Hi Jon and welcome to UKDF. Some thoughts and questions came to my mind in reading your interesting and well-written comments on Prozac, your sleep, and panic and anxiety. First, is your tapering schedule one that was suggested by your MD, and is he a pdoc or just an MD? Have you told him/her about all your difficulties tapering off Prozac? I would think he might have suggested other tapering schedules since so far the approaches you've tried haven't worked. For example, instead of just taking 20 mg at decreasing intervals, taking the same amount each day but reducing the amount each week, as gradually as you can tolerate.
If your doc is not a psychiatrist, then perhaps he can refer you to one, since psychiatrists are the docs who specialize in the areas of emotional problems, psychiatric medications, side effect problems. and tapering. Also (I know, I'm asking too many questions), have you tried other medications for anxiety and panic? Generally, Prozac is thought to be the easiest antidepressant (SSRI class) to taper and discontinue, because it has the longest half-life.
One more thought: Since your anxiety, panic, and insomnia returned the last time you stopped Prozac, maybe that just indicates that Prozac works well for you, so that you're better off just continuing to take it.
Just my opinions, your doctor is the expert here. Once again, welcome to UKDF and hope you find it a good, supportive place, with lots of fine people who have experienced all sorts of emotional difficulties, including those similar to yours.
Many thanks for the warm welcome to the forums and for your questions - much appreciated and its great to be able to speak with someone about this as it can be quite a lonely experience.
The tapering schedule that I experimented with last year and this year (once every 2nd, 3rd, 4th day etc) was my own idea after checking the net and confirming with my GP. My impression is that many GPs are not well informed about SSRI withdrawal and you're quite right about suggesting being referred to a Psychiatrist for more appropriate advice (which will be my last resort if I cannot do it myself).
However, after experiencing sleep problems again since Oct this year (after reducing to one 20mg every third day), my new GP advised precisely what you have done - to have a stable dose - taking the same amount each day and gradually reducing. I am now on the fluoxetine fluid taking 10mg per day for 5 days and 15mg for two days (=80mg per week).
In terms of anxiety/panic symptoms - I have not had these since the 1990s when I attempted to withdraw cold turkey. Last year, when I first had the terrible insomnia, I became depressed/anxious through prolonged sleep deprivation which was recognised by Cognitive Behavioural Therapist and GP - so I was sure it was not the original symptoms returning from the early 1990s. It was only by reinstating 20mg fluoxetine did my sleep return after 5-6 weeks of taking it.
I have read a number of research papers from PubMed on fluoxetine withdrawal and what annoys me is that most of these studies are only for 6-8 weeks. Given that fluoxetine has such a long half life then I think they should focus on longitudinal studies across 6-12 months to ascertain the true impact of the various withdrawal strategies. For example, last year I had no symptoms when reducing to 20mg every second day; persistent dizziness on every third day and fourth day. My insomnia did not appear with the dizziness until two months later (or its severity didnt become apparent until then).
I am just hoping that taking the fluoxetine fluid will help restore my sleep soon as I'm back at work this week and I need to be sharp and focused....which is hard to do when your sleep deprived. I've asked for a weeks worth of Zopiclone to help so will take half a tablet a night....as I definately dont want to get addicted to those bad boys! I'm convinced the insomnia is a transient problem and will resolve over the next week.
It would be great if we could obtain the following stats from our GP/NHS:
1) How many people were prescribed fluoxetine in the UK 5 years ago?
2) What % of those in (1) are still on fluoxetine (or transferred to another AD)?
3) For those who successfully withdrew, how long had they been taking it, what was their tapering strategy?
4) For those in (2), how many had attempted and failed to withdraw and what strategies did they employ?
This would help us to identify which strategies work and those that don't. Maybe I'm being naive but I think this would be useful.