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Hello all, Looking mostly for some feedback regarding tapering and switching from escitalopram to fluoxetine. My psychiatrist has recommended a switch and wrote my prescribing doctor to switch my script and his suggestion for tapering was 5mg for 2 days, then nothing for two days, then start the fluoxetine at 10mg for a week before taking my full dose. To me, from what I've read, this sounds quick but I've never tapered to switch so I don't really know. Currently I have no side effects from escitalopram, just not seeing the benefits I used to and have regressed to pre escitalopram feelings. I have been on escitalopram for around 11 months give or take a month and taking 10mg for the whole time. Any feedback or suggestions would be very helpful. Thanks!

Hello, I really didn’t want to post a long intro because I’ve been battling either anxiety or med side effects or med w/d side effects for a long long time and I’m tired, sad, and angry and don’t have the energy, but I wanted to be able to reply to another member on here, so here goes. I’m not anti med and they did help for a very short period when I first took them but overall my life has been one of struggle even with them or partly because of them. Idk. I got OCD as a teen in the 80’s, so obviously DO have anxiety but muddled thru pretty well with little help for meds. I got on meds full time, in the 90’s, due to a horrendous breakup that put me in major depression/anxiety and after a couple years developed a mysterious symptom I call “boatiness” (non vertigo dizziness) which causes anxiety and was written off as anxiety but never remedied. I’ve struggled and suffered, missing out on lots of life’s joys…. yet I kept pushing thru and was “successful” in some ways, trying to do ‘normal’ life things, and keeping hope alive until the last few years. now I am tired and defeated. I tapered decades of Klonopin in 2019 thinking that would stop the boatiness. But it remains 2 years later. Now I’m tapering Luvox and I wouldn’t even bother tapering because it probably does help a tiny bit, who knows, but it makes me lethargic. It’s been a year of taper so far. I resigned myself to wasting another year and was suffering along but recently started getting an increase in debilitating symptoms. I really don’t even care if I’m off meds. I probably do need something at this point, because my thinking is so skewed to the negative after so much suffering and trauma, watching others live happily normal lives and yet they still complain about their brand of “anxiety.” I challenge them to try mine. I think I’m too damaged and disabled to do life without meds now at age 55. This coming from someone who was so hesitant and afraid to take them, I had to go to the hospital to get started on them. I’d like to switch to a different med or add it to the Luvox, but I’m told I can’t add anything or switch because “Luvox is special”. I have to taper completely off AND have a two week wash out of Luvox even though I’m only on a few grains of it, at this point. I can’t see how this is true because people are on multi meds all the time and I, personally, was on Luvox with Mirtazipine, but all the drs, ARNP s, and pharmacists are sticking to this “non-mixing Luvox” story, so I suffer another taper. Family and psych docs are useless… unless their is a pill or procedure, they don’t even want to know about it. I don’t know the doses, usually middle of the road because I was too scared to go to the high doses. 1980—OCD, kept secret, struggled thru school , age 14 1984—Told mom about OCD, first med anafranil for 6 months helped alot 1993-1994—Harsh breakup, major anxious depression, too scared to take meds, went to hospital to get help, klonopin/Zoloft 1996—Started having a symptom I call “boatiness”, never diagnosed, told it was anxiety to go back on meds, Klonopin/Zoloft 1997-2015—Family, college, work, struggled thru constant boaty dizzy symptom, Zoloft or Lexapro or Paxil or Prozac and Klonopin plus Xanax 2015-2018 Life becoming more and more limited, decided meds might be part of the problem and/or had barely helped for decades, started first tapers, repeatedly 2018—complete instability and disability, no work, no relationship, limited driving, tapered anti d too fast before klonopin, in maximum klonopin tolerance, landed in hospital from severe “boatiness” and unreality 2019—Mirtazipine, Luvox, Klonopin, complete instabiltiy but less than 2018 2019—Tapered Mirtazipine and Klonopin 2020—Luvox only, still disabled, now depressed 2021—Luvox taper from 100 mg, complete disability, hopeless, given up, angry, most of life behind me now

I'm desperate for help and advice. I've been in protracted withdrawals for almost 4 years caused by Effexor. Doctors tried to cover up the withdrawls with different drugs which made it worse. I reinstated Effexor after being drug free for 6 months as the wd were unbearable (I didn't know at the time that it was to late to reinstate) I managed to stabilize a bit but it also made things worse. After the reinstatement I became hyperactive, developed akathisia and became suicidal. I'm at 14 mg now but I've hit tolerance. I'm dreading every time I take the dose cause I start to hallucinate when the drug kicks in. Any advice of what to do would be greatly appreciated. Thanks in advance.

Hi I am Hopefulstill and new. I started at 20 mg. Paxil...... Now years later on 50 mg. but seems to have pooped out. I am going to try tapering off. Started with 46 mg. yesterday Here goes! Glad I found this site

Pharmacol Res. 2018 Oct 29. pii: S1043-6618(18)31201-5. doi: 10.1016/j.phrs.2018.10.025. [Epub ahead of print] The Emergence of loss of efficacy during Antidepressant Drug Treatment for Major Depressive Disorder: An Integrative Review of Evidence, Mechanisms, and Clinical Implications. Fornaro M1, Anastasia A2, Novello S3, Fusco A4, Pariano R5, De Berardis D6, Solmi M7, Veronese N8, Stubbs B9, Vieta E10, Berk M11, de Bartolomeis A12, Carvalho AF13. Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30385364 The re-emergence (i.e. 'breakthrough') of depressive symptoms despite maintenance treatment of depression with antidepressant drugs is a complex clinical phenomenon referred to as tolerance. Herein we critically appraise evidence from both pre-clinical and clinical studies, focusing on putative mechanisms as well as clinical correlates and implications of the emergence tolerance during antidepressant treatment for major depressive disorder (MDD). It is firstly unclear to what extent this phenotype reflects a pharmacological effect of an antidepressant, is driven by non-adherence, is a marker of latent bipolarity or another comorbidity, a marker of neuroprogression of the underlying disorder or the intrusion of the impact of psychosocial variables into the clinical course. The operational definitions of tolerance and its related phenomena have also been largely inconsistent. Several protective clinical indicators have been proposed, including a rapid-cycling course and comorbid chronic anxiety, whilst poor treatment adherence, proneness to emotional blunting and sub-threshold bipolarity have been identified as possible correlates of tolerance to antidepressant treatment in MDD. Putative neurobiological underpinnings include adaptations in the hypothalamic-pituitary-adrenal (HPA) axis and the serotonergic system. Due to the clinical and diagnostic challenges imposed by the emergence of tolerance to antidepressants, there is an urgent need for upcoming international guidelines to reach a consensus on operational definitions for this complex clinical phenomenon, thus enabling a more precise appreciation of the incidence and correlates of tolerance to antidepressants. Taken together, the present review underscores the need to cautiously weight benefits and risks prior to considering long-term antidepressant treatment for patients with MDD as tolerance may emerge in a subset of patients.

Greetings to all members of this community... I am a new member. Unfortunately, I have joined this forum during a time of personal crisis, as I assume is often the case. Before requesting your advice and input on my current predicament, I would like to make it clear that I fully intend to participate in this community as a source of comfort and support when my personal experience is relevant, not just a beneficiary of the comfort and support that I have noticed is such a defining aspect of the courageous individuals that define this community. In the fall of 1999 during the first semester of my first year in University, I saw a Psych and I was diagnosed with OCD (Mostly Pure O) and panic disorder and prescribed Paxil. I'm hoping my medication history appears as a signature once I post this discussion, I included it while signing up. In a nutshell, after 15 years on Paxil my psych believes I've reached tolerance and wants me to switch to another medication. I am extremely concerned about this. First of all, I always intended to ween myself "properly" off paxil one day, regardless of how long it took to succeed. Unfortunately, this has to be the worst relapse I have ever experienced; my anxiety and OCD are terrible, I'm very depressed, I feel extremely depersonalized, and I'm really lacking focus and concentration. I literally feel like I'm losing my mind. Because of the way I feel, my main objective at the moment is simply to feel better. This has always been my main focus during past relapses, however, the one significant difference this time around and a major addition to my anxiety is the fear that now consumes me regarding the length of time and long term effects of being on an SSRI. It may not mean too much with regards to the long term damage I've most likely suffered, but I always took a little comfort in knowing that the first psychotropic drug (Paxil) I was prescribed had worked and remained the only one I'd ever been on. I had always felt for sufferers who had been through the chemical gambit of multiple SSRI's, SNRI's, Benzo's and other drugs, desperate for just a little salvation. To wrap this up, what clearly concerns me the most at the moment is the lack of clarity in mental health with regards to next steps. Notwithstanding my strong intention to get off this crap one day, what I'm hoping for at the moment is advice and input as to what you guys believe is the quickest and smartest option for me to reach mental stability. I just want to feel somewhat sane again. Below is a list of options that I've compiled, the first two were received as "professional" advice. Please feel free to ignore them all if you favour an additional option. 1. Stop the Paxil cold turkey and immediately switch to another SSRI or SNRI the next day - My Psych's preference 2. Increase the Paxil to 40mg, then to 50mg if necessary - A 2nd opinion I sought from my family doctor 3. Gradually withdrawal off the Paxil while starting and gradually increasing a new medication at the same time - Information I came across. 4. Add Wellbutrin as an add-on medication to help boost the Paxil's effect and deal with the depression component - Information I came across. 5. Just stop the Paxil and withdrawal properly - Not sure how I'd feel better any time soon with this option Thank you in advance for any advice and/or comforting support. Cheers