A timetable for recovery on Fluoxetine / prozac

[panic_down_under]

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?

I don't know. I don't think anyone does. But while all SSRIs primarily inhibit the serotonin reuptake transporters they each affect other receptor subsystems differently which may account for it. This is also probably why one SSRI is often more effective than the others. That said some find none of them will work after one quits.

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?

Hard to say as there is little data on this. What usually happens is that they are switched to one or two SSRIs after a poop-out and if there is no response, or the second SSRI subsequently quits then a SNRI, or less often a TCA is the next option. Imo, TCAs are the better bet. Not a SNRI fan.

[Don777x]

Thanks pdu. Honestly, I've only heard horror stories from SNRIs so I refuse to even give them a try. I haven't done much research on TCAs so I can't really form an opinion on them. They might be my next go to if Fluox doesn't work out.

I had my meeting with my therapist and I feel like it was really nice to talk about everything. I feel like I did 80 percent of the talking but having someone listen is nice. August 21 is my deadline and will determine if Fluox is right for me at that time. I'm still very optimistic it is though because I have moments where I feel ok.

What TCA do you take pdu? And how has it compared to certain ssris you've taken?

[panic_down_under]

What TCA do you take pdu?

Dosulepin, aka dothiepin, which has never been marketed in the U.S. and is being phrased out in the UK which used to be its biggest market because the minimum potentially lethal dose is not that much higher than the maximum therapeutic dose. I've been taking it for about 26 years without issue even though I've been on more than the maximum recommended dose for all that time. Ironically, I switched to it because it was then considered to be the safest TCA.

The closest TCA to it is amitriptyline (Elavil), however, imipramine (Tofranil) may be a better option for panic and/or depression.

And how has it compared to certain ssris you've taken?

I can't tolerate SSRIs, they make me manic, so I can't say. Unlike the SSRIs the TCAs have diverse modes of action ranging from the most potent serotonin reuptake inhibitor available (clomipramine) to the most potent noradrenaline, aka norepinephrine, reuptake inhibitor (desipramine). They usually produce fewer initial side-effects and easier to wean off, are less likely to poop-out and are generally more effective than SSRIs. Their down-side is they tend to have more ongoing side-effects, mostly constipation and dry-mouth, but there are ways of minimising these.

[Don777x]

TCAs could definitely be in my future. I'm glad you found your drug of choice pdu!

I talked to my therapist which was very nice to get a lot of stuff off my chest. She said considering I was on a higher dose of Sertraline that she would like me to increase to 60 mg of Prozac. Right now I'm on day 22 of 40 mg and I'm definitely hesitant as I don't want to start at square One. She also prescribed me .5mg of Xanax as a last line of defense. My goal with Xanax is to not even touch the stuff but it will be nice knowing that I have some sort of lifeline if I needed and I think that alone will be therapeutic for me.

I'm having days where I'm starting to feel a little bit of improvement but out of 100% I'm probably still only at about 40%. What are your guys's thoughts? Should I stay the course with 40 or does she have a point in me going up to 60 and getting it over with as soon as possible?

[panic_down_under]

Should I stay the course with 40 or does she have a point in me going up to 60 and getting it over with as soon as possible?

Yes, she probably does, imo. You can always reduce back to 40mg once stable to see if it still gives good result. One of the curiosities of ADs is that any excess dosage just ends up down the 'S' bend anyway. Taking more than needed doesn't increase mood, or lessen anxiety further though it may increase side-effects for a while.

[Don777x]

Its been a few days since I posted so I figured I would do an update. I'll be starting 60mg some time this week. A little nervous but I'm content with knowing that's where I have to be at, even if the side effects come back. Tomorrow is Day 27. Been having more bad days than good lately. It doesn't help that I confine myself to my home but even leaving the house seems like an impossible task. I really thought the therapy would help but it seems to make me more anxious. Been sleeping a lot lately which to me isn't a bad thing, I like when I sleep because it shuts everything down for a bit. Normality seems light years away and the days are passing me by. Hopefully the dosage increase is what I need.

[panic_down_under]

It doesn't help that I confine myself to my home but even leaving the house seems like an impossible task.

...Been sleeping a lot lately which to me isn't a bad thing, I like when I sleep because it shuts everything down for a bit.

Sleep can be a very good thing when first taking an AD. The one danger is it becoming a refuge from life so try and get out of the house at least once a day even if it's only just a few feet from the door. Agoraphobia can be hard to shake if allowed to set in and is no way to live.

[KayMK]

I'm the same at the moment Don. Just want to sleep and sleep and sleep. I seem to have a bit more of a handle on the anxiety now but the depression is awful. Can't stop crying.
Having a slightly better day today but that almost makes me panic that tommorow won't be as good.
I haven't left the house either in about 5 weeks. I can't even remember when I last went in the garden. I have felt the same the last few times I have gone through this so I'm confident as soon as I feel better I will be up and out doing all the things I've missed the last few weeks. Nothing exciting, I'm a simple girl, just a Costa coffee, maybe a wander round a book shop.
Keep strong. You will be prepared so you can deal with it better if you get any effects from upping. Keep going, you can get there. I tell myself every day I'm one day closer to feeling better and that tommorow has all the potential to be a better day.
I'm annoyingly optimistic for a depressive!!

[Don777x]

pdu i could not agree more. My therapist said the same thing. She said even if it was a matter of sitting in my backyard for a bit that could go a long way.

Kay, I feel you on that. Being in these situations before in the past and getting out of them you would think it would be easier this time around. It's just hard to see the light when you're at the bottom of the well. It's good you are optimistic, I need to feed off some of that optimism. I see improvement and that's a very good sign because I know I'll eventually turn that corner. I will start 60 mg later this week as I believe that's exactly where I want to be. Keep us updated Kay, we are in this together! Day 28 for me

[KayMK]

Well I needed some of that optimism myself this morning!! I just woke up feeling dreadful. Full of despair, thoughts of never getting better and couldn't stop crying! I had had a couple of better days so it was a bit of a shock. 7 weeks for me on Sunday and please god I've got to be over the worst. I'm just so tired!
I brightened up this evening as per my normal pattern and managed to eat something but its still not really living, I'm just too exhausted to do anything but lay on the sofa.
Another day down and one day closer hopefully to feeling better.