Meds advice please

[bendylouise]

Hi Everyone.

I have been on Prozac for depression and ocd for prob over 20 yrs. I think I started on 80mg, or it may have been more. Anyway, I was told it was a high dose.

After a few years I cut down to 60mg on my own and then naively thought I could cut down again to 40mg straight away. I hit rock bottom with depression, had an emergency apt and was pput back on 60mg and have stayed put for prob 10 yrs.

I have never tried any other meds and just wonder whether I should. I have asked and was told I could but no advice really given. Just thoughts on this appreciated. Thank you. BL

[PolarBear]

Prozac is really an older type of SSRI. There are newer ones on the market like Cipralex and Sertraline that have fewer side effects. The problem is that switching over drugs can lead to some problems. I won't lie to you. Getting one drug out of your system and getting another drug into your system can cause problems. To me it should only be done if the original drug is no longer giving you much benefit.

[Guest Saved by zero]

I've been on prozac for over 20 years as well.

I've been up and down in dosage and have been at 60 mg for the last few years.

It helps me a lot with my OCD.

It doesn't get rid of it but makes it possible to have a more normal life.

If it has been working for you for 20 years I would probably go back to the dosage you were on.

The problem with meds is that they can make you feel better so you think you done need them.

After you change dosage or go off them you realize that they were what was making you feel better.

[taurean]

I agree from the point of view of my sister, who does really well on a higher dose (80mg prozac) but she is a big woman so can handke thst dose.

Roy

[dksea]

One of the unfortunate things about medication for mental illness is that the effects, both positive and negative, can vary to a large degree from person to person. We just don't yet know enough about how the brain works to REALLY nail down these sorts of questions yet. If you want a career with a lot of future potential you really can't go wrong with neuroscience and neuro-chemical research! As such treatment with medication for OCD can involve a bit of trial and error. In addition because our body chemistry shifts over time what works for a period may not for another. I took Prozac for 10 years ranging between 20 and 60 mg doses (usually 40) and eventually it just stopped being effective for me so I switched to Citalopram which has been fine since (10+ years).

Based on my conservations with my own psychiatrist I get the impression that this hit or miss nature of SSRI's, along with the unfortunately long lead times it can take (weeks, even months) to see full results is why they are generally reluctant to suggest medication switches if the sufferer is doing reasonably well on their current medication. Switching dosage is far easier.

So my advice is to consider the following before you decide whether you want to switch or not:

1. How effective is your current medication
2. What side effects you experience on it
3. How willing/comfortable are you with trying a higher dose
4. How willing/comfortable are you with the possibility of having issues during the transition period between the old and new medication

While its true that some people experience some significant side effects during switching or from specific medications, and you should be aware of that, its also possible to have a reasonably comfortable and straight forward transition. Personally I found switching from Prozac to Citalopram to be pretty much trouble free, I started lowering my dosage on one while upping my dosage on the other over a period of a number of weeks. Something like 30 mg Prozac/ 10 mg Citalopram for a few weeks, then 20/20, then 10/30, then just 40 citalopram. Doing it slowly probably helped the transition, and I've been lucky that both medications have been relatively effective for me. Unfortunately, as I stated above, its going to vary from person to person, the only way to know for yourself is to do it. I hope that helps!

[bendylouise]

One of the unfortunate things about medication for mental illness is that the effects, both positive and negative, can vary to a large degree from person to person. We just don't yet know enough about how the brain works to REALLY nail down these sorts of questions yet. If you want a career with a lot of future potential you really can't go wrong with neuroscience and neuro-chemical research! As such treatment with medication for OCD can involve a bit of trial and error. In addition because our body chemistry shifts over time what works for a period may not for another. I took Prozac for 10 years ranging between 20 and 60 mg doses (usually 40) and eventually it just stopped being effective for me so I switched to Citalopram which has been fine since (10+ years).

Based on my conservations with my own psychiatrist I get the impression that this hit or miss nature of SSRI's, along with the unfortunately long lead times it can take (weeks, even months) to see full results is why they are generally reluctant to suggest medication switches if the sufferer is doing reasonably well on their current medication. Switching dosage is far easier.

So my advice is to consider the following before you decide whether you want to switch or not:

1. How effective is your current medication

2. What side effects you experience on it

3. How willing/comfortable are you with trying a higher dose

4. How willing/comfortable are you with the possibility of having issues during the transition period between the old and new medication

While its true that some people experience some significant side effects during switching or from specific medications, and you should be aware of that, its also possible to have a reasonably comfortable and straight forward transition. Personally I found switching from Prozac to Citalopram to be pretty much trouble free, I started lowering my dosage on one while upping my dosage on the other over a period of a number of weeks. Something like 30 mg Prozac/ 10 mg Citalopram for a few weeks, then 20/20, then 10/30, then just 40 citalopram. Doing it slowly probably helped the transition, and I've been lucky that both medications have been relatively effective for me. Unfortunately, as I stated above, its going to vary from person to person, the only way to know for yourself is to do it. I hope that helps!

Thank you dksea, your response was v informative and interesting and thefore, yes - helpful.I now have an insight into was to expect maybe.

Also thanks to PolarBear, Savedbyzero and Taurean 4 yr interesting opinions and comments.BL

[ACE]

Hi Everyone.

I have been on Prozac for depression and ocd for prob over 20 yrs. I think I started on 80mg, or it may have been more. Anyway, I was told it was a high dose.

After a few years I cut down to 60mg on my own and then naively thought I could cut down again to 40mg straight away. I hit rock bottom with depression, had an emergency apt and was pput back on 60mg and have stayed put for prob 10 yrs.

I have never tried any other meds and just wonder whether I should. I have asked and was told I could but no advice really given. Just thoughts on this appreciated. Thank you. BL

Hey there louise how are you doing? Well I would certainly have a very good think about this like dk has mentioned if the Prozac has really helped you&had such a benefit personally I wouldn't really be changing.It depends on what impact this has on your life,is it worth changing,have a very good talk of course with you DR of course most importantly&don't make any decision very lightly all the very best hun :original: .

[bendylouise]

Hi Ace, I am struggling at mo. Thanks for yr reply your advice. Hope u ok. xx

[Yrrow]

Can I piggyback on this thread? Realistically, how bad are SSRI side effects when you first start? I've read all the typical side effects, but I'm wondering if an episode of extreme shaking/tremoring, nausea, confusion, dizziness, and deafening roar in the ears is within the normal realm. I know these things are supposed to get better with time, but I wasn't sure if this could be a normal meds reaction or a reason to stop. Thanks in advance.

[Guest lizinlondon]

I had extremely bad side effects on 20mg prozac but since stepping up to 40mg the.side effects went away and the benefits came. It was a rollarcoaster of a ride to get used to it but I am glad I did it. My OCD is very severe so I really needed it.

[dksea]

@Yrrow - Keep in mind that people who have side effects are more likely to talk about them than people who don't, or have mild ones. I'm an example of the later, so far as I can tell the only side effect I've ever experienced on fluoxetine (10 years) and citalopram/escitalopram (10+ years) is mild drowsiness. I've never had shaking, nausea, confusion, sexual apathy, dizziness, etc. Just another point of data for you to consider!

[ACE]

Hi Ace, I am struggling at mo. Thanks for yr reply your advice. Hope u ok. xx

Hey there lou I'm very sorry you're struggling right now hun.You're always very welcome,are you on any meds right now& or seeing someone for how you're feeling?.I hope you feel better very soon always here if you need ok? :original: xoxox

[bendylouise]

Hiya there ACE. Am on fluoxetine 60mg. Not seeing anyone at present. Finished last course a few months ago. Hope u ok. Take care xx

[bendylouise]

I also wonder if I should up my dose of fluoxetine again (I did have more in beginning) from 60mg. I would have to see my gp 'cos I have 60mg tabs, not individual, say 20mg tabs. I don't need more for depression I don't think, just wonder if it may help me make some progress, or is it just up to me to learn and go for it, no matter what? I don't think I can take any more stress and frustration from not doing ordinary things.

Edited October 8, 2014 by bendylouise

[dksea]

When it comes to medication I think its always good to talk to your doctor, they are going to have the most experience in how changes in dosage effect multiple people and so may be able to better help guide you if you need to go to a higher dose. Plus you should never start taking more or less of a drug without your doctors ok.

Based on my own past experiences I would encourage you to try your best to manage things with CBT techniques as well before relying on the medication as the solution (you may already have been doing this). Its always great when upping the dose results in a relatively quick turn around, but it means that medication becomes your ONLY method for dealing with the OCD. I found that my OCD spikes decreased in intensity quite a bit when I started using a CBT first/Meds second approach because it didn't matter when or where the spike occurred, I could immediately use CBT. With medication there would be a delay and I'd treat every spike as a major event because of all it entailed. That said, sometimes, for some of us, changing medication dosage (or type) is the right and best choice.

[ACE]

Hey there Lou how are you doing? I would see your GP asap just like dk said& discuss with them about upping your dose best thing to do may definitely help and could be what you need.Do you think the fluoxetine is helping you&how long have you been taking it hun? :original: .

[bendylouise]

When it comes to medication I think its always good to talk to your doctor, they are going to have the most experience in how changes in dosage effect multiple people and so may be able to better help guide you if you need to go to a higher dose. Plus you should never start taking more or less of a drug without your doctors ok.

Based on my own past experiences I would encourage you to try your best to manage things with CBT techniques as well before relying on the medication as the solution (you may already have been doing this). Its always great when upping the dose results in a relatively quick turn around, but it means that medication becomes your ONLY method for dealing with the OCD. I found that my OCD spikes decreased in intensity quite a bit when I started using a CBT first/Meds second approach because it didn't matter when or where the spike occurred, I could immediately use CBT. With medication there would be a delay and I'd treat every spike as a major event because of all it entailed. That said, sometimes, for some of us, changing medication dosage (or type) is the right and best choice.

Thanks a lot dksea, that's helpful.

Hi ACE - not sure if it helps, have been taking it over 20 yrs! x

[ACE]

Thanks a lot dksea, that's helpful.

Hi ACE - not sure if it helps, have been taking it over 20 yrs! x

Wow 20 myrs that's a fair while hun .I would certainly look at maybe talking to your Dr definitely about either increasing or certainly reviewing your meds that's for sure especially if you feel they may not be helping you :original: .