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The Prozac switch or "bridging" with Prozac


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#1 strawberry17

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Posted 16 November 2011 - 11:59 AM

Note from site administrator:
Read this entire topic before attempting a switch to Prozac. Be sure to read details and cautions here. Consult a knowledgeable medical practitioner before changing medications.

Also see Tips for tapering off Prozac (fluoxetine)



I was on Lustral (Zoloft) which also has a short half life and was very sensitive to withdrawal, long story short, I did however find I was able to switch to liquid Prozac which has a long half life and taper excrutiatingly slowly from that, I was even sensitive to going too fast on Prozac to start with and the first time had to go back to square one and start again, slower. This might be worth thinking about? I don't know if anyone else here has any thoughts on switching to Prozac?

Edited by Altostrata, 22 March 2014 - 02:16 PM.
added introductory note

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#2 Shanti

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Posted 16 November 2011 - 12:28 PM

I was just thinking about switching from Paxil to Prozac too Strawberry. I would like to hear if anyone has had experience with it. Did you find the symptoms more bearable than before?
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
My Paxil Website
My Intro

#3 strawberry17

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Posted 16 November 2011 - 01:14 PM

I have read that some experts recommend switching to Prozac (David Healy I think?) and I've heard other says it's a no no. I got to a point where there was nothing I could do to reduce the Lustral without severe withdrawals, it was only available in tablet and not liquid form (I'm in the UK) at the time, so I felt I had nothing to lose by trying the switch, I had in the past switched from Lustral to Citalopran and back to Lustral with no problems. Luckily I had no problems with switching from one SSRI to another at all, I did have a problem withdrawing, but switching to liquid Prozac was definately the answer for me. Tapering off liquid Prozac has been far far better and virtually problem free, although excrutiatingly slow, 4/5 years all in to get off, I've managed to get down from 5ml to 1.40ml so far.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#4 Shanti

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Posted 16 November 2011 - 02:42 PM

Hmm. Thank you Strawberry. I looked on the internet about Prozac withdrawals and it doesn't seem as severe as Paxil and other short half life drugs. I don't see as many complaining like we do. I went ahead and left a message for my doctor to switch me to Prozac. Hopefully she'll just do it without calling me and asking me why. I just told the receptionist I'm having trouble with Paxil. If she doesn't call it in, then I'll ask the new doctor. I just didn't want to bombard him with several big problems in one visit if I don't have to.
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
My Paxil Website
My Intro

#5 strawberry17

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Posted 17 November 2011 - 12:06 AM

Make sure you get liquid Prozac, equal dose to the med you are taking now. Don't make any reductions when you get it, take the Prozac for a month or so to make sure you're ok with the switch before considering the taper!

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#6 strawberry17

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Posted 17 November 2011 - 12:12 AM

Just had a look at your web site, it's really good, very clear. I also have a web site/blog (see below)about my Prozac withdrawal, you might find some useful info there.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#7 Altostrata

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Posted 17 November 2011 - 11:23 AM

Switching or bridging with another drug, usually of a longer half-life, is a recognized way to get off antidepressants, particularly those that people find difficult to taper.
 
Many people with failed tapers from venlafaxine (Effexor), desvenlafaxine (Pristiq), paroxetine (Paxil), and duloxetine (Cymbalta) find they need to bridge in order to go off the drug.
 
Fluoxetine (Prozac) has the longest half-life of any of the modern antidepressants. Because it takes about a week for a dose to be metabolized completely, if a switch to fluoxetine is successful -- that is, does not cause withdrawal symptoms from the original drug -- a careful taper off fluoxetine is easier for most people -- see information about Tapering off Prozac. And, at least fluoxetine comes in a liquid.
 
(Citalopram or Celexa and its sibling escilatopram or Lexapro have half-lives of about 35 hours, a relatively long half-life among SSRIs, and are other candidates for a bridging strategy. They also come in a liquid form. The drawbacks and advantages of switching to another drug to get off the first drug, described below, apply to a switch to citalopram or escilatopram as well as fluoxetine.)
 
While going off fluoxetine usually has less risk, one might still develop withdrawal symptoms going off fluoxetine. No bridging strategy is risk-free.
 
You must find a knowledgeable doctor to help you to with a bridging strategy. You might wish to print this post out to discuss it with your doctor.
 
When to switch or bridge
A direct taper from the drug to which your nervous system is accustomed carries less risk than a switch to a new drug. You may have a bad reaction to a new drug, or the substitution may not work to forestall withdrawal symptoms. This is the "the devil you know is better than the devil you don't know" rule.
 
The risk of a switch is justified if you find a  taper from the original drug is simply too difficult. Usually people will do a switch when they find reducing the original antidepressant by even a small amount -- 10% or even 5% -- causes intolerable withdrawal symptoms. (I have heard doctors say they don't even try tapering off Effexor and Paxil, they do the Prozac switch from the beginning.)

 

Sometimes when people go down to a low dose of an antidepressant (such as paroxetine), they find further reduction is very difficult. Substituting a longer-acting SSRI such as fluoxetine may be worth the risk.

If you're thinking of switching simply as a matter of convenience, you need to weigh the risks against the amount of convenience you would gain. Generally, switching for convenience is a bad idea.

Risks of bridging
For most people the switch goes smoothly but for some it doesn't. A bridging strategy has the following drawbacks for a minority of those who try it:

  • Adverse reaction to the bridge drug, such as Prozac.
  • Dropping the first antidepressant in the switch causes withdrawal symptoms even though you're taking a bridge drug.
  • If withdrawal symptoms are already underway, switching to a bridge drug doesn't help
  • Difficulty tapering off the bridge drug. All of the bridge drugs can be difficult to taper themselves.

So, like anything else, the Prozac switch is not guaranteed to work. But if you are having intolerable withdrawal from another antidepressant, it may be worth risking the worst case in the Prozac switch: It doesn't help and you have withdrawal syndrome anyway.

 

CAUTION: A switch to a bridge drug is not guaranteed to work. It's safer to slow down a taper than count on a switch. A switch really should be used only when a taper becomes unbearable or there are other serious adverse effects from the medication. You must work with a doctor who is familiar with bridging, in case you develop severe symptoms.

Below is information I've gathered from doctors about exactly how to do the Prozac switch.

Healy 2009 method for the Prozac switch
From Healy 2009 Halting SSRIs withdrawal guidelines:
 


  • 1A Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid. Seroxat/Paxil 20mg, Effexor 75mg, Cipramil/Celexa 20mgs, Lustral/Zoloft 50mgs are equivalent to 20mg of Prozac liquid. Or 40 mg of Paxil/Seroxat to 40 mg Prozac. The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.
  • Some people may become agitated on switching from Paxil/Seroxat to fluoxetine in which cases one option is take a short course of diazepam until this settles down. Whether this agitation is caused by fluoxetine or because for some people the substitution simply cannot be made may be difficult to determine. If the agitation gets better when the dose of fluoxetine is reduced then its more likely to be caused by fluoxetine, if it gets worse, then it is more likely to be linked to withdrawal.
  • 1B A further option is to convert to a liquid form of whatever drug you are on. Many people cannot change easily from paroxetine tablets to fluoxetine and switching to paroxetine liquid may do the trick instead.
  • 1C Yet another option is to change from paroxetine to a mixture of half the previous dose in the form of paroxetine and the other half in the form of fluoxetine, and then to reduce the dose of paroxetine gradually.

 
Phelps-Kelly 2010 method for Prozac switch
From Clinicians share information about slow tapering (2010)
 

For any anti-depressant you can add in 20 mg of Prozac, get them off the anti-depressant, then taper the Prozac.

 
Jim Phelps, one of the authors of the above, posted in 2005 in some detail about the so-called "Prozac bridging" strategy. He said it is described in Joseph Glenmullen's book, Prozac Backlash, maybe in the chapter titled of "Held Hostage."
 
The technique Dr. Phelps described in this post skips doses and finishes with alternating dosages, which we do not recommend for people who are sensitive to withdrawal symptoms. Given that Prozac liquid is available, this is completely unnecessary.
 
Foster 2012 method for Prozac switch
Dr. Mark Foster, a GP whose mission is to get people safely off psychiatric drugs includes this in a presentation he gives to doctors. http://www.gobhi.org...[autosaved].ppt.
 

Special Situations: The Prozac Switch

  • For patients that have a hard time withdrawing from other SSRIs (such as Effexor or Paxil), switching to Prozac can be effective bridging.
  • Prozac has the longest half-life and therefore the most gradual withdrawal effects.
  • Start the patient on a low dose of Prozac when severe withdrawal symptoms occur.
  • Wait two to four weeks, and then resume the prior tapering schedule.
  • Once the first SSRI has been stopped, then taper the low dose of Prozac over another 4-8 weeks.

 

 
His method involves overlapping Prozac with the other antidepressant.
 
Note on above: If you have tapered to a lower dose of Seroxat/Paxil, Effexor, Cipramil/Celexa, Lustral/Zoloft, etc., a lower dose of Prozac may be more tolerable. If you are about half-way down, you might want to try 10mg Prozac. If you have decreased further, you may wish to try 5mg Prozac. More is not better for nervous systems sensitized by withdrawal.
 
Prey 2012 method for Prozac switch
Another knowledgeable doctor (whom I trust) explained his technique to me (this is the technique I personally would prefer if I had to do it, it seems much gentler):

  • For a "normal" dose of Effexor (150mg per day or more) or Paxil (20mg) or Cymbalta (20mg), he would switch to 10mg Prozac with a week of overlap. In other words, take both medications for a week and then drop the Effexor. Lower doses of Effexor or other antidepressant require lower doses of Prozac as a "bridge."
  • The lower dose of Prozac reduces the risk of excessive serotoninergic stimulation from the combination of the two antidepressants during the overlap period.
  • Do not stay on the combination of the first antidepressant and Prozac for more than 2 weeks, or you run the risk of your nervous system accommodating to the combination and having difficulty tapering off both antidepressants.
  • Later, taper off Prozac. He acknowledged Prozac can have its withdrawal problems, but given Prozac's long half-life, gradual tapering should be much easier than tapering off Effexor.

WARNING Serotonergic effects of an SSRI such as Prozac, Celexa, or Lexapro are ADDED when you are taking an SNRI such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), venlafaxine (Effexor), venlafaxine XR (Effexor XR), milnacipran (Savella), and levomilnacipran (Fetzima). You run the risk of serotonergic toxicity if you are taking an SNRI, particularly at a high dose, with an SSRI. This is why doctors familiar with the Prozac switch will add in a LOW DOSE of Prozac to an SNRI.

 

In addition, escilatopram (Lexapro) is several times stronger, milligram for milligram, than the other SSRIs. If you add 10mg Lexapro to, for example, the high dose of 60mg Cymbalta, you will run the risk of serotonergic toxicity -- 10mg Lexapro is equal to approximately 30mg Prozac.


Edited by Altostrata, 15 July 2016 - 10:45 AM.
updated

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#8 InNeedOfHope

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Posted 17 November 2011 - 11:51 AM

One thing I just can't work out is this. In the cases of SRNI's it is working on two systems. How does Prozac, cover the effects of withdrawal and brain function that needs to heal? It may cover the pain, but how does it pick up and replace the actual function of noradrenaline? I would be so scared because noradrenaline is involved in the heart beating and other bodily functions. Any ideas? Of course it is tempting, but if it goes wrong it could go wrong horribly. The charity who helps me contacted David Healy and he would only suggest liquid Cymbalta. I wonder why he did not recommend Prozac for me? He had all the details of what had happened to me but did not suggest it, I wonder why?
Sept 2010 - Citalopram 1 day
Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)
Ocober 2010 - Cymbalta 30mg
November 2010 - Cymbalta 60mg
February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg
March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)
March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.
26th June - 26mg
3rd July - 25mg
17th July - 24mg
24th July - 23mg
7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall
24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.
8th Jan 2012 17.8mg (currently reducing 0.2mg a week)
8th Jan 2012 17.6mg last reduction was 6 days ago.
15th Jan 17.4mg
21st Jan 17.2mg

#9 Altostrata

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Posted 17 November 2011 - 12:08 PM

Only David Healy could answer that, InNeed. As for how Prozac manages substitution even for SNRIs, nobody knows how that works. Perhaps the actual mechanisms of these drugs are not completely understood.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#10 strawberry17

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Posted 17 November 2011 - 12:13 PM

Is it possible for the charity helping you to contact David Healey again and ask those questions for you?? Have you thought about liquid Cymbalta?

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#11 Altostrata

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Posted 17 November 2011 - 12:28 PM

Cymbalta does not come in liquid form. I just got off the phone with Lilly. The pellets have a timed-release coating on them. They cannot be dissolved. I don't know what Dr. Healy was thinking. Something must have gotten lost in translation. Info about Cymbalta tapering http://survivinganti...ch__1#entry3034
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#12 InNeedOfHope

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Posted 17 November 2011 - 01:18 PM

I thought that, but I spoke to a chemist in Wales I think it is called Rosemount(they were in one of Dr Healy's protocol guides, an old one I think) and was told it can be done, but it costs a huge amount. Can't remember how much, around £400 for a months supply. I wonder if they are mistaken, they must be, if Lily themselves say no. It is strange because I wrote to him in February and he suggested imipramine, which my psychiatrist said no way to. The charity wanted to check out if he had any more ideas as things move on all the time, hence why they wrote again. They were worried I lack an enzyme that breaks it down and wanted his input and that is when he suggested liquid Cymbalta saying it was expensive but I should insist upon it. He must have made a mistake.
Sept 2010 - Citalopram 1 day
Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)
Ocober 2010 - Cymbalta 30mg
November 2010 - Cymbalta 60mg
February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg
March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)
March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.
26th June - 26mg
3rd July - 25mg
17th July - 24mg
24th July - 23mg
7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall
24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.
8th Jan 2012 17.8mg (currently reducing 0.2mg a week)
8th Jan 2012 17.6mg last reduction was 6 days ago.
15th Jan 17.4mg
21st Jan 17.2mg

#13 Altostrata

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Posted 17 November 2011 - 02:38 PM

There's no way to tell where the miscommunication was. The enzyme question involves liver enzymes. If you lack or are weak in a liver enzyme, you are a "poor metabolizer" and may have adverse reactions when you take even a low dose of a drug. I can't see how CITA or Dr. Healy could have supposed you are a poor metabolizer because Cymbalta is metabolized by 2 liver enzymes, not one. It's unlikely you are a poor metabolizer in both enzymes. At any rate, the liquid Cymbalta suggestion is not actionable.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

#14 strawberry17

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Posted 17 November 2011 - 11:44 PM

Can I just say, I know a lady who tried to taper off tablets and had terrible results because she used a jewellry scale, but it was really hard to get a consistent reading and she struggled dreadfully. The tablets will be ok to stabilize on for a month or so but when it comes to the taper, you would be much better off with liquid Prozac and a 5ml syringe to get an accurate measurement. For example I was able to go from 5ml to 4.90ml for my first reduction.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#15 strawberry17

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Posted 18 November 2011 - 09:42 AM

Have a look at my blog because I've done exactly what you are about to do, I couldn't get off Lustral (Zoloft) so I switched to Prozac, stabilized on Prozac and have been tapering stupidly slowly off the liquid Prozac.

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#16 Shanti

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Posted 18 November 2011 - 11:14 AM

Thank you InNeed :)

Strawberry, I was just looking at your Prozac timeline. So you've been tapering since 2008? Wow, that's a long time. But, if I have to do that I will. I just want to get far far away from this Paxil and I feel like Prozac will really help. I'm glad you kept a blog.
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
My Paxil Website
My Intro

#17 summer

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Posted 18 November 2011 - 02:15 PM

I can't exactly remember my Prozac taper... but, Prozac definitely helped me taper off Paxil. I think I started Prozac (20mg) when I had tapered down to around 5mgs of Paxil. At that point I went off the Paxil, and that worked really well for me. Once I was ready, I tapered the Prozac (cutting the pills) with little or no problems. Really can't remember any. I eventually started taking Celexa, but that's a whole other story.

Wellbutrin: 150mg.

Xanax: .5 once daily

 

Charter Member 2011


#18 Shanti

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Posted 18 November 2011 - 03:45 PM

Thanks Summer. I'm glad to hear that. Does anyone know why a longer half-life makes withdrawals easier? It seems to me it would just delay the withdrawal symptoms.
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
My Paxil Website
My Intro

#19 Altostrata

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Posted 18 November 2011 - 05:40 PM

A longer half-life means it's leaving your body slower, giving your nervous system more time to adapt to the change.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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#20 compsports

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Posted 19 November 2011 - 12:25 AM

Thanks Summer. I'm glad to hear that.

Does anyone know why a longer half-life makes withdrawals easier? It seems to me it would just delay the withdrawal symptoms.


Good question.

I have read that with most ADs, you should wait a minimum of 3 weeks before making the next cut. With Prozac, you might want to wait a minimum of 4 weeks.

Personally, I experienced hell with Prozac cold turkeys which supposedly doesn't happen due its long half life. Another story.

In spite of these questions and concerns, if I was having the experience from hell in tapering off of my current AD and there was no hope for improvement, I would take the risk and cross taper to Prozac.

CS

Drug cocktail 1995 - 2010
Started taper of Adderall, Wellbutrin XL, Remeron, and Doxepin in 2006
Finished taper on June 10, 2010

Diagnosed with sleep apnea 2012 and on pap machine

Dealing with protracted sleep issues


#21 Altostrata

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Posted 27 November 2011 - 07:22 PM

Strawberry, how exactly did you do the switch? I mean go off the Lustral after you started liquid Prozac. Here's the thing: Nobody knows exactly how the Prozac makes up for the disappearance of the other drug. It's just known to work sometimes. As I understand it, you go off the first drug fairly soon after starting the Prozac. I'm thinking that's while your brain is still "lifted up" by the new drug. My worry is that if you wait too long, you lose the element of surprise. Your brain accommodates to the combination of your first antidepressant and Prozac, and then you still have problems withdrawing from the first drug. Some doctors call this a "cross-taper" and as far as I know, it's done in a short amount of time. I won't be able to confirm this for 10 days, when I talk to a doctor who knows this method very well.
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#22 Shanti

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Posted 27 November 2011 - 07:50 PM

Strawberry, how exactly did you do the switch? I mean go off the Lustral after you started liquid Prozac.

Here's the thing:

Nobody knows exactly how the Prozac makes up for the disappearance of the other drug. It's just known to work sometimes.

As I understand it, you go off the first drug fairly soon after starting the Prozac. I'm thinking that's while your brain is still "lifted up" by the new drug.

My worry is that if you wait too long, you lose the element of surprise. Your brain accommodates to the combination of your first antidepressant and Prozac, and then you still have problems withdrawing from the first drug.

Some doctors call this a "cross-taper" and as far as I know, it's done in a short amount of time.

I won't be able to confirm this for 10 days, when I talk to a doctor who knows this method very well.


I didn't think of that. I planned on taking my time. I'm glad you said something. Do you think this applies to the amount of time you spend on titrating up?
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
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#23 strawberry17

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Posted 27 November 2011 - 11:32 PM

I didn't do any cross taper, I just switched from Lustral one day to equivalent dose Prozac the next day and miraculously that worked, strangely I was always able to switch from one SSRI to another no problem, just couldn't get off the bloody things! I don't know if this would work for everyone though, sorry that wasn't much help?

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#24 Altostrata

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Posted 28 November 2011 - 10:50 AM

Yes, I think the switch is like changing a tire: you jack up the car, then pull the tire out.

Or I hope this is the case!!!! As I said, I won't be able to ask a knowledgeable doctor for a week. But that will be enough time to get back to you, Shanti.

I know that after suffering horrible withdrawal symptoms, it can be scary thinking about just dropping the offending drug.

As we discussed, Shanti, you might consider coming off Paxil in 4 steps, but rather quickly. In consultation with your doctor, of course.
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#25 Baxter

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Posted 28 November 2011 - 11:16 AM

One thing I just can't work out is this. In the cases of SRNI's it is working on two systems. How does Prozac, cover the effects of withdrawal and brain function that needs to heal? It may cover the pain, but how does it pick up and replace the actual function of noradrenaline? I would be so scared because noradrenaline is involved in the heart beating and other bodily functions. Any ideas? Of course it is tempting, but if it goes wrong it could go wrong horribly.

The charity who helps me contacted David Healy and he would only suggest liquid Cymbalta. I wonder why he did not recommend Prozac for me? He had all the details of what had happened to me but did not suggest it, I wonder why?



T I am disappointed that Healey isn't aware of that there is no liquid Cymbalta, and because it is extended release, compounding pharmacists cannot work with it by grinding it.
ct Serax and Inderol April 2007
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#26 InNeedOfHope

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Posted 28 November 2011 - 11:40 AM

I know that Altostrata on here said it can't be done, the charity rang Eli Lily to check today as they usually follow David Healys advice. As I expected, no, it can't be done.
Sept 2010 - Citalopram 1 day
Sept 2010 - Zopliclone for ten weeks (paranoia ended a couple of months after coming off this and sleep settled down again until the last couple of months)
Ocober 2010 - Cymbalta 30mg
November 2010 - Cymbalta 60mg
February 2011 - 60mg to 30 mg (lasted 10 days)reinstated 60mg
March 2011 - Took 2 60mg tablets on one evening in error - paralysis of face, back of head, shoulder, stabbing in right kidney, lost 30% of hearing)
March - June 2011 went down quickly 1mg a day until I got stuck at 25mg, went up to 27mg, because couldn't breath.
26th June - 26mg
3rd July - 25mg
17th July - 24mg
24th July - 23mg
7th Aug - began reducing by a bead every couple of days or so went well at first then hit a wall
24th October - now on 18.5mg. Since the kidney infection at start of September, have been in constant pain and anxiety, no let up. Given Ciprofloxacin.
8th Jan 2012 17.8mg (currently reducing 0.2mg a week)
8th Jan 2012 17.6mg last reduction was 6 days ago.
15th Jan 17.4mg
21st Jan 17.2mg

#27 Altostrata

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Posted 28 November 2011 - 05:10 PM

I phoned Lilly myself some time back, asked about liquid Cymbalta, and posted what I found on this site in several places. No, there is no liquid Cymbalta. Either Dr. Healy erred, CITA misunderstood him, or CITA misspoke and said InNeed was on citalopram instead of Cymbalta. It's quite easy to phone any pharmaceutical company to get details like this, and I urge everyone on this site to do this if they have any questions about the forms a medication comes in.
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#28 Altostrata

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Posted 06 December 2011 - 06:43 PM

Yes, I think the switch is like changing a tire: you jack up the car, then pull the tire out.

Or I hope this is the case!!!! As I said, I won't be able to ask a knowledgeable doctor for a week. But that will be enough time to get back to you, Shanti.

I know that after suffering horrible withdrawal symptoms, it can be scary thinking about just dropping the offending drug.

....In consultation with your doctor, of course.

I checked with a knowledgeable doctor and he confirmed the "changing tires" metaphor. To do the Prozac switch, you quit the offending drug (Paxil, Effexor, Pristiq, Cymbalta, etc.) fairly soon after starting Prozac -- within 2 weeks.

Any longer than 2 weeks, you run the risk of your nervous system accommodating to the combination of the two antidepressant. He said if this happens, you lose the advantage of the Prozac boost and you could have difficulty tapering off both of them. He also was concerned about excessive serotonergic stimulation from taking two antidepressants together.

He said he's seen it frequently that people manage to taper about half-way off Paxil, Effexor, Pristiq, Cymbalta, etc. and get stuck, any further reductions in dosage causing unacceptable withdrawal symptoms. That's when he does the Prozac switch, with a half-dose (10mg) of Prozac.

Please be aware the Prozac switch has these drawbacks for a minority of those who try it:
  • Adverse reaction to Prozac
  • Switch causes withdrawal symptoms on its own
  • If withdrawal symptoms are already underway, switching to Prozac doesn't help
  • Difficulty tapering off Prozac

More information at http://survivinganti...dpost__p__13616

Please consider this in consultation with your doctor, of course.
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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#29 Shanti

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Posted 12 December 2011 - 09:22 AM

I thought it would be a good time for an update on my Prozac switch. The switch was easy and without incident at all. I was doing great until I went from 20 mg Prozac to 16 mg. It was too big a drop. I didn't have severe symptoms though. Only some zaps upon sleep. I updosed to 18 mg Prozac and am fine now. I have to taper a bit more slowly off the Prozac than I thought I would. I didn't have any mood changes, no depression or anxiety. One thing that bothers me is that I have had tinnitus but it started just before the Prozac switch. This hasn't gone away. I pray it isn't permanent.
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
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#30 Altostrata

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Posted 12 December 2011 - 09:52 AM

That is such good news, Shanti. You might want to stabilize on Prozac for a bit, then think in terms of decreasing it 1mg at a time, or less if you get any withdrawal symptoms at all. Remember, your system has gone through a lot of stress! The tinnitus may be a legacy of the Paxil withdrawal symptoms. All the more reason to go very slowly with any more changes in your nervous system balance.
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#31 strawberry17

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Posted 12 December 2011 - 10:53 AM

I am seconding Alostrata's comment, it would be best to stabilize on the Prozac first, in my experience there really is no such thing as too slow, even with Prozac. Trying to work out the maths as over here in the UK I measure it from a starting dose of 5ml. I think 20mg to 18mg. you've dropped by 1/10th, which is still a biggish drop (well for me it would be).

*** Please note this is not medical advice,discuss any decisions about your medical care with a knowledgeable medical practitioner***





http://prozacwithdrawal.blogspot.com/

Original drug was sertraline/Zoloft, switched to Prozac in 2007.

Tapering from 5mls liquid prozac since Feb 2008, got down to 0.85ml 23/09/2012, reinstated back to 1ml(4mg) 07/11/2012, didn't appear to work, upped to 1.05ml 17/11/2012, back down to 1ml 12/12/2012 didn't work, up to 1.30ml 16/3/2013 didn't work, bumped up to 2ml (8mg) 4/4/2013 didn't work, reinstated Sertraline (Zoloft) 50mg, feeling better now. Been on the antidepressant merry go round since November 1998.


#32 Shanti

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Posted 12 December 2011 - 11:23 AM

Okay. I'm taking both your advice. I wanted to hurry off of Prozac. But yeah, I need to let my CNS rest. I'll stay on 20 mg a little longer then go slow drops. At least I'm far away from that horrid Paxil. I feel like I'm on the lesser of two evils now. Or the evil of two lessers lol.
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
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#33 Shanti

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Posted 14 December 2011 - 09:09 AM

My tinnitus is gone! Thank God! I haven't had it for 2 days now. I'm sure it was left over from the Paxil now.
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
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#34 Shanti

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Posted 14 May 2012 - 08:42 AM

Now if Only I can get her to switch me from Xanax to Valium. I'll find out tomorrow. That's another story unrelated to ad. I wanted to post an update on my Prozac switch. I am so grateful to have learned of this option here! It has been hundreds of times easier to taper off the Prozac than it was trying to taper even by 1 mg below 20 mg of Paxil. I have motivation and feel hope for my future. I'm not done yet, but I'm very close and I feel good :)
Taper from Cymbalta, Paxil, Prozac & Antipsychotics finished June 2012.
Xanax 5% Taper - (8/12 - .5 mg) - (9/12 - .45) - (10/12 - .43) - (11/12 - .41) - (12/12 - .38)
My Paxil Website
My Intro

#35 electron

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Posted 25 May 2012 - 01:20 PM

Hello everyone, I'm new to the forum but wanted to let you know that I successfully switched to Prozac from Sertraline. I was taking 100 mg Sertraline to begin with, then down to 50 mg each day, then 25 mg. I then explained to my doctor what I wanted to do and then managed a straight switch to 20 mg Prozac with no overlap. I had no withdrawal symptoms from the Sertraline. I put the success of this switch down to tapering off the first drug as much as possible to begin with and then switching to an equivalent dose of Prozac with no overlap between the two drugs. I think 20 mg Prozac is roughly equal to 10 mg Sertraline. I then stabilised on the Prozac and am now on my second withdrawal attempt from that. I hope this is helpful! electron

Currently withdrawing from fluoxetine after a switch from sertraline.
04/12-12/12 5.0-0.9 ml
30/01/13 - 0.88 ml     29/08/13 - 0.72 ml     21/11/13 - 0.66 ml     16/04/14 - 0.63 ml     29/03/15 - 0.58 ml
22/02/13 - 0.86 ml     12/08/13 - 0.74 ml     04/12/13 - 0.64 ml     21/11/14 - 0.62 ml     08/05/15 - 0.57 ml
14/05/13 - 0.84 ml     25/09/13 - 0.72 ml     19/12/13 - 0.62 ml     26/12/14 - 0.61 ml     23/05/15 - 0.56 ml

11/06/13 - 0.80 ml     13/10/13 - 0.70 ml     31/12/13 - 0.63 ml     23/01/15 - 0.60 ml

06/07/13 - 0.76 ml     07/11/13 - 0.68 ml     06/01/14 - 0.64 ml     08/03/15 - 0.59 ml


#36 Altostrata

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Posted 25 May 2012 - 06:09 PM

20mg Prozac, considered to be the usual adult dose, is equivalent to the usual adult dose of 50mg sertraline. Good to hear this worked for you, electron! Please let us know how you're doing in your topic http://survivinganti...ring-off-prozac
This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

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