Struggling with prozac ?

[razzer]

Hi , so i been taking Clonazepam for a long time. Many years ago i was on Lexapro , then got off that. And so for the last 10 years i did fine on about a pill and a half of .5mg clonazepam only. Then a couple weeks ago something must have triggered and my anxiety really suddenly increased and i had a panic attack at work. So my doc got me going on 10mg Prozac to start , and in 2 days it will be 2 weeks . So i have had some nausea from the begininng of the Prozac , but in the last couple days or so , my nausea seems to have increased , though it is mainly in the morning then seems better as the day goes on , is back again in the morning , is this from laying down all night? I take the prozac at around 6 or 7 after dinner . But also it feels at times like my anxiety has increased , where there is like adrenaline flowing in my stomach. Before when i had anxiety i could take the Clonazepam and it go away all day , now since on the prozac , it's like the Clonazepam barely stops it , for just a while. Like it pushes right through. Also sometimes i feel very irritable , almost rabid like . Is this stuff normal or is something wrong? Would it help me to back off and skip a day? Needless to say it is very uncomfortable. My daughter takes it and has had no side effects as of yet. My brother been on Prozac and clonazepam for like 35 years , even his kids are on Prozac ( anxiety seems to run in the family ) , and they have not really reported any side effects either . Just wondering if anyone has any ideas or help? Thanks

[razzer]

Hi , so i been taking Clonazepam for a long time. Many years ago i was on Lexapro , then got off that. And so for the last 10 years i did fine on about a pill and a half of .5mg clonazepam only. Then a couple weeks ago something must have triggered and my anxiety really suddenly increased and i had a panic attack at work. So my doc got me going on 10mg Prozac to start , and in 2 days it will be 2 weeks . So i have had some nausea from the begininng of the Prozac , but in the last couple days or so , my nausea seems to have increased , though it is mainly in the morning then seems better as the day goes on , is back again in the morning , is this from laying down all night? I take the prozac at around 6 or 7 after dinner . But also it feels at times like my anxiety has increased , where there is like adrenaline flowing in my stomach. Before when i had anxiety i could take the Clonazepam and it go away all day , now since on the prozac , it's like the Clonazepam barely stops it , for just a while. Like it pushes right through. Also sometimes i feel very irritable , almost rabid like . Is this stuff normal or is something wrong? Would it help me to back off and skip a day? Needless to say it is very uncomfortable. My daughter takes it and has had no side effects as of yet. My brother been on Prozac and clonazepam for like 35 years , even his kids are on Prozac ( anxiety seems to run in the family ) , and they have not really reported any side effects either . Just wondering if anyone has any ideas or help? Thanks

Well doctor figured i was struggling with the Prozac , so i just started a direct switch to Lexapro. Gonna give it a shot. Strange the first day i stopped taking the Prozac i felt almost normal again and like a weight had been lifted.

[panic_down_under]

And so for the last 10 years i did fine on about a pill and a half of .5mg clonazepam only.

The benzodiazepines are good anti anxiety pills when taken occasionally for breakthrough anxiety, but shouldn't be taken continually, less so because of the dependence issue which everyone worries about, but because they worsen anxiety/depression.

The anxiety disorders and depression are symptoms of a physical brain malfunction, atrophy of parts of the two hippocampal regions of the brain, caused by high brain stress hormone levels killing off brain cells and inhibiting the growth of replacements.

Depression, antidepressants, and the shrinking hippocampus

Antidepressants work by stimulating the growth of new brain cells in the two hippocampal regions of the brain (neurogenesis). These new cells and the connections they form create the therapeutic response, not the meds, directly:

What is neurogenesis?

Structural changes in the hippocampus in major depressive disorder: contributions of disease and treatment

The cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies also work via hippocampus neurogenesis.

Association Among Clinical Response, Hippocampal Volume, and FKBP5 Gene Expression in Individuals with Posttraumatic Stress Disorder Receiving Cognitive Behavioral Therapy

The problem with BZDs is that they inhibit neurogenesis which exacerbates anxiety and depression and reduces the effectiveness of antidepressants:

Benzodiazepines And The Potential Trophic Effect Of Antidepressants On Dentate Gyrus Cells In Mood Disorders

Co-Treatment with Diazepam Prevents the Effects of Fluoxetine on the Proliferation and Survival of Hippocampal Dentate Granule Cells

See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and The Ugly

So i have had some nausea from the begininng of the Prozac , but in the last couple days or so , my nausea seems to have increased ,

Nausea is both a common anxiety symptom and a potential SSRI side-effect triggered by the initial increase in serotonin activity.

Serotonin is not just a brain neurotransmitter. In fact the brain makes and uses little, less about 1.7%. By far the most serotonergic organ is the G.I. tract which makes about 50 times more serotonin, together with the enteric nervous system, the mini brain which controls it (and has great influence over the brain between our ears) and the gut microbiome, the bacteria, viruses and other microbes which process the food and feed on each other. All of these can thus be more affected by serotonergic antidepressants than the brain.

Think Twice: How the Gut's "Second Brain" Influences Mood and Well-Being

The microbiota–gut–brain axis

How do antidepressants affect gut bacteria?

Indigenous Bacteria from the Gut Microbiota Regulate Host Serotonin Biosynthesis

Ginger and/or vitamin B6 (pyridoxine) supplements are often effective for nausea. At least when treating the nausea of morning sickness taking both seems to be more effective than each alone.

Ginger alone or with vitamin B6 for nausea and vomiting in pregnancy

Note 1: B6 can be toxic when taken at high doses so I wouldn't exceed 50-75 mg/day taken in 2-3 split doses.

Note 2: I regularly take ginger in tablet form for seasickness and often experience a short-lived flush of heat soon after taking it. It doesn't seem to be significant so don't be spooked if it happens to you too.

I take the prozac at around 6 or 7 after dinner

It doesn't matter when you take it. Prozac (fluoxetine) has a very long half-life, about 6 days for fluoxetine itself, plus up to 16 days for its active metabolite norfluoxetine which is mostly responsible for its efficacy, so plasma levels don't change much between doses.

Before when i had anxiety i could take the Clonazepam and it go away all day , now since on the prozac , it's like the Clonazepam barely stops it

Anxiety disorders and depression often wax and wane over time. I suspect you developed tolerance to clonazepam some time ago and you continued being okay because you were in the waning/remission stage of the cycle. Now that anxiety is waxing again that tolerance has become exposed.

Also sometimes i feel very irritable , almost rabid like . Is this stuff normal or is something wrong?

Normal, yes, at least to the extent that anything about the initial side-effects can be considered 'normal'. But I suggest you discuss this with your GP especially if it gets worse.

Would it help me to back off and skip a day?

Nope, because of the long Prozac half-life.

Needless to say it is very uncomfortable.

The initial side-effects can be very unpleasant. Unfortunately, there is no way of preventing them. You can only treat the symptoms. They usually ease within a week or two as biofeedback mechanisms kick-in to reduce serotonin synthesis and expression. They may return for a while after dose increases, although usually at lesser severity.

My daughter takes it and has had no side effects as of yet. My brother been on Prozac and clonazepam for like 35 years , even his kids are on Prozac ( anxiety seems to run in the family ) , and they have not really reported any side effects either .

Everyone's experience is unique to them. It all depends on how the med meshes with your individual biology.

[panic_down_under]

Strange the first day i stopped taking the Prozac i felt almost normal again and like a weight had been lifted.

Ah, the wonders of the placebo effect. If only we could bottle it.

[Scissel]

The benzodiazepines are good anti anxiety pills when taken occasionally for breakthrough anxiety, but shouldn't be taken continually, less so because of the dependence issue which everyone worries about, but because they worsen anxiety/depression. .

Yes I try to remind myself of this and I'm also trying to cut back on the benzodiazepines; but each time I try I hit a wall and the breakthrough becomes far too often, though, I still try and would like to go back to only as needed as it once was on the Clonazepam. For a while I was doing very well and hardly used it but life happened and now its almost a daily occurrence.

Wishing the OP good luck,

Sal

[panic_down_under]

but life happened and now its almost a daily occurrence

You could try hydroxyzine and/or a gabapentinoid, either gabapentin (Neurontin) or pregabalin (Lyrica). They would be better longer-term options than benzodiazepines. Note: dependency is also an issue with gabapentinoids, but it usually takes longer to develop. If needed daily then rotating with hydroxyzine should lessen the risk. Physical dependency is not an issue with hydroxyzine, but psychological dependency is possible with any medication and can be more powerful and harder to overcome than the physical.

Hydroxyzine is a prescription antihistamine with good anti anxiety properties. It isn't quite as potent as the benzodiazepines, but is often potent enough to make a substantial difference.

Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). The pamoate form is claimed to be the more effective anxiolytic, but this is a cause of much debate.

Gabapentinoids have essentially the same effect on anxiety as the benzodiazepines, but do it from another angle.

Benzodiazepines work by increasing the inflow of negatively charged chlorine ions into neurons thus making it harder for them to raise their voltage to the 'firing' potential.

Otoh, gabapentinoids slow the firing rate by reducing the inflow of positively charged calcium and sodium ions into the cells so also making it harder for neurons to increase their voltage. Crucially, unlike the benzodiazepines, they aid maturity of neurogenesis generated hippocampal brain cells.

[Scissel]

You could try hydroxyzine and/or a gabapentinoid, either gabapentin (Neurontin) or pregabalin (Lyrica). They would be better longer-term options than benzodiazepines. Note: dependency is also an issue with gabapentinoids, but it usually takes longer to develop. If needed daily then rotating with hydroxyzine should lessen the risk. Physical dependency is not an issue with hydroxyzine, but psychological dependency is possible with any medication and can be more powerful and harder to overcome than the physical.

Hydroxyzine is a prescription antihistamine with good anti anxiety properties. It isn't quite as potent as the benzodiazepines, but is often potent enough to make a substantial difference.

Hydroxyzine comes in two forms, hydroxyzine pamoate (Vistaril) and hydroxyzine hydrochloride (Atarax). The pamoate form is claimed to be the more effective anxiolytic, but this is a cause of much debate.

Gabapentinoids have essentially the same effect on anxiety as the benzodiazepines, but do it from another angle.

Benzodiazepines work by increasing the inflow of negatively charged chlorine ions into neurons thus making it harder for them to raise their voltage to the 'firing' potential.

Otoh, gabapentinoids slow the firing rate by reducing the inflow of positively charged calcium and sodium ions into the cells so also making it harder for neurons to increase their voltage. Crucially, unlike the benzodiazepines, they aid maturity of neurogenesis generated hippocampal brain cells.

Thank you for the advice; PDU, and I forgot to say I am on gabapentin and does help a lot compare to without it. I'm cutting back each day on the benzo now and hoping I can return to only as needed again like I used to be. I'll be sure to mention hydroxyzine at the next visit with my APRN and see what she says - she has been a godsend compare to the last APRN I used to have that was downright dangerous to my well being. My APRN is also my therapist now because the last therapist I had was also a flake. I'm getting better now that I'm back on the Sertraline 150MG but still struggling with almost zero libido even I'm not sexually active and have no plans to become active ever again with another person.

I hope you are doing well yourself.

Take good care,

Sal

[panic_down_under]

I'm cutting back each day on the benzo now

Quitting them can be difficult for many. The following was written for tapering off SSRIs, but the same techniques are just as relevant for BZDs too

There are basically three ways of tapering off BZDs (and most other psych meds), the moderately slow way which most tolerate reasonably well, the even slower hyperbolic tapering method, or a combination of both by reducing the higher doses moderately slowly and switching to the hyperbolic method for the last few milligrams as they are sometimes the hardest to quit.

The moderately slow way is explained in "Example 1" under "Examples of tapering plans" of this webpage:

Stopping antidepressants

If the link is geo-blocked then use this link instead.

"Example 2" explains hyperbolic tapering. Ideally, you should get your BZD as an oral solution to dilute to make up the correct doses. Ask your pharmacist to explain how to do it.

I'm getting better now that I'm back on the Sertraline 150MG but still struggling with almost zero libido even I'm not sexually active and have no plans to become active ever again with another person.

You may find this useful:

Drug-induced sexual dysfunction in men and women (PDF)

and if you really want to get into the weeds then this is excruciatingly thorough and a good cure for insomnia:

Strategies for managing sexual dysfunction induced by antidepressant medication (PDF)

My thoughts:

Pretty much all antidepressants will negatively impact the libido. The exceptions are bupropion (Wellbutrin), mirtazapine (Remeron) and trazodone (Desyrel, Oleptro).

Wellbutrin is a very stimulating antidepressant which can have many with anxiety disorders almost literally climbing the wall, but small augment doses (<=75mg immediate-release, 100mg slow-release) taken daily may counter SSRI/SNRI/TCA caused sexual dysfunction, usually without increasing anxiety. The slow-release version seem to be more effect for this than the immediate-release

Mirtazapine isn't a great long-term antidepressant, imho (whether it is a true antidepressant is debatable, it acts mostly just as an antihistamine). It is notorious for causing carbohydrate cravings which may trigger large weight gains and is by far the most poop-out prone med, often quitting within only a few months.

Trazodone is the pick of the bunch because at typical therapeutic doses, 225-300mg, it may enhance the libido. In the past it was never that successful as an antidepressant because of the severe sedation at lower doses, but there is now a slow-release version available (Oleptro) which is better at keeping plasma levels above the sedation threshold.

Supplementing SSRIs with 30mg buspirone (Buspar) may reduce SSRI induced sexual dysfunction. Buspar is a GAD specific med which doesn't actually work for most, but when taken with SSRIs can reduced some of their side-effects and boost their effectiveness.

Mianserin (Bolvidon, Depnon, Norval, Tolvon) at 15-20mg/day has been reported to ease dysfunction in about 60% of cases when taken daily. It may take 3-4 weeks to become active. However, it is no longer available in many countries. Mirtazapine is chemically almost identical to mianserin (it was released by the same drug company after the mianserin patent expired), but isn't quite as effective in countering sexual dysfunction apparently.

The 5-HT3 antagonist ondansetron (Zofran), a potentially very effective anti anxiety med BTW, supposedly temporarily reduces dysfunction if taken 2-3 hours beforehand, but cost might limit its use.

And of course there are those little blue pills which no male admits to taking but which sell in their millions (tadalafil (Cialis) may be a little more effective than sildenafil (Viagra) for antidepressant induced erectile dysfunction).

Ginkgo biloba at 240mg/day taken in two divided dose of 120mg has been shown to reverse anorgasmia and decreased libido in both men and women, plus erectile failure in men. Dosage should be increased from an initial 2 x 30mg/day by a similar amount every 5-7 days.

Warning: Don't take Ginkgo, or any other supplement, without first discussing its suitability and safety with your doctor or pharmacist.

Ginkgo should not be used by those on anticoagulants or with a known allergy to Ginkgo. Some antidepressants, particularly the SSRIs and SNRIs, also some TCAs, affect blood coagulation so caution is needed. Stop taking it if you become more prone to bruising, or if you experience nose, or gum bleeding!

Other things that may help are:

Slightly reducing the daily antidepressant dose by 10-20% after being on the med for a while. This can be enough to kick start the hormonal processes. Sometimes a break from taking an antidepressant for a day is enough to break the cycle for a few days. This seems to work best with the shorter half-life SSRIs, Zoloft (sertraline), Paxil (paroxetine) and Luvox (fluvoxamine), however, this can sometimes trigger withdrawal symptoms, so some trial and error may be needed. Taking the usual daily dose should stop the withdrawal symptoms within an hour or so.

For those (both genders) that are only affected by inability/difficulty in achieving orgasm while taking a SSRI, a change to either a TCA or MAOI class antidepressant will solve this problem in the majority of cases. However, both may produce other sexual side-effects.

Problems with ejaculatory delay (anorgasmia) may be eased or even eliminated by changing to another SSRI. During research into meds that may reduce premature ejaculation the SSRI with the least effect on this condition, and therefore probably the least likely to cause delayed ejaculation, was fluvoxamine (Luvox) with an ejaculatory delay response of 1.9 times the non medicated response (those taking the placebo reported a 1.5 times delay). Sertraline( Zoloft) delayed things by 4.4 times, fluoxetine (Prozac) by 6.6 times normal and paroxetine (Paxil) had the worst results at 7.8 times normal. So if this is your problem then Luvox might be worth considering, but there is no guarantee that it will work as well as the antidepressant you're now on. It can also be problematic is if there are other medical issues as it interacts with many other medications and supplements.

Problems with erectile disorder are mainly produced by the TCAs and paroxetine (Paxil). Switching to a SSRI (except Paxil) will often overcome this disorder, although other dysfunctions may occur.

WARNING: Yohimbe is often promoted as a 'natural' treatment for sexual dysfunction. While it does work, it is very stimulating, so much so that it is used by researchers to trigger panic attacks, therefore, it is contraindicated for those with anxiety disorders and should be treated with initial caution by those with depression.

I hope you are doing well yourself.

I'm doing okayish, though my doctor has a different opinion usually emphasized with much finger waving and head shaking and I fear this isn't far off: But what would she know, she looks too young to have graduated elementary school, much less have a medical degree.

I've begun feeling my age this year probably not helped by a darker and colder than usual winter. This retirement caper isn't as much fun as I thought it would be. I'm thinking of asking for my money back.

Take good care,

You too, Sal

Ian

[Scissel]

Thank you very much, Ian