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Any tips for stopping long term SSRIs?
I’ve been taking a stack of meds for a couple years now and they work great for me. It’s Prozac, Wellbutrin, and Vyvanse.
But I’ve been feeling numb recently. I told my psych, and we’re going to trial letting go of the Prozac. What should I expect? I’d like to have food taste good again, but I also don’t want the depression to come back.
My psychiatrist says that I should reach out to her if I feel intense multiday sadness, but are there other signs I should be looking out for?
I guess I’m just trying hear more about other people’s experiences with quitting/tapering off antidepressants.
Honestly, nobody knows what you will experience. But that's okay, its why you are going on this journey with your psychiatrists help. Everyone's experience on these drugs is just a bit different unique and you have three of them at the same time. Your doctor is trying to figure out which one is causing the issue in a safe way.
For me, I only ever was taking one drug at a time but if they are suggesting that you get off a drug, then they are targeting a better floor for you than you have right now. I assume that you have been in therapy sessions to help with healthy coping mechanisms as well. If so, then don't slack off on the healthy behaviors. You will be able to understand what your new floor is.
Be open in your communications with your psychiatrist and they should safely guide you. It might not work perfectly the first time and that is okay. They will then take a different approach in their search to find a better, more healthy mental state for you.
Decades-long SSRI user here... I strongly suggest that you talk to your psychiatrist about tapering the Prozac dosage very, very slowly. Like no more than 10% per month decrease in dosage. You'll need a tablet cutter and a milligram scale...
I've been on cross-tapers where a new drug was ramped up over the course of a few weeks, and the old drug was decreased at the same rate... All the discontinuation symptoms (dizziness, brain fog, depression recurrence, electric shock sensations, tremors, headache, chills, muscle aches, etc.) plus the side effects of adapting to the new drug, for a couple of months.
Tapering off Zoloft without switching to a new SSRI felt like it took about 6 months to properly balance out the discontinuation effects.
YMMV, but it's also possible that the slow taper will let you arrive at a dosage that's effective for depression, but with less of the undesirable numbness. It's also possible that a different SSRI, or replacing both the Prozac and Wellbutrin with an SNRI, will have more mood brightening effect with less emotional blunting.
10% per month would take a year to stop taking a drug. That seems extreme and unheard of. Just curious?
The point is to titrate the dosage slowly enough to avoid discontinuation symptoms and at the same time get a feel for whether it's still effective at the new dose with less of the bothersome side effects. If you've been on an SSRI for a long time, it's been remodeling your neurotransmitter receptor abundance, and that doesn't stabilize quickly. If it takes 6 - 8 weeks for an SSRI to reach full effect, it seems reasonable to take half that amount of time to adjust to a new dose. I'm not saying you couldn't try bigger steps, but I found that decreasing by 25% a month was too much.
Edit: I'm on a very small dose of vortioxetine (5 mg) these days, but I definitely notice it within 12 hours if I accidentally miss a pill. People's experiences with these medications are ridiculously variable; my experience was bad enough that my recommendation bends heavily in the direction of caution. It sounds like you're not doing too badly so far, but I got the worst of the discontinuation syndrome starting at about 10 days to two weeks. You could always resume a lower dose if it's too bothersome, and see how that fits.
Second edit: I knew I'd come across recent research that suggested a "hyperbolic" strategy for tapering antidepressants, which may require months to years. Good summary here.
I can't claim to have much knowledge of this other than second/third hand... my wife is on some SSRI's and told me that her research on it suggests it could take a few years to get off of it at her current dose. If she misses a day or two there are definitely some physical withdraw effects as well as the mental effects. Obviously that's going cold turkey vs a taper down over a month or two, but some of these drugs are pretty serious and of course the mental changes should probably not be done quickly either.
Is it?
That is not a rethorical question. I've never taken SSRIs (or really any serious medicine) and I have no idea what the normal timelines are. But taking a year to slowly get off a drug you depend on and have been on for multiple years sounds pretty plausible to me. Is it not?
I think it’s because it has been more widely accepted somewhat recently.
From what I understand, it used to be that the accepted protocol was to reduce the dose to zero over a couple of weeks. Many people didn’t do well at that rate and got long term side effects and a much harder ride. The consensus is now to taper off much, much slower (especially in patients taking the medicine for years), so people who were used to the “old school” way might find it crazy.
But it does seem the outcomes are much better tapering slowly than following the previous, steep off-ramp protocol.
Yeah I keep seeing the psychs like stop way too fast. My psych had me taper off Wellbutrin for like a week then all hell broke loose.
I’ve been cold turkey for two days and it’s been ok so far. I was talking to Claude and it pointed out that most of the lifestyle changes I made boosted serotonin, so I might be better off than I expect. I’m wary of trusting AI, but the logic is logicking lol
FWIW slow tapering has been shown to work much better (less long term side effects, more successful) than fast tapering or quitting cold turkey.
Brupropion isn't an SSRI, so tapering isn't necessary as far as I know.
Exercising regularly? Improved sleep? I'm curious what lifestyle changes you're referring to.
Edit: Found your answer later in the thread. Good on you for improving your lifestyle! Don't feel any shame though if you're actually happier and healthier on a low dose of Prozac or another SSRI.
It’s the Prozac causing the numbness. It’s why we added the Wellbutrin to counteract it. The Vyvanse is for ADHD and it works great.
I started out taking medication for depression, but started treating my ADHD later. I’ve been making lifestyle changes (diet, exercise, gratitude, positive social interactions, etc…) and they’ve been paying off.
I’ve tried dropping each of these meds before but this current stack has been working for me. Now I think it’s time for a change.
I want to narrow down what to check for. I’ve realized a lot of depression comes from living with ADHD. Now that I’m ready to leave the Prozac, I just want to know what type of things to check for.
Also, I agree that all of this has different effects on different people. Wellbutrin gives me the craziest mood swings when I adjust dosage or even take it late.
Overall, I just want to hear about other people’s experiences. Like I know how neurotransmitters each drug works on (Prozac for serotonin. Wellbutrin & Vyvanse for dopamine/norepinephrine), but I was interested in how that translated into the real world and what other potential experiences to look out for.
tl;dr I’m curious about other people’s experiences
Abrupt discontinuation is safe, but you might experience nausea, dizziness, lightheadedness, dysphoria, insomnia, and headaches. Generally, these are tolerable and will resolve within a few weeks. The half-life of fluoxetine's main active metabolite is dramatically longer than other SSRI's, so weaning is not strictly as necessary compared to other SSRI's; however, it never hurts to wean gradually if your dose is above 20 mg. The clinical effects of discontinuation on mood may be felt within a week, but can take 3-6 months to stabilize.
I wouldn't advice people to cold turkey medication that has an onset for getting functional relief. Discuss it with the psychiatrist and don't get your info from a few random folk on a social platform without any medication accreditation who don't know your full story or health history.
I went to go write my own comment advising against cold turkey, but it does seem like fluoxetine is pretty forgiving. Thanks doc. I’ll leave a few snippets and link here in case other people want a read.
Source: a questionably legal mirror of UpToDate (a paid medical wiki commonly used by doctors). Here
Medication discontinuation is actually one of my favorite topics to think about. Going about asking lived experience is certainly a great way to approach this topic. Especially since the evidence based information on this topic is limited.
Do note that there’s probably some kind of bias in self-reporting: I suspect an overestimation of bad experiences.
Disclaimer: I am not your doctor and this is not medical advice. I am sharing lived experience that in no way whatsoever has to shape yours or anyone else’s that’s reading this.
In my opinion the most important part is shared decision making and actually agreeing on the chosen path together. That could also be: “I am thinking about discontinuing or switching, but I need some time to think about it.” Or sometimes I’ll advise against it, but am open about the fact that I cannot control what one will do after leaving the consulting room. My door will always be open to discuss any difference in perspective, even if someone didn’t take my advice.
It is hard to predict if someone will have a hard time or an easy one during the discontinuation process. Not all people are the same, not all medications are the same. Also differences exist by indication. If used for anxiety, the experience is often different then if used for depression.
That being said, my experience with Prozac has been the same one as @drdna mentioned. Because of the long time it takes to leave your system, it tapers itself off when you stop it. So the possible adverse effects are rarely harsh. However, the few times I guided people -I suspect that most Prozac users just stop without help and experience little issue, unlike with some other medications- they did mention that it felt like some filtering layer dropped off. In general it meant that emotions were felt more raw, therapy felt more real. Not necessarily a bad time, but also not always necessarily easy.
Ok I’m kinda looking forward to that. I miss feeling things lol. I don’t want to be stuck being sad but I miss the highs and lows lol.
One thing I noticed starting out on medication is my fear of dark went away. I used to extremely creeped out around 3am. Now I’m a little worried that it might come back. Also my social anxiety used to be much worse.
But I think I’ve made enough lifestyle changes to be ok. Also I’ve recently gone through a glow up and people are much nicer to me haha
Haven't been on your ones but never had problems, or felt anything really, when tapering off things. Sertralin, lamictal, abilify, more I can't remember. I did once cold turkey quit sertralin though and it was horrible - it was a couple days of shaking, dizzy, nausea.
So I can only say: don't instant quit things, taper off. Follow your psych's advice. You'll be just fine.
Oh she’s having me instantly quit lol. I’ve been fine the last two days, but I know the half life of Prozac is hella long.
Would I be able to space out the doses and taper like that? If I start feeling bad, I think I’ll ask her about doing 10mg for a bit
If you've been fine then you'll probably continue to be fine.
Can't answer your question sorry, I'm not a doctor.
Seems like you're in safe hands with this psychiatrist. Do what the educated professional says. Try not to worry if you don't feel anything.
Prozac is sometimes prescribed as-needed (like for PMDD), so yeah, every other day is perfectly reasonable. I've gone on and off it several times, sometimes titrated like that, sometimes cold, and the only side effect I've ever had was a headache for the first day or two. And then, ya know, a gradual drop of my emotional baseline, which is why I'm on it again. The drop was gradual enough that I didn't really notice in a meaningful way; my therapist mentioned it.
That’s great to hear! Thank you so much
(Edit: I just googled it and it’s only recommended for PMDD 😢)
You mean on-again-off-again is only recommended for PMDD? What I was more getting at was that if you wanted to come off it completely, titrating by days or just stopping cold are both valid options for this particular ssri. You're not going to get brain zaps or other scary withdrawal symptoms like you might with others, so it's an easier one to play around with.
I can give you a breakdown of my current "journey".
I started taking fluoxetine around late 2020 I think then switched to duloxetine about 2 years later. I've also been taking lamotrigine for about 1.5 years and Adderall for maybe 5 months. My psych and I decided to get me off of the duloxetine earlier this year, so I began the process of weaning down from my 60mg daily dose.
Bumping down to 50mg I felt no difference after a little over week or so. I decided to go rogue and went down to 40 right after. I played it safe and rode that dose for a month. My mood still felt fine but I did experience some nausea.
Reducing to 30mg and then to 20mg took a few months in total. I was going through nausea basically every day for the first 4-6 hours. It sucked really bad even though my mood overall was fine and stable. Of course my mood wouldn't be all that awesome when I was nauseated lol. I was also experiencing brain zaps/shivers sometimes in waves what felt like all day some of the days. So yeah, at that point I wasn't having the greatest time but my stubbornness was my guiding force. Oh yeah, there were a few times when after I dropped my dose I would alternate the new dose and old dose, then spread out the frequency till I could hang.
Since they don't make 10mg pills I dropped to zero after 20mg. I'm now on the beginning of week 3 of zero mg of duloxetine. In this last phase fortunately I haven't had any nausea issues but the brain zaps are the main issue. The frequency and intensity is much lower overall but certain days it's still kinda shitty. Mood still pretty good, though I've noticed that the range of emotions I've been having has a much wider scope. Anger and frustration are the current big ones. I've been going to my therapist every single week for all of this - that's been extremely helpful.
The biggest takeaway? It can be done but it can really test your tolerance for things. You might also have a much easier time. Be aware of what you're experiencing and try to understand that you can learn how to not identify with the unpleasantness you might do through. Check in with your medical team as much as possible and report all of your experiences.
I wish you luck on your ride!
I have accidentally* stopped Paroxetine suddenly and for me I started getting bad withdrawal effects a few days later. First few days were fine but after that it was dizziness, headaches, and general badness, to the point that I almost couldn't leave the bed. That continued until I was able to restart it and then the symptoms went away within a day. A lot of people don't get side effects, or they're minor, but if you start feeling awful then there's a good chance it's related and you'll want to taper it off slowly next attempt.
*: medication ran out and the new one wouldn't ship in time because of an issue with my credit card on file.
I had stopped Lexapro cold turkey and had little to no symptoms - your mileage may vary with other meds but FFT
I had the same thing with my Lexapro, though I suspect it was partially because I was already on a pretty low dose.