Fluoxetine withdrawal or just anxiety?

[Arie12]

Hey there,

I have used fluoxetine 20mg earlier last year for 4 months but quit. Felt bad 3 months later and started 20 mg again. My body reacted completely different with bad anxiety and severe insomnia. I quit after 17 days of use because I basically could not sleep. This is now 2 weeks ago, I'm still having sleep issues, with mostly 4 to 5 hours of sleep and trouble sleeping in. I occassionally need a sleeping pill.

My doc told it could last up to 3 weeks before it goes completely out of my system, but can this be? That would mean it would last longer than I used it! Can fluoxetine take this long to leave the body even after 2.5 weeks of use? I'm desperate for a good sleep

[panic_down_under]

I have used fluoxetine 20mg earlier last year for 4 months but quit.

Why did you stop?

Felt bad 3 months later

Bad how?

and started 20 mg again. My body reacted completely different with bad anxiety and severe insomnia.

The initial side-effects when taking SSRIs/SNRIs can be both more severe and/or different the second time they are taken. Starting on 20mg would be too much for most with anxiety anyway even the first time. If you ever want to take an AD again I suggest you start on no more than half the usual starting dose for depression and a quarter may be even kinder.

My doc told it could last up to 3 weeks before it goes completely out of my system, but can this be? That would mean it would last longer than I used it! Can fluoxetine take this long to leave the body even after 2.5 weeks of use? I'm desperate for a good sleep

Fluoxetine has by far the longest half-life of all ADs, up to 6 days for fluoxetine itself and up to 16 days for its active metabolite, norfluoxetine, which actually does most of the work. The rule of thumb is that it takes about 5 half-lives for a med to be metabolized and eliminated after cessation, so around 30 days for fluoxetine and up to 80 days for norfluoxetine. However, given the relatively short time you were back on the med it will likely be out of your system earlier as plasma levels likely hadn't stabilized. How soon I can't say.

I'm not convinced your insomnia is all down to the med. I suspect anxiety is also a significant factor.

[Arie12]

Why did you stop?



Bad how?



The initial side-effects when taking SSRIs/SNRIs can be both more severe and/or different the second time they are taken. Starting on 20mg would be too much for most with anxiety anyway even the first time. If you ever want to take an AD again I suggest you start on no more than half the usual starting dose for depression and a quarter may be even kinder.



Fluoxetine has by far the longest half-life of all ADs, up to 6 days for fluoxetine itself and up to 16 days for its active metabolite, norfluoxetine, which actually does most of the work. The rule of thumb is that it takes about 5 half-lives for a med to be metabolized and eliminated after cessation, so around 30 days for fluoxetine and up to 80 days for norfluoxetine. However, given the relatively short time you were back on the med it will likely be out of your system earlier as plasma levels likely hadn't stabilized. How soon I can't say.

I'm not convinced your insomnia is all down to the med. I suspect anxiety is also a significant factor.

Thanks for the in depth reply. I quit due to sudden diarrhea which lasted a few weeks which I thought was due to prozac which really upped my anxiety. Which in hindsight was very stupid of me. I started again because of the depression associated with sudden vestibular neuritis, but that backfired and worsened my dizziness and anxiety. So yes anxiety is a big theme, and panic makes me do some really stupid stuff. I think the insomnia is probably due to anxiety if I'm honest with myself, thanks for replying!

[panic_down_under]

I quit due to sudden diarrhea which lasted a few weeks which I thought was due to prozac which really upped my anxiety.

The gut is by far the most serotonergic organ of the body so SSRIs/SNRIs can sometimes trigger diarrhea when starting them, but this is unlikely to begin after being on them for 4 months. Remedies containing loperamide (Imodium) are usually effective.

I started again because of the depression associated with sudden vestibular neuritis, but that backfired and worsened my dizziness and anxiety. So yes anxiety is a big theme, and panic makes me do some really stupid stuff. I think the insomnia is probably due to anxiety if I'm honest with myself, thanks for replying!

Cool. As per my previous post, should you wish to try fluoxetine again then start on a low dose, no more than 10mg/day, 5mg may be even better. But discuss this with your doctor first. A prescription for fluoxetine liquid would make it easier to prepare a low dose.

[Arie12]

The gut is by far the most serotonergic organ of the body so SSRIs/SNRIs can sometimes trigger diarrhea when starting them, but this is unlikely to begin after being on them for 4 months. Remedies containing loperamide (Imodium) are usually effective.



Cool. As per my previous post, should you wish to try fluoxetine again then start on a low dose, no more than 10mg/day, 5mg may be even better. But discuss this with your doctor first. A prescription for fluoxetine liquid would make it easier to prepare a low dose.

Thanks for the additional info! To be honest I blame my doc a bit for starting me at 20mg. I've had some sleepless nights but it was never that bad as it is now. You mentioned the half life of norfluoxetine and that scares me a bit, I still feel really energised at night and it gives me a lot of uncertainty because I do not know the exact cause. Hoping for better days!

[Arie12]

Well just to update my sleep seems to have returned. It it took like 3 weeks to get 2.5 weeks of fluoxetine use out of my system. Not entirely sure if it was just the fluoxetine, I have also used a good app to help with the insomnia

[panic_down_under]

Well just to update my sleep seems to have returned