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Thread: Beginning cross taper from citalopram to fluxotine tomorrow.

  1. #11
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    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Quote Originally Posted by panic_down_under View Post
    It is probably longer than it needs to be. I would have suggested 2 weeks on 10mg fluoxetine then 20mg with a drop in the citalopram. But your doctor is in a better position to make that call.
    It sounds like the doctor is considering the steady-state issue, which is more than many seem to, but I do question that in a cross taper since it's the same class. It's sensible to consider not dropping too low before the new med is propping things up more.

    The funny thing is, Ian, I've read the guidelines for this in the UK and cross tapering seems widely open to interpretation, which is not ideal with GP's. At least the OP has a plan that can be easily modified based on response unlike a full stop & start regime.
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  2. #12
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    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Quote Originally Posted by MyNameIsTerry View Post
    It sounds like the doctor is considering the steady-state issue, which is more than many seem to, but I do question that in a cross taper since it's the same class.
    Yes, switching to fluoxetine has its difficulties because of the long half-life. The problem is that for most plasma levels don't stabilize for 3-4 weeks so it probably won't make that much difference to side-effects severity if the dose is ramped up at one or two week intervals so, imho, you may as well take the quicker option to get onto an effective dose asap and hope the side-effects don't go through the roof. This may be a case of there being not only no good option, but no least worst one either.

    I've read the guidelines for this in the UK and cross tapering seems widely open to interpretation, which is not ideal with GP's.
    Interesting. I'd be wary about setting hard and fast rules as every patient reacts differently, and not always because of a direct physical response to the meds being switched to and from. Psychology can be just as important. So guidelines should allow for considerable latitude, though I can see they then may not be much help to those GPs that need them the most. To quote a former Australian PM, "life wasn't meant to be easy"!

  3. #13
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    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Hi Kain.

    I was on 40mg of Cit for 12 months, helped with anxiety but not mood, so my GP had a chat with a friend of his who is a Psychiatrist and they decided Fluoxetine would help with the mood lift. This appears to be happening, fingers crossed.

    All he told me to do was stop the Cit for 3 days and then start the Fluox at 20mg, no problems at all, we have increased to 30mg now and this seems fine.

  4. #14

    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Thanks for the advice guys I havnt taken the Prozac yet I'm just so worried about serotonin syndrome. Maybe I'm being irrational but I'm terrified.

  5. #15
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    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Quote Originally Posted by kain View Post
    Thanks for the advice guys I havnt taken the Prozac yet I'm just so worried about serotonin syndrome. Maybe I'm being irrational but I'm terrified.
    Dr Google has much to answer for.

    Most of the stuff online about SS is male bovine excreta, heck, most of the stuff in medical journals is. Almost all the serious SS injuries and deaths have occurred when MAOI class antidepressants have been combined with either SSRIs, some SNRIs and TCAs, or serotonin releasing drugs.

    SSRIs, individually or in combination, rarely cause issues on their own even in massive overdose, thousands of milligrams. To quote Ken Gillman, arguably the leading authority on serotonin syndrome/toxicity:
    The bodies capacity to break down serotonin is so rapid that it seems to be difficult to raise levels sufficiently high to cause death (from serotonin toxicity) by taking only one type of drug (e.g. MDMA, ecstasy (3,4-methylenedioxymethamphetamine)). It is almost always the case that serious toxicity and death is associated with combining two different types of drug with a different mechanisms of action. The great majority of human fatalities have been associated with a combination of MAOIs and (S)SRIs. So far, just about the only other combination capable of causing fatalities is MAOIs with serotonin releasers (‘indirect agonists’) e.g. MDMA (but not methylphenidate)

  6. #16

    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Ya doctor Google doesn't help. It just repeatedly keeps telling me not to take two Ssris at the same time.

    You sound like you know what your talking about and the pharmacist says they don't think I'll devolp serotonin syndrome though they couldn't say i wouldn't so I'll do it tomorrow.

  7. #17
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    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Quote Originally Posted by kain View Post
    You sound like you know what your talking about
    The bloke that does know what he's talking about if Ken Gillman. He's written over 70 papers on serotonin syndrome. I'm just passing on the message.

  8. #18

    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    I read the entire article you referred to above. Good stuff. I took the fluxotine and citalopram about 10 minutes ago so if I'm going to get sick I'll know I'm the next 24 hours lol.

  9. #19
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    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Quote Originally Posted by kain View Post
    I took the fluxotine and citalopram about 10 minutes ago so if I'm going to get sick I'll know I'm the next 24 hours lol.
    You'll be fine. You may experience some side-effects, but they won't be serotonin syndrome, just the usual initial SSRI 'fun and games'.

  10. #20

    Re: Beginning cross taper from citalopram to fluxotine tomorrow.

    Thanks for all of your reassurance.

    I had real bad side affects when I started citalopram but at the time they had me keep mixing it with other stuff like mirtazapam and gabapentin then amitriptyline and propranol then buspar...but ever since I settled on citalopram alone I've only had minor side effects when increasing doses like loss of appetite for a few days.

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