Fluoxetine for 3rd time

[Ayresstew]

Hi I’m just coming up to 12 weeks on 20mg and I’m no where near I was last time. Can it take longer
Thanks

[panic_down_under]

Hi I’m just coming up to 12 weeks on 20mg and I’m no where near I was last time. Can it take longer

to NMP,

Yes, it can. Fluoxetine tends to take longer to kick-in than other antidepressants (ADs) anyway because of its long half-life and that may increase further when restarting it. You may also need to take a higher dose to achieve previous levels of effectiveness too.

What are you taking fluoxetine for and how long were you off it?

[Ayresstew]

Hi thanks for getting back to me, I’m on it for anxiety and depression. I was on it for over 10 years last time on 20 mg never stopped working, was on 10 mg for 6 months and still no dip then off. Was a couple years then relapsed. I’m not sure if this has stopped some of the positive effects but because the side effects was so intense I couldn’t sleep or eat so they put me on mirtazipine which helped with the sleep and eating but increased my heart rate and very agitated on it. I was on it 6 weeks with one week taper and been off 10 days which the first few days I immediately felt better and heart rate better but the last 3 days bad depression and agitation but I’m assuming even though I was on it a short time my brain still needs to adjust causing these symptoms and I almost stopped cold turkey

[Ayresstew]

Sorry something else , the doctor has said about an increase to 30mg but he said he would change it to the delayed release which can ease side effects and he thinks I could see an effect in 2-3 weeks. Do you know anything about this as it seems a bit quick for fluoxetine to get results.
What did you mean by saying the half life might increase to starting it again ?
Thanks again

[panic_down_under]

they put me on mirtazipine which helped with the sleep and eating but increased my heart rate and very agitated on it.

How much were you taking?

I was on it 6 weeks with one week taper and been off 10 days which the first few days I immediately felt better and heart rate better but the last 3 days bad depression and agitation but I’m assuming even though I was on it a short time my brain still needs to adjust causing these symptoms and I almost stopped cold turkey

I don't think the depression and agitation are mirtazapine withdrawal symptoms, but are more likely from fluoxetine and/or anxiety.

the doctor has said about an increase to 30mg but he said he would change it to the delayed release which can ease side effects and he thinks I could see an effect in 2-3 weeks. Do you know anything about this as it seems a bit quick for fluoxetine to get results.

Taking delayed release to ease side-effects from the dose increase may do the trick.

What did you mean by saying the half life might increase to starting it again ?

Fluoxetine has a very long half-life, about 6 days for fluoxetine itself and up to 16 days for its active metabolite norfluoxetine which does most of the work. So it takes about a month for fluoxetine plasma levels to stabilize to a steady-state, and up to 80 days for norfluoxetine to do so. To put this into perspective most of the other commonly prescribed ADs have half-lives of 20-36 hours with the parent compound doing the work. Fluctuations in plasma levels can slow response to the med.

[Ayresstew]

Hi I was on 15 mg mirtazipine but the agitation started about 2 days after starting but thought that would go. By the time I got to week 4 it got worse so they put me on 30 mg but straight away I was even worse and my heart was beating fast in the night. But on that dose it actually made me angry which I’ve never experienced before so they said stop quickly.
The first couple of days I actually felt better but now I’m feeling down more than before but thought maybe it’s the brain adjusting without the drug.

As for the fluoxetine does that mean it can take up to nearly 100 days to work properly for some and In my case longer because I’ve been on it a few times.
The delayed release the doctor said it’s effective quicker do you know if that’s true because I can’t find much on the delayed release
The fluoxetine has done something and that’s my health anxiety is better and I’ve had some better afternoons with odd patches of me feeling myself so I think it will work but still not fully working.
Thanks for your help

[panic_down_under]

they put me on 30 mg but straight away I was even worse and my heart was beating fast in the night. But on that dose it actually made me angry which I’ve never experienced before so they said stop quickly.

That's an unusual response to what is usually a fairly benign med other than the carbohydrate cravings.

The first couple of days I actually felt better but now I’m feeling down more than before but thought maybe it’s the brain adjusting without the drug.

I'm not sure this is down to withdrawal. Despite what it says on the box mirtazapine isn't really an AD, only a antihistamine which mostly works as a sedative.

As for the fluoxetine does that mean it can take up to nearly 100 days to work properly for some and In my case longer because I’ve been on it a few times.

If it isn't working within 100 days then it probably won't at whatever dose is being taken at. But it may take longer than the usual 5-12 weeks.

The delayed release the doctor said it’s effective quicker do you know if that’s true because I can’t find much on the delayed release

I'd love to hear the explanation for why it would work sooner. The only advantage I can see is it may lower side-effects severity by trickling the drug into your system over 24 hours instead of the surge in the hour or two after taking the immediate-release.

The fluoxetine has done something and that’s my health anxiety is better and I’ve had some better afternoons with odd patches of me feeling myself so I think it will work but still not fully working.

This sounds promising.

If fluoxetine is effective I suggest you consider staying on it permanently as there is good evidence that ADs become gradually less effective each time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002).

[Ayresstew]

Hi so realistically how long should I leave it as it’s my 3rd time. 13-14 weeks as I’ve seen some people say it only started working then. I’m just hitting the full twelve weeks now and not sure on going up in dose just incase it could still do more in a week or two.

[Ayresstew]

So sorry m on 91 days and no where near recovered not even 50% so I just don’t know how much longer to wait or go up. Or can it take 100 days to actually start working, sorry for all the questions I just don’t want to stay any longer if there isn’t a chance of working then I need to go on something else or another add on if there is one

[Ayresstew]

Sorry for another message, just looking through my diary. 1st week dizzy anxious ect
2nd week much the same but felt suicidal one day which wasn’t before.
3rd week had a couple better days and eating ,
4th week I had 4 good days in a row
5th week really bad week tremors really anxious couldn’t sleep
6th week really bad week and a suicidal day again then just anxious all week.
So I seem to have some good days ect
Then I was started on the mirtazipine which was very tired the first few weeks but my best time was the evening and had some good days again with agitation. The 4th week I seen to get more anxiety again.
So now I’m off I am anxious and agitated so I don’t know what to think. It seems like the fluoxetine gave me a run of good days early on then got worse so I don’t know what to think but the mornings are always worse
Maybe it is time to try another but I’ve gone 12 weeks and not sure maybe it could kick in in another two weeks. Do you think it’s worth waiting a bit longer