Restarting fluoxetine

[IrishLondon]

Hi everyone

I’ve been on and off the forum for about ten years now. The majority of that time I’ve been feeling good.

In 2017 I was prescribed 20mg fluoxetine. And since then I’ve been feeling pretty much great. So great that a few months ago I decided to come off them. I came off them over 2 months, with my last dose 10mg every other day. And then I stopped in September.

Fast forward four weeks, and I have had a massive crash. All my anxiety came flooding back a few weeks ago. My GP restarted me on 20mg fluoxetine which I’ve been taking for a week now. But my god, my anxiety is so intense.

Has anyone been through restarting after one month off? Do I have to go through all the initial side effects again?

Im finding it a real struggle and i’m not sure whether to continue.

Thanks so much.

[panic_down_under]

I came off them over 2 months, with my last dose 10mg every other day.

Tapering off by missing doses might be a worthwile with short half-life ADs such as the SNRIs (particularly duloxetine) and paroxetine, but is pointless with fluoxetine because of its very long half-life, about 6 days for fluoxetine itself and up to 16 days for its active metabolite norfluoxetine which actually does most of the work. Missing a dose every second day would have made almost no difference to the med's plasma levels. Cutting the daily dose would have after a week or so.

My GP restarted me on 20mg fluoxetine which I’ve been taking for a week now. But my god, my anxiety is so intense.

It might have been better to start back on 10mg for the first 2-3 weeks, but whether dropping back now is worth doing is debatable. Perhaps try 10mg for a day or two to see if it makes a difference. If the 20mg is in capsule form dissolve the contents in a measured quantity of water or fruit juice (but not of grapefruit) and drink half one day, the other half the next. The mixture will keep for at least a week when refrigerated.

Has anyone been through restarting after one month off? Do I have to go through all the initial side effects again?

You may get some of the initial side-effects but it shouldn't take as long for the med to kick-in as you still have some in your system from before you quit. The rule of thumb is that it takes about 5 half-lives for a med to be metabolised and eliminated, so around 30 days for fluoxetine and 80 for the metabolite.

Im finding it a real struggle and i’m not sure whether to continue

I'd be asking the GP to prescribe something to ease the anxiety until the initial spike diminishes as bio-feedback mechanisms kick-in to reduce serotonin output.

[IrishLondon]

Thank you so much for this. I really appreciate it. I’ve been on the 20mg for six days now so do you think it’s probably worth just pushing through at this point? I don’t know whether what I’m feeling is withdrawal or my previous anxiety problem returning. I feel I just need some reassurance that going back on these meds is the right thing to do. To be honest, I just wish I never came off them as I was doing so well.

[panic_down_under]

I’ve been on the 20mg for six days now so do you think it’s probably worth just pushing through at this point?

It is probably what I would do, but I'm not in your shoes so... I'd rather you dialled back the dose if the side-effects becomes too difficult than quitting the med altogether.

I don’t know whether what I’m feeling is withdrawal or my previous anxiety problem returning.

That is always the unanswerable question when anxiety rears it head soon after quitting an AD. It could also be a bit of both.

I feel I just need some reassurance that going back on these meds is the right thing to do.

I can't say whether it is the 'right' thing to do, but it is likely to be the quickest way to banish the anxiety. If you want off meds and therapy is an option then I suggest you try for that before thinking about quitting fluoxetine again. For some, e.g. me, anxiety can be a chronic condition which waxes and wanes, but never completely goes away so one needs a way of controlling it when it flares and therapy is the only reliable med free way of doing so.

[IrishLondon]

Thanks so much. Again you’ve no idea how much it means to have someone to talk to about this.

I’m going to continue pushing through on the 20mg and try to cope with the anxiety.

It’s just so unbelievable that 1 month ago I was on top of the world and now I’m back in the dark hole of anxiety. But hopefully this is the start of the climb out.

[panic_down_under]

But hopefully this is the start of the climb out.

There is no reason why fluoxetine won't be just as effective this time. But it will take some weeks to fully kick-in.

[IrishLondon]

Thank you. Yes I keep telling myself patience is the key here. They worked great for me before - so I just have to remember they can work again. Day 9 and counting!

[IrishLondon]

Hey,

Just an update from me. I guess I’m writing this to track what I’m going through but also for anyone who might find it useful now or in the future. I’m now on day 18. Very much still right in the anxiety at the moment. And not sleeping at all without an antihistamine to help me nod off. Heartbeat also very noticeable. But I have noticed some occasional good moments when I feel more like myself. I know I’m early days - only 2 weeks and 4 days since restarting the fluoxetine - so I’ve got a while to go yet. I’ve not been able to return to work yet as the days are just so up and down and not sure I can deal with the added stress right now - but equally I know that returning to work might be good to take my mind off myself. Anyway, I’m going to hold the course at 20mg and give it enough time to work fully which I’m hoping will be around the 5/6 week mark?
Irish

[panic_down_under]

give it enough time to work fully which I’m hoping will be around the 5/6 week mark?

There's no way of predicting when an AD will kick-in. Fluoxetine tends to take longer than other SSRIs because of its very long half-life and having been on ADs before can also slow things down a little, but neither factor is set in stone. It all comes down to individual biology. All you can do is take each day as it comes.

[IrishLondon]

Hey. Wanted to say thank you so much for replying. Really appreciate it. I hope all is ok with you?