A timetable for recovery on Fluoxetine / prozac

[KHPanic]

Well looks like I'm going to be moving up to 40mg. Kind of expected it honestly with this being my third go for ADs. Hopefully I can get them to give me tablets instead of capsules so I can go to 30 first.

[panic_down_under]

Well looks like I'm going to be moving up to 40mg. Kind of expected it honestly with this being my third go for ADs.

Most do need to take progressively higher doses each time an AD is restarted to get previous levels of control.

Hopefully I can get them to give me tablets instead of capsules so I can go to 30 first.

Back in the dark ages when fluoxetine came only in 20mg capsules it was common to *dissolve capsule contents in a measured amount of water or fruit juice (but NOT of grapefruit) and drinking half one day and the other half the next. According to Eli Lilly the mixture can be kept refrigerated for up to a week without losing potency. See: MHS MRG 02 –Safe & Cost Effective Administration For Covert Medication and in Dysphagia (PDF, p 9). You should get your GP's okay before doing this.

* Note: does not apply to fluoxetine 90mg extended release capsules which should not be opened.

[KHPanic]

I don't think I've ever had grapefruit juice in my life. I always see the warnings though so people must like it somewhere. I just went for it and took two this morning. So far I feel fine so hopefully that continues.

[KHPanic]

Day 11 on 40mg. Sleep schedule is all screwy. Very hard to wake up. But my anxiety is doing ok. Just feel like my head is really stuffy and hard to concentrate, easily frustrated. Feels like DP/DR but not as pronounced? Odd feeling. Hard to tell where my anxiety stops and the side effects start.

[Don777x]

Hi everyone, this thread has helped more than you know. I was referred here by KHpanic and can say all this information has helped so much.

A little bit about me, I am on Day 18 of 40mg Fluoxetine. For a reference I'm 29. For me my journey begins 11 years ago in 2010. I was in bed for a week in which my doctor assumed it was vertigo (may have been I'm not sure until this day). I was prescribed 10 mg Citalopram and over the course of 6-7 years I increased to 40mg. Anxiety was a non issue, I was as normal as I've ever been and even lost a ton of weight and exercised daily.

I hit a roadblock in February of 2017 when I had a severe panic attack at work. My caffeine intake was out of control so I think that played a part. I went to the doctor the next day and she said it was very possible the citalopram ran its course so she out me in 10mg of escitalopram. I weaned off citalopram fairly quickly. From 40mg to 20mg for a week and then stopped as ordered and started Escitalopram the following day. After a week I noticed myself getting worse. (Looking back it was definitely the citalopram withdrawals) and I never gave escitalopram a fair shot. She put me on Buspar with the Escitalopram and if anything I felt worse, (again, could've just been citalopram withdrawals). After a couple weeks she offered to put me on 20mg of escitalopram but I told her I didn't think it was working. She then out me in 50mg of sertraline and also gave me hydroxyzine and Mirtazapine and discontinued Buspar. Mirtazapine definitely put me to sleep but I remember being so hungry all the time and there was one night I woke up seeing colors and everything was slow motion as I used the bathroom. I messaged her the next day and told her I didn't want to feel that again so the Mirtazapine was done. Hydroxyzine didn't seem to help either so we discontinued that and moved me up to 100mg of sertraline. This of course was a roller coaster as the side effects had no end in sight. After reading forums I told myself I would persevere. After a month or 2 out of work and basically bed ridden I started feeling relief. I eventually increased to 150mg of sertraline and it did quite well. Until a dizzy spell almost induced a panic attack at work back in April.

It is now June and I've since lost my job. What happened in between was quite a bit of experimenting. I was put on wellbutrin 150mg with my Sertraline. After a few weeks I was wayyy more anxious and couldn't sleep. I quit that and gave Buspar another shot. Again, after a couple weeks didn't feel any effects of anything I was worse off. Then my last ditch effort was to increase to 200mg of sertraline. It did nothing. Then comes the Fluoxetine. My doctor had me taper off Sertraline fairly quickly. I did 150mg for a week. Then 100mg for a week. Then the final day I took 50mg. I started Fluoxetine 20mg immediately the following day. After a few days I was starting to do research and found out 20mg is equivalent to 50mg of sertraline. I told myself that wouldn't be nearly enough. After a couple days of 20mg I started 40mg and have been on that since. Between those side effects and the sertraline withdrawls, omg.. I wish that Hell on no one! Stayed up all night, and when I did sleep I'd wake up with my pillow soaked. Brain zaps were off the charts. Whenever I'd get close to REM sleep my brain woukd zap me awake. I'm on the other side of it but am still far from 100 percent. It's day 18 of Fluoxetine and I'm at 40mg. I've been in bed all day everyday. I have a baby on the way and it took everything for me to go to my girlfriends ultrasound on June 1. The DPDR is the worst of it. I wake up in the mornings with dread. I tend to get through my day by browsing forums or playing video games. Life is sort of just passing me by and my baby is due in October. I want so badly to be 100 percent by then. I've been tempted to give Escitalopram a fair shot or even ask my doctor for a Benzo but I'm not sure. I feel so stuck. I had to sell my car for rent and now I'm in a joke I can't seem to get out of. Any advice or input would be appreciated. It's been nice to talk to KHpanic as noone in my life really understands what's going on. I know I've been here before and I've improved but it just seems when I get into these ruts I feel like I won't get out. On too if that I feel like I'm running out of SSRIs and am desperate for Fluoxetine to work and kick in.

I'm aware this is a very long lost and I'm grateful to anyone who took the time to read. God bless you all.

[panic_down_under]

Hi everyone,

to NMP,

I went to the doctor the next day and she said it was very possible the citalopram ran its course so she out me in 10mg of escitalopram.

They are essentially the same med. Citalopram is made up of two isomers (technically enantiomers), the 'S' form of citalopram, which is the active component, and a 'R' mirror image form which is a poorer fit biologically and so is mostly inactive. Lexapro (escitalopram) is more refined and only contains the 'S' isomer hence the name escitalopram.

I weaned off citalopram fairly quickly. From 40mg to 20mg for a week and then stopped as ordered and started Escitalopram the following day.

Sigh! This was completely unneccessary. You could have switched overnight with no issues. Most experience few problems switching overnight from one SSRI to an equivalent dose of another. The only time weaning off one antidepressant (AD) to another is necessary is when switching to/from a MAOI class AD to a serotonergic AD, i.e. SSRIs/SNRIs, and some TCAs.

After a week I noticed myself getting worse. (Looking back it was definitely the citalopram withdrawals) and I never gave escitalopram a fair shot.

Withdrawal would have been likely if the escitalopram dose was less than 20mg which seems to have been the case. However, if citalopram had pooped-out then escitalopram was unlikely to work either.

She put me on Buspar with the Escitalopram and if anything I felt worse, (again, could've just been citalopram withdrawals). After a couple weeks she offered to put me on 20mg of escitalopram but I told her I didn't think it was working.

Hurray, finally something which makes sense. Buspirone (Buspar) is a generalised anxiety disorder med (GAD) which works well for some, but not at all for most, however, small aduvant doses may revive SSRIs/SNRIs and some TCAs that have stopped working. It may also ease some common SSRI/SNRI/TCA side-effects, particular sexual dysfunction.

She then out me in 50mg of sertraline and also gave me hydroxyzine and Mirtazapine and discontinued Buspar. Mirtazapine definitely put me to sleep but I remember being so hungry all the time and there was one night I woke up seeing colors and everything was slow motion as I used the bathroom.

Mirtazapine is mostly a very sedating antihistamine whose main non sedating side-effect is severe carbohydrate cravings. People will literally eat sugar straight from the bag when on it. But I'm not sure that it was the cause of the colours and slow-motion.

Hydroxyzine is also a sedating antihistamine with pretty good anti anxiety properties. Not quite as potent as benzodiazepine (BZDs) such as diazepam, but often potent enough to make life easier. However, I don't understand why she prescribed both hydroxyzine and mirtazapine as they essentially do the same thing.

Hydroxyzine didn't seem to help either so we discontinued that and moved me up to 100mg of sertraline.

Which should have happened after a week on 50mg as this is only the recommended starting dose for depression (25mg for anxiety). Most need to take 100-150mg/day for good results.

After a month or 2 out of work and basically bed ridden I started feeling relief. I eventually increased to 150mg of sertraline and it did quite well. Until a dizzy spell almost induced a panic attack at work back in April.

It typically takes 4-12 weeks for an AD to kick-in and is most likely to do so at the upper end of the range if this isn't the first time on ADs.

It is now June and I've since lost my job. What happened in between was quite a bit of experimenting. I was put on wellbutrin 150mg with my Sertraline. After a few weeks I was wayyy more anxious and couldn't sleep.

Hardly surprising as bupropion (Wellbutrin) is by far the most stimulating AD. Way too stimulating for most with anxiety disorders. It can almost literally have some climbing the walls! However, most can tolerate small aduvant doses, <=75mg, to ease SSRI induced weight gain and sexual dysfunction. The extended-release formulations seem to work better for this than the immediate-release does.

I quit that and gave Buspar another shot. Again, after a couple weeks didn't feel any effects of anything I was worse off.

As per above, buspirone only works well for a few and then only for GAD, and maybe social anxiety. I haven't come across anyone with panic disorder, PTSD, or OCD who found it effective.

Then my last ditch effort was to increase to 200mg of sertraline. It did nothing.

How long were you on 200mg?

Then comes the Fluoxetine. My doctor had me taper off Sertraline fairly quickly. I did 150mg for a week. Then 100mg for a week. Then the final day I took 50mg. I started Fluoxetine 20mg immediately the following day. After a few days I was starting to do research and found out 20mg is equivalent to 50mg of sertraline. I told myself that wouldn't be nearly enough. After a couple days of 20mg I started 40mg and have been on that since. Between those side effects and the sertraline withdrawls, omg..

Most can tolerate an overnight switch from one SSRI to another with minimum discomfort. It would have been better to reduce to 150mg for a week, to 100mg sertraline for another and then stop it and begin taking 40mg fluoxetine the next day, or have done a short cross-taper, however, this requires a doctor who knows what they are doing.

It's day 18 of Fluoxetine and I'm at 40mg. I've been in bed all day everyday. I have a baby on the way and it took everything for me to go to my girlfriends ultrasound on June 1. The DPDR is the worst of it. I wake up in the mornings with dread. I tend to get through my day by browsing forums or playing video games. Life is sort of just passing me by and my baby is due in October. I want so badly to be 100 percent by then.

The problem with fluoxetine is that it can take quite a while to kick-in due to it's very long half-life. It can take a month just for plasma levels to stabilize to a steady-state after a dose increase (or decrease). Unfortunately, there is no way of speeding this up.

I've been tempted to give Escitalopram a fair shot or even ask my doctor for a Benzo but I'm not sure.

As per above, escitalopram is unlikely to be effective. As for the BZD, by all means ask for one to help you cope as suffering is counterproductive. However, only take it on days that you really need it, not just in case, because BZDs inhibit the mechanism by which ADs work.

Imo, by far your biggest problem hasn't been the meds, but the ignorance of your doctor. She seems to be clueless when it comes to psych meds. I urge you to find another asap. Ime, pharmacists have a pretty good idea which doctors in their area are the most knowledgable about specific conditions.

[Don777x]

Thank you so much for the reply pdu. To answer your question I was on 200mg of the sertraline for maybe a couple weeks. I was on 150mg for 4 years so when upping it to 200 I think I convinced myself it didn't work fast enough even though I probably just didn't give it enough time. Everything you said was spot on. I found a therapist and I have an appointment with her tomorrow as I do think this will be a lot better for me. I have a good relationship with my doctor but I think it's due time I see somebody who specializes in what I'm going through.

My day started off kind of rough but I think as of now I feel a little better and I'm super tired but I dread going to sleep because I know the morning is going to suck. I'm just ready to live a normal life again 😰 I know recovery can't be rushed but I wish Fluoxetine wasn't so slow. I'm pretty shocked that after Citalopram ran its course that she would immediately put me on escitalopram when it is a mirror drug. I never knew that it was so similar besides the name of course.

I am determined to see this through. Reading all these success stories.. how could I not. Do you think supplements help at all? I took a couple omega-3 fish oil pills this morning and I took some magnesium glycinate last night. But in my head I'm thinking I should hold off on that just because I don't want to confuse the Fluoxetine recovery with any possible outside help.

[panic_down_under]

To answer your question I was on 200mg of the sertraline for maybe a couple weeks. I was on 150mg for 4 years so when upping it to 200 I think I convinced myself it didn't work fast enough even though I probably just didn't give it enough time.

ADs have no direct impact on anxiety or depression in the way say aspirin has on a headache. They work by stimulating the growth of new brain cells in the hippocampal regions of the brain (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels (therapy also via neurogenesis, btw). The new cells and the interconnections they form produced the therapeutic response, not the meds, and it takes time for all this to happen.

I found a therapist and I have an appointment with her tomorrow as I do think this will be a lot better for me.

This sounds promising.

I'm pretty shocked that after Citalopram ran its course that she would immediately put me on escitalopram when it is a mirror drug. I never knew that it was so similar besides the name of course.

They share the same active ingredient. The addition of the 'R' isomer in citalopram can produce subtle differences in its side-effects compared to escitalopram so switching between them might resolve an unpleasant side-effect, but if one doesn't work the other is almost certainly not going to.

Do you think supplements help at all? I took a couple omega-3 fish oil pills this morning and I took some magnesium glycinate last night. But in my head I'm thinking I should hold off on that just because I don't want to confuse the Fluoxetine recovery with any possible outside help.

I used to take 2,000mg of fish oil daily for its cardiovascular benefits until recently (had to stop for a while because I'm currently on an anticoagulant for DVT) and 1,000mg of magnesium to lessen leg cramps. Both are claimed to reduce anxiety and depression, but I can't say if they have had much impact on my panic disorder as is well controlled by the TCA I've been taking for ~26 years. They probably won't hurt. Just don't go overboard on the fish oil. SSRIs are mild anticoagulants as is fish oil so watch out for bleeding gums an/or nose, bruising more easily, etc, and cut back the dose if these occur.

[KayMK]

Welcome Don
Congrats on the baby!
Wow you have been through it medication wise.
Fluoxetine does take soo long but its always worked well for me. Too well in fact because I think I'm totally fine and stop taking it!!
I've literally spent the 5 weeks mostly in bed battling the side effects.
Good luck, hope you start to feel brighter soon. X

[Don777x]

Hello Kay and thank you! I think for me I'm in a place where I can accept being on medication for quite a while yet. It has worked wonders for me for 10+ years so I think I'll stick with it. But I'm glad to hear you're doing much better, your journey has definitely given me hope.

Pdu, I like how knowledgeable you are.. you've given some of the best advice on here. A couple questions for you. 1. Why do you think it is that certain medication stops working after awhile but when you switch to something similar like another ssri, it can work wonders? 2. Do you think since citalopram worked for me for many years and being off it for 4 years it's something that could work for me again? Or do you think I just built up that tolerance and the drug ran its course for good?

I appreciate the responses everyone, this is truly a journey through Hell. You are all warriors for coming out on the other side. I have my appointment with my therapist in a couple hours so I'll update you as to how that goes. 🙏