Zoloft to Prozac

[bajope]

Hi,

I’m hoping that someone can give me some encouragement. I was on 50 mg of Zoloft for 12 years. After a time of very high stress, I spiraled into a really bad bout of anxiety and depression, and it seemed like the Zoloft stopped working, so my Dr. bumped my dosage to 100 mg. After 7 weeks on that dosage, I still didn’t feel any relief. My Dr. Is now cross tapering me from Zoloft to Prozac. I started at for 1 week of Zoloft 50 mg. and Prozac 10 mg. This week I’m on 25 mg Zoloft and 20 mg Prozac. I’ve been having some DP/DR issues this whole time, however with this week’s increase, the DP/DR had kicked way up. Like all my waking hours. Also, I sorta feel like I’ve been drugged (If that makes sense). I just feel weird overall. Can anyone relate?

[panic_down_under]

I started at for 1 week of Zoloft 50 mg. and Prozac 10 mg. This week I’m on 25 mg Zoloft and 20 mg Prozac.

So you were taking 100mg sertraline (Zoloft) then on week 1 this was reduced to 50mg and 10mg fluoxetine (Prozac) was added and then on week 2 sertraline was reduced again to 25mg and the fluoxetine increased to 20mg? If so the DP/DR are almost certainly mostly caused by withdrawal and to some degree by an uptick in anxiety.

The problem is sertraline has a relatively short half-life, around 25 hours, while fluoxetine's is very long, about 6 days for fluoxetine itself and up to 16 days for its active metabolite norfluoxetine which actually does most of the work. You've gone from 100mg sertraline to 25mg, but the fluoxetine is doing very little. It typically takes 30 days just for its plasma levels to stabilize.

Unfortunately, there is not much that can be done to speed the process up. Your doctor seems to have tried to minimize the withdrawal potential by not tapering you completely off sertraline before starting fluoxetine as many guidelines advocate (wrongly, imho). So that leaves treating the DP/DR until the fluoxetine starts having a positive effect. Have you talked to your doctor about this? If not I urge you to do so asap as you don't need to white-knuckle you way through this.