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Medication increase - time frame?


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Hi everyone, 

I had my fluoxetine increased from 20 to 40mg almost 5 weeks ago and am struggling with the worst side effects.. increased agitation, shaking, sweating, nausea, vomiting, insomnia (4-5hrs sleep per night). I've been trying to be hopeful that these issues are because of the dosage increase, because this is exactly what happened when I first started anti depressants a year ago, and it took a good long while to wear off. But I'm losing faith in the fluoxetine now. I'm so tired I'm running on empty and I'm not sure what my next move should be. 

Doctors are quick to hand out medication but not to tell you how you'd know if it's even working. I was given some short term  sleeping tablets when I increased but they've been almost useless. My other half thinks she can see a difference in me since I switched to Fluoxetine (had been on sertraline a long while)... but am just really struggling with this increase? Or are the meds just not working?

It's so confusing.

 

 

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I couldn't cope with Fluoxetine, couldn't even get above 20mg. The side effects beat me and I was exhausted. Hardly a positive benefit. My psychiatrist was disappointed, she had patients doing well on it, but not me. 

I manage OK now on 20mg Citalopram, but it's really just keeping my spirits up as "water wings"  so I can use what I learned in therapy. 

I also had problems acclimatising to that, and had to start on 10mg for several weeks and take anti-diarrhoea meds in addition when needed and under the guidance of the doctor. 

 

Edited by taurean
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It was about a month but even on a low dose there was no letting off at all in the side effects and the psychiatrist told me a minimum of 40mg was needed before there would be any likely benefit to my OCD. 

But it had turned me into something reminiscent of a zombie with perpetual diarrhoea and I was trying to keep my job going as well - plus with meds there is no guarantee that any, or any one, will be beneficial re OCD anyway. 

I felt I had no choice but to gradually come off it. 

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My blood relative sister, also a sufferer, was doing well she said on 80mg Fluoxetine but under more detailed questioning admitted it didn't improve her OCD, just propped her up. 

My own view is that it's a lottery as to whether any one drug will help any particular person with their OCD and often it's just as "water wings",  though some get fortunate and the drug really helps with their OCD. 

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Hi Danielle

Sorry to hear your increase is still causing you problems. I started flu 20mg 8wks ago and have only really started feeling normal in the last 2wks. Just had them increased and I was advised by my doctor to expect the same again. It's hoped the side effects won't be as severe but she did say 6-8wks again before I feel the full effects.

Could you speak to your GP and see what they say?  Hope you start to feel more comfortable soon. If you don't mind I'd be interested to hear how you get on as it could help me as I progress through the next few weeks.

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Hi @SB21 thanks for your reply. Sorry to hear you've struggled with fluox too. I'm almost 30 and have never used anti-deps before last year so I still find it hard to know whether they're working or not? 

I'm definitely going to call my GP on Monday because I literally can not cope with the lack of sleep. Lack of sleep always makes everything worse doesn't it?! That's what I mean.. I'm so tired I don't know if it's that it makes my OCD worse or just actually the fluox isn't working lol. 

I'll keep you updated.

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Hi Danielle,

sorry your struggling with your increased dosage, I know my GP was quite vague with what to expect from firstly going onto fluoxetine and then having an increased dosage. The list of side effects on the leaflet that comes with it lists so many side effects that its quite overwhelming. I think head falling off was the only one not there.

It's very much an individual experience, I struggled with citalopram but found fluoxetine more palatable after the initial side effects, my wife has said she thinks I am calmer and more balanced since starting the fluoxetine. I feel that too. I would say it has not reduced my OCD symptoms but has helped me balance out and be more receptive to my CBT.

Sleep deprivation is horrible and makes everything harder, no doubt about it. I would contact your GP on Monday to discuss how things are going. Do you feel that the initial dosage of 20mg benefitted you? 

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Hi @avo, sorry I haven't replied to your message yet. My head has been a bit of a shed.

When I initially moved from Sertraline to Fluoxetine I felt like I could feel a difference straight away, that was on an equivalent dosage to the Sertraline I was on. It felt different to my Sertraline - I felt calmer and had a few really good weeks. It was short lived however as I ended up needing to increase about 3 weeks later. I had quite a big relapse as it was approaching the time of year I first became unwell (didn't think it was because of the fluox). I had already started getting nervous before I made the switch. And that was 5 weeks ago. But when you're so sleep deprived it's hard to know what's right and what's just because you're so tired?! I had a better night's sleep about three nights ago and I had a much better few days after that. Then last night barely slept again and now today I just feel ****. But like I said, these same things troubled me when I first started my anti-depressant journey. Sleep and agitation were the last things to calm down. 

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Hi Danielle

21 minutes ago, Danielle_l said:

Hi @SB21

I'm definitely going to call my GP on Monday because I literally can not cope with the lack of sleep. Lack of sleep always makes everything worse doesn't it?! That's what I mean.. I'm so tired I don't know if it's that it makes my OCD worse or just actually the fluox isn't working lol. 

I agree lack of sleep makes everything seem worse.  I found that my anxiety/OCD increased to a really high level around wk4-6 on 20mg, thankfully my doctor and therapist kept me going.  I know it's hard but try to stay positive hopefully it will only be another week or so and the improvements will make it all seem worthwhile.

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Just now, SB21 said:

Hi Danielle

I agree lack of sleep makes everything seem worse.  I found that my anxiety/OCD increased to a really high level around wk4-6 on 20mg, thankfully my doctor and therapist kept me going.  I know it's hard but try to stay positive hopefully it will only be another week or so and the improvements will make it all seem worthwhile.

Thanks for the support hun. Yes I think I know what you mean - my agitation and anxiety has definitely been up for the last couple of weeks (more so than when I initially increased). I think I read somewhere that with fluox it can go up and down after the initial introduction of the medication, until it settles down. But it drives my OCD wild - literally makes me feel like I must be going mad / getting really unwell / ruminating! 

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7 minutes ago, Danielle_l said:

But it drives my OCD wild - literally makes me feel like I must be going mad / getting really unwell / ruminating! 

This was exactly the same for me.  Maybe try to hold onto how calm you felt on 20mg prior to it not working. I know that is what keeps me going. 

 

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50 minutes ago, SB21 said:

 

This was exactly the same for me.  Maybe try to hold onto how calm you felt on 20mg prior to it not working. I know that is what keeps me going. 

 

Some people seem to get just one or two of the side effects. I get all of them! Sounds like you do too hun. Hope you're okay.

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16 minutes ago, Danielle_l said:

Some people seem to get just one or two of the side effects. I get all of them! Sounds like you do too hun. Hope you're okay.

It certainly sounds like you have won first prize for the most side effects. I don't normally have any side effects to medication but was certainly a little rough with this. Can't believe I agreed to do it all over again lol. My doctor put me on the sick while I get used to it (she said 2wks initially but it's now been 2mths). Supposed to go back at the beginning of September but not convinced that will happen. It's hard when you don't feel physically ill to accept time off, its caused a lot of my stress and ocd issues etc.

As I said earlier if it follows to 20mg experience you should start feeling a little better in a few days , fingers crossed. With me it literally was like switching on a light. One minute I was in full melt down 10mins later I was facing up to a compulsion at the top of my list. Short lived (approx a wk) but so worth going through the bad days for.

Hopefully my experience will help you to get through the next few days. We all react differently but I really do hope you see improvements soon. Stay motivated, remember why you are doing it,  you can get there x

 

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33 minutes ago, SB21 said:

It certainly sounds like you have won first prize for the most side effects. I don't normally have any side effects to medication but was certainly a little rough with this. Can't believe I agreed to do it all over again lol. My doctor put me on the sick while I get used to it (she said 2wks initially but it's now been 2mths). Supposed to go back at the beginning of September but not convinced that will happen. It's hard when you don't feel physically ill to accept time off, its caused a lot of my stress and ocd issues etc.

As I said earlier if it follows to 20mg experience you should start feeling a little better in a few days , fingers crossed. With me it literally was like switching on a light. One minute I was in full melt down 10mins later I was facing up to a compulsion at the top of my list. Short lived (approx a wk) but so worth going through the bad days for.

Hopefully my experience will help you to get through the next few days. We all react differently but I really do hope you see improvements soon. Stay motivated, remember why you are doing it,  you can get there x

 

Sorry to hear you've been off sick. I too was off for a while when I had my first big onset last year, I returned to work in April and it has been wonderful. In fact on my worst days if it's a weekend day I always end up wishing I was at work as it's a good distraction and the day goes fast. With this particular increase I've had a few scary moments with potential new obsessions - I.e obsessions I've never had before. And I've been like a scared little baby I've been so agitated at times, and that really is not usual for me. I managed to use techniques I learnt at CBT on the new obsession / worries though and they have begun to subside. My first and worst obsession is still strong though at the moment. 

My CBT therapist has asked me to focus on my need for certainty recently, as all my obsessive worries are based around demanding certainty. I'm new to therapy so haven't mastered it yet. 

 

Edited by Danielle_l
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1 hour ago, Danielle_l said:

 I returned to work in April and it has been wonderful. In fact on my worst days if it's a weekend day I always end up wishing I was at work as it's a good distraction and the day goes fast. 

 

That's good to know. I'm a little worried about coping on my return, new boss and unsettled staff. I'm desperate to get back but know my OCD needs to be under control in order to support my staff effectively.  My doctor isn't willing to negotiate so I have to try and accept it. 

1 hour ago, Danielle_l said:

With this particular increase I've had a few scary moments with potential new obsessions - I.e obsessions I've never had before. And I've been like a scared little baby I've been so agitated at times, and that really is not usual for me. 

 

Im sorry to hear this has been so bad, the fluoxetine can increase anxiety like this but it will pass.  It's good you recognise this for what it is though. It's hard when your thoughts are not characteristic of you. However you need to remember they are just thoughts and are not you. 

1 hour ago, Danielle_l said:

 I managed to use techniques I learnt at CBT on the new obsession / worries though and they have begun to subside. My first and worst obsession is still strong though at the moment. 

 

This is great, be proud of your success. Rome wasn't built in a day, you will conquer your strongest thoughts with time and determination. Don't give up. If you havent already it may be useful to read Lostintime's post on the members forum on ruminating. May give you a helping hand. 

1 hour ago, Danielle_l said:

My CBT therapist has asked me to focus on my need for certainty recently, as all my obsessive worries are based around demanding certainty. I'm new to therapy so haven't mastered it yet. 

 

It's good you're getting CBT, your therapist should be able to give you some advice about your meds.  

Uncertainty is a common issue. Unfortunately this is an area I haven't addressed yet but you could try putting it into the search on the forum and see if anyone had created a post already on it. I'm sure someone could help.

You seem to have the right attitude and are making good progress. Celebrate the positives and rest when needed. Be kind to yourself, you're doing really well. x

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Hi @SB21,

Take heed of your doctors advice regarding work. Be sure to be kind to yourself and not give yourself a hard time.  Now is the time to focus on yourself. In terms of your new boss and unsettled staff - they are all adults. I've found that my OCD gives me an over inflated sense of responsibility.. ask yourself whether you really must worry about them at the moment?

I do recognise most of this is down to my fluoxetine increase but just the length of time it's gone on makes me worry it's not that, and more like my tablets just aren't working. 

I practice meditation all the time and it really helps. It's the only time during the day that I get actual space from the way I feel. Do you ever try it? It takes time to master but has proved at times to be the only thing that can help. I also start the day by telling myself 'today might be a good day' - this limits the amount of time I spend worrying whether today will be good or bad (black and white thinking).

and I also just take one day at a time when I'm bad like this.. I literally say to myself 'today is Sunday' and just leave it at that. I'm only a few sessions in to CBT so haven't learnt a huge amount yet, but I am practicing what I've learnt as much as I can.

i really hope you settle in to your increase soon, too. And wish you warmth and good vibes! 

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ThanksDanielle, how are you feeling this morning? 

Responsibility is a major issue but I am trying to deal with it.  The problem is that I've supported everyone for so long it's hard to take that step back (for them and me). Makes me feel like I'm failing them. 

I can't really advise on how your meds are going, it's natural to doubt them - be careful it doesn't cause you to constantly ruminate over it. Try to accept how you feel, put it down to a bad day and do something positive with your time - this will lift your mood and hopefully keep you going until you get back to your GP.

I haven't tried meditation, I've got a relaxation CD from my physio to help with back pain, it is quite useful at times.  My therapist suggested I look into mindfulness as I struggle to control obsessions and looping thoughts but doing well with stopping compulsions.  Just not sure how I go about find someone who does it.

You may be only a few weeks into CBT but you seem to have some good skills and a great attitude to support you with your journey. I hope it gives you the results you are looking for. Hope you have a good day x  

 

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Hey @SB21 I slept a bit better last night with no sleeping tablets so today feels better just because I'm not so tired. Thanks for asking, how's your day so far?

i really really do recommend meditation so if you're open minded to it I can give you some information and some resources I've found helpful. It doesn't work overnight and you have to persist with practice - practice makes permanent. At first I felt silly doing it but it has gotten me out of some really hard situations and has kept me going these weeks whilst I've increased my meds. I actually really enjoy it now, too, and look forward to the effect it has on me. I started off with 10 minute meditations and then now I usually meditate for a minimum of 30 mins at a time and it's now part of my bed time routine. Better than watching tv or playing on my phone!

Thanks for the heads up on Lost's post btw it has really helped.

i have a good resource on accepting uncertainty you may find useful. Everything to do with work that you're saying is actually not to do with work but is more about the fact you are demanding certainty from yourself in 'not failing them' - let me know if you want that resource too. It was recommended to me by my therapist and is another weapon in my arsenal against OCD. I have a few now. 

I used to be in senior management and actually part of the responsibility I felt in that role (I think) contributed to the issues I faced with my OCD. I wasn't thinking about things sensibly or reasonably, and put a ton of pressure on myself to constantly achieve and succeed. I did both of those things but burnt myself out. Remember, what use to your staff are you if you're not well in yourself? So what if you don't hit the expectation you set yourself? 

Its really good btw that you're doing well at stopping your compulsions. That is part of the battle. Everything has to come piece by piece. My therapist told me that if I can use a technique and get even 15 seconds break from my thoughts then that's a massive achievement so I remind myself of that when I'm feeling a bit shakey. 

Danielle x

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That's great news, a good night's sleep always makes things seem a little more manageable. I'm ok, it's only day 3 of my increase so a long way to go yet. Had the headache/dizziness but less intense than last time, which is good. I remember sleeping my first 2 weeks away with 20mg so learning from that mistake and keeping busy. 

Would love to hear more about meditation and uncertainty thanks, I'll try anything to get a little bit of peace from my thoughts.

Pleased Lost's post was useful, she is a very insightful lady, lots of excellent advice, taurean's posts are very informative too. I love how helpful people are on here, I'm doing this with limited help (2 very special friends who are keeping me busy) so love the feeling of belonging, people are so kind. 

Thanks for the kind words about work. I have only had 1 other absence 15yrs ago so it's all a learning curve. Fingers crossed I'll be back soon, sitting around makes me worse!

It sounds like you have a good therapist who is giving you lots of advice. I've just finished my first round last week so know how valuable that is.  It's great you're finding it useful. Be brave and ask the questions you need to. I didn't and regret that a little now. 

Thanks for the help Danielle, it's good to talk. Enjoy the rest of your day. x

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