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strawberry17

The Prozac switch or "bridging" with Prozac

126 posts in this topic

Of course. It's done frequently. You might search this thread for Lexapro if anyone's mentioned it here.

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I have copied this statement from post no. 7 by Alto:

 

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.

 

My question is in regard to the 3rd bullet.  Is this saying that if I ALREADY have severe w/d symptoms from the paxil, that a switch to, say prozac, will not cure those symptoms?  Is that right?

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grandmaD -- you are interpreting that statement correctly.

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Okay, thanks Scallywag.  Bit of a let down there!  I was hoping the crossover/bridge to Prozac would help w/d symptoms!  I have finished reading this thread now, and my opinion now, is that it is best to do it when you are stable (sufficiently I gather, but not entirely) on current a/d.  Then the only reason to switch would be that it is easier to get off Prozac.  It seems there might be more success stories than failures, at least.

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Hi there!

 

i switched to prozac 6 months ago. I was on Paxil 14 mg. And i just couldn't  taper off any further. Even 0,2 mg gave me sooo much withdrawal symptoms. So i decided to switch to prozac. I have a pill i can turn into liquit myself. There was no suspension available. Wich i did have for paxil.

I switched from 14mg paxil to 15mg prozac. It was a very difficult decision to make and i've doubted for a very long time to. At first i thought i wanted to witch slowly, but docters recomended to switch all at once, because the meds. are so simular they said. I was allready experiencing a lot of wd symptoms because of tapering off paxil. And whatever i did i would experience them anyway so in the end i listened to the docters and i took the risk to switch all at once. Switching caused me a lot of extra wd symptoms again for like 3 weeks. then i started tapering off again. The docters told me i could stop all at once again because of the long half life time. ( is that the right word btw? haha) I knew that would be wayyy to fast for me but i still had a little hope this meds would be easier to get off than paxil so i decided to taper off 2 mg. a week. i was allready experiencing a lot off wd symptoms from tapering off paxil and switching to prozac but after that first week i really felt no extra wd at all. so the next week i tapered off 2 mg again. Stil my wd symptoms didnt worsened.so i kept doing the same thing untill i was on 4 mg. I was scared the whole time that my wd reaction would still come, but docters told me it would be ok. Somewhere i knew better but  at the same time i hoped i was wrong. Well it turned out i wasnt wrong again :(. When i was on 4 mg the very very bad wd symptoms still appeared. And they're with me ever since.

 

Still i think it was a good decision to switch to prozac. I tapered off way to fast again, but im sure i would have never gotten this far by staying on paxil.

If you reduce slowely i think switching to prozac is a goot thing to do. But only if it's impossible to taper off the meds. your on. Because the switch itself isnt easy either. I switched at once of cource. But i think switching is always a risk... I hope my story might be helpfull. :)

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Thanks, fredericke. We would advise against tapering while you are experiencing withdrawal symptoms. After a switch, we urge people to allow their nervous systems to stabilize on Prozac for some months before reducing it.

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Yes altostrata you are right and if i could make that decision again i would definitely do that. :(

My psychiatrist told me i could start tapering.

Foolisch of me to believe that of cource.

On the other hand though, i never was stabel before, because of my earlier fast tapering off fluvoxamine an paroxetine.

And the reason i started tapering off fluvoxamine was because i already was experiencing "poop out" (i think because my symptoms worsened more then they had ever been)  after using the meds 12 years.

Wich i did not know back then by the way....So i think i never could have done it without being unstable. That's what makes it so difficult......:(

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Please post questions about your particular situation in your Intro topic.

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im sorry if i am overlooking information posted in other areas, but i was wondering if there are any studies supporting the decision to cold swap between SSRIs rather than tapering or cross-tapering.

 

a lot of psychiatrists seem to think SSRIs, in particular, are okay to switch between without a taper--and not just drugs being exchanged with active metabolites ala citalopram/escitalopram or fluoxetine/norfluoxetine.  is this backed by evidence or is this just massive assumption paired with 'discerning clinical judgement' from 'years of experience with hundreds of patients'?

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Invisibleunless: have you done a web search, e.g. google "prozac switch" "research OR study"?

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nope.  frankly, i would not be asking here unless i was too sick to be trying to track down things on my own.  relying on journal databases is less useful than the experience of users here in terms of finding pertinent articles, as well, because most do not take into account withdrawal syndrome in the first place.  of course, even those potentially inappropriate articles are good to know of at least as part of a rebuttal.

 

i have pretty limited cognitive and energy resources so i try to be tactical about asking for help.  it is fine if this request is not fielded over here, but i figured to make the attempt.  i have pre-identified articles to parse numbering into the hundreds at present, on the general topic of psychotropic side effects, and reading even one a day is usually not feasible most of the time.  reading through search results, even just titles, is overtaxing a lot of the time and i try to spend my limited resources or more urgent issues like acute instances being presented to me rather than clashing with psychiatrists in public forums.  convergences of those concerns are where i occasionally ask for assistance.

 

i do appreciate your suggestion, though.  many other individuals here are not well enough to be running the literature, either, and people that are are likely to have their hands full with other issues.  this was just asking if someone has something handy.

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There are no studies supporting a cold swap. Psychiatrists who believe this is a good idea are not listening to their patients.

 

There are studies recommending cross-tapering.

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thanks for combining the two sources.  i am too sick to rigorously parse the google search, but it has nice booleans.  i peeked at the study but will have to do so again when i am more able.

 

There are no studies supporting a cold swap. Psychiatrists who believe this is a good idea are not listening to their patients.

 

There are studies recommending cross-tapering.

i suspected as much, but did not want to jump to any conclusions.  thanks for jumping in.

 

then again, when has "do you have any research to support that?" ever flown with the average psychiatrist.

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"then again, when has "do you have any research to support that?" ever flown with the average psychiatrist."
:lol:


Or the other way around, when a patient says, "I've looked at the research, and I think this is the best way to handle X"...
and the doctor generally doesn't take it very well.
I actually have a copy of some fairly snarky notes from my GP when I explained why I am no longer on buproprion. [Patient says she "did some research" and decided to stop taking it.]  :angry:  <_<  *
In this practice, all notes, labs, etc. are available online, so she had to know that I'd be able to see it. Her notes were really poorly written too.

I had my last shrink pretty well trained. When I'd tell him, "this is my plan, and I've done my research", he'd generally accept it, sometimes ask a few questions, usually check back in the following weeks to see how I was doing. He also knew my educational background, and that I don't mess around with poor-quality evidence.  :D 
Of course, when I decided to stop buproprion, and taper off slowly, I came up with probably 20 recent relevant journal citations, and would have had no problem handing him the list if he'd questioned my decision.

* In most cases, me doing research for something involving my health starts with PubMed, which should be at or near the top of the list of where that doctor should head when she needs to look up recent, relevant, peer-reviewed, published journal articles. But she didn't bother to ask anything about my "research" (as she put it), just assumed I'm an uneducated idiot. :angry:

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I'm wondering if there are people who used Prozac as a "stepping stone" from another SSRI near the end of the taper. I'm on ~1.8mg of Paxil after a long taper, and I'm considering a switch to Prozac to make the final stretch easier. I understand the risks involved, but I seem to find a lot of people who have succeeded with a cross taper. 

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Henosis  there may well be people who have succeeded with a cross taper but it depends on how you define success. I guess if one was successful they wouldn't be here right. However this site is voluminous  in bridge switch attempts that  have been problematic.

I wouldn't call being on  paxil one day and then on (many) multiples of that dosage in Prozac the next and then still stuck there many months later a 'success' while pushing the drug free ETA out by many years in the process.

Reading through your drug sig I get the feeling that you shoudnt go there. Just look what happened  with the prior cross taper attempt with nortrip. Not to mention the many failed past drug switch attempts sending you into a complete mess only to end up back on paxil again. Qu. Will things will be any different this time? Answer : What do you think? 

 

I think you should be congratulated on getting down to 3.5mg and being free of other drugs.  

By the way if you tapered from 3.5 to 1.8 in the last 3 months then that is faster than the 10% rate rec here. You are tapering too fast. Personally I wouldn't be in any hurry at this stage. If it was me I would be conservative by dropping the taper rate so I make even smaller cuts with longer holds following in the Brassmonkey footsteps. To go from 1.8 mg to 0.5 mg with cuts every 4 weeks (at 5% of previous dose) will take another 2 years but is that such a big deal if you have a life and can function. You may hardly notice it. Whats another two or three years in light of the 14 years prior drug use.

In my opinion especially for you anyway it would be a high risk move.

Heres the thing say you manage to pull off a 1mg to 1mg switch to Prozac  are you thinking that you can then speed up the taper? If so that would be a big mistake.

What if things turn bad then what ? I am in no doubt about what the doctor will then do ....it will be an escalation of dosage and  an introduction of other drugs to quell wdl symptoms and on top of that your intelligence will be insulted by the doctor  establishing for all of time that you have now had a relapse, while talk of  withdrawal symptoms will be non existant.

 

nz11

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Henosis, I agree with NZ.  In general it is better to taper off the drug you are currently taking rather than risk trying to change to a different drug.  Changing over can be difficult because you can experience WD from the first drug and start up/side effects/bad reaction to the new drug and you will not know what is causing what.  Slow and steady wins this "race", but it's not a hurrying race, it's slow and steady reaches the goal of getting off.

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