Withdrawal "advice"?

[pulisa]

My 30 year old son has been on Prozac for a number of years. His GP today said he should reduce his dose by only taking the Prozac from Sunday to Friday-thus having the weekend off meds...

Interesting new approach or pig ignorance? I'd value any comments/opinions..

[MyNameIsTerry]

Did you manage to prevent the urge for your eyebrows to raise followed by some eye rolling?

This is a new one, a 5:2 diet for meds. It could be a bit like the one day on, one day off method some of them go by.

To be honest, I would trust my GP as much as my postman on advice over these meds. GP's often seem to contradict the guidelines the NHS hand out. I've seen people say their psychiatrists do the same on here but I doubt I would have much faith in a GP over specialist meds a psychiatrist is supposed to be more clued up on.

This med has such a long half life, 4-6 days in chronic use, I wonder what exactly 2 days will achieve? Also, by saying Sunday-Friday, does that mean he would take both a Sunday and Friday dose? If so, that's only 1 day.

I would also question how this is a reduction. It will allow the med to drop further (or will it given the long half life?) so as to unbalance the blood plasma steady-state he spent the first 5 weeks building. But does this mean the next stage will be to stop completely? If so, that's a bit of a cold turkey to me because each pill he takes will take him back closer to steady-state the rest of the week.

I wonder where this GP gets this regime from?

[MrsCav]

When I came off, I did a couple of weeks where I took one every other day, then a couple of weeks are one every 3 days ... it was when I got to one tablet every 5 days for a couple of weeks that I stopped.

From some of the links Terry has posted in the past, some say don't taper fluoxetine because of the half life. I was unsure if I had tapered long enough, but again, according to some different links, I had tapered long enough, maybe longer than needed.

Thing is, I either got ill or got normal again and didn't like it. I'd like to say my normal anxiety returned after a series of unfortunate events and I knew I could feel better so I didn't hesitate going back on Fluoxetine.

[pulisa]

Thanks very much for your replies. I don't trust this GP one inch. He is more interested in his private dermatology clinic (heavily advertised at the surgery where he is a partner). I think the point was to not take the meds on Friday and Saturday and to resume on Sunday (thus to prepare for the week ahead).

This is a GP who hands out antidepressants and says "see you in 2 months". I'm sure he would be more interested if you booked in for botox as well to boost "mental wellbeing":lac:(privately, of course). I'm advising my son not to play around with the Prozac like this-it's not a drug you should mess with,is it?

[NoPoet]

I've never agreed with any kind of "alternating dose" strategy - it is begging for trouble. As Pulisa says, you should never mess about with this kind of medication.

I would always, always suggest taking the dose every day and GRADUALLY lowering the dose. Tablet cutters, available at chemists, are useful here as you can measure exact dose changes.

IIRC, I used to recommend no more than a 5mg decrease every 2 weeks.

[MyNameIsTerry]

I've never agreed with any kind of "alternating dose" strategy - it is begging for trouble. As Pulisa says, you should never mess about with this kind of medication.

I would always, always suggest taking the dose every day and GRADUALLY lowering the dose. Tablet cutters, available at chemists, are useful here as you can measure exact dose changes.

IIRC, I used to recommend no more than a 5mg decrease every 2 weeks.

I agree with you but a pill cutter will never give exact dosage measurements. You could add a jewellery scale though to weigh them. But you have to weigh the pill first as you will need to take into account the added ingredients so any 10% or quartering needs to be based on gross with not dosage.

[MyNameIsTerry]

When I came off, I did a couple of weeks where I took one every other day, then a couple of weeks are one every 3 days ... it was when I got to one tablet every 5 days for a couple of weeks that I stopped.

From some of the links Terry has posted in the past, some say don't taper fluoxetine because of the half life. I was unsure if I had tapered long enough, but again, according to some different links, I had tapered long enough, maybe longer than needed.

Thing is, I either got ill or got normal again and didn't like it. I'd like to say my normal anxiety returned after a series of unfortunate events and I knew I could feel better so I didn't hesitate going back on Fluoxetine.

Which links do you mean, MrsCav? Was it the GP Notebook ones? If so, I think it just includes info about the different ways to withdraw. Tapering is always best.

I can see the merits in removing doses like you did but the only issue I have with these "on/off" methods is that each time you take a new pill, it will attempt to whack up the active drug to it's peak in the blood. So, I would have thought reducing the active dose too would be needed so it is jumping about all over the place?

[MrsCav]

Morning Folks!

Terry, yes it is the GP notes, it talks about how to stop different anti d's when changing to other anti d's. But then further down it says
''fluoxetine
at 20mg per day - just stop
at 40 mg per day, reduce over four weeks'' .... I did ask you about it at the time as surely just stopping is wrong, so wrong. But then it's GP's notes (and I have a belting relationship with my GP) but they are jack of all trades master of none.

[pulisa]

"Just stop" eh? His GP said that Prozac has no withdrawal effects so all would be fine and dandy if he went cold turkey..

I contacted NHS111 and a pharmacist and both said this advice was incorrect. I have been advised to contact the practice for a second opinion.

[Carnation]

I'm no expert on Meds Pulisa, but it just doesn't sound right to me.
I can't see what could be gained from doing this anyway.
It is not a weaning off technique, it is messing around with a dosage. :huh:

[MyNameIsTerry]

Morning Folks!

Terry, yes it is the GP notes, it talks about how to stop different anti d's when changing to other anti d's. But then further down it says
''fluoxetine
at 20mg per day - just stop
at 40 mg per day, reduce over four weeks'' .... I did ask you about it at the time as surely just stopping is wrong, so wrong. But then it's GP's notes (and I have a belting relationship with my GP) but they are jack of all trades master of none.

The only bit I could see was:

normally, gradually reduce the dose over 4 weeks (this is not necessary with fluoxetine). Reduce the dose over longer periods for drugs with a shorter half-life (for example, paroxetine and venlafaxine)

That's the NICE guidance bit.

I did just spot something interesting though:

Stopping antidepressant treatment
the timing of when to stop antidepressant treatment is discussed in menu item below (length of antidepressant treatment)
patients should be advised not to stop treatment suddenly or omit doses - patients should also be forewarned about possible symptoms that may occur when treatment is discontinued

Yeah, stopping altogether is bad. I know GP's do the stop dead method because they are told not to split pills so if the manufacturer doesn't make it, they are left to stick their necks out or not...so they probably won't. Definitely taper.

---------- Post added at 09:31 ---------- Previous post was at 09:29 ----------


"Just stop" eh? His GP said that Prozac has no withdrawal effects so all would be fine and dandy if he went cold turkey..
I think that answers your question. Any medical professional that says any antidepressant has no side effects...is deluded or incompetent. :doh: