☼ Kittygiggles: generic Prozac (fluoxetine), stabilization

March 10, 2017

Introduction

Hi everyone. I have been lurking here since last year but decided to start my thread as my waves are getting more frequent. I am trying to stabilize at 20mg of generic Prozac (fluoxetine) daily, and have been taking it for 6 months. I thought stabilization was finally happening in January this year but waves are now weekly. I am here to see if anyone can shed light on why my horrible waves are more frequent now.

I've read “The windows and waves pattern of recovery” (http://survivingantidepressants.org/index.php?/topic/82-the-windows-and-waves-pattern-of-recovery/). Maybe I'm missing something? I'm not feeling very bright since WD hit me!

Wave and window frequency

Stabilization seemed to work right away and my intense waves were about every 14 to 21 days (3 to 4 weeks). Last month and this month, waves have increased frequency to about every week and last 2 to 5 days, with a window inbetween. Currently working on a graph based on my daily notes to visualize my stabilization journey.

WD waves

This is how I recall them now but I will update this description when I consult my notes next during a window.

A headache and dizziness accompany a vice-like tightness around my head. I then get intensely irritable, depressed, and quite sleepy. I then get akathisia, mostly in the legs. I have tried pushing through it but I find it very hard to concentrate on anything and I just can’t bring myself to talk or interact with anyone. Any conversation or touch terrifies me and I just have to dismiss myself and apologize to whoever is around me at the time and hope they don’t take my sudden departure personally. I then go to sleep. When I wake, I feel better but the wave is still there. I tend to get better over the next day or two, only for the cycle to repeat as mentioned above. Aside from sleeping the only relief I get, for but a moment, is when my rescue cat comes home and deigns to grace me with her presence on the bed next to me or in my chair.

This WD has meant that I can no longer keep many commitments, I can only work on a casual basis (i.e. I put in a few hours a day in a window), and my relationships have become skeletal. My life is slowly falling apart and I am now dependent on my partner. She is understanding of my withdrawal, having been on SSRIs herself but luckily avoided a protracted WD. Sadly though, I just feel so guilty and frustrated at how I am now a slave to this window and wave cycle, and largely a useless partner.

Windows (something positive)

I am myself: productive, fairly positive, happy, thoughtful of others, and able to tackle my anxiety properly. I still live in fear of waves but I am learning to try not to ruminate on them. I feel a willingness to connect with people. I am starting to put too much pressure on myself to do everything during a window and that is leading to problems. To be fair to myself though, my waves are iatrogenic and I must forgive myself for feeling wretched, even during a window, because SSRI withdrawal is the worst thing I’ve ever experienced and it has ruined my life.

Why are my waves more frequent?

I will share some of my hypotheses below regarding why my waves are more frequent. If anyone has any thoughts please let me know, I’d love to hear them. I’ve learned so much from SA already. As mentioned in my signature I am working on compiling all the daily data I have into a graph so I can get a better picture of my stabilization journey (and what proceeded it). I don’t know when that will happen as my windows are now spent doing all the things I put off in my waves and just improving my loosening grip on the good things in life. I know though that I have to finish this data processing as soon as I can in case the waves merge into one big, long one.

1. My SSRI history during the last two years is peppered with ignorant tapering attempts, maybe it is catching up with me?

2. The optimist inside me is hoping that the frequency is increasing because it could be a pattern that occurs prior to a period of flatter frequencies (perhaps the ebbs and flows of homeostasis). I am perhaps just fantasizing but I imagine that if the frequency increases so much, like in a radio wave, the peaks and troughs (waves and windows) will be indistinguishable, which could be what homeostasis looks like. I am laughing at this hypothesis as I can see I am desperate for some good news XD

3. Maybe my reinstatement/stabilization dose was a little too low (considering I was on 40mg daily for the longest time) and I am catching up with the WD that it would have caused in recent months. If this is the case, I can’t see any benefit in updosing now anyway. Sure, it could always get worse but I think it would definitely get worse if I start guessing at an updose level. I could be wrong.

4. Some of my family wish to visit me later this month for a few days. I haven’t seen them in years. They planned it during one of my windows in December and I felt positive about it all. I also felt optimistic that given about 6 months of trying to stabilize, my waves would be a thing of the past, or a rarer occasion.

I tried to get them to postpone but they can’t change their plans without losing all their money. I don’t want them to stop their holiday for me but as the reason for travelling is to see me, I have warned them that I may be in bed, only able to talk to them for a few minutes.

I hope I have a window when they are here but I think I’ve had a huge amount of stress about the visit because I just don’t need the guilt I will undoubtedly feel when I am only able to see them for a few minutes. In other words, perhaps stressors and other factors in my life are making waves more frequent.

My expectations for stabilization and my tapering plan

I didn’t expect stabilization to take this long but after reading “After reinstating or updosing how long to stabilize” (http://survivingantidepressants.org/index.php?/topic/4244-after-reinstating-or-updosing-how-long-to-stabilize/?hl=%2Bhow+%2Blong+%2Bstabilize) I realize it could take a long time, maybe years based on how much damage my ignorant tapering did in the past. When I stabilize (I suppose I have to believe that I will) I plan to do an SA taper, spanning years, with water titration (I have done a few trial runs of it and it’s very easy to get accurate doses this way). I have the syringes ready but it could be a long time before I get to use them!

My current plan is to keep plodding along at 20mg until I can get a more stable window and wave frequency. I don’t expect my waves to disappear completely but this increase in frequency means I am questioning things and hope that someone out there may have an idea about what’s happening and what I may expect to happen for the next 6 months.

Lifestyle

As for my lifestyle, I am healthy, eat well, and exercise most days. I take some supplements but I don’t think they’ve made much of a difference either way. I will list them later when I can manage it but they include B12, magnesium, and fish oil. Sadly, during waves I mostly lie in bed as it provides me some relief. One of the side effects from fluoxetine is sleepiness and lethargy, which I've always had, so that contributes to me lying about a lot. It took so much out of me to write this but I am glad I did it now!

Good luck to you all and I wish you the best, regardless of what stage of withdrawal and recovery you are.

Kittygiggles

March 10, 2017

Hi KittyGiggles. Welcome to SA.

I'll give you some links to check out. You may have already seen some of them.

This is your Intro/Update topic where you can ask questions and journal your progress.

March 10, 2017

Hi ChessieCat,

Thank you for the quick response. I hope your post means that my increasing frequency of waves doesn't surprise you, which is good news I guess! I have read those links but reading them again can only help!

March 10, 2017

Would you please increase the size of the font for your drug history. It is minute and when I increase the size then everything else becomes enormous? Thank you.

Since becoming a member here at the end of 2015, very little is surprising me regarding psychiatric drugs. It may be that the method you used to taper has caught up with you. Do you have any external stressors which might be impacting you? Are you taking any other drug, prescription, non-prescription, street? Are you drinking alcohol, caffeine, smoking? Are you taking any supplements? Some people find that they become sensitive to things that may not have been a problem in the past. Some people have issues with Vitamin B hypersensitive-to-b-vitamin-or-b-vitamin-complex

Keeping notes as per the link can be helpful in being able to see any pattern to your symptoms.

From What is Happening in Your Brain:

Basically- you have a building where the MAJOR steel structures are [...] to be rebuilt at different times - ALL while people are coming and going in the building and attempting to work.

It would be like if the World Trade Center Towers hadn't completely fallen - but had crumbled inside in different places.. Imagine if you were [...] to rebuild the tower - WHILE people were coming and going and [...] to work in the building! You'd have to set up a temporary elevator - but when you needed to fix part of that area, you'd have to tear down that elevator and set up a temporary elevator somewhere else. And so on. You'd have to build, work around, then tear down, then build again, then work around, then build... ALL while people are coming and going, ALL while the furniture is being replaced, ALL while the walls are getting repainted... ALL while [...] is going on INSIDE the building. No doubt it would be chaotic. That is EXACTLY what is happening with windows and waves. The windows are where the body has "got it right" for a day or so - but then the building shifts and the brain works on something else - and it's chaos again while another temporary pathway is set up to reroute function until repairs are made.
And just like the Twin Towers- it's possible - but the building is a major effort -and it takes a good year or more sometimes.
(Now look at the new Tower that stands at Ground Zero! It's taller, [...], and a symbol of freedom. JUST like you will be! )

The most important thing is to not try and taper again until you are stable. That doesn't mean symptom free but having consistency. See the Withdrawal Normal topic.

When you do taper it may be better to start with a 5% reduction instead of 10% just to see how you react to the dose drop.

March 10, 2017

Hi Chessie, thanks again for your response. Would you say increased frequency of waves is fairly common? I have been keeping notes throughout WD and I am trying to transform them into a chart, when I can muster the strength to do so.

"Do you have any external stressors which might be impacting you?"

Many but WD is making it impossible to deal with them effectively. I keep trying though and hope to resolve some soon! My take on stressors though is that they make waves worse or longer-lasting but the iatrogenic nature of waves in my experience means that I can be having a great day, without stressors, laughing, joking, feeling on top of the world (as my notes state), then BANG, my wave hits and my life has to be put on hold as I clutch my head and shut down for a few days.

"Are you taking any other drug, prescription, non-prescription, street?"

I do not take any other drug but for 25micrograms of T4 (thyroxine) daily, which I started about 2 years ago. If at all possible, I avoid taking any drug, including painkillers. I've had my fill of pharmacology for a lifetime. Sorry to laugh at the latter part of the question! My answer is no. I'd have to be crazy and stupid to take street drugs with this neurotic brain, let alone the WD one! :lol:

"Are you drinking alcohol, caffeine, smoking?"

I haven't consumed alcohol regularly for years, since starting SSRIs. The last time was one glass of wine on the 2nd of January. I had an awful wave the next day. Looking at my notes I had my single updose in this 6-month stabilizing period on the 4th to 40mg, and it seemed to help me get through the wave after what I presume to be an alcohol induced disaster. Prior to that I hadn't had alcohol since June 2016.

I don't drink tea or coffee (I do not consume any caffeine)

I do not smoke

"Are you taking any supplements?"

I will try to get a list soon. Sorry, writing here is taking everything I've got; I am desperate for answers (as is everyone here I guess)! I take the minimum effective dose of things and try to take most things on my list just once a week. If anything, I have stopped taking some things daily (zinc and selenium), as I prefer to try to get what I need from food or at least not take supplements if I can help it. I still take vitamin D3 every day and have done since the start of stabilizing (perhaps I started before then, again I will check). I was taking B12 daily as a blood test revealed I was slightly deficient. I stopped for the last few weeks as I had some indigestion from one brand, so I am trying another from today. I'd hate for supplements to be the reason for these more frequent waves because analyzing every single mineral and vitamin in food and supplements and trying to assess their effect on my neurology is a daunting task! It also means I've developed yet another kind of dependence

"The most important thing is to not try and taper again until you are stable."

This was my instinct when writing my introduction and I am glad you advise the same. I mentioned above that I would wait for stability and I do appreciate it won't mean that all waves are gone but that the waves will become a little more predictable so I can tell if drops in dosage are having an impact. I expect not to start tapering until next year maybe. 5% is about as cautious as I would be; anything to avoid making WD worse! I am also planning very long holds, about 6 weeks or more. Still, I need to get stable first, hence this thread!

Again, sorry if some of the information I've given is muddy but as pathetic as it sounds, doing a spreadsheet to cover my experience so far is almost beyond me... the old me would have done it in a day and have done a few other things to boot!

Thank you again for your help so far. Also, congratulations on your taper so far; it's an inspiration.

March 10, 2017

Thank you for taking the time to answer my questions.

Re external stressors: "Many but WD is making it impossible to deal with them effectively."

It may be the other way around, in that you are experiencing worse withdrawal symptoms because of the stress.

"The last time was one glass of wine on the 2nd of January. I had an awful wave the next day. Looking at my notes I had my single updose in this 6-month stabilizing period on the 4th to 40mg"

This may be the cause of you current issues.

Keep it Simple, Slow and Stable

March 11, 2017

Hi ChessieCat,

Thank you so much for sharing your perspective on this. It could well be the single updose. It would be surprising to me if it was but as you say, when you've been at this for a while, nothing is surprising with these drugs! I hope I can finish my graph of wonder soon, it will hopefully help people see what's going on at a glance, so people are more inclined to weigh in on this.

Yes I agree that stress will make waves worse but could it make them more frequent? I suppose it could raise the baseline so that tolerable days slip over into intolerable when otherwise they wouldn't. There's a lot of hope in your suggestions as I can see things I could tweak or change to feel better during this period. I found it hard to deal with this recently because when I first reinstated I had such great relief and the windows were much broader.

I'll update here if something changes and I will be content to get my graph uploaded as soon as possible (sorry for going on about that!)

I hope you have a great day and thanks again ChessieCat.

March 11, 2017

It may have been a combination of the wine and the updose.

I believe that stress, both internal and external, causes our brain to divert its attention away from healing so it's important to learn ways to manage the stress. Learning to accept is very important.

Claire Weekes is excellent. Even though her topic is anxiety I think that what she teaches can help with stress as well. This is because when we get stressed we don't always understand what is happening, or the physical feelings, and then we become scared/fearful which is what she calls the second fear, or fear of the fear.

March 23, 2017

My waves are still fairly frequent but with a lot of effort I think I am getting used to them. One thing that is making them worse are the adverse effects from reinstating fluoxetine 6 months ago. I have many that I experienced before (constant lethargy, excessive sleepiness, muscle weakness, dizziness, headaches and a few more) but one that has bothered me a lot since reinstatement is paresthesia in the hands. There are other possible causes but fluoxetine does look likely. I am keen to get this damn drug out of my system. A fast taper will make it all come crashing down. This post is to help me vent and find some hope that adverse effects can reduce fairly early in tapering.

Although I cannot tell if I am stable, I am still working on my spreadsheet to see that for myself, I think adverse effects may now be a hindrance to me ever feeling stable. So, how long did it take anyone reading to notice adverse effects reducing when they started tapering (including suspected placebo effects)? Has anyone decided to taper because adverse effects were becoming problematic and how did it affect your withdrawal i.e. did you keep tapering and eventually sort things out?

My paresthesia has become a problem because the cold weather masked it, I had gloves, I put down numbness to the house being old and therefore quite a cold one and so on. Now things are warmer it's getting obvious that temperature doesn't have much of a role to play in causing it, only masking or exacerbating it (it feels worse in warmer temperatures).

March 24, 2017

Are you experiencing side effects, which you would have had when on the drug previously, or adverse effects, new symptoms which you have never had before?

Stabilising After a Reduction - What Does That Mean?

Withdrawal Normal Description

adverse-reactions-kindling

My own personal situation, I found that the side effects I was experiencing on 100mg Pristiq started reducing once my dose got lower.

You could always try a small dose reduction to test to see how things go. The 10% reduction is a recommended maximum. You can do less than a 10% reduction.

Rhi's "Start Small, Listen to Your Body" Taper Plan

Micro-taper instead of 10% or 5% decreases

Slowness of slow tapers

March 24, 2017

Hi Chessie,

Thanks for your response. If I start tapering it will be 5%. It's good to hear that as tapering commences things can improve slightly - even a tiny amount is encouraging. I think I need to get on with my spreadsheet before making a decision as I'm not seeing things clearly.

I recall that the parasthesia which is common to most people after sleeping on one's arm or sitting awkwardly for a prolonged period afflicted me a lot more when I was on fluoxetine normally. What is new is its intensity in the hands, persistence, and how it became noticeable within a few days of commencing reinstatement. It's the latter point that makes me blame fluoxetine for this although I have a list of other factors it could be.

Thank you for the links. I've been reading Stabilizing after a reduction and Brassmonkey's withdrawal normal threads. I think I should see my new doctor about the parasthesia because I've not seen one about it yet. This is just to rule out anything serious that he would know about.

I will try to get all my data work done as soon as I can, then make a decision. The lethargy/sleepiness has been with me since the first day of taking an SSRI, and that has slowed my productivity for many years. I'll be glad to see a reduction in that again, as I did during my 'bad' tapers.

Off to do more reading and research. For now, I'll keep holding a little longer; I'll be hitting the 7-month mark soon!

Thank you again Chessie; this thread has been a great support during waves.

March 24, 2017

Check out this SA topic: paresthesia-pins-needles-numbness-tingling-burning-sensations

March 24, 2017

I should have looked for paresthesia on the SA forums - why didn't I think of that?! I use another forum to discuss my parasthesia/peripheral neuropathy as a blood test last year revealed I was deficient in B12, and had elevated B6, so I've been supplementing the former with some success. However, it never occurred to me to really look at people going through withdrawal having parasthesia, rather I focused on people experiencing it upon taking fluoxetine.

That's a great thread and so interesting - I'm eating it up pretty fast.

Argh! I kept reading and saw a new possibility - my parasthesia probably coincides with when I started taking vitamin D3 daily or at least got worse after it. Maybe a coincidence but I read it just after taking my latest dose of vitamin D3. It is something new I can try. I will reduce it to a weekly dose (as I do with some supplements) and see if I notice any changes.

I am so happy with that thread.

Thank you again and sorry for not using the search function in the first place.

Edited March 24, 2017 by ChessieCat
Deleted duplicate paras as requested by KG

March 28, 2017

Hello ChessieCat,

Sorry to address you but you're the only one who's replied yet! No pressure to keep doing so though; I imagine you've got a lot of people to get through each week. I saw my new doctor today who is great (I finally found one - they do exist!) I had a blood test in order to rule out some things and help him diagnose a probable cause. He agreed it could well be fluoxetine that is causing my hand and foot paresthesia (whether withdrawal or adverse reaction is unclear so far - my spreadsheet is still under construction but I'm getting there). In light of this I have a pre-tapering plan:

My pre-tapering plan & question

I've read the fluoxetine tapering thread: http://survivingantidepressants.org/index.php?/topic/759-tips-for-tapering-off-prozac-fluoxetine/?hl=capsule

I also tried to search a relevant thread with the term 'capsule'. Simply put, I want to start taking 20mg in liquid form using water titration for a while, so I can get used to it, as I imagine there could be consequences (as I've had in the past simply from changing manufacturer and form). I've tried preparing a water solution a few times in order to practice for the real thing. However, a consistent problem is the tiny amount (but possibly significant knowing SSRIs) of powder that clings to the capsule's interior surfaces. I've tried rinsing it off but that doesn't seem to work very well.

I don't know how many mg of fluoxetine the remaining powder contains. My initial solution is to 'pretend' that I've got all the powder out of the capsule and carry on with normal water titration as described in the thread above. Once I've measured out the 'correct' dose with a syringe, swallow the solution along with the mostly empty capsule. This will ensure I don't miss out on any powder but it does mean that the liquid solution will never reflect 100% of the 20mg dose. As long as I am consistent in this method, I think it should work out okay. So for my pre-tapering period I am going to swallow all the solution and the capsule for a few weeks or longer to acclimatize to taking 20mg fluoxetine in a water solution.

My question is: can anyone foresee any problems with this? If not I'll probably go ahead with this soon as I think it is a safe first step towards my slow tapering plan.

March 28, 2017

Kittygiggles, -- Welcome to Surviving Antidepressants (SA)

Chessie's great, no? If she were online, she'd give you this link:

Making a liquid from a tablet or capsules .

People have been using DIY liquids to taper medications for decades, starting with opioid drugs like methadone. The technique is to dissolve the contents of 1 full capsule into a known, measured quantity of water, e.g. a 20 mg capsule of fluoxetine in 20 ml of water which gives you a liquid where 1 ml solution = 1 mg fluoxetine.

Hope that helps.

March 30, 2017

Hi Scallywag,

Yes, she's given me a lot of peace of mind so far with all the good advice! Coming here has helped immensely. Organisations like this make a real, positive difference in the world. I'm involved with a couple of others and I imagine at times how difficult life would be if no one bothered to set them up and volunteer for them.

The thread you linked slipped me by so thank you; it was very useful and I've read it twice. Now I have a better understanding of the importance of residual powders. My proposed plan is below, which I am very comfortable with as a few trial runs have gone well. If anyone sees a problem with it please don't hesitate to criticize it, I don't want to mess anything up. However what isn't known at this stage is what will happen when I transition to liquid completely.

To begin with I won't drop the dose for about 4 to 6 weeks at least and as said above, the first cut will be 5%. I'm not sure when I will go ahead with this plan as I have a couple of more appointments and test results to obtain to help conclude whether my paresthesia is caused by fluoxetine (seems likely though). I also need to finish my spreadsheet. Anyway, more time trying to stabilize is always a good thing in my humble opinion!

Water titration plan (sticking to 20mg initially to get used to liquid fluoxetine)

(I am comfortable with the math involved below - luckily fluoxetine withdrawal hasn't affected my math skills yet!)

1. Measure an amount of room-temperature water (likely 20ml or 40ml to start) with a syringe

2. Transfer water from the syringe into a tube with a stopper

3. Break the fluoxetine (20mg) capsule over the tube’s opening and pour as much powder as possible from the capsule into the tube

4. Shake the tube

5. With sharp and clean scissors, cut the closed ends of the capsule’s two parts over the tube's opening and drop all parts of the capsule into the tube

6. Shake the tube

7. Extract the amount of the dose that needs to be cut in its entirety with a syringe UNLESS it exceeds 10mg of fluoxetine. If it is greater than 10mg then extract just 10mg and discard the syringe's contents; then add more water (as in step 1) to increase the overall volume of the titration to make the next extraction (e.g. another 5mg) easier, then extract.

8. Discard the contents of the syringe

9. Drink the tube

10. Refill the tube with any amount of water to capture any remaining powder and/or capsule parts, then drink again. Repeat as necessary.

11. Keep utensils in fridge for use next morning.

Thank you so much Scallywag for your input and congratulations on your tapering so far (counting beads can't be fun but I suppose none of this is right?!) I thought recently that it would be nice if we lived in a world where we could put our tapering and withdrawal journeys on our CVs! If I saw someone's tapering details on a CV, I'd be impressed - it's an accomplishment and says a lot about a person when they're willing to set aside valuable, irreplaceable time in their life to fight what I would consider my worst experience so far.

I will update the paresthesia thread with my experience once I have a plausible conclusion, which I hope will be soon.

Until next time, best of luck to everyone,

I'm currently 12 hours into a wave but with sheer willpower I am staying positive and managing at times to ignore the hell out of it! :lol:

March 30, 2017

Your proposed method looks good -- thumbs up!

March 31, 2017

Thank you for the feedback, I appreciate it.

I took my dose today as a liquid. I was fine until this evening. My wave got worse but rearranging my day to be less stressful helped a lot, so I am better again now. I can't do that every time though sadly! Not sure if I should try the liquid again tomorrow but I thought I would mention it here. Still at 20mg as proposed above but I understand transitioning can be problematic for some people. I could be one of those people but I am willing to try to push through it and keep taking the liquid. I just don't want to cause myself problems long term. I know I could start with liquid more slowly but weighing powder is something I want to avoid - liquid is so much easier to manage.

Could introducing a liquid dose once, twice, thrice and so on a week be a good way to transition? For example, I could go back to capsules daily until Friday next week, try one liquid dose and see what happens. I am not sure if it's a good idea as it reminds me of the horrors of skipping doses! Perhaps it's not as bad as that.

Later!

March 31, 2017

The switch in formulation -- from tablet/capsule to liquid -- can cause symptoms because your body absorbs the medication faster.

You could try a mixed form dose - part solid part liquid. Just modify your step 3 - open the capsule over a folded piece of paper, shake approximately half of the power into water and pour the other half back into the capsule. Close the capsule. Shake the liquid. Take the capsule and wash it down with the liquid.

March 31, 2017

I'm happy to try that as long as approximating the amount of powder (I will take care with it though) will not cause too many problems. Thank you

March 31, 2017

All I've got are best guesses based on what I've read. The slight day-to-day variation probably won't be as much of a problem as an overnight 100% variation from switching to all liquid. Hope it goes well for you.

March 31, 2017

Sorry Scallywag, I didn't mean to place all the pressure on you; what I meant was can transitioning cause problems long term? I.e. another withdrawal syndrome?

To be honest I think I'm a little too scared to try again today. I think I'll take the capsules for a while then slowly transition to liquid, as described above. I'll update this thread as usual based on what I decide.

April 1, 2017

I decided to split my dose roughly 50% solid 50% liquid. My capsules have text, so I used one of the letters as a marker that denotes roughly 50% of the powder. It's easy to do and very quick, all done over a container.

I think I was spooked last night and I did recover fairly quickly. Through most of the night I was doing quite well and that was on a full liquid dose so hopefully things will be a little better today.

April 1, 2017

Thanks for updating us. Please post how things go for you over the next few days.

April 2, 2017

Saturday was possibly worse than Friday. I took the capsule whole this morning so I can return to my previous baseline. I am not sure how long I will take capsules whole for but I envisage about one month as I have some changes coming soon in terms of supplements and my other medication (levothyroxine). Urgh! Anyway, I live to fight another day. I now realise I probably need to reconsider liquid tapering and if I go ahead with it (it still appeals to me greatly) I need to plan my transition more carefully, starting with maybe 10% liquid 90% solid with a linear increase each week (to account for the 4-day blood stabilisation period) of 10%. That would be 10 weeks to change over to liquid.

My hypothesis about why it is so hard to transition to liquid is based on the reasoning that liquid is a much faster medium for absorption of the SSRI, which results in the brain perceiving an updose for about half the day, then a cut in dose for the remainder, with it slowly recovering by the next due dose time. I base this also on my experience today, much like the day before: sleeping most of the day, with the evening resulting in a severe wave that dissipates towards the next morning when it's my medication time again.

As for my paresthesia: I cut out some supplements and introduced daily vitamin B1. It improved slowly but dramatically. This could have been self-limiting, or some weird SSRI withdrawal phase but I think a change in supplements would be the cause of this improvement. My doctor wishes me to increase my levothyroxine based on a recent blood test, where my TSH was higher. Although my asymptomatic non-autoimmune hypothyroidism could be the cause of paresthesia, the fact that I've not changed my hormone treatment makes me doubt it is.

I'm also pretty certain that a few anomalies, including my hypothyroidism are caused by fluoxetine. My TSH was and is always much higher on fluoxetine whereas during my bad tapers it was much better with very little medication, sometimes reducing on its own without any levothyroxine.

I just want to ask whoever approved SSRIs despite the evidence of adverse continuation and discontinuation effects in the first clinical trials done: 'seriously?!'

Sigh.

Anyway, keep on keepin' on everyone, and I'll be back soon

PS I would have made more progress on my spreadsheet but for the last two days as a zombie. It accounts for all the above changes tracked by my diary, and I can't wait to share it but must for now!

April 2, 2017

Because the endocrine system and the CNS (central nervous system) are highly interconnected, you'll want to keep your fluoxetine doses stable while your levothyroxine dose is adjusted. One-factor-at-a-time, or OFAT, allows you to narrow down the source of issues.

If you want to learn about the history of psychiatric medications, read Anatomy of an Epidemic, by Robert Whitaker, an investigative journalist. It's available as a physical book and ebooks (Kindle, Nook, Kobo, etc.); my local library had copies at various branches. It's an eye-opening and stomach-churning read.

April 2, 2017

Thanks Scallywag.

I am feeling better today. It's a happy coincidence that may be explained by returning to capsules alone. I will have a look at Anatomy of an Epidemic. It sounds good. I mostly read scientific journals about all this when I'm not in a wave but it's hard work!

Edited April 3, 2017 by scallywag
deleted statement as suggested by Kittygiggles

April 4, 2017

Awful day with some amplified physical symptoms. Remembering that waves always end is helping, as is knowing this place exists. Last night I came up with a solution for dry tapering. I'll update here when I make a working prototype.

Good luck to all who are in waves and my happy thoughts to those in windows!

April 5, 2017

Window since last night! Gotta not ruminate on the waves returning and also manage my expectations on what I can do within this window. So far made the most of it though without going over the top.

"Hello brain, I've missed you!"

I'll try to get some work done on my spreadsheet today and my tapering prototype.

PS One question: I try to take my dose at the same time every day. This isn't always possible. Everyone is different but I'm curious if there's a period that people have noticed makes a difference? I try not to vary more than a minute or two but some days I can go up to an hour early or late.

April 5, 2017

"I try not to vary more than a minute or two but some days I can go up to an hour early or late."

My dose time can vary by about 2 hours although most days I take it within 1 hour.

April 8, 2017

The window ended as yesterday progressed, with the wave returning; by the end of the day it crushed me. A good night's sleep and it's still here. Not sure why I'm writing about it here other than I guess I am sharing with people who understand.

I had a nap in the afternoon yesterday and in my experience they tend to kill windows. I knew I shouldn't have done it but I was so happy but very tired that I thought it wouldn't affect me. It's a hypothesis and I've yet to finish my spreadsheet to get a better understanding of things. Sometimes though I just think waves happen no matter what we do, or, there are so many variables it is beyond the sufferer's current ability to work out what's going on.

I hope all your waves end soon.

April 9, 2017

Back in a window after persevering yesterday. I think such transitions would drive anyone mad if they didn't know it was iatrogenic!

In other news: I think my recent wave was caused by increasing my levothyroxine dose. Something I discovered recently looking over my detailed notes is that my TSH was normal at my previous low dose of levothyroxine. The only thing to have changed from then to the recent blood test is that I stopped taking zinc and selenium daily as I was concerned they may have been contributing to my paresthesia. The evidence suggests that they were in fact helping my thyroid make T4 and T3. In addition, I was only taking iodine once a week, which I will now change to daily but at half a pill to start.

Irritability is a side effect of levothyroxine so it makes sense that it could have a compounding effect with my fluoxetine withdrawal. In addition, a relationship I've not yet found much information on but has been noted by some reasonable sources as being significant is a possible synergistic effect between fluoxetine and levothyroxine. I seemed to be doing better when I took less levothyroxine and my blood test done months later also revealed my TSH was normal.

If none of this is true, at least it cheered me up and I am a big advocate of enjoying placebos as much as one can on the side!

April 12, 2017

Suffice to say, I will have a wave again but wanted to leave a note saying I've had almost 48 hours of a window and boy did I work hard to get here!

April 22, 2017

I am pleased to report a 12 day window! I'm not sure what I've done to deserve this but I am very happy with it. I've only had a few minor setbacks but it's felt amazing. I just wanted to note it here. It's a reminder to me in the future that a big window happened! It is possibly due to some changes I made to my levothyroxine dose and my supplements. Time will tell.

Otherwise, I have revisited trying to cut my capsule dose with a weighing scale. My Gemini 20 doesn't calibrate very well on a level surface as I can see variances in the 2x10g weights that come with it for calibration. Still though it is a variance of 2 to 3mg, which for my initial cuts on a capsule's powder contents that are greater than 200mg, should be okay.

I have a hypothesis regarding filler, for which I invite criticism gladly! I have felt stupid since withdrawal started so if I make mistakes or my ideas seem pretty dumb, I am sorry! My hypothesis is that because the smallest divisible amount of fluoxetine is one molecule, there is probably a very even distribution of it bound to every part of dry filler. Assuming that the filler is used to bind the medication to a useful substrate, I think it serves to reassure me that when we weigh powder.

I have read http://survivingantidepressants.org/index.php?/topic/1596-using-a-digital-scale-to-measure-doses/a few times but I can't seem to find anything that goes into detail about the contents of pills. Perhaps it is beyond me and/or it isn't something worth worrying about, or in fact, it is something only the manufacturer would know or someone with access to lab equipment to test pills!

Anyway, I hope everyone enjoys their windows and those in waves manage to ride it out.

April 22, 2017

I use the Gemini but my pills are weighted pretty evenly so just have to convert average weight by what dose I want to take. I don't know I'm not great at math. So lucky to have a window.

April 23, 2017

Hello, Kittygiggles.

I am just catching up with your topic. You are a thinker!

When you're make a suspension, don't worry about the powder that clings to the inside of the capsule. What I'd do is simply put the empty capsule back together (so the edges don't scratch your throat) and swallow it. Whatever tiny amount of drug is in it, will go into you.

As soon as I saw you were taking thyroid medication, I thought rebalancing your levothyroxine might be needed. Excessive levothyroxine incurs many of the same symptoms as withdrawal! It can be activating.

It sounds like you might have made a good levothyroxine adjustment. If I were you, I'd stabilize for some months and then consider a very small reduction in fluoxetine, perhaps 1mg, using the liquid method (or liquid-solid combo).

☼ Kittygiggles: generic Prozac (fluoxetine), stabilization

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