Time for a Change? (Again)

[Pythonian]

I was on Lexapro (20mg) about 10 years. Could be wishful memories but I don't recall any major rough patches. A 30 day supply of supplemental Xanax could last a year. Unfortunately the Lexapro faded out and stopped working.

Switched to Prozac and a had a long and tough transition before it kicked in at 60mg. Been on that for two years now, but it feels like I definitely have more rough patches and use more Xanax. Wondering if I should discuss changing again? Any insights? Suggestions? Thanks. Best wishes.

[panic_down_under]

Switched to Prozac and a had a long and tough transition before it kicked in at 60mg. Been on that for two years now, but it feels like I definitely have more rough patches and use more Xanax. Wondering if I should discuss changing again?.

The quickest and easiest option would be to supplement fluoxetine with buspirone (Buspar). This is a GAD specific med which doesn't actually work for most, but can boost the effectiveness of SSRIs, kick start those pooping-out and ease some SSRI side-effects, particularly sexual dysfunction. Doses around 30mg/day in 2-3 divided doses are usually enough. If it works you should begin seeing results within a couple of weeks.

The second quickest option would be to up the fluoxetine dose to the recommended maximum 80mg/day.

If neither works, then your best bet would be to switch to either a SNRI (but not venlafaxine (Effexor), or desvenlafaxine (Pristiq) which are really only SSRIs), or a TCA. These inhibit both serotonin and norepinephrine, aka noradrenaline, reuptake and are usually less likely to quit working than SSRIs.