Unsure about doctors advice (Coming off of Fluoxetine)

[monalisavito]

Hi, I was first prescribed Fluoxetine (20mg for PMDD, Intrusive thoughts, Anxiety) in 2012 and at the beginning of this year I was on 80g. I decided to consult a gp about coming off of meds, and was advised by the doctor I saw (I don't have a regular gp that I see) that I should reduce my dosage by 20mg every 2 weeks and that would be it. I was surprised by such a brief time frame but he reassured me that it's fine and that I should simply monitor how I'm feeling and take more or less accordingly :/

I've just finished my first two weeks on 60mg and since Sunday reduced to 40mg. I felt fine, but coupled with hormones (time of the month), I've been very emotional and irritable which is standard for me, but I've also been massively exhausted mentally and physically..lacking any energy whatsoever. Hardly ideal for anyone, but I work in education and stamina is crucial.

So I'd like to know if anyone can offer any thoughts as to whether the tiredness may be from such a drastic and quick reduction in mgs? Or if this is what is normally advised when coming off of fluoxetine? It was very encouraging that I'd be off it so soon, but I'd rather slow the process down if it means I can get through the day normally.

[MissShabby]

Hi monalisa,I'm in a similar boat to you. I've just been tapering my Prozac. I'm not very clued up and don't feel confident enough to give advice but what I've read on a forum called survivingantidepressants is that tapering your antidepressants by 10% a month is the way to go.
I myself was on 20mg Prozac since around 2009 and suddenly felt ill on them, so I was changed go sertraline which I took for a few days but wasn't happy, so I went totally cold turkey but upon reading about tapering I decided to reintroduce 5mg Prozac which I have been taking for a week and a bit so far.
I think the tiredness is from the withdrawal, I've been extremely fatigued but starting to feel better now.
I hope you can find some sense somewhere about withdrawal. :)

[MyNameIsTerry]

This webpage will explain about how to taper too:

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.

The taper suggested by that GP is far too fast. You may be able to do it, but it's more likely to cause withdrawal than a slow controlled taper.

The thing is, the NHS has no policy on pill splitting so GP's will only taper based on the dosages they can actually prescribe and these are just what the manufacturers make and are not based on varying patient needs. It's irresponsible and political, but the GP's are just following the NHS on this. Pill splitting is approved in Germany and they do it in the US too plus the reason a manufacturer even puts a score line down the middle of the pill is to say you can split it if you wish. There are rules to pill splitting though which you have to follow e.g. the pill must be homogenised (all with a score line are, but many without are too), never split it down the side edges (pills are layered so the active drug will be in it's own layer and splitting down the side will effect this), never split a timed release med (it can cause overdose), never split enteric coated meds (can cause irritation) and never split capsules (the capsule is often to protect from irritation).

[monalisavito]

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.

The taper suggested by that GP is far too fast. You may be able to do it, but it's more likely to cause withdrawal than a slow controlled taper.

The thing is, the NHS has no policy on pill splitting so GP's will only taper based on the dosages they can actually prescribe and these are just what the manufacturers make and are not based on varying patient needs. It's irresponsible and political, but the GP's are just following the NHS on this. Pill splitting is approved in Germany and they do it in the US too plus the reason a manufacturer even puts a score line down the middle of the pill is to say you can split it if you wish. There are rules to pill splitting though which you have to follow e.g. the pill must be homogenised (all with a score line are, but many without are too), never split it down the side edges (pills are layered so the active drug will be in it's own layer and splitting down the side will effect this), never split a timed release med (it can cause overdose), never split enteric coated meds (can cause irritation) and never split capsules (the capsule is often to protect from irritation).

Thank you for all this information.
I'm confused as to how a slow taper would work being that, as you've said, the capsules are only prescribed in 20mg doses? If I wanted to reduce by 5mg - how would I do that?

I've managed to get a phone consultation appointment for next week with a doctor I'm more familiar with.

---------- Post added at 23:03 ---------- Previous post was at 23:01 ----------


Hi monalisa,I'm in a similar boat to you. I've just been tapering my Prozac. I'm not very clued up and don't feel confident enough to give advice but what I've read on a forum called survivingantidepressants is that tapering your antidepressants by 10% a month is the way to go.
I myself was on 20mg Prozac since around 2009 and suddenly felt ill on them, so I was changed go sertraline which I took for a few days but wasn't happy, so I went totally cold turkey but upon reading about tapering I decided to reintroduce 5mg Prozac which I have been taking for a week and a bit so far.
I think the tiredness is from the withdrawal, I've been extremely fatigued but starting to feel better now.
I hope you can find some sense somewhere about withdrawal. :)

Thanks for your reply! Best of luck with your withdrawal too :hugs:

[MyNameIsTerry]

Thank you for all this information.
I'm confused as to how a slow taper would work being that, as you've said, the capsules are only prescribed in 20mg doses? If I wanted to reduce by 5mg - how would I do that?

I've managed to get a phone consultation appointment for next week with a doctor I'm more familiar with.

You can cut the pills as long as it's not a contradiction of the tips I put above (which comes from medical websites including the NHS). Pill cutters can be purchased in chemists as well as online. You should be able to cut them into quarters with these cutters, others on here have.

If the manufacturer has placed a "score line" down the middle, you can use that for the cutting into the half and then it just means judging it again to cut those halves into halves again. You can do it with knives, Stanley blades, etc. Just be careful you don't crush as you don't want to be losing some of the dose hence a sharp blade is always needed, the thinner the better.

If you are concerned about the cutting, you can always weigh the pill. Jewellery scales cost a few quid off Ebay and can measure 0.01-200g dependant on the one you choose. Remember though, it's not the mg of the dose but the weight of the pill when you do this as they also have other things in them like fillers & binding agents, so 10% of a pill weight is more than 10% of the active drug hence the active drug removed by this route ends up less than 10% at a time, if that's makes sense? (you may not need to know this, it's just in case) . People tend to need to do this though when they are taking the 10% reduction approach as that's very hard to judge but halves & quarters should be achievable pretty well from how they look.

With any taper the most important thing is you. If you feel a lot worse, can you adjust to make it more gradual? If you feel you are doing well enough, perhaps you can go a bit more next time. It's always a very individual process so see how you take it.

[monalisavito]

You can cut the pills as long as it's not a contradiction of the tips I put above (which comes from medical websites including the NHS). Pill cutters can be purchased in chemists as well as online. You should be able to cut them into quarters with these cutters, others on here have.

If the manufacturer has placed a "score line" down the middle, you can use that for the cutting into the half and then it just means judging it again to cut those halves into halves again. You can do it with knives, Stanley blades, etc. Just be careful you don't crush as you don't want to be losing some of the dose hence a sharp blade is always needed, the thinner the better.

If you are concerned about the cutting, you can always weigh the pill. Jewellery scales cost a few quid off Ebay and can measure 0.01-200g dependant on the one you choose. Remember though, it's not the mg of the dose but the weight of the pill when you do this as they also have other things in them like fillers & binding agents, so 10% of a pill weight is more than 10% of the active drug hence the active drug removed by this route ends up less than 10% at a time, if that's makes sense? (you may not need to know this, it's just in case) . People tend to need to do this though when they are taking the 10% reduction approach as that's very hard to judge but halves & quarters should be achievable pretty well from how they look.

With any taper the most important thing is you. If you feel a lot worse, can you adjust to make it more gradual? If you feel you are doing well enough, perhaps you can go a bit more next time. It's always a very individual process so see how you take it.
Thanks again for all of your advice :)