Hi I’m just coming up to 12 weeks on 20mg and I’m no where near I was last time. Can it take longer
Thanks
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Hi I’m just coming up to 12 weeks on 20mg and I’m no where near I was last time. Can it take longer
Thanks
:welcome: to NMP,
Yes, it can. Fluoxetine tends to take longer to kick-in than other antidepressants (ADs) anyway because of its long half-life and that may increase further when restarting it. You may also need to take a higher dose to achieve previous levels of effectiveness too. :sad:
What are you taking fluoxetine for and how long were you off it?
Hi thanks for getting back to me, I’m on it for anxiety and depression. I was on it for over 10 years last time on 20 mg never stopped working, was on 10 mg for 6 months and still no dip then off. Was a couple years then relapsed. I’m not sure if this has stopped some of the positive effects but because the side effects was so intense I couldn’t sleep or eat so they put me on mirtazipine which helped with the sleep and eating but increased my heart rate and very agitated on it. I was on it 6 weeks with one week taper and been off 10 days which the first few days I immediately felt better and heart rate better but the last 3 days bad depression and agitation but I’m assuming even though I was on it a short time my brain still needs to adjust causing these symptoms and I almost stopped cold turkey
Sorry something else , the doctor has said about an increase to 30mg but he said he would change it to the delayed release which can ease side effects and he thinks I could see an effect in 2-3 weeks. Do you know anything about this as it seems a bit quick for fluoxetine to get results.
What did you mean by saying the half life might increase to starting it again ?
Thanks again
How much were you taking?
I don't think the depression and agitation are mirtazapine withdrawal symptoms, but are more likely from fluoxetine and/or anxiety.Quote:
I was on it 6 weeks with one week taper and been off 10 days which the first few days I immediately felt better and heart rate better but the last 3 days bad depression and agitation but I’m assuming even though I was on it a short time my brain still needs to adjust causing these symptoms and I almost stopped cold turkey
Taking delayed release to ease side-effects from the dose increase may do the trick.Quote:
the doctor has said about an increase to 30mg but he said he would change it to the delayed release which can ease side effects and he thinks I could see an effect in 2-3 weeks. Do you know anything about this as it seems a bit quick for fluoxetine to get results.
Fluoxetine has a very long half-life, about 6 days for fluoxetine itself and up to 16 days for its active metabolite norfluoxetine which does most of the work. So it takes about a month for fluoxetine plasma levels to stabilize to a steady-state, and up to 80 days for norfluoxetine to do so. To put this into perspective most of the other commonly prescribed ADs have half-lives of 20-36 hours with the parent compound doing the work. Fluctuations in plasma levels can slow response to the med.Quote:
What did you mean by saying the half life might increase to starting it again ?
Hi I was on 15 mg mirtazipine but the agitation started about 2 days after starting but thought that would go. By the time I got to week 4 it got worse so they put me on 30 mg but straight away I was even worse and my heart was beating fast in the night. But on that dose it actually made me angry which I’ve never experienced before so they said stop quickly.
The first couple of days I actually felt better but now I’m feeling down more than before but thought maybe it’s the brain adjusting without the drug.
As for the fluoxetine does that mean it can take up to nearly 100 days to work properly for some and In my case longer because I’ve been on it a few times.
The delayed release the doctor said it’s effective quicker do you know if that’s true because I can’t find much on the delayed release
The fluoxetine has done something and that’s my health anxiety is better and I’ve had some better afternoons with odd patches of me feeling myself so I think it will work but still not fully working.
Thanks for your help
That's an unusual response to what is usually a fairly benign med other than the carbohydrate cravings.
I'm not sure this is down to withdrawal. Despite what it says on the box mirtazapine isn't really an AD, only a antihistamine which mostly works as a sedative.Quote:
The first couple of days I actually felt better but now I’m feeling down more than before but thought maybe it’s the brain adjusting without the drug.
If it isn't working within 100 days then it probably won't at whatever dose is being taken at. But it may take longer than the usual 5-12 weeks.Quote:
As for the fluoxetine does that mean it can take up to nearly 100 days to work properly for some and In my case longer because I’ve been on it a few times.
I'd love to hear the explanation for why it would work sooner. The only advantage I can see is it may lower side-effects severity by trickling the drug into your system over 24 hours instead of the surge in the hour or two after taking the immediate-release.Quote:
The delayed release the doctor said it’s effective quicker do you know if that’s true because I can’t find much on the delayed release
This sounds promising. :)Quote:
The fluoxetine has done something and that’s my health anxiety is better and I’ve had some better afternoons with odd patches of me feeling myself so I think it will work but still not fully working.
If fluoxetine is effective I suggest you consider staying on it permanently as there is good evidence that ADs become gradually less effective each time they are stopped and restarted. Two studies, Amsterdam JD, 2016 and Amsterdam JD, 2009 found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC 2018; Amsterdam JD, 2009; Leykin Y, 2007); Paholpak S, 2002).
Hi so realistically how long should I leave it as it’s my 3rd time. 13-14 weeks as I’ve seen some people say it only started working then. I’m just hitting the full twelve weeks now and not sure on going up in dose just incase it could still do more in a week or two.
So sorry m on 91 days and no where near recovered not even 50% so I just don’t know how much longer to wait or go up. Or can it take 100 days to actually start working, sorry for all the questions I just don’t want to stay any longer if there isn’t a chance of working then I need to go on something else or another add on if there is one
Sorry for another message, just looking through my diary. 1st week dizzy anxious ect
2nd week much the same but felt suicidal one day which wasn’t before.
3rd week had a couple better days and eating ,
4th week I had 4 good days in a row
5th week really bad week tremors really anxious couldn’t sleep
6th week really bad week and a suicidal day again then just anxious all week.
So I seem to have some good days ect
Then I was started on the mirtazipine which was very tired the first few weeks but my best time was the evening and had some good days again with agitation. The 4th week I seen to get more anxiety again.
So now I’m off I am anxious and agitated so I don’t know what to think. It seems like the fluoxetine gave me a run of good days early on then got worse so I don’t know what to think but the mornings are always worse
Maybe it is time to try another but I’ve gone 12 weeks and not sure maybe it could kick in in another two weeks. Do you think it’s worth waiting a bit longer
I don't see the value in staying on 20mg. Imo, your GP should be thinking of increased the dose to probably to 40mg after a couple of weeks on 30mg. The alternative is to switch to another AD. Citalopram (Celexa) and the very similar escitalopram (Lexapro) have a good record for working when another SSRI has failed.
Does your GP know about the agitation and the suicidal thoughts? If not s/he should. Also ask for something to ease the anxiety. White-knuckling it is counterproductive.
The thing is I’ve never been suicidal until this time on fluoxetine I had 4 terrible days out of a month where I thought I couldn’t carry on. I never had that before but I think the doctor just assumed because I was depressed it was that instead but some of the intense symptoms actually scared me so maybe after all this time my body just doesn’t want that in me anymore. Probably the mirtazipine just gave me relief of some symptoms. Before I finished fluoxetine I was drinking heavily last time maybe that didn’t help but I definitely experienced severe reaction to it for a good 6 weeks
I actually think I’ve had a bad reaction to it now I’m looking back through I think I need to come off. How long do I need to taper before I could go on citalopram
I’ve been on citalopram about twenty years ago which worked really well Only on them for 2 years but could I be in the same situation worse side effects and not work So frustrating
You don't need to taper off fluoxetine. You GP will probably recommend an overnight switch, or a short cross-taper. That way there is no time lost.
:weep: Correction: When switching to another SSRI, SNRI, or serotonergic TCA fluoxetine should be stopped for 4-7 days to allow plasma levels to halve before beginning the new AD.
There is no way of predicting what will happen, but, as per my previous post, citalopram has a good record of working when another SSRI has quit.Quote:
I’ve been on citalopram about twenty years ago which worked really well Only on them for 2 years but could I be in the same situation worse side effects and not work
Thanks for your help I will probably go on citalopram again. Does that take quicker to get stable in the blood. Doesn’t take as long as fluoxetine to kick in I think
Yes. Citalopram has a half-life of about 35 hours so plasma levels will typically stabilise within 7-8 days. While it has 2 active metabolites the data indicates they don't contribute much to the med's efficacy.
Usually not when starting from scratch, but the switch will have some delaying effect.Quote:
Doesn’t take as long as fluoxetine to kick in I think
Hi I’ve been of fluoxetine 3 days and haven’t started escitalopram yet. I’m already getting withdrawals is this possible with the long half life
Hi , been getting racing thoughts and a drop in mood even though I wasn’t feeling good. Jittery and more anxiety. Maybe it was doing something but I’m starting escitalopram tomorrow I’m anxious because the fluoxetine is in my system
I also take this tablet. I have asked my GP how long I can take it for, I have not needed a review yet.
It seems to have helped my anxiety a lot
Obviously I suffer with anxiety and do get anxious about new medications. I have been on citalopram in the past and worked well. Is Escitalopram similar in chemical. If so I shouldn’t have a reaction to it
Which tablet are you on
Citalopram and escitalopram contain the same active drug, the 'S' isomer of citalopram, aka escitalopram. Citalopram also contains the 'R' mirror image isomer which is a poorer fit biologically and so is mostly inactive. Lexapro (escitalopram) is more refined and only contains the 'S' isomer which is why doses are half those of citalopram. There can be subtle differences in the side-effects each med produces because of that 'R' isomer in citalopram.
Thanks for your info it’s been helpful thanks.
I’m still can’t understand why this time the side effects was so bad like I’ve never had. Can the body almost build a tolerance to it when you have been on and of for years
These are good questions for which there are no good answers, afaik. I'm not even aware of any research looking for the answers. However, tolerance to ADs can occur even when taking them continually. It seems to happen more often with SSRIs than SNRIs, TCAs and MAOIS.
Hi I’ve been on escitalopram for 14 days now I’m just wondering what you meant by it might take a bit longer to work because of moving from fluoxetine. How long does it take for fluoxetine to come out your system
Thanks
Because of the washout break rather than switching overnight.
Completely, up to 30 days for fluoxetine and to 80 days for its active metabolite norfluoxetine. The rule of thumb is most meds take 5 times their elimination half-life to clear. The half-life of fluoxetine is up to 6 days and 16 days for the metabolite.Quote:
How long does it take for fluoxetine to come out your system
Hi thanks how long does it take for escitalopram take to start working and is it the same as fluoxetine when you up the dose it’s starting again
Thanks
Usually anywhere from 4-12 weeks, but being on fluoxetine for a while may shorten this even though it didn't work, however, as with everything AD related that isn't a guarantee. The only predictable thing about these meds is their unpredictability. :sad:
Increasing the dose doesn't put you back to square one, but it will take some weeks for the higher dose to have a significant effect.Quote:
and is it the same as fluoxetine when you up the dose it’s starting again
IÂ’m on day 17 and just increased 10 mg a few days ago had minimal side effects and last night felt like myself almost and having a joke which I was surprised then woke up anxious but Is that just a sign the message is starting to work and is a good sign
While it is still early days it is promising sign. :)
Hi it’s been a long time but would love your opinion or advice. I’m on week 10mg of Escitalopram now and so far I had minimal side effects just increased anxiety and depression week 4 my worst. I was on fluoxetine last time which seemed to react bad the 3rd time so was given lorezapam to help with the fluoxetine.
By week 6 on escitalopram my anxiety was improving and I started going out on my own , seeing customers about future work ect. I didn’t leave the house for 5 months before this even taking lorezapam. So this was massive improvement I could go anywhere. I hadn’t had any improvement in my mood or motivation all the way through also started a fast tapper on lorezapam and have been of that a few weeks.
For the first time 3 days ago my depression wasn’t there not really happy but definitely better and had 2 1/2 days where I had a more positive outlook and had some enjoyment so great especially as my brain has been going through withdrawals. I’ve seen people not get good improvement till 12 weeks onwards but do you think I’m better to stick at the dose with those new improvements even though it’s not every day or all the day but I haven’t had that in months. Doctor wanted to up my dose early on but I’ve never needed a high dose before. Through everything do you think these improvements can continue from 10 weeks my anxiety is very much under control
Thanks for your time
How many weeks?
That's good because benzodiazepines (BZDs) such as lorazepam inhibit the mechanism by which antidepressants (ADs) work. However, I'm not a fan of fast tapers. Psychology is at least as important as chemistry and biology when quitting BZDs (or ADs) and slow tapers with small dose reductions are more likely to instil confidence in the process by minimising withdrawal symptoms.Quote:
also started a fast tapper on lorezapam and have been of that a few weeks.
As this is your third time on ADs the escitalopram may take longer to kick-in than the fluoxetine did the first and possibly the second time, though escitalopram's shorter half-line may counter this to some degree.Quote:
I’ve seen people not get good improvement till 12 weeks onwards but do you think I’m better to stick at the dose with those new improvements even though it’s not every day or all the day but I haven’t had that in months.
For reasons which aren't really understood, ADs tend to become progressively less effective each time they are stopped and restarted so higher doses are often required to achieve previous levels of control.Quote:
Doctor wanted to up my dose early on but I’ve never needed a high dose before.
So you are at week 10 on escitalopram? If so, you will likely still see some improvement in the next few weeks, but I suspect you will need a higher dose in the future.Quote:
Through everything do you think these improvements can continue from 10 weeks my anxiety is very much under control
While most would prefer to be on the lowest possible dose ADs don't directly affect anxiety (&/or depression) in the way BZDs do, or aspirin does with headaches. They work by stimulating the growth of new brain cells and it is these cells and the connections they form which create the improvement. This process requires a minimum dose to initiate and sustain it and in the absence of a readily available blood test to measure plasma levels being over medicated is better than under medication. Any excess ends up down the 'S' bend anyway.
Sorry week 10
Because I’ve been on antidepressants in the past I would probably need a higher dose ?
I never knew benzo stopped the antidepressant working or do you mean not as effective.
Does that apply for zopiclone as it’s a z drug
It is possible.
Anxiety disorders and depression result from a loss of brain cells in parts of the two hippocampal regions of the brain caused by high levels of stress hormones, particularly cortisol. It is essentially a type of auto-immune reaction which is also why both anxiety and depression may worsen when we are fighting an infection.Quote:
I never knew benzo stopped the antidepressant working or do you mean not as effective.
Both antidepressants and the cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies stimulate the growth new brain cells by neurogenesis. The new cells and the connects they forge create the therapeutic response. This is why it takes weeks for ADs to work. It takes about 7 weeks for new cells to bud, grow and mature, though some improvement may begin a little earlier.
See also:
Unfortunately, benzodiazepines (BZDs) can significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis. 1 In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking antidepressants just to ease the initial increase in anxiety levels, for a while after AD dose increases for the same reason and thereafter for occasional breakthrough anxiety. If an antidepressant isn't adequately controlling anxiety on its own even at the maximum recommended or tolerated dose then switching to another which might be more effective should be considered ahead of supplementing it with a benzodiazepine. See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly
Depends on the med. Eszopiclone (Lunesta) seem to enhance maturation of hippocampal cells2, at least in rats, but zolpidem3 has the opposite effect in acute administration, and no effect either way when taken daily. I don't know about zopiclone, or zaleplon. However, imo, this is not a good reason to take eszopiclone. Just as with BZDs the 'Z' class hypnotics are not good sleeping pills.Quote:
Does that apply for zopiclone as it’s a z drug
References:
[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)
Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)
Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)
Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)
[2]
Methippara M, Bashir T, Suntsova N, et al (2010)
Hippocampal adult neurogenesis is enhanced by chronic eszopiclone treatment in rats.
J Sleep Res. Sep;19(3):384-93. (Full text)
Su XW, Li XY, Banasr M, Duman RS. (2009)
Eszopiclone and fluoxetine enhance the survival of newborn neurons in the adult rat hippocampus
Int J Neuropsychopharmacol, Nov;12(10):1421-8 (Full text)
[3]
Takase LF, Fornal CA, Jacobs BL. (2009)
Effects of the hypnotic drug zolpidem on cell proliferation and survival in the dentate gyrus of young and old rats
Brain Res Mar 9;1259:26-31 (Abstract)
What’s that mean on the eszopliclone enhance the cells as in shouldn’t hinder the effect of the antidepressant. Zopiclone is very similar to this like escitalopram and citalopram
I’m going to leave increasing my dose for about 4 weeks so week 14 to see if I get any more improvement. If I go up will it be as long for results because I’ve see people in 3-4 weeks having improved but thought it would be at least 6 weeks
It may be very similar, but just as with citalopram and escitalopram there can be differences that might include their impact on neurogenesis. I haven't been able to find any data on zopiclone so would be wary of using it especially as there are better meds for insomnia, especially SSRI/SNRI induced insomnia, such as trazodone and mirtazapine.
I'd be making that call at 12 weeks, but it's your choice.Quote:
I’m going to leave increasing my dose for about 4 weeks so week 14 to see if I get any more improvement.