Starting Prozac again for maybe the 5th time.

[Deepseathree]

I’ve been on and off different medications for years and years and I realize that I need to be back on medication. So here we are with Prozac again.

Curious how much harder the side effects will be and if it will be less effective as well. I’m only starting on 10mg the first week and then upping to 20mg. 20mg is all I ever remember taking.

[panic_down_under]

Curious how much harder the side effects will be and if it will be less effective as well.

Unfortunately, my observation is that initial side-effects can be more severe each time an AD is restarted and/or different. Often a higher dose is required to achieve previous levels of control too. But, as with everything about antidepressants, YMMV.

Given your history there is a strong case for remaining medicated permanently, imo, as there is good evidence showing response to ADs, especially SSRIs, can weaken significantly with each discontinuation and restart. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123793/), 2016 and Amsterdam JD (http://www.karger.com/Article/FullText/226611), 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/), 2018; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007; Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002).


I’m only starting on 10mg the first week and then upping to 20mg. 20mg is all I ever remember taking.

That's a good plan. If the side-effects become severe consider delaying the increase to 20mg by a week or two. It takes about 5 half-lives of a med for its plasma levels to stabilise to a steady-state. Raising the dose before reaching steady-state may increase the severity of any side-effects which can be a problem with fluoxetine as it has a very long half-life, around 5-6 days for fluoxetine itself and up to 16 days for its active metabolite norfluoxetine which does most of the work.

[Deepseathree]

Unfortunately, my observation is that initial side-effects can be more severe each time an AD is restarted and/or different. Often a higher dose is required to achieve previous levels of control too. But, as with everything about antidepressants, YMMV.

Given your history there is a strong case for remaining medicated permanently, imo, as there is good evidence showing response to ADs, especially SSRIs, can weaken significantly with each discontinuation and restart. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123793/), 2016 and Amsterdam JD (http://www.karger.com/Article/FullText/226611), 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/), 2018; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007; Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002).



That's a good plan. If the side-effects become severe consider delaying the increase to 20mg by a week or two. It takes about 5 half-lives of a med for its plasma levels to stabilise to a steady-state. Raising the dose before reaching steady-state may increase the severity of any side-effects which can be a problem with fluoxetine as it has a very long half-life, around 5-6 days for fluoxetine itself and up to 16 days for its active metabolite norfluoxetine which does most of the work.

I don’t think you or Fishmanpa get enough praise and thanks for all the time you take and help you give. I’m sure there are others as well, but you all have stood out the most to me. So thanks for that.

hope that people take the time to read the studies you cite in your comments. As someone who appreciates science and statistics and reading, you not just voicing your opinion, but also backing it up with science should be assuring to people.

I’m not too awfully worried about the side effects such as increased anxiety or depression. It had an effect on my sleep and brain zaps from what I remember. At least those stuck out the most.

I always worried about the irrational side of things such as QT long prolongation. Which isn’t really a probably with a stand alone SSRI, especially at such a low dose and a medication like Prozac. Also bradycardia was a worry, as I do remember it lowering my heart rate into the highs 40s. But i don’t remember affecting me in my daily routine of things so it wasn’t an issue.

Nevertheless. Thanks again for all you do.

[panic_down_under]

I don’t think you or Fishmanpa get enough praise and thanks for all the time you take and help you give.

:blush:


I’m not too awfully worried about the side effects such as increased anxiety or depression. It had an effect on my sleep and brain zaps from what I remember.

Insomnia is a frequent initial side-effect of most serotonergic ADs, though a few have a paradoxical reaction. In the UK mirtazapine seems to be the sedative of choice for this, though trazodone is the better option if you can persuade your GP to prescribe it because it has a much shorter half-life, around 3-5 hours compared to 20-40 hours for mirtazapine, so its sedation is less likely to continue into the next day. I don't know if anyone has determined what causes the brain zaps, though they are more common when discontinuing ADs than starting on them. My suspicion is they are an artifact of brain rewiring as I've observed they are fairly common in the weeks after a stroke.


I always worried about the irrational side of things such as QT long prolongation. Which isn’t really a probably with a stand alone SSRI, especially at such a low dose and a medication like Prozac.

With the possible exception of citalopram and escitalopram prolonged QT interval is not usually a concern with SSRIs alone though they may increase the risk when taken with other meds which have the potential to cause it.


Also bradycardia was a worry, as I do remember it lowering my heart rate into the highs 40s. But i don’t remember affecting me in my daily routine of things so it wasn’t an issue.

Cardiologists are increasing coming to the view that the 60-100 bmp resting heart rate that is considered to be the normal range is too high and the ideal range is really 50-75 bpm so an upper 40s, low 50s rate is probably a good thing. Mine is at that lower end too. See: What is a Normal Heart Rate? (https://myheart.net/articles/what-is-a-normal-heart-rate/) and 5 Heart Rate Myths Debunked (https://www.webmd.com/heart-disease/features/5-heart-rate-myths-debunked).

[Speranza]

Wow this was so helpful. I came looking for heartrate posts! I've always had quite a low heartrate but recently it's been down as low as 48 (normal BP - which was elevated before Prozac due to anxiety).I suddenly remembered there was a correlation with SSRIs.

I don't seem to be suffering undue tiredness and certainly am still energetic so I can't see it's a problem...

But thanks! :)

[panic_down_under]

You're welcome :)

[Ayresstew]

Hi did it work for the 5th time, I’m on my 3rd