Fluoxetine max dose and no longer working

[DanJ1971]

Hello out there. I’m on 60mg fluoxetine a day (the doc says this is maximum dose). Long story short, I’m incredibly anxious and depressed and take Lorazepam when I need to. My point is that the fluoxetine appears to have stopped working and I’m terrified. I feel utterly stuck and have no idea what medication I could take now given I’m on max dose already. I’m rapidly losing hope, and feeling scared 😟. Thanks

[panic_down_under]

Hello out there. I'm on 60mg fluoxetine a day (the doc says this is maximum dose).

You say you're on 60mg, but your signature says 40mg. Have you only recently increased the dose to 60mg?

You are also on pregabalin. Is that also for anxiety, or another condition. How long have you been taking it?

and take Lorazepam when I need to

By all means take lorazepam when you need to, but try to avoid taking it 'just in case', as there is good evidence that when taken regularly the benzodiazepines can block neurogenesis, the mechanism by which antidepressants (ADs) produce the therapeutic response.

I feel utterly stuck and have no idea what medication I could take now given I'm on max dose already.

Is fluoxetine the only AD you've been on and how long have you been taking it?

I'm rapidly losing hope, and feeling scared

There is no need to be. There are many alternatives. It is not uncommon for ADs, especially the SSRIs, to quit working after a while. Usually switching to another AD will work although it may require a couple of changes to find the most effective one.

[DanJ1971]

Thank you. My signature is wrong. I am not on pregablin. I have been on fluoxetine since 2012, 6 month break in 2017, then back on in 2018. Before that I was on paroxetine from 1994 to 2012
I am currently on 60mg fluoxetine (most recent increase from 40mg was November 2023). That seemed to do the trick but then a couple of big life events have happened and my mental state has gone downhill severely in a matter of a few weeks. I take a very low dose of lorazepam when I feel like I need to calm down but only take in really very tough moments.
My comment about being scared is I would need to come off fluoxetine first before changing to another. That might make me feel even worse and I am already in severe anxiety state and just want to feel better.
Thank you 🙏

[DanJ1971]

I tried to change my signature but couldn’t find out how.

[DanJ1971]

I’m just really scared of current feelings, as bad as I have ever had- and I’m doing all the right things- meditation, yoga, therapy, exercise, no alcohol, no recreational drugs, grounding techniques and so on.

[DanJ1971]

The big life events are obviously the catalyst, I know that, but the feelings are here and very horrible

[panic_down_under]

My comment about being scared is I would need to come off fluoxetine first before changing to another. That might make me feel even worse and I am already in severe anxiety state and just want to feel better.

It probably won't be as bad as you fear as fluoxetine has a very long half-life, up to 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 30 days for fluoxetine to be metabolized and eliminated and 80 days for the metabolite. This is why you will need to come of it first. The NHS protocol for switching to another SSRI is to taper down to 20mg which can be done fairly quickly, stop taking it for 4-7 days and then start the new med. You will still have quite a lot of fluoxetine in your system throughout that.

If the plan is to switch to another SSRI then, imho, your best bet would be citalopram as it has a good track record for working when another SSRI has become ineffective.

[DanJ1971]

Thank you 🙏