Prozac questions

[[Al...]]

 

Hi @[Cr...]

I suffered an adverse reaction to raising my Prozac dose in February of this year, which is why I ended up on a benzo and have to taper now. I also had to drop the Prozac dose from 30 to 20 mg. I suffer from OCD and Prozac was helpful in allowing me to function for a long time. Now it feels like I am just taking it to stop withdrawals and it has lost its effectiveness. I feel a bit stuck and wonder if there is anything I can do, like switching to another AD.

I tried to switch to Lexapro in 2017 but had to go back on Prozac due to bad side effects. Do you think I'm stuck and should just stick with Prozac or do you think it might still be possible to switch to another AD? The trouble with switching is that I would need to discontinue Prozac first and I think that would be really risky. Have you had any experience switching between ADs? I know that some doctors say it is possible to taper off the first one while tapering onto the second one, but again that sounds very risky to me.

I wish I'd never got on the AD merry go round but once you are on it your brain does get used to having the support and I'm not sure I can function without that support now.

 

[[Cr...]]

Thanks @[Al...], I will get back to you ASAP. In the meantime I hope others offer input as well. Good night 

[[Cr...]]

Hello Alpha,

Sorry to see you found yourself caught in a psyche med riddle that doesn't appear to have a clear cut answer.

From what I could gather from your past posts, you increased the Prozac to 30 because 20mg was no longer helping your OCD symptoms. Doing so caused insomnia and agitation to occur, but it took about 3 weeks due to the long half-life.

From the outset, I would suspect that you may have experienced the 'Poop-out' effect with Prozac where it was less effective at tackling the symptoms you were using it for. When this happens the patient is often advised to increase the dose or switch ADs. It is more likely that your body may have just turned against Prozac in particular after it was used for so long and that is why an increase was not tolerated well. Although a longshot, due you recall the manufacturers changing on your bottle right before it stopped working or when you received your 30mg bottle? Sometimes different filler forumaltions are less tolerated and affect how much people absorb.

Regardless, I doubt you want to take a chance of sticking with Prozac as a viable option. If you feel you need to be on an ssri and don't want to taper off completely, it may be best to switch to another one.

Since Prozac has a long half-life you are correct to assume that an instant crossover could lead to a bad reaction like Serotonin Syndrome. Luckily the long half-life also makes it easy to quickly taper to a lower dose allowing for a smooth crossover.

You will have to talk with your doctor about a taper schedule. It would probably be based on the ssri chosen as the replacement. Just because Lexapro did not go over well does not mean that other ssris won't be tolerated. In fact, depending on the start-up circumstances surrounding your use of Lexapro the first time, it may still be a viable option to attempt again.

In 2011 I had a horrible reaction to one 5mg tablet of Lexapro, but in 2014  I instantly crossed over to it from sertraline and had zero issues and even felt better. That was taking 20 mgs right off the bat too. 

Since Prozac has such a long half-life you might be able to rapid taper down to 5mg or off in two weeks and then slowly work up the dose on whatever other ssri you chose. The Prozac still being in your system may actually prevent withdrawal symptoms while starting up a new AD. It may also decrease those dreaded start-up effects as well. Just make sure that when you start up the new AD that the dose you start with is equivalent to about only 5 to 10 mgs of Prozac, as due to the long half-life it may take awhile for Prozac to fully clear your system even when off. 

Of course, benzo dependence may complicate things a bit. If you are currently tapering you may need to hold off on that as you try to adjust to the new AD.

You are right that there is always risk when doing any med/dose changes. There is no way to predict with certainty how things will go. Beyond switching, your only other options are hoping your body stabilizes on 20mg of Prozac or you start tapering off of Prozac in conjunction with your benzo. I doubt you want to taper 2 meds at once. So if you don't think you will ever stabilize you may have to switch.

[[Al...]]

Thanks @[Cr...]

Have you ever experienced the "poop-out" effect, and did switching to another SSRI solve the problem? I'm just wondering if another SSRI can be effective even though it's working on the same down-regulated receptors.

[[Al...]]

Just wondering if anyone else has experienced the "poop-out" effect and managed to switch to another SSRI to solve the problem?