First day on Prozac

[Lady Penelope]

Hello
i am on my first day of Prozac for anxiety. I am going away on holiday in a week and am really worried about when the side effects will kick in. I have been told symptoms will get worse before they get better. I have been taking propanalol 20 x 2 per day for the last two years fro anxiety but this does not seem to be enough now. I have also been given 14 x 2mg Diazipam for emergency use.
how can I minimise the side effects from the Prozac? Any tips?
Thanks.

[panic_down_under]

how can I minimise the side effects from the Prozac? Any tips?
Thanks.

The first thing to keep in mind is that severe initial side-effects are not the norm. Most experience no to only mild side-effects at the beginning. Nor are all side-effects necessarily caused by the med. Believe you will suffer severe symptoms and an anxious mind is very capable of producing the whole catastrophe all on its own, no med required. :sad:

Most initial side-effects can be successfully treated, for example benzodiazepines, sparingly, or the prescription antihistamine hydroxyzine (Vistaril) for increased anxiety, ginger and/or vitamin B6 supplements for nausea, loperamide (Imodium) for diarrhoea, small doses of mirtazapine or trazodone for insomnia, paracetamol, aka acetaminophen, for headaches, etc.

[Lady Penelope]

Thank you. That makes a lot of sense. I am watching and waiting for side effects! What you said has made me think and I know how powerful my mind is at giving me strange bodily symptoms.
i have been prescribed 20mg per day.
i have been given a mixture of 10mg and 20mg capsules (stock shortage apparently)

After reading through lots of other threads in hear I am wondering if I would be better taking 10mg for 7 days then upping to 20mg to minimise side effects.

Any thoughts on that please?

[panic_down_under]

i have been prescribed 20mg per day.
i have been given a mixture of 10mg and 20mg capsules (stock shortage apparently)

After reading through lots of other threads in hear I am wondering if I would be better taking 10mg for 7 days then upping to 20mg to minimise side effects.

There is only one reason why 10mg capsules exist and that is to ease people onto fluoxetine. Eli Lilly resisted making it available in doses smaller than 20mg for many years, and then began backtracking once they realised how the problems people were having, especially those with anxiety, were affecting sales. Initially they promoted dissolving the 20mg capsule contents in a measure amount of fruit juice (but not of grapefruit) and drinking half the mixture to arrive at 10mg while they hurriedly sought FDA approval to release the med in 10mg capsules. So, yes, generally I think it might be better to start on 10mg, but you should okay this with the prescribing physician first.

That said, the very long fluoxetine half-life renders starting on a smaller initial dose less effective than it is for other SSRIs. The rule of thump is that it takes about 5 times the half-life of a med for its blood plasma levels to stabilize to a steady-state. Increasing doses before steady-state is achieved may significantly raise side-effect severity above that which would have occurred with the full 5x wait (but delaying longer won't usually significantly diminish any post increase spike).

The problem is fluoxetine's half-life is up to 6 days, so ideally doses should be raised no sooner than every 30 days. That is a long time to be on a sub therapeutic dose not doing much when fighting severe anxiety and/or depression. To complicate it even further most of the med's activity comes from its active metabolite which has a half-life of up to 16 days! Apply the 5x rule and people could be waiting up to 6 months for the med to kick-in which is not only impracticable, but also potentially harmful. So I'd up the dose to 20mg within 10 days if side-effects are mild to moderate, or 14 days if they are severe. That may generate worse side-effects than if you waited 30 days, but they should still be less than from starting on 20mg.

[Lady Penelope]

Thank you so much for taking the time and trouble to give such a detailed reply.

[Lady Penelope]

Third day and feeling worse than I have for years. Standing in the kitchen and developed blurry visions and felt faint. Could not focus at all. Went to bed and then about half an hour later got zig zag lights in vision. Took 2mg Diazipam and fell asleep for an hour or so.
i took 20mg Prozac first day and then 10mg second and third day.
Scared to get out of bed now

[panic_down_under]

Standing in the kitchen and developed blurry visions and felt faint. Could not focus at all. Went to bed and then about half an hour later got zig zag lights in vision.

Sounds like an ocular migraine which have the aura, but are painless, exacerbated by the anxiety it triggered. Fluoxetine is often prescribed to treat migraine, but paradoxical reactions can sometimes happen. Or it might just be a coincidence.

If it is a fluoxetine side-effect is will likely be short lived. Serotonin isn't only a brain neurotransmitter, in fact that is one of its lesser roles. One of the other things it does is mediate blood vessel tone, constriction and dilation. Serotonergic ADs such as fluoxetine may affect this function at the beginning until the body adjusts. They are also mild anticoagulants. While scary, ocular migraines are usually harmless provided care is taken in potentially hazard situation.

[Lady Penelope]

Thank you. I decided to take one of the Diazipam first thing. Previous days I have been taking it when I feel anxious but though it would be good to pre-emp.
I have only been prescribed 14 x 2mg and that was reluctantly so can’t imagine I could get any more. Just want them to help get me through the first two weeks of taking fluoxetine. Day 4 now and feeling ok so far. Going away on holiday for a week on Friday so really need to get through the next 10 days.

[panic_down_under]

I have only been prescribed 14 x 2mg and that was reluctantly so can’t imagine I could get any more.

Try asking your GP for *hydroxyzine (Vistaril). It is a prescription antihistamine with pretty good anti anxiety properties. Not quite as potent as the BZDs, but often potent enough.


*Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.

[Lady Penelope]

Thank you. I have never heard of anti histamine being used for anxiety. I was given one a couple of months ago for labyrinthitis- Cyclizine Hydrocloride. Would that be similar?

[panic_down_under]

Thank you. I have never heard of anti histamine being used for anxiety.

Several antidepressants and anti psychotics are also powerful antihistamines including amitriptyline, doxepin, mirtazapine, quetiapine. Some are more potent than the meds marketed as antihistamines.


I was given one a couple of months ago for labyrinthitis- Cyclizine Hydrocloride. Would that be similar?

It is an antihistamine, but its mainly blocks nausea. It doesn't seem to have any specific anti anxiety properties.

[Lady Penelope]

Thank you. You have great knowledge and it it very good of you to take the time to share it.

[Lady Penelope]

Well day 5 on 10mg fluoxetine. Taken 2mg Diazipam on day 4 & 5 first thing in the morning as anxiety has been bad.
Also upped propanol from 20mg twice a day to 20 three times and still feeling very anxious. Blurry vision at times and lightheaded. Hope next few days will be better.
thinking of upping Diazipam to twice a day?
any thoughts or tips ?

[panic_down_under]

Also upped propanol from 20mg twice a day to 20 three times and still feeling very anxious.

Propranolol isn't an anti anxiety med as such. It only blocks the common adrenaline fuelled flight-or-flight rush which can really spook people, but it has no impact on anxiety pathways in the brain.


Blurry vision at times and lightheaded. Hope next few days will be better.

Both are typical initial SSRI side-effects.


thinking of upping Diazipam to twice a day?

Take it if you need it, but will you get another prescription if this continues for more than 7 days? You may experience a resurgence of side-effects for a while after raising to dose to 20mg too.

[Lady Penelope]

Thank you once again. I doubt I can get another prescription so I think I will have to try and it save it. I am going away for a week on Friday so I know I will need it for the flights, I am planning on staying on 10mg fluoxetine for 14 days in total and upping to 20mg the day after I get home from holiday. I don’t want even more side effects while I am away.

[panic_down_under]

I am planning on staying on 10mg fluoxetine for 14 days in total and upping to 20mg the day after I get home from holiday. I don’t want even more side effects while I am away.

A very good idea, imho.

[Lady Penelope]

Day 6. Tried to start the day without Diazipam but felt very anxious so had to take 2mg. Does Diazipam haVe a cumulative effect if taken every day? I have 9 left so enough for every day until I get home from holiday if I take one daily.
thank you panic down under for taking the time to read my posts and reply. It is nice to feel I am not on this journey alone. I don’t have anyone I can talk to about it.

[panic_down_under]

Day 6. Tried to start the day without Diazipam but felt very anxious so had to take 2mg. Does Diazipam haVe a cumulative effect if taken every day?

No. While it has a long elimination half-life, it is only effective for around 4-10 hours and this doesn't change with daily dosing.


I have 9 left so enough for every day until I get home from holiday if I take one daily.

Cool. Take it if you need it, but only if you need it. If the anxiety builds you can speed up absorption by crushing the tablet with your teeth and holding the powder under the tongue for 30-60 seconds. It doesn't taste great, by this will absorb some of the dose directly into the bloodstream which is much faster than via the stomach.


I don’t have anyone I can talk to about it.

This is largely why support groups exist. Unfortunately, while a large segment of the population will experience a psych disorder at some time, talking about them with family and friends can be difficult because most have little understanding of them. Most of what people believe is wrong, and that, sadly, also applies to quite a few GPs too, ime.

The other problem is many doctors treat their patients like mushrooms, i,e, keep them in the dark and feed them on BS. Most of the problems folk have with ADs and the other psych meds would be diminished if not prevented if GPs and psychiatrists educated patients about what to expect.

[Lady Penelope]

Thank you. That’s a great tip about speeding absorption. I am definitely feeling so much more anxious since I started on Fluoxetine so I am glad I am taking the 10mg and not 20mg. I took it once before about 4 years ago and the side effects were horrendous so I was given Diazipam then to help me through. Once I had been on it a while it worked very well so I am going to power through even though the timing is not good with me going away. Mind you the timing is never good for these things! I am hoping the second week on it will be better than the first but I know everyone is different how they react. I have just found two 5mg Diazipam Left over from what I was given for a surgical procedure last year so I have them for emergency use as well.

[Lady Penelope]

The flight is about 3 hours so I worry about that and also worry about trying to act like I’m feeling ok all week when I may not be.

[panic_down_under]

The flight is about 3 hours so I worry about that and also worry about trying to act like I’m feeling ok all week when I may not be.

Is flying itself the problem, or agoraphobia, both?

[Lady Penelope]

It’s the flying that’s the problem. Almost thinking of not going.
had a panic attack yesterday afternoon and felt awful for the rest of the day.
then woke up about 5.30 am feeling really anxious. Tried breathing exercises but it did not go and seemed to be building so took 2mg Diazipam under my tongue. Within 5 minutes felt really sick dizzy. Finally fell asleep and have recently woken up. Feel a bit defeated by it all. I am feel much worse this week that I was before I started the fluoxetine. Day 7 today. I am really worried about the holiday and not being able to get there.

[Lady Penelope]

I had been on fluoxetine before in 2016 and weaned off by end of 2017. I have been feeling anxiety building up over last six months so went back to GP to nip it in the bud. She suggested going back on fluoxetine as it worked before. Beginning to regret it now as I am getting panic attacks again which I was not before I went back on it. I had been feeling anxious quite often but the panic attacks have only been over the last week. I suffer with health anxiety and it was a minor heal scare 6 months ago that started it off again. I though I was managing it well with just propranolol but it has escalated. Don’t know what to do

[panic_down_under]

It’s the flying that’s the problem.

Flying is a piece of cake - used to be my day job, it's the drive to/from the airport which is scary. I've spent most of today driving nearly 800 km, too tired/lazy to convert that to miles, but a long day in the saddle for an old bugger. I would gladly have traded places with you.


Feel a bit defeated by it all. I am feel much worse this week that I was before I started the fluoxetine.

That is the major problem with ADs for anxiety, they can make it much worse before they begin making it better. Unfortunately, there is no magic incantations to make it any easier. :sad:


Day 7 today. I am really worried about the holiday and not being able to get there.

Can you cancel, or postpone without loosing your money? I don't know if travel insurance would cover this. Perhaps not if it's a pre existing condition.


I had been on fluoxetine before in 2016 and weaned off by end of 2017. I have been feeling anxiety building up over last six months so went back to GP to nip it in the bud. She suggested going back on fluoxetine as it worked before.

The initial side-effects can be both more severe and different than the first time and it can take longer for the AD to kick-in too. Why seems to be a mystery, although this may mostly be because no one is looking that hard.


Don’t know what to do

It comes down to either powering through the worst of it while treating the side-effects as best you can, switching to something else in the hope it will provide an easier ride, or trying therapy instead.

Option one is hard, but likely to work, 2 is about a 50:50 chance with another SSRI or SNRI, possibly slightly better odds with a TCA, and 3 has a good chance of working, but it could be a long wait to access.

[Lady Penelope]

Thank you. The holiday cannot be postponed- it was booked a year ago when I was feeling fine!
lots of other people going who can go without me. I would be really disappointed if I could not go.
I am going to pack a s assume I am going. I will take half of one of my 5mg Diazipam before I go to bed and the other half when I wake up. I will be all ready to go and decide in the morning if I feel ok. I could not have gone today - the physical effects of the anxiety and or fluoxetine were way to strong. I though about stopping them all together but I have taken 7 days worth now.
you are very kind to reply. I just wish I knew how the next week would pan out. If I felt really bad on holiday I may as well be at home but maybe the second week won’t be as bad. Crystal ball anyone?

[Lady Penelope]

Well been back to GP today - different doctor. I explained all the terrible side effects I had with Fluoxetine and said I wanted to try and manage with out anti depressants. I asked for The anti histamine suggested and she had never heard of it - looked it up - and said no! Would not give me any more diazepam either. I need to wait for CBT. She persuaded me to accept a prescription for Sertataline 50mg but I have not collected it. I am so scared to try another anti depressant after the awful experience last week. I would love your thoughts on the subject panic_down_under if you don’t mind.

[panic_down_under]

I asked for The anti histamine suggested and she had never heard of it - looked it up - and said no!

Did she say why?


She persuaded me to accept a prescription for Sertataline 50mg but I have not collected it. I am so scared to try another anti depressant after the awful experience last week.

I can't say whether sertraline will produce fewer, or worse initial side-effects. They only way to know is by trying it.

But NOT at 50mg! Try starting at 12.5mg and increase the dose by the same amount every 7-10 days. You should clear this with the GP first and it would be easier if you had a script for 25mg, if available, as the oval tablets can be tricky to quarter accurately. Failing that, some generics do come in round 50mg tablets so ask the pharmacy if they have/can get you some of them.

[Lady Penelope]

She first said she had never heard of it then she had not prescribed it for years - then looked it up and said it’s not really suitable for anxiety. She seemed very keen for me to try sertraline. She did say I could increase propanalol from 20mg twice a day to 20mg three times a day.

I have decided to try and manage without the sertraline for the moment. I could not function on the fluoxetine at all and spent most of the week unable to get out of bed. I feel so much better since I stopped it.

I have arranged for some private counselling to start next week and I am on the waitlist to some NHS CBT. I am also using camomile tea and Bach flower remedies. I still have 8 x2mg diazepam for emergency use.

The doctor I saw yesterday was a locum. I have another appointment at the end of next week with a different GP so I am going to print out the information about Vistaril mentioning it’s anti anxiety properties and try again.

When I had CBT a few years ago they seemed quite against anti depressants and would have preferred that I was not taking them while having CBT. I kind of wished I had stayed on them instead of weaning off in 2017. It was my idea to come off as I was feeling so much better and managed quite well without them for about 18 months.

I am willing to try anything - apart from the anti depressants at the moment. I keep hearing about CBD oil for anxiety but it is very expensive and unproven. Do you know if there are any over the counter anti histamines that could help? Or anything else?

you have been a great help to me over the last two weeks panic_down_under so thank you very much.

[Lady Penelope]

I have also been avidly listening to three books. The Dare book by Barry Mcdonagh. Claire Weekes Freedom from Nervous suffering and Anxiety Rebalance by Carl Vernon. All really have the same message about accepting the anxious feelings so I am trying hard to to that. All very good books - although Claire Weekes is a bit dated now it’s a great listen.

[panic_down_under]

She first said she had never heard of it then she had not prescribed it for years - then looked it up and said it’s not really suitable for anxiety.

:weep: And yet she would probably happily prescribe mirtazapine, or the antipsychotic quetiapine which mostly rely on their antihistamine properties to sedate anxiety.


She did say I could increase propanalol from 20mg twice a day to 20mg three times a day.

Is the 1 x 20mg propranolol having a positive impact after you take it?


I am also using camomile tea and Bach flower remedies.

Omega-3 fatty acids/fish oil and exercise have proven positive affects on anxiety and depression by stimulating hippocampal neurogenesis just as AD do and may be all that's needed for mild anxiety and/or depression. Magnesium supplements may also help.


When I had CBT a few years ago they seemed quite against anti depressants and would have preferred that I was not taking them while having CBT.

Psychologists/therapists seem to spend a lot of their energy in bad mouthing ADs and doing meta studies to prove they don't work, while, at least in the U.S., not sure about the UK, they lobby politicians (https://en.wikipedia.org/wiki/Prescriptive_authority_for_psychologists_movement) to legislate prescribing rights for psychologists. They've succeeded in some states.


I keep hearing about CBD oil for anxiety but it is very expensive and unproven.

The jury is still out on this. CBD seems to work well for some and not at all for others.


Do you know if there are any over the counter anti histamines that could help? Or anything else?

Maybe. In the U.S. the over-the-counter (otc) antihistamine Benadryl contains diphenhydramine which has some anti anxiety properties, but it is not quite as potent as hydroxyzine. However, in the UK it contains another drug which doesn't have the same effect. I don't know if diphenhydramine is available in another otc med, but your pharmacy will (ask about its suitability is you're on any other medication).

[Lady Penelope]

Hello again
i am finding the propranalol useful but I have been on 2 x 20mg for 2 years and the anxiety has reappeared. The problem with taking 3 times a days is my heart rate drops to low 50’s and I am finding they make me tired. I am also getting some blurry vision which I understand can be a side effect and that sparks my health anxiety so it’s a bit of a vicious circle!
I will look at the fish oils and magnesium. I already take Vit B complex and Vitamin D.
I have looked up diphenhydramine and it’s the ingredient in Nytol tablets and liquid. These can be bought from a pharmacy over the counter so Might give that a try as well!

thanks again for your informative answer. I am sure it will help a lot of people.

[panic_down_under]

i am finding the propranalol useful but I have been on 2 x 20mg for 2 years and the anxiety has reappeared.

Beta-blockers don't actually reduce anxiety as such, but prevent, or lessen the adrenaline fueled flight-or-flight symptoms of anxiety which can make it easier to cope with anxiety to some extent.


The problem with taking 3 times a days is my heart rate drops to low 50’s and I am finding they make me tired.

I'm currently taking another med which has the same effect so my caffeine intake is through the roof. :sad: Fortunately, I'll soon be off it. It's turning me into an even older geezer than I am reduced to taking afternoon naps. :weep:


I will look at the fish oils and magnesium. I already take Vit B complex and Vitamin D.

The amount of B6 in multi vitamins is likely too low to have an effect. The usual dose for morning sickness is 10-25mg 3 times a day. Don't take more than 75-100mg/day.


I have looked up diphenhydramine and it’s the ingredient in Nytol tablets and liquid. These can be bought from a pharmacy over the counter so Might give that a try as well!


Thanks for the info on Nytol.

[Lady Penelope]

Thank you. Checked the B complex. It’s only 10mg B6 and suggested 2 tablets a day. Might be better on just B6 at a higher dose.

i always avoid caffeine as I feel it’s bad for my anxiety. I do find the 3 doses of propranalol make me sleepy and if I’m not working I would definitely have an afternoon nap. I do wonder if I would be better on the slow release one instead of trying to space out the 3 doses each day. Might mention to GP when I see her next week.

take care