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Withdrawing From Fluoxetine After Long-Term Use


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Poll: Withdrawing From Fluoxetine After Long-Term Use (6 member(s) have cast votes)

How many years have you been using fluoxetine?

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Before withdrawing, what was your usual daily dosage?

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How slowly did you taper off?

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#1 Guest_Dr Doolittle_*

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Posted 03 January 2011 - 09:10 PM

Hi,
I'd like to share my experiences of taking and attempting to withdraw from the SSRI drug fluoxetine (aka prozac). The purpose of this is to share my experiences with others in a similar situation and hopefully gain some additional information and advice about withdrawing successfully from fluoxetine.

The following is an overview of my situation:


  • I originally starting taking 20mg fluoxetine each day from Dec 1993. This was to counter regular panic attacks and insomnia experienced during some difficult times.
  • I felt better after 6-8 months and attempted to come off the drug via cold turkey twice (in late 1994 and then again in 1996). I was not given any advice by the GP regarding withdrawal strategy. Consequently, I started experiencing terrible anxiety - obssessive worrying and panic - and also insomnia. I therefore resumed taking fluoxetine - 20mg a day. Again, my symptoms disappeared and I was able to continue with my study and professional life.
  • In Feb 2009, I decided to come off again but this time to taper off gradually over a period of 3 months. My strategy was as follows: one 20mg every second day for 1 month, one 20mg every third day for a month and one 20mg every fourth day for a month then off completely.
  • In July 2009 I began to suffer from sleep-onset insomnia (not able to fall asleep even though no apparent stress or anxiety). I saw a CBT to see whether it was to do with thought patterns and sleep hygeine - all proved fine. To combat insomina, I took 3.75mg Zopiclone max of three times a week but usually after four days without sleep. Also took melatonin from Nov 2009.
  • Resumed 20mg fluoxetine daily from 29th September 2009 and sleep returned to normal late Nov-early Dec 2009
  • January 2010, I reduced to one 20mg every second day.
  • In August, I decided to reduce again, with one 20mg every second day for week 1 and one 20mg every third day for week 2.
  • In Oct, I stayed on one 20mg every third day.
  • Mid Oct until mid Dec - serious sleep-onset insomnia again!!!
So I have now started to take the fluoxetine syrup so I can control the dosage myself. My strategy is to take fluoxetine every day to avoid troughs (even though it has a long half life) and am now taking 80mg across seven days (15mg for two days and 10mg for 5 days). My sleep is still affected at the moment and I'm just hoping my fluoxetine levels rise before I go back to work after the Christmas break.

Thank you for listening and I'd welcome any comments and suggestions regarding fluoxetine withdrawal strategies and more generally your experiences with this drug.

Best wishes,
Jon





#2 Guest_Jakey_*

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Posted 03 January 2011 - 11:31 PM

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.

#3 jessie

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Posted 04 January 2011 - 05:47 PM

I've quit fluoxetine several times - not a decisive quit, more forget to take them, then it continues over a long period. I just find that once they have worn off I gradually return to the same anxious/depressive state I was in in the first place. If you're anything like me then Jakey is right, perhaps you are just better on it and should continue taking it. Do the withdrawal effects wear off over a given period of time or do you just continue to feel bad until you resume taking it?

#4 Guest_Dr Doolittle_*

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Posted 05 January 2011 - 10:20 PM

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.


Hi Jakey,
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.

Best,
Jon

#5 lady e

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Posted 06 January 2011 - 10:52 PM

Hi I have been on various SSRI's including fluoxetine, I am now on citalopram and am trying and failing to drop from 20mg to 10mg a day. I find I get bad side effects when I up the strength- insomnia, shaking, headache, clenching my jaw and grinding my teeth, feeling out of it, all wonderful stuff.
Trouble is withdrawal is even worse, I cant sleep at all at the moment and I feel so anxious and angry, tearful over nothing, so tired and weak. I also have terrible dizziness but I dont know if this is made worse by the withdrawal ( I get the dizziness anyway as I am partially deaf and have problems with my ears) but the dizziness has been so much worse since trying to withdraw from the citalopram.

I am scared at the moment because whilst on the SSRI's I feel numb - stable but nothing really affects me, good or bad. I now am feeling a full range of emotions both good and bad and its terrifying trying to live with them cos they have been absent for so long.

I had to take 20mg today as I feel awful again. I have been taking 20mg one day and 10mg the next but I am not doing too good so am going to take the 20mg for the next few days and try and get an appointment to see my GP. I really wish there was a easy way to do it but unfortunetely it takes a long long time and a lot of patience. I have been off them in the past and stayed off them for about a year before I had a relapse, so my advice is do it very slowly with the support of a doctor / psychologist etc. At the end of the day if the drug is working for you without major side effects then why not stay on it?

My only reason for reducing the dose and hopefully coming off SSRI's is so I can become pregnant and not risk my babies health. If I have a child and then become depressed I will be straight back on them, no hesitation.

Sorry this isnt much help, just thought I would share my experiences x

#6 Guest_Dr Doolittle_*

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Posted 07 January 2011 - 12:01 PM

Hi I have been on various SSRI's including fluoxetine, I am now on citalopram and am trying and failing to drop from 20mg to 10mg a day. I find I get bad side effects when I up the strength- insomnia, shaking, headache, clenching my jaw and grinding my teeth, feeling out of it, all wonderful stuff.
Trouble is withdrawal is even worse, I cant sleep at all at the moment and I feel so anxious and angry, tearful over nothing, so tired and weak. I also have terrible dizziness but I dont know if this is made worse by the withdrawal ( I get the dizziness anyway as I am partially deaf and have problems with my ears) but the dizziness has been so much worse since trying to withdraw from the citalopram.

I am scared at the moment because whilst on the SSRI's I feel numb - stable but nothing really affects me, good or bad. I now am feeling a full range of emotions both good and bad and its terrifying trying to live with them cos they have been absent for so long.

I had to take 20mg today as I feel awful again. I have been taking 20mg one day and 10mg the next but I am not doing too good so am going to take the 20mg for the next few days and try and get an appointment to see my GP. I really wish there was a easy way to do it but unfortunetely it takes a long long time and a lot of patience. I have been off them in the past and stayed off them for about a year before I had a relapse, so my advice is do it very slowly with the support of a doctor / psychologist etc. At the end of the day if the drug is working for you without major side effects then why not stay on it?

My only reason for reducing the dose and hopefully coming off SSRI's is so I can become pregnant and not risk my babies health. If I have a child and then become depressed I will be straight back on them, no hesitation.

Sorry this isnt much help, just thought I would share my experiences x


Hi lady e,
Many thanks for sharing your experiences. These SSRIs really do sound difficult to come off don't they? If the GP had told me about these withdrawal issues back in 1993 I would never have taken them.

I totally agree about withdrawing very slowly and I know I'm in this for the long haul - I don't care if it takes 12 months or 18 months to come off them. I know these SSRIs are beneficial (at least in the short term) but the long term effects are unknown and we're the guinea pigs! Ideally, I don't want to take any synthetic drug that I do not need (emotionally). I suspect that I am physically dependent on fluoxetine hence the sleep issues when withdrawing. However, the legal distinction between addiction and dependence favours Pharma companies over the patient in my opinion - addiction is where the user actively seeks out the drug to maintain the effect whereas dependence refers to a withdrawal syndrome when one withdraws (i think). Eitherway, both are unpleasant to the patient and the Pharma companies make £billions in the process. Apologies for my cynacism.

Can you have lower denominations of citalopram? For example, is there a fluid option so that you could reduce by 5% each month? In the past when you have withdrew from an SSRI, how slowly did you do so? Was your relapse really a relapse or a natural response to persistent withdrawal effects?

Jon

#7 Guest_Dr Doolittle_*

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Posted 07 January 2011 - 12:10 PM

I've quit fluoxetine several times - not a decisive quit, more forget to take them, then it continues over a long period. I just find that once they have worn off I gradually return to the same anxious/depressive state I was in in the first place. If you're anything like me then Jakey is right, perhaps you are just better on it and should continue taking it. Do the withdrawal effects wear off over a given period of time or do you just continue to feel bad until you resume taking it?



Hi Jessie,
It sounds like you withdrew from fluoxetine cold turkey - could this be the reason why you returned to an anxious/depressive state? Did the symptoms disappear when you reinstated fluoxetine? When I tried cold turkey in the 1990s I had terrible withdrawal effects, albeit after 2 weeks or so of stopping so tapering is important (although I did not know this back then).

When I withdrew by tapering in 2009 and experienced insomnia, it was that bad that I couldn't function properly so I had to go back on the fluoxetine and within one to two months my sleep returned. As I followed a similar tapering process in 2010 but over a longer time period, I realised when I get down to taking 20mg every third day my sleep disappears again so now I'm trying to get a constant level in my system using the the fluid so my sleep returns. Although I felt tired last night, I still didn't drop off....but finished the book I was reading! Posted Image

Jon

#8 msmaz

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Posted 08 January 2011 - 10:48 AM

Hi Jon,My own experience of trying to come off Paroxetine (seroxat) has not been great.I was prescribed them in 1997 after birth of my first child and stayed on them til 2000 and when I discovered I was pregnant again I came off them straight away -cold turkey-that was a big mistake within months I had plunged into a very deep depression with anxiety attacks,insomnia.constant anxiety and worrying.I also became agorphobic too which is not great considering I was pregnant too!so I got a CPN through the Doctor who put me on another type of antidepressant which was safe to take whilst I was pregnant this helped but basically zonked me out all the time!eventually when my baby was born in November of 2000 they put me back on paroxetine and I got a lot better no panic attacks,insomnia,anxiety or depression and I started gradually getting out and about again with no problems.However in December 09 I felt strong enough to try and come off them so went to GP who gave me advice on tapering them so I went from 20mgs every day to 20mg one day and 10mg the next which was fine then in March of last yr I started reducing them further and all my anxiety and everything came back and I ended quitting my full time job I had started the previous yr cos I could not handle it(was stressful type of job anyway)so I have been back on 20mg since June of last yr and am slowly getting better although still got some anxiety but nowhere nr as bad!It is a really difficult process and I am not sure if I will ever be able to come off them as the side effects are too bad :( I hope you can manage it though-good luck xx

Marie x

#9 Guest_Jakey_*

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Posted 08 January 2011 - 06:38 PM

Dr. Doolittle:

Can you have lower denominations of citalopram? For example, is there a fluid option so that you could reduce by 5% each month?

Hi Dr. D,
I believe the 20 mg citalopram tablets are scored so they can easily be broken in half. I found that I can reduce the tablets to whatever size I want by using a box cutting knife with a sharp blade. You can readily divide the 10 mg tablet into two 5 mg tablets.

long term effects are unknown and we're the guinea pigs

Dr.D., according to my Google seasrches, citalopram and other antidepressants in it's class (SSRIs, including citalopram, escitalopram, Prozac, Paxil Zoloft) have been used by millions of people, more likely hudnreds of millions, over the past 20 years and are generally considered safe, amongst the safest of all psychotropic drugs. Citalopram was approved for use in Europe in 1980 and Prozac in the US in 1987, and both are generally considered safe for the vast majority of people. So in that sense, we're not really guinea pigs, although all medications have adverse side effects, including aspirin and other widespread over-the-counter meds, but the class of drugs that include citalopram and Prozac (SSRIs) are generally considered safe, certainly much safer than the older antidepressants such as amitryptaline (the TCAs).

Having said that, I have experienced some adverse effects of SSRIs myself, particularly with Paxil, in the form of weight gain, sexual dysfunction, and and sedations, but these effects are well documented with Paxil and I don't expereince them with sertraline (Zoloft). It's all an individual matter as to who has what side effects with any given drug. The crucial issue is whether the benefits outweigh the adverse effects in any individual case. For many millions the benefits are well worth it.

#10 jessie

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Posted 08 January 2011 - 08:58 PM

Hi Jessie,
It sounds like you withdrew from fluoxetine cold turkey - could this be the reason why you returned to an anxious/depressive state? Did the symptoms disappear when you reinstated fluoxetine? When I tried cold turkey in the 1990s I had terrible withdrawal effects, albeit after 2 weeks or so of stopping so tapering is important (although I did not know this back then).

When I withdrew by tapering in 2009 and experienced insomnia, it was that bad that I couldn't function properly so I had to go back on the fluoxetine and within one to two months my sleep returned. As I followed a similar tapering process in 2010 but over a longer time period, I realised when I get down to taking 20mg every third day my sleep disappears again so now I'm trying to get a constant level in my system using the the fluid so my sleep returns. Although I felt tired last night, I still didn't drop off....but finished the book I was reading! Posted Image

Jon


Hi, I don't think so, I had no side effects from withdrawal at all, just 6-12 months after stopping would get depressed again. First few months I felt absolutely fine, but gradually slipped back into a low mood.

Fair play for finishing your book...I'm usually asleep after reading the same paragraph 4 times :/

#11 Tryingreallytrying

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Posted 09 January 2011 - 07:25 PM

I found Venlafaxine withdrawal really hard, even with tapering. And like you I was back in the mess again 6 months later. Serotonin has been easier. Saying that though, I've stayed on it as I would hate the depression to come back, as each time it seems to be worse. Most days I break the tablet in half though and just take 25mg rather than 50

#12 Guest_Jakey_*

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Posted 13 January 2011 - 06:47 AM

Dr. D, how is it going?

#13 Guest_Dr Doolittle_*

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Posted 15 September 2011 - 09:17 PM

Dr. D, how is it going?



Hi Jakey,
Sorry I've not been in touch for a while and I hope you and the other forum members are well.

Just to summarise my progress over the last 8 months:

1) My sleep returned to normal(ish) in Feb 2011 after reinstating 20mg fluoxetine per day
2) In July, my GP consulted her Psychiatrist friend and they devised a more gradual withdrawal strategy - Img per month for 20 months using the Fluoxetine fluid (brand=Prozit) and syringes.
3) I am currently taking 4.5ml per day of the fluid (where 5ml = 20mg fluox) and due to reduce to 4.25ml in Oct
4) I have little or no symptoms at present other than some nights I have trouble sleeping but I accept that and just look forward to the nights that I do sleep...which is most.

Sooooo, touch wood, life is good at the moment and I think a crucial milestone for me will be when I hit 60mg a week (or 2ml a day)....but fingers crossed this very gradual reduction is the right one!
Posted Image

I hope all is well with you and other forum members and wishing you all the best on your SSRI journey.

best
Jon





#14 Guest_Jakey_*

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Posted 16 September 2011 - 04:53 AM

life is good at the moment

That's really good news Jon.


#15 jeff bee

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Posted 09 July 2012 - 11:10 PM

Hi..

I am going through the withdrawal process of Prozac now. I tapered off my dosage from 20mg per day (full tablet) down to 1 quarter of a tablet every second day. I did this over a period of 3 months. All was going well until last Thursday when I took my last dosage, then the withdrawal effects started.

Lots of anxiety and worrying about the future. Had my first sleep disturbance last night, woke up at 4am with anxiety.

My stomach is upset and am having trouble eating. Feel lethargic and have dizziness sometimes. Crying spells, some suicidal thoughts and worry worry worry.

My anxious mind state is making me think that I have made a big mistake in trying to come off these and that the symptoms will only get worse. I have hope though in reading forums like this that other people are going through the same thing.

I decided to come off them after 10 years as I feel as though im emotionally dead most of the time, just numbed out. My initial reason for starting the medication was to help with anxiety, which the drug did very well.

I think it would be better to treat the underlying causes of the anxiety through therapy rather than just pop a pill and make it all go away.

My thanks for the other posts.

Jeff