Prozac for years, 3days of sertraline

[MissShabby]

Hi everyone, I've been on antideprssants since I was 17 for anxiety, venelaxafine, citaolopram, then went onto prozac around 2009 until last week, so I was on them roughly 7years.

The prozac has suited me well, I got my life back together, made friends etc. However the last year or 2 they made me more and more anxious, until 2 weeks ago when I couldn't cope any longer and had to call into work sick with anxiety attacks.

I went to the DR the followinf day, saw a nurse practitioner and she went back and forth to the DR to find out what I needed. So they said I was to double my 20mg dose of prozac to 40mg, which I did. I went even worse and couldn't cope with anything, so after having suspicions the prozac were having a reverse effect I came off them for 2 or 3 days, and even though I felt a little odd I was ok.

So I went back to the Drs to let them know and ask if there was anything I could take instead that was lighter, just to ease me off as I wanted to come off ADs altogether.
I was given 25mg of sertraline which I have been taking for 3 days.

Thing is I started thinking then about withdrawal from sertraline so I wondered if I would be better to just come off ADs altogether now instead of in a few months down the line.
I'm seeing a CBT therapist next week, so I'm hoping she will give me methods on how to deal with my anxiety.

I was just wondering if anyone has gone through anything similar?

I've been on ADs half my life and I just want to see what it's like to be AD free. I'm 32 now, and I think I've learnt how to deal with things better. But I suppose we'll see.
Should I see any withdrawal coming off sertraline 25mg after 3 days? Or will I still be feeling the prozac withdrawal? I came off prozac last monday, and now it is sunday morning. Thank you

[Shazamataz]

Hi Shabby,

I doubt 3 days or sertraline will make much difference, especially at such a low dose. Coming of SSRIs can be hard and you may experience withdrawal effects. The worst for me were 'brain zaps' - like constant electric shocks in my brain that lasted about 4 weeks. My anxiety attacks also came back really bad but some of that was likely situational as I was working my way up to putting my elderly dog to sleep.

S

[MissShabby]

Hi Shabby,

I doubt 3 days or sertraline will make much difference, especially at such a low dose. Coming of SSRIs can be hard and you may experience withdrawal effects. The worst for me were 'brain zaps' - like constant electric shocks in my brain that lasted about 4 weeks. My anxiety attacks also came back really bad but some of that was likely situational as I was working my way up to putting my elderly dog to sleep.

S

Oh I'm so sorry about your dog, that must have been extremely difficult. I hope you're ok.
I've taken my sertraline now just in case. I thought maybe I'll take it until I see a doctor. I'm hoping that it being such a low dose that when I do come off it won't be too difficult.
I think I have little brain zaps at the moment, usually when trying to sleep :/

[Shazamataz]

Thanks for the condolences, it was the hardest thing I've ever had to do and unfortunately has ended up with me being in the worse bout of anxiety since october now. It wasn't just the dog but anniversary of Dad's death the year before etc.

Meanwhile, I had a really hard time on SSRIs so have not had any luck there.

Long story is I was on Escitalopram and before that citalopram for years, had a super bad reaction to doubling the dose when my attacks started back, tapered off (brain zaps etc), then a month later the anxiety came back again worse than ever so tried sertraline, citalopram, again and then mirtazipine, all with horiffic side effects I couldn't deal with.

But this isn't about me! I'd say it's okay to wait and speak to the doctor. 25mg is a low dose of sertraline so coming off won;t be any worse after a few more days and, in fact, it might be helping with the prozac withdrawal?

[MyNameIsTerry]

I'm struggling to get my head around what your GP is thinking here to be honest. You asked for something "lighter" and they gave another SSRI when the one you were on you could have just withdrawn from. So, they have basically enacted a switch and they haven't followed NHS guidelines for a switch from Fluoxetine since there should be a "wash out" period.

Here are the guidelines:

http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179592

The thing is, Fluoxetine has a very long half life of 1-3 days and that becomes 4-6 days for chronic use. Those few days wouldn't have allowed it below 50% from what I can tell but if you felt better, perhaps this is a sign that the med is too much? You were struggling and found the increase made it worse so either too much again or side effects since any dosage increase can bring them again.

The Sertraline is just another SSRI so the potential for withdrawal will be there once you have been on them for a while like any other. However, these meds both primarily work on changes to your Serotonin levels and Serotonin receptors as they are in the same class of meds. So, being on the Sertraline a few days doesn't mean you can cold turkey them because you have to consider the fact you are a long term SSRI user and that usually means a taper.

I think having a chat with your GP is the way to go. I would be asking why they have switched to Sertraline when you could have kept with withdrawing from the Fluoxetine. Perhaps your GP is adding in a low dose started in a switch as a step down? A 20mg dose of Fluoxetine is equivalent in it's main objective to 50mg of Sertraline so it is a step down BUT I have reservations about how your GP has not used the wash out period.

Starting any of these meds can mean side effects. The switching protocols are to allow a smoother transition because there will be an overlap in what they are doing with your Serotonin. However, they need a gap with coming off Fluoxetine as it's half life is so long the new med will be adding onto what that one is already doing for you.

I don't want to worry you, I know seeing this could be triggering but you need to be aware if a GP isn't following the advice from above.

[MissShabby]

Thanks for the condolences, it was the hardest thing I've ever had to do and unfortunately has ended up with me being in the worse bout of anxiety since october now. It wasn't just the dog but anniversary of Dad's death the year before etc.

Meanwhile, I had a really hard time on SSRIs so have not had any luck there.

Long story is I was on Escitalopram and before that citalopram for years, had a super bad reaction to doubling the dose when my attacks started back, tapered off (brain zaps etc), then a month later the anxiety came back again worse than ever so tried sertraline, citalopram, again and then mirtazipine, all with horiffic side effects I couldn't deal with.

But this isn't about me! I'd say it's okay to wait and speak to the doctor. 25mg is a low dose of sertraline so coming off won;t be any worse after a few more days and, in fact, it might be helping with the prozac withdrawal?

Oh my. I'm so sorry. The two are bound to have made your anxiety worse, I'd be the same. Life can really suck sometimes but try to think that you made your dog very happy. Love is all that really matters.

Oh I tried mirtazapine once and it knocked me Out for two days straight, I didn't really wake up once. My mum had to call the doctor. I didn't stay on those long at all. My friend takes them though and finds them wonderful.
My friends mother takes an antidepressant for her anxiety after losing her husband, mother and father in a short space of time all to dementia, I can't remember what it's called but it starts with a D I think.

I guess I'll just wait to see a doctor and see what they say. My two usual doctors have left the practice, so at the moment I'm not very confident with the Gps I see.

---------- Post added at 06:07 ---------- Previous post was at 06:00 ----------


I'm struggling to get my head around what your GP is thinking here to be honest. You asked for something "lighter" and they gave another SSRI when the one you were on you could have just withdrawn from. So, they have basically enacted a switch and they haven't followed NHS guidelines for a switch from Fluoxetine since there should be a "wash out" period.

Here are the guidelines:

http://www.gpnotebook.co.uk/simplepage.cfm?ID=1651179592

The thing is, Fluoxetine has a very long half life of 1-3 days and that becomes 4-6 days for chronic use. Those few days wouldn't have allowed it below 50% from what I can tell but if you felt better, perhaps this is a sign that the med is too much? You were struggling and found the increase made it worse so either too much again or side effects since any dosage increase can bring them again.

The Sertraline is just another SSRI so the potential for withdrawal will be there once you have been on them for a while like any other. However, these meds both primarily work on changes to your Serotonin levels and Serotonin receptors as they are in the same class of meds. So, being on the Sertraline a few days doesn't mean you can cold turkey them because you have to consider the fact you are a long term SSRI user and that usually means a taper.

I think having a chat with your GP is the way to go. I would be asking why they have switched to Sertraline when you could have kept with withdrawing from the Fluoxetine. Perhaps your GP is adding in a low dose started in a switch as a step down? A 20mg dose of Fluoxetine is equivalent in it's main objective to 50mg of Sertraline so it is a step down BUT I have reservations about how your GP has not used the wash out period.

Starting any of these meds can mean side effects. The switching protocols are to allow a smoother transition because there will be an overlap in what they are doing with your Serotonin. However, they need a gap with coming off Fluoxetine as it's half life is so long the new med will be adding onto what that one is already doing for you.

I don't want to worry you, I know seeing this could be triggering but you need to be aware if a GP isn't following the advice from above.

Thank you :) to be honest I don't think my Gps gave a monkeys. At first I saw a nurse practitioner who didn't really know anything about medicine and that when I had my dosage doubled. The other GP I saw was a new GP who I've never seen before and she just went through a list of tablets and asked if I'd taken them and I'd answer 'yes or no', so we came to sertraline and she just asked if I'd like that, so I said yes as I've heard some people get along well with it.
There was no talk of tapering or anything, I just walked out with my new shiny prescription in the hope Id be back to my normal self.
I did discus wanting to come off ADs altogether though. So I'm not sure if that's what she had in mind. :/

[MyNameIsTerry]

Sometimes if people find withdrawal hard or more commonly if they are coming off a very short half life med like Venlafaxine, they will switch people to Fluoxetine because of it's longer half life as it makes for a steadier withdrawal with less side effects. It seems strange to shift to a shorter half life med though. Having said that, Sertraline has a half life of 22 hours but it's longer for women (32 hours) so for women the half life is quite close to Citalopram (35 hours) so it may be similar in terms of impact...but you know it's always individual.

I really don't think they have listened to your request to come off them. They haven't even followed guidelines for a switch from Fluoxetine. Most of the switches carry a risk of Serotonin Syndrome because of the overlap but since one med is being reduced and another started on a lower dose, this is an acceptable risk as so SS is on the rare side. Obviously, people here SS and think of the dangerous side of it but it can also be mild so don't worry but do keep an eye on your symptoms because they should have not introduced the Sertraline for a bit longer to let more of the Fluoxetine out of your blood plasma. However, just to add you weren't on the 40mg long enough for it to reach it's "steady-state" (as much going in as coming out) so it's not quite like you have an overlap of a fully stable max dose against introduction of the new med.

I've just re-read your OP and noticed you came off the Fluoxetine completely for 2-3 days and felt better. This is interesting because like I said it would be 4-6 days for it to reach 50%, although your additional 20mg was not stable so that would be reducing a bit quicker. So, basically you reduced a fair amount of the active drug in your blood plasma and felt better. Missing doses on longer half life drugs is less of an issue because of the long half life but it is interesting that the less you had, the better you felt.

It takes quite a long time for Fluoxetine to fully be eliminated. It's not just the active drug but also the active metabolite. The metabolite has a much longer half life but it won't be as powerful as the drug. So, it will take some time when you come off and now you have the Sertraline also going in.

There is a standard pharmacokinetic calculation used with drugs but all drugs differ so it's never accurate, it's just a guide.

Some drugs have study info about how fast they are eliminated or reach steady-state so it can be accurately determined. I know for Fluoxetine there is one showing how fast it becomes stable (steady-state) but not how fast it eliminates. So, you could use the standard calc which is 5x half life to reach <5% (clinically insignificant) or 7x half life for 100% elimination. It's just something you could use to know when you are finally hoping to see it gone. Just remember though, that active metabolite needs to go too. The half life for the active metabolite is 4-16 days but I can also see 9.3 days quoted by the same medical source so that may be an average? The drug itself is 4-6 days in chronic use. Since these drugs work differently, they may have not interaction on that level that affects these timescales but they do both work on Serotonin so there is obviously overlap there which won't affect withdrawal but could affect symptoms.

I know that seems complex, it just saves answering it later if you need it. Just ask if you are unsure.

[MissShabby]

Sometimes if people find withdrawal hard or more commonly if they are coming off a very short half life med like Venlafaxine, they will switch people to Fluoxetine because of it's longer half life as it makes for a steadier withdrawal with less side effects. It seems strange to shift to a shorter half life med though. Having said that, Sertraline has a half life of 22 hours but it's longer for women (32 hours) so for women the half life is quite close to Citalopram (35 hours) so it may be similar in terms of impact...but you know it's always individual.

I really don't think they have listened to your request to come off them. They haven't even followed guidelines for a switch from Fluoxetine. Most of the switches carry a risk of Serotonin Syndrome because of the overlap but since one med is being reduced and another started on a lower dose, this is an acceptable risk as so SS is on the rare side. Obviously, people here SS and think of the dangerous side of it but it can also be mild so don't worry but do keep an eye on your symptoms because they should have not introduced the Sertraline for a bit longer to let more of the Fluoxetine out of your blood plasma. However, just to add you weren't on the 40mg long enough for it to reach it's "steady-state" (as much going in as coming out) so it's not quite like you have an overlap of a fully stable max dose against introduction of the new med.

I've just re-read your OP and noticed you came off the Fluoxetine completely for 2-3 days and felt better. This is interesting because like I said it would be 4-6 days for it to reach 50%, although your additional 20mg was not stable so that would be reducing a bit quicker. So, basically you reduced a fair amount of the active drug in your blood plasma and felt better. Missing doses on longer half life drugs is less of an issue because of the long half life but it is interesting that the less you had, the better you felt.

It takes quite a long time for Fluoxetine to fully be eliminated. It's not just the active drug but also the active metabolite. The metabolite has a much longer half life but it won't be as powerful as the drug. So, it will take some time when you come off and now you have the Sertraline also going in.

There is a standard pharmacokinetic calculation used with drugs but all drugs differ so it's never accurate, it's just a guide.

Some drugs have study info about how fast they are eliminated or reach steady-state so it can be accurately determined. I know for Fluoxetine there is one showing how fast it becomes stable (steady-state) but not how fast it eliminates. So, you could use the standard calc which is 5x half life to reach <5% (clinically insignificant) or 7x half life for 100% elimination. It's just something you could use to know when you are finally hoping to see it gone. Just remember though, that active metabolite needs to go too. The half life for the active metabolite is 4-16 days but I can also see 9.3 days quoted by the same medical source so that may be an average? The drug itself is 4-6 days in chronic use. Since these drugs work differently, they may have not interaction on that level that affects these timescales but they do both work on Serotonin so there is obviously overlap there which won't affect withdrawal but could affect symptoms.

I know that seems complex, it just saves answering it later if you need it. Just ask if you are unsure.

Thank you so much for replying. I'm going to try to see a doctor tomorrow that I can get some sense out of.

Today my eyes weren't feeling right, like they couldn't focus, so I had a look in the mirror and my left pupil was huge and my right was smaller. It was very weird. I showed my parents to confirm I wasn't being crazy, and they agreed they were.
So I'm thinking this sertraline might not be for me.

[MissShabby]

Didn't take a sertraline tonight because of the one large, one small pupil thing. Going to try seeing a doctor this morning.

[MyNameIsTerry]

Yes, seeing a GP is a very good idea.

Dilated pupils (mydriasis) are in the Uncommon side effect category (0.1-1%) so this could just be a side effect of starting this med, because you will have side effects but hopefully to a lesser extent than starting a med completely new.

However, dilated pupils can also be a sign of SS. So, it's best to be safe given how you have switched over. I think not taking another is a very good idea and providing your GP is happy it's only a side effect, you can get them started again very quickly.

If they recommend a different med, I suggest you ask them about the lack of the proper wash out period from the original one as that could still be a factor right now.

[MissShabby]

Hi, I'm back again :) I saw my doctor and my eyes are fine. The different sized pupils have gone back to normal now.
I explained my situation to him and he said since I've been off Prozac a week already I should be ok. He said he would have rather have tapered me off but thought I was quite alright. So I've bought some omega oils and magnesium to help with along my hopeful recovery :)
Been looking into 5htp but I don't think I'll take that for at least a few weeks.
I'm quite excited :)

---------- Post added at 14:57 ---------- Previous post was at 14:54 ----------

One thing I was going to ask is that I was wondering if maybe being on Prozac for 7 years had somehow caused me to have serotonin syndrome? I've read it usually comes on acutely after starring meds, but I was just wondering if it was a possibility? I looked at the symptoms and I had a few of them while on Prozac.

[MissShabby]

Feeling moody and annoyed today. Feel frustrated.
I'm going to try to get a lower dose of Prozac tomorrow so I can taper off.

[MissShabby]

Today I have taken 5mg of Prozac, I'm even going to taper it lower or higher, I'm going to see how I get on first.

[MyNameIsTerry]

SS is something more likely to occur when combining two drugs that work on Serotonin. Everytime we switch, we are usually at risk of this when a cautious cross-taper is used (between SSRI's for example, the exception being Fluoxetine as the wash out period is needed first).

My thoughts on this are that if you were at risk of SS, it would be introducing that Sertraline far too quickly as your GP didn't follow the prescribing guidelines. With you stopping the Sertraline, you could have stopped this from continuing as the Sert would then start to be permanently eliminated, which takes over about a week.

Although, it could have been that the Fluoxetine dose was too strong for you. SS is pretty rare though, it's more a risk when combining rather than adjusting like that.

Your GP is getting confused though, you were never off Fluoxetine for a week for a wash out because the other GP introduced a drug from the same class too early. Regardless of whether it was a week until you saw him, he should be considering the impact of adding in a new SSRI too early. Whilst the Fluoxetine would continue to eliminate, the doses of Sert were building and both these meds work on your Serotonin.

Also, because your Serotonin was being impacted by this Sert, it should have reduced the impact of the withdrawal of the other. Now that is gone, you basically in a cold turket situation, which is not advisable.

I see you are now re-introducing your old med. This seems like a good idea because then you can taper off.

Seriously, these GP's don't seem to understand how to use these meds - it's all too common I'm afraid, mine is the same.

Some additional info on withdrawing from the psychiatrists:

http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants/comingoffantidepressants.aspx

DURING
•Reduce slowly
•Research suggests:
•if treatment has lasted less than 8 weeks, stopping over 1-2 weeks should be OK
•after 6-8 months treatment, taper off over 6-8 weeks
•if you have been on maintenance treatment, taper more gradually: e.g. reduce the dose by not more than ¼ every 4-6 weeks.

•Stay in touch with your doctor
•Be prepared to stop the reduction or increase your dose again if needed
•Keep a diary of your symptoms and drug doses.

[MissShabby]

Thank you terry that makes so much sense.
I've just had my day two dose of 5mg Prozac. I felt more stable today, I was very moody on Thursday though, I felt intense aggression which isn't like me at all, that's why I decided to start taking Prozac again.
I'm happy to stay on 5mg for a long time as long as it doesn't give me those weird adrenaline feelings. Also I found it hard to pass water on 20mg, which has now gone, I just hope it doesn't come back.

[MissShabby]

Felt really anxious before bed last night, couldn't sleep even though I was exhausted. I slept for 15hours today though :blush:
I asked my doctor for liquid form of prozac so I could taper slowly, but they just advised taking 20mg every other day, so no help there. I have to measure my prozac myself:weep:

[MissShabby]

Last week I went back to work. No anxiety on the first day, was nice and exciting to be back. Woke up the next morning feeling like is been hit by a bus and felt so exhausted. I experienced a few anxiety attacks on the bus, when I got to work I was ok though. Was exhausted all day though. When I got home I decided to have a nap but everything I closed my eyes I felt like I was falling head first.
Anyway the following day I felt fine again. Feel a bit zoned out, feel a bit odd but fine otherwise. The tiredness can proper suck though.

[MyNameIsTerry]

Yeah, I know what you mean, I remember my first week back. It does improve though as you keep going and you build a new routine that you feel safe with and your confidence starts coming back.

Falling sensations when falling asleep are a well known phenomena and can happen to anyone so don't let it worry you.

[MissShabby]

Thank you Terry, those falling sensations were horrible.
I'm glad to be back at work, it keeps me from obsessing about my feelings and it's just good to get out. My work mates are amazing, I'm extremely lucky to have them. Have been in other jobs where no one understood.

[MyNameIsTerry]

That's great to hear. Having wonderful people in your life makes a big difference. It's certainly good to get into healthy routines. I resisted going off sick for a while because I knew my anxiety would then focus on my home life and all the extra thinking time would be very hard to deal with. We spend so much time at work in our lives that it can be hard to adjust to a black hole in the day.

Yeah, the falling sensations give you a little shock. It's like with the jerks, they are the same.

[MissShabby]

I've just had three days off for the holidays and now I'm dreading going back to work again, I know it's just the thought of it all.

[MissShabby]

Hi, I thought I'd pop back.
I'm on 4mg of Prozac and I'm finding I'm stressed out a lot about housework. I live with my parents and when I come home from work there's still loads of housework to be done. I'm really tired after work and I find myself getting really worked up and annoyed, and rather moody. When I was on Prozac I didn't really care, but now I want everything a certain way �� I don't know if it's my old personality coming back or its withdrawal. I only find myself moody when I'm stressed about everything that needs to be done though.
I'm scared in case I need to up my dose, but otherwise I'm ok.
I feel that when I was on Prozac I didn't care, I was happy to not be doing much and now I feel like I want to be independent etc. I'm just scared because I haven't felt like this for years.

[MissShabby]

Still on 4mg of Prozac but for the past few days I've felt morbidly depressed. I can't stop crying :(

[MissShabby]

So earlier I was looking at my diary and this Sunday coming it will be 10weeks since I stopped 20mg Prozac. I'm still on 5mg though. I do feel after all the physical symptoms at first like the flu like feelings, headaches etc. That I'm now having bits of anxiety and depression here and there. Mainly when I'm stressed I get depressed or anxious. I find I do worry about stuff too much, therefore making myself feel ill at times.
My slight obsession with withdrawal and reading about withdrawal helps but doesn't at the same time.
I have strange thoughts now and then that go and soon as they come.
I worry about relapse continuously. I worry what if I will always need to be on tablets.
I think of my childhood and the horrible bullying I suffered by my teacher and fellow classmates, I think that triggered my depression many years ago. I worry what if all that made me ill, and so ill I'll always need tablets.
I worry what if I hallucinate coming off.
I feel quite happy in myself I laugh and find certain things really funny, I laugh without the numb feeling I use to have. I also cry much easier too.

Okay I'll leave it there for now.