetine from tomorrow onwards.

 

I thought the immediate lessening of the depression in the last 4 days couldn't be down to the Fluoxetine but Alto has made me reconsider that and I now believe maybe it is down to the Fluoxetine and tbh it has been nice not waking up crying and instantly thinking of suicide. I have even been cracking a few jokes.

 

Would it be ridiculous of me to start taking 5mg Fluoxetine from now on?

 

A break from this awful depression for a while and then when it's time to wean I will be taking the so called easiest to wean off AD. 

[stone]

Ok, well I am going to do it. 5mg Fluoxetine from now on. 

 

I am basically following Alto's advice except taking 5mg instead of 10mg. Given that I was on 1.25mg of Citaolpram for months (and not 2.5mg, like Alto thought when recommending 10mg) and that I only took 20mg of Fluoextine for 2 days I think 10mg may be too high of a compromise and 5mg seems better to me.

 

I feel a bit of an idiot changing my mind again and I don't like that I took 1.5mg of Citalopram yesterday but today is day 5 since I started "messing about" with doses and in the long run I hope that won't matter so much as making the right choice on day 5. I believe 5mg of Fluoxetine is the right choice and won't be changing my mind again, except for unforseen side-effects (or unless it turns out 10mg is better, I am still open to the possibility that 10mg would be better than 5). I will stay on 5mg for a few months at least all being well, before any weaning. Thanks everyone and I will keep posting.

[stone]

Input welcome, especially re-assurance that I have done the right thing, lol.

 

 

If I had known 5 days ago what I know now, I would have swapped to 5mg of Fluoxetine - therefore 5mg of Fluoxetine feels like the right decision now. I hate the fact that I messed about with different doses for the last 4 days (and particularly taking 1.5mg of Citalopram yesterday) but it's done now.

 

I decided on Fluoxetine not only for bridging but because it also just feels "nicer" than Citalopram. It seems to have pulled me out of awful depression almost immediately and I like that tbh.

[KarenB]

Good call Stone, I hope you feel better for having made a decision.  Thank goodness for Alto huh?

 

Now you can focus on putting heaps of goodness into your life - healing food, gentle exercise, plenty of rest, maybe some fish-oil or magnesium.  Let your brain/body/nervous-system know you'll give it all the support you can. 

 

That's cool about your depression lifting too - makes things a lot easier to cope with.

 

Karen

[Altostrata]

If you're feeling better, it's probably the fluoxetine.

 

Please just stick with one drug and dosage for at least a week to see how it affects you.

[stone]

Thanks Karen. Yea, I already take fish oil and magnesium actually, funny you mention them. I take the fish oil dose recommended by this guy https://tlc.ku.edu/I am surprised how quickly the depression lifted, I had been waking up in tears, immediately getting suicidal thoughts for weeks and that all stopped the day after my first Fluoxetine.

 

 

Thanks Alto, yes I think so too. The improvement is the Fluoxetine and not some kind of placebo like I was thinking originally. Thank you for your advice, it encouraged me to stick with the Fluoxetine, I don't think I would have done that otherwise and I do think it was the right decision.

 

Don't worry I won't be swapping around anymore. I am not the type of person who thinks it's ok to do that, the last week was very unusual (I explained how I panicked and then had second thoughts and third thoughts etc) and I hate the fact that I messed about with my brain chems like that.

 

My intention is to stay on 5mg Fluoxetine for at least 3 months, my poor brain needs time to settle down.

 

I still feel better today and have not had a splitting headache for the last 2 days. Thanks again.

[Altostrata]

Sounds good. Let us know how you're doing.

[stone]

Hi Alto.

 

I will do. 

[stone]

Can feel the some feelings depression returning, I am almost tempted to go back to 10mg Fluoxetine (I felt so much relief those first few days after taking the higher dose) but it's only been 6 days on 5mg. I have been so set on weaning off ADs for so long that I know it seems ridiculous to contemplate going up to 10mg but it's just how I feel this morning.

[bubble]

The most important part of successful coping with AD with the view of coming off of them is to learn not to react to symptoms by changing doses.

 

Changing doses is very destabilising. You have been through so many changes that you are bound to feel unwell for quite some time. Stabilising happens through windows and waves and is not linear. Please read the thread on windows and waves pattern of healing/stabilising.

 

This process takes time and any attempts to speed it up only prolong it in the end.

[stone]

Thanks bubble, I took 5mg this morning and will continue to do so.

 

I just felt such instant relief from the higher doses of Fluoxetine that I would like to feel that way again. But I know it's a bad idea to mess about with doses any more than I already have.

 

edit

Also, my brain would just adjust to 10mg eventually and I would be back to square one again. My aim is still to wean off eventually. I am sticking to 5mg for the foreseeable future (months).

 

edit 2

I have had mild diarroeah since starting Fluoxetine.

[KarenB]

Hey Stone,

 

Glad you voiced your thoughts here and got some help.  You are managing things really well, a lot calmer now than at the start - you must be pretty happy about that.  It isn't pleasant when you get waves, but just hang in there cause waves always end.  Right about now you might be finding reserves of strenght you didn't know you had! 

 

As for diarrohea , I think that is quite common - either that or constipation.  I get the latter .  But it has improved, maybe yours will too?  Not sure if there's a topic for that.

 

Have you got some non-drug things to do which could help with the depression?  When I am really really badly depressed, I drag myself outside and lie on the grass.  I lie there for ages, and I always end up in a better place.  Earth, grass, sky, clouds, sun, little insects - somehow they all help. 

 

Wishing you little bits of light in your days,

KarenB

[stone]

Hi Karen and thanks.

 

A bit cold for lying outside here atm but I can see how outside and nature helps. I am limited in what I can do due to a physical illness (and I think that is part of why the depression became so bad lately, along with stopping the meds too soon etc). I am interested in Buddhism and Mindfulness and I listen to quite a lot of Podcasts and audiobooks about the subjects as well as trying to practice them, I must admit I have got out of the habit lately though, but I still try. I also tend to watch TV comedies quite a bit. 

[stone]

I thought I would share how I am taking my 5mg dose, I use one of these urine sample bottles, it has 5ml to 20ml marks on it which I like and a rubber seal in the cap, so it's airtight and good for shaking. 20mg capsule in 20ml of bottled water and a 5ml syringe for the dose. I will switch to a bigger bottle (when I find something I like) and use cranberry juice soon but for now I like this method.

 

[KarenB]

I should have realised - you are in the UK and currently in autumn? 

 

Yup, comedies are good.  I've been watching old shows like Hogan's Heroes and The Nanny.  

 

Depression comes in waves, like everything else in life, and it will shift again for you.  Sorry it's there so strongly at the moment.

 

Wishing you peace,

KarenB 

[stone]

Thanks Karen. You too.

[stone]

Hi everyone, I just thought I would update what's going on with me. It's not great, long story short I wish I had never started on the Fluoxetine and had stuck with the Citalopram at a slightly dose, like 1.5mg. I say that now due to hindsight of course, there was no way of knowing that I would really not take to Fluoxetine and it seemed like a good idea at the time.

 

The problem is that even though I only take 5mg of Fluoxetine I have had side-effects for the last month, it's hard to describe the main one as anything other than feeling "weird" mentally, also a constant mild headache, sort of like a hand squeezing my brain, also dire-rear and tense muscles - but the worst symptom has been just feeling "weird" mentally. 

 

I decided to stick with it because I had already messed about so much with doses/meds that I didn't dare change anything again and I hoped the side effects wouldn't last too long, it's been a month and I still have them, hopefully they will go soon. Like I say, if I had known a month ago what I know now I would not have started on Fluoxetine. I wasn't expecting such side-effects from 5mg.

 

I will update again soon, I hope I have better news and the side-effects have gone.

[dalsaan]

Keep your chin up, hopefully a window is just around the corner

 

Dalsaan

[oskcajga]

Hi everyone, I just thought I would update what's going on with me. It's not great, long story short I wish I had never started on the Fluoxetine and had stuck with the Citalopram at a slightly dose, like 1.5mg. I say that now due to hindsight of course, there was no way of knowing that I would really not take to Fluoxetine and it seemed like a good idea at the time.

 

The problem is that even though I only take 5mg of Fluoxetine I have had side-effects for the last month, it's hard to describe the main one as anything other than feeling "weird" mentally, also a constant mild headache, sort of like a hand squeezing my brain, also dire-rear and tense muscles - but the worst symptom has been just feeling "weird" mentally. 

 

I decided to stick with it because I had already messed about so much with doses/meds that I didn't dare change anything again and I hoped the side effects wouldn't last too long, it's been a month and I still have them, hopefully they will go soon. Like I say, if I had known a month ago what I know now I would not have started on Fluoxetine. I wasn't expecting such side-effects from 5mg.

 

I will update again soon, I hope I have better news and the side-effects have gone.

 

I tried reinstating 10mg of fluoxetine and had horrendous side effects. 5mg is not a super small dose, unfortunately.  I'd rather see you at 1 mg to start but this is your decision not mine. 

 

The problem with fluoxetine is that it stays in your body for a LONG time - 3 months at least, and I've read even longer than that by some sources.

 

In my case the side effects got worse and worth over about a 1 month period until they were no longer tolerable.  My side effects were basically mild mania, tingling numbness in legs, headaches in the sinus (this was very alarming, now I know that it was damage to my trigeminal nerve), spots in my vision, visual snow.  Basically most of my symptoms from my previous SSRI were made worse or not improved, and now I had a litany of new neuropathy like symptoms from the prozac after only taking 10mg for a month.

 

I then rapidly tapered over a 4 day period - did not experience any withdrawals - but the fluoxetine did some sort of nerve damage that lingered to this day.   I've had a couple of doctors indicate to me that my symptoms were consistent with neuropathy - if I had known this would be possible I wouldn't have started at 10mg of fluxoetine.  I trusted my doctor to my own peril, unfortunately.

 

I'm not trying to scare you - but I can't help but share my story because it sounds similar to what you are describing and I've paid for that mistake for a long time now.

 

Good luck and let us know what happens.

[LexAnger]

Hi Stone, So sorry you are going through such a hard time as well. Those are clearly caused by the multiple changes your brain/system have to adjusting to.

 

No one knows for sure what would happen even with intensive knowledge learned from others. Its a constant trial and error process. So dont stress yourself more with that.  

 

Holding for your system to stablize is the bet strategy to relieve symptoms. It happened to me even I felt it would never do.

[stone]

Thanks everyone. I should have mentioned that there are signs of the side-effects improving slowly, the "weird" feeling is getting less weird. I am hopeful that I will get used to the Fluoxetine. It's been pretty horrible though and not what I expected. Maybe tapering for so long has left me sensitive to them? I don't know.

[bubble]

Thank you for updating Stone and sorry to hear that you are struggling. Unfortunately I'm not surprised looking at your history. When I came here after CTing my drugs and reinstating, it took me 4 months to start feeling better but not as well as I was before CTing.

 

I didn't think of the symptoms I had as side effects of reinstatement but rather workings of my brain to stabilise after everything it had been through. I was just relieved that things were not getting worse as they were after the CT when I kept discovering new bottoms all the time. 

 

Whether you call them side-effects or whatever it's encouraging to hear you are improving slowly. This will continue. I kept reading about windows and waves to survive that time. I'm personally against bridging but since you took that course it seems best to keep it.

 

I'm certain more improvement is coming your way.

[stone]

Thanks bubble, I hope you are right. It does seem likely that things should level out in time. I remember when I was first put on Citalopram 18 years ago-ish the Doctor tried me on Venlafaxine for a while and I hated it, this "weird" feeling is similar to how that made me feel. I wish I had done what you were suggesting and just increased the Citalopram dose. 

 

Also, (some background) I should never have been placed on AD's at all in the first place imo. I had a breakdown with schizophrenic type symptoms (delusions, paranoia, TV and radio talking to me etc) and it was handled very badly. I should have been on anti-psychotics for a while at least. The ADs did not help at all, I wasn't depressed but a GP saw me after a manic period when I hadn't slept for days and days and was just exhausted and flat and he made a snap diagnosis of depression.

 

I ended up self-medicating the "schizo-type" symptoms with alcohol and became dependent on alcohol. I have been sober a while now though.

 

I know a guy who takes anti-depressants in the winter and just stops in the spring, he also skips days so his libido returns! He doesn't seem to be affected by what he does, I guess some of us are more sensitive than others. 

[stone]

They "schizo-type" symptoms gradually stopped after a few years but I am left with various mental problems and fragility, intrusive type thoughts (not extreme ones, more like constant bad memories and obsessive thoughts). I can't believe, looking back, that Doctors and those around me helped me so little and (the GP) got the diagnosis and treatment so wrong.

[stone]

I meant to say thanks to dalsaan, oskcajga and LexAnger. osk, that sounds bad, I am sorry you had to go through that.

 

bubble, the reason I class the new symptoms as side-effects (of Fluoxetine) and not effects of re-instatement is because they began when I started taking Fluoxetine. I had re-instated Citalopram nearly two months previously and did not have the terrible headaches, diarrhea or the weird mental feeling (like I was going to go insane).

 

Given that I went to a higher dose of a new drug and that was when these side-effects started - I think it is logical to assume it is the new drug causing them.

 

They also keep me awake when I need to sleep, which is making my physical illness worse. All in all, I hate Fluoxetine. I really wish I had never started on it.

[Altostrata]

What is your daily symptom pattern? This is helpful to see if symptoms are coming from the drug. Please keep notes on paper.

[stone]

Hi Alto, first I should mention that the symptom that was upsetting me the most was the feeling "weird" mentally, like I was cracking up. That has eased, I am doing better with that.

 

The diarreah I have twice a day, used to be more,  it started a few days after beginning the Fluoxetine.

 

Keeping me awake, started with the Fluoxetine.

 

Headaches, ok since I went down to 5mg, but very bad when I took 20mg or even 10mg.

 

So, I don't think there is a daily pattern as such, I just have them each day and they all began when I started the Fluoxetine. I have been on it 6 weeks. I was thinking it might be easier to wean off than to swap drugs again, but I don't know.

 

When would you recommend it is safe to start weaning please? 

[Petunia]

Hi Stone,

I'm not Alto, but will try and address your questions.

 

So, I don't think there is a daily pattern as such, I just have them each day and they all began when I started the Fluoxetine. I have been on it 6 weeks. I was thinking it might be easier to wean off than to swap drugs again, but I don't know.

 

When would you recommend it is safe to start weaning please? 

 

I agree that a slow, safe taper off Fluoxetine would be better than switching drugs again. Is your goal to become drug free eventually and stay that way?

 

Keeping notes of your symptom pattern will help you decide when its safe to start weaning. You want to wait until you have stabilized, that means when you are not seeing fluctuations in your symptoms from day to day or week to week. The best way to keep notes is to rate the symptom. If they are still changing, then its best to wait. If I were you, I would monitor for another 2 - 3 weeks and if there are no changes, then you could try a 10% cut.

 

See: The Windows and Waves Pattern of Stabilization

What does stabilizing mean? - Surviving Antidepressants

 

When you are ready you will need this thread:

 

Tips for tapering off Prozac (fluoxetine)

 

[stone]

Thanks Petunia, I feel like things have mostly stabilised at this point but will wait a while before beginning weaning, to make sure. Yes, my goal is to be free of them entirely. I had spent years weaning to 2.5mg of Citalopram a day and while I needn't have took that long it was quite successful until I tried to get below 2.5mg a day, it was when I started alternating days of 2.5mg  and then stopped them altogether that all the problems began, I thought 2.5mg was a tiny amount and it would be ok but I was very wrong.

[JanCarol]

Hey Stone - 

 

Overall, after your "week of indecision" it sounds as though you are well on the road to healing from antidepressants.

 

Your reinstatement has gone - mostly - well, and since you understand that changes are the enemy as much as anything, and if you make it a point to get the support you need for your recurring depression (you may have a few of those to go through before you come out on the other side), you will do fine.

 

I doubt you needed antipsychotics.  Many people have "spiritual emergencies" and frequently the pass.  Drugging them as "psychosis" only deepens the psychosis - it doesn't give the mind/body/spirit time to heal and work through the emergency.  Just a thought for you to ponder.  

 

Anti-psychotics are not "anti-psychotics," they are "anti-brain." They do not cure or treat psychosis.  What they do instead is create a numbing effect so that the intrusive thoughts, psychosis, voices, whatever manifestations there are - no longer matter so much.  I prefer to call them "neuroleptics," because that's what they do - they depress/supress brain & nerve functions.

 

You are lucky you've not been put on a cocktail - and that you have just one drug (even if you think it was the wrong one - that's not uncommon, either!) to taper down from.

 

Please keep us posted as to how you are going, and I think it was Fresh who said on another thread - if you are stable for a month - hold for another month before starting your taper.

 

After 20 years, what's a few months among friends?  

[stone]

Hi JanCarol, I think I should have been prescribed anti-psychotics for a short time 20 years ago (a few weeks/months to get a break from the delusions) but it would have been bad had I been left on them as I did spontaneously mostly recover. What annoys me is that I was wrongly prescribed anti-depressants and told I would need to take them for the rest of my life - and was just left on them for 20 years. Had the GP seen me the day before he did I doubt very much he would have diagnosed depression, because I was manic, paranoid and talking about the delusions etc, but the day he saw me I did look depressed. It would have been worse had I been on anti-psychotics for 20 years though, that is true. 

 

Right now, the mental discomfort and feelings of cracking up have eased off and that is a big relief. As for other ways of coping with depression and other mental stuff, I like Mindfulness and Buddhism and have a sort of support structure too. I find it hard to do the things that help me when I am overwhelmed with mental troubles, but right now I am getting a bit of a grip on the stuff that helps again. I have just started counselling also.

 

I think a month or two before making any changes to the dose makes sense.

[JanCarol]

Hey stone - 

 

I guess my point is - if you were given antipsychotics 20 years ago, you would be more likely to have recurring, chronic psychosis than if you never did.  Yours resolved without the neuroleptics, which was my point.  Most spiritual emergencies do resolve, if there is an opportunity - and safe space - to work through the crisis.

 

Robert Whitaker explains the Harrow study so clearly in his "Anatomy of an Epidemic" in which patients who were on few or no drugs had better long term outcomes.  (it was a neuroleptic - or 'antipsychotic' trial, one of the few long term ones which have been done).

 

If you haven't read the Robert Whitaker book, I highly recommend it - it will open your eyes to how these drugs sensitize us to the very thing we're trying to medicate.

 

There are many people here who were put on AD's for chronic pain, IBS (and with your own diarrhea, you know how wise that is), fibromyalgia, menopause, chronic fatigue - all kinds of things.  That you were slammed on them 20 years ago for a spiritual emergency is not so unusual.  ADs have become the panacea of the modern age, with no concern for side effects, tolerance, withdrawal procedures or effects.  And yet - all of these things - depression, chronic pain, IBS, fibromyalgia, chronic fatigue, can be made worse by the drugs.

 

Be glad you've only got one to deal with, and it's slightly "old-fangled," unlike some of the newer "atypical" weird things they are coming up with!

 

I'm not discounting your difficulties.  It's hard for all of us, or we wouldn't be here.  I look forward to hearing your tapering plans - maybe for after Christmas?

I hope you see the sun today.

[stone]

Hi again JanCarol, I did get your point and I agree with you.  My only addendum was that maybe very short term use of anti-psychotics would have been a good idea for me during the worst of the breakdown to get a break from the extreme delusions and hallucinations.

 

I think the way AD's get handed out for everything these days is shocking, and the recycling of older AD's (like Amytriptiline) for pain etc is also despicable. It reminds me of the 70's when every time a person went to see a Family Doctor they got told "there is a bug going around take these anti-biotics", and we know what that led to, super-bugs resistance etc. 

 

It's hard to take certain aspects of medicine seriously these days when they are so led by the pharmaceutical industry and money.