Feeling fed up

[Mrsmitchell1984]

I have lost two jobs over it- because I was so angry with my employer each time x

[panic_down_under]

for example at 20mg, I will gradually go down to 10mg (reducing one 20mg tablet per week) and stay on 10mg for about 6 months and then reduce by one tablet a month- and I stayed on 2x20mg per week for about 3 months so a very slow quitting time period.

Did your GP or psychiatrist tell you to do this? It is way beyond what is necessary, and, imo, counterproductive.

I don't know where this idea that the best way of weaning of ADs is by skip dosing came from, possibly from the problems with quitting duloxetine because of limitations with that med, and that med alone, although I'm still not convinced this is the best way of quitting it. Even with fluoxetine' long half-life there would be significant fluctuations in plasma levels which can't be good either for the brain, or the psyche.

Far better, imho, to just gradually reduce the dose taken each day. This is fairly easy with fluoxetine. Simply dissolve the capsule contents in a measured quantity of water, or fruit juice (but not of grapefruit), measure off 20% and drink the rest. The mixture should keep for a week if refrigerated. Keep drinking only 80% for 2-3 weeks and then drop the amount drunk to 60% for another 2-3 weeks and keep reducing it by 20% every 2-3 weeks until you reach zero, or maybe do the last 20% in 2 x 10mg drops if it eases your mind. You could probably cut back the dose by even more without significant issue as fluoxetine is virtually self-tapering, but having confidence in the process is import, indeed probably the most important factor, far more so than the chemistry.

[Mrsmitchell1984]

Thanks PDU- I prefer your method. I have never had a psychiatrist - but probably should have considering it’s been 5 times I have had this. But oh well - that’s the NHS for you. Still don’t understand why I become angry after withdrawing particularly if I am doing it slowly. It may not be withdrawal at all, but descent back to anxiety again x

[panic_down_under]

Still don’t understand why I become angry after withdrawing particularly if I am doing it slowly. It may not be withdrawal at all, but descent back to anxiety again x

I can't say, Sally. If it was the med I would expect anger would be worse when at therapeutic doses, not when tapering off, but ADs and brains are unpredictable things, the ultimate expression of Heisenberg's Uncertainty Principle, imo, far more so than quantum physics.

When did the anger begin, immediately, half way through, or right at the end when you were taking hardly anything?

[Mrsmitchell1984]

About a month after not taking anything x

[Mrsmitchell1984]

It’s uncanny as it was a month each time x

[panic_down_under]

About a month after not taking anything x

Hmmm. Beats me given your final doses were so low.

[Mrsmitchell1984]

Thanks PDU x

[Mrsmitchell1984]

Hi PDU,

I have been on 40mg for 3 days now. Should I give the increase at least 2 weeks before I consider upping dose further or trying something else? I have only tried st Johns wort and fluoxetine before- this is my fourth time on fluoxetine and usually I get better as soon as I take the dose I need (1st time 20mg helped straight away, 2nd time started on 10mg - as soon as I took 20mg I was better, 3rd time started on 20mg and as soon as I took 40mg was better). Thank you for your help. I am still getting quite strong morning anxiety which is really bothering me- I am all twitchy from 5am onwards until I get out of bed. I am getting bouts of constant depression some days too. I can’t seem to take my mind off how I feel. It may be because of the dose increases though- 30mg since 25/12 and 40mg for last 2 days. When I speak to a doctor they are not sure what to advise just pick an option out of thin air x

[panic_down_under]

Should I give the increase at least 2 weeks before I consider upping dose further or trying something else

...usually I get better as soon as I take the dose I need (1st time 20mg helped straight away, 2nd time started on 10mg - as soon as I took 20mg I was better, 3rd time started on 20mg and as soon as I took 40mg was better).

It could take a month or two for the 40mg to achieve maximum effectiveness. Dose increases don't take effect immediately, the fact they seem to have for you in the past may have been either because the lower dose kicked-in around the same time as the increase, or from the placebo effect which continued until the med began to work. It's great when either happens, but neither is a reliable outcome.

Thank you for your help. I am still getting quite strong morning anxiety which is really bothering me- I am all twitchy from 5am onwards until I get out of bed. I am getting bouts of constant depression some days too. I can’t seem to take my mind off how I feel. It may be because of the dose increases though- 30mg since 25/12 and 40mg for last 2 days.

It is most likely from the dose increases. They often trigger a side-effects resurgence. The time of day when anxiety is worse seems to rely most on individual bio-rhythms, whether you're a morning, or evening person, not the meds per se.

When I speak to a doctor they are not sure what to advise just pick an option out of thin air x

One of life's many great mysteries is why GPs/PCPs get so little training in psych disorders and the meds to treat them given probably 20-25% of the patients in their waiting rooms have a disorder, diagnosed or not.