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  1. #1
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    Mar 2020
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    Side effects! Hoping for some help

    Sorry I have posted this previously on a different thread(just getting to grips with this forum)
    Hi. Im new here and started 40mg fluoxetine 5 weeks ago and my anxiety doesnt seem to be getting better. I just want some reassurance I suppose that its not making matters worse.
    Im waking at around 4am every morning and then the anxiety slowly builds. I have this strange thing where by 3/4 ish in the afternoon Im feeling calmer and by bedtime I almost feel back to normal. So much so that Im always hoping that tommorow will be different but it never is.
    I have taken it before but stopped last October. Around 5 weeks ago I had an anxiety attack and was so panicked that I would be as ill as before I started myself back on 40mg straight away.
    I then had a terrible crash of symptoms around day 6 and ended up seeing the emergency dr who prescribed diazapam. I feel so foolish for just starting the tablets again. Im having strange symptoms, feeling edgy, shaky and if i try to nap during the day I get woken by a vibrating shaking sensation all through my body. My anxiety at points is horrific. Im not managing to work or do much at all.
    Is there any light at the end of the tunnel. Feeling like Im not sure how much longer I can cope.
    X

  2. #2
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    Jan 2017
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    Re: Side effects! Hoping for some help

    Quote Originally Posted by KayMK View Post
    I just want some reassurance I suppose that its not making matters worse.
    Unfortunately, serotonergic ADs can make anxiety worse at the beginning because of the increased serotonin activity. Despite the common myth, serotonin is not a 'feel good' neurotransmitter, just the opposite as you've discovered. But after some weeks the body and brain respond to the extra activity by down-regulating serotonin synthesis and expression and the anxiety and other initial side-effects begin to diminish. Fluoxetine has a very long half-life which can cause these initial side-effects to linger longer than they typically do for other SSRIs.

    I have taken it before but stopped last October. Around 5 weeks ago I had an anxiety attack and was so panicked that I would be as ill as before I started myself back on 40mg straight away.
    Which was unwise on several counts. Firstly, the usual starting dose for anxiety is 10mg due to the increased serotonin activity mentioned above. Secondly, for reasons that are not yet understood side-effects can become progressively more severe and/or different each time a AD is stopped and restarted. A higher dose may also be required to achieve previous levels of control.

    The other issue is that ADs don't have a direct affect on anxiety (or depression) in the way, say, aspirin has on a headache. They work by stimulating the growth of new brain cells (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and they take time to bud, grow and mature. Starting at a high dose won't significantly speed up this process, just increase side-effects severity.

    I then had a terrible crash of symptoms around day 6 and ended up seeing the emergency dr who prescribed diazapam.
    While diazepam is usually effective there are two potential problems with taking benzodiazepines (BZDs) for extended periods. As you probably know dependence can be an issue if they are taken for more than a month, or two, however, the bigger problem is that they can inhibit the growth of new hippocampal brain cells which can reduce, possibly cancel out the AD therapeutic response if taken regularly for extended periods. Small doses of the prescription antihistamine hydroxyzine (*Vistaril) is an alternative, but one not often prescribed in the UK for some reason. While not quite as potent as the BZDs it is often potent enough. It can be alternated with diazepam to reduce the risk of dependence and to limit interference in AD induced neurogenesis. If your GP won't prescribe hydroxyzine then ask for a small dose of mirtazapine instead.

    *Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). Anecdotally, the pamoate form is claimed to be the more effective anxiolytic, but just how true this is remains a matter of debate in forums.

    I feel so foolish for just starting the tablets again. Im having strange symptoms, feeling edgy, shaky and if i try to nap during the day I get woken by a vibrating shaking sensation all through my body. My anxiety at points is horrific. Im not managing to work or do much at all.
    Is there any light at the end of the tunnel. Feeling like Im not sure how much longer I can cope.
    X
    First step, discuss your situation with your doctor asap. If diazepam and/or hydroxyzine prove inadequate at easing the side-effects then consider reducing the fluoxetine dose to 20mg for a month or so, but okay this with your GP first.
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  3. #3
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    Mar 2020
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    Re: Side effects! Hoping for some help

    Thanks so much for your reply. Its really helpful. I havent taken the diazapam for a couple of weeks. Im just about managing without it.
    Im not sure if the antihistamine you mentioned is similar to phenergan? Ive been taking one of those at night to help me sleep and it seems to be working until around 3.30/4. Although reading through the forum this seems to be a common time for waking up with this medication.

  4. #4
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    Re: Side effects! Hoping for some help

    Also if I reduce my dose to 20mg am I likely to experience any withdrawal/side effects from reducing?

  5. #5
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    Re: Side effects! Hoping for some help

    Quote Originally Posted by KayMK View Post
    Im not sure if the antihistamine you mentioned is similar to phenergan? Ive been taking one of those at night to help me sleep and it seems to be working until around 3.30/4. Although reading through the forum this seems to be a common time for waking up with this medication.
    Promethazine (Phenergan) is usually a more sedating antihistamine than hydroxyzine, but has less direct affect on anxiety.

    Also if I reduce my dose to 20mg am I likely to experience any withdrawal/side effects from reducing?
    Unlikely at 5 weeks. Any slight withdrawal will probably be outweighed by a reduction in side-effects from the high dose.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  6. #6
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    Mar 2020
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    Re: Side effects! Hoping for some help

    Why dont the doctors tell you this stuff! So annoying. When I was rushed in at day 6 and they had decreased my dose then I may not have suffered so much for weeks.
    Every time I see a doctor they tell me different things. It would be so nice to actually see someone who knows about mental health.
    Im so scared im never going to feel better and my brain is so full of this and then when it lifts and I feel more calm I know I will get back to myself, I have done before. Hard to stay positive though.
    Im so undecided what to do about dosage. Last time I went to the dr he said that he would increase it to 60mg if i wasnt better in a couple of weeks but i dont want to do that. Annoyingly I wasnt suffering with extreme anxiety when i decided to go back on the meds. I had had a couple of mild attacks so I feel like ive done this to myself.
    Its made it so much worse. But I dont know whether I should just plow on at 40mg now Im this far in.
    To be honest I struggle to make any decisions at the moment let alone one that feels so massive.
    Any ideas on how many weeks in this will settle down? I know everyones different.

  7. #7
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    Re: Side effects! Hoping for some help

    Quote Originally Posted by KayMK View Post
    Why dont the doctors tell you this stuff! So annoying. When I was rushed in at day 6 and they had decreased my dose then I may not have suffered so much for weeks.
    Ignorance and/or some GPs think treating their patients like mushrooms is doing them a favour. It isn't.

    Every time I see a doctor they tell me different things. It would be so nice to actually see someone who knows about mental health.
    Blame the way GPs are trained. What training they get on psych disorders is woefully inadequate especially when you consider probably 20-25% of the patients in a GPs waiting room are there because of one of these disorders, diagnosed or not. Your GP qualified better prepared to deal with rare tropical diseases which he will likely never see during his career than he was for anxiety and depression.

    Also, from what I've observed here, NHS GPs seem to be more hamstrung in what they can prescribe than is the case elsewhere. They mostly seem to follow a prepared script - first prescribe AD 'A', if that doesn't work then try AD 'B', then antipsychotic 'Y' etc, etc. Not sure where the patient fits in that.

    Last time I went to the dr he said that he would increase it to 60mg if i wasnt better in a couple of weeks but i dont want to do that.
    You may need 60mg, but it is way too early to make that call, imho. Fluoxetine is often slow to kick-in because of its long half-life. It takes about a month just for plasma levels to settle down to a steady-state after a dose increase.

    Any ideas on how many weeks in this will settle down? I know everyones different.
    Hard to say. As per above, plasma levels of fluoxetine itself will have only recently levelled out to a steady-state after which side-effects usually begin to ease, but everyone's experience is unique to them.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  8. #8
    Join Date
    Dec 2018
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    115

    Re: Side effects! Hoping for some help

    3rd box in feel normal side effects to start were worse than anxiety and stress lol but stick with it u get around 20 min spells of low anxiety per week or if u drink on the meds in my case other wise level headed no stress life is good

  9. #9
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    Mar 2020
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    Re: Side effects! Hoping for some help

    Thats good news. Thanks for replying. Its always nice to hear from someone who has a positive story.
    I had a couple of hours on sunday evening where I suddenly felt completely back to normal. It was so nice.
    The mornings are especially hard but by the time I go to bed Im feeling ok and i cant believe I will wake up feeling bad again and yet I do. Its so strange to go to bed one person and wake up another!!
    Im struggling today. Cant stop crying this afternoon and this morning the anxiety was pretty rough.
    Im on week 6 now so I just keep reading the timeline and trying to stay positive.
    X

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