Need Help - 17.5 Weeks Off Rapid Taper

The serotonin involvement in the optic nerve appears to be the key with Cymbalta withdrawal as several of the members who had bad vision problems like your were diagnosed with Optic Neuritis. This instability in the serotonin levels in the optic nerve leads to the various vision symptoms we see in members.

Many members have had the symptoms that you mentioned in item one but the drug combination is also a possibility fur to both effecting the peripheral nerves.

Prozac and Zyprexa are not normally prescribed together due to the heart.


Drug interaction.
Moderate
FLUoxetine  OLANZapine

Applies to: Prozac (fluoxetine), Zyprexa (olanzapine)

Using OLANZapine together with FLUoxetine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect. You may be more susceptible if you have a heart condition called congenital long QT syndrome, other cardiac diseases, conduction abnormalities, or electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting). Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

I know it is tough driven but just hang in there. I remember when I was only having short breaks in my symptoms. A hour here and an hour there. It seemed like there was no improvement. I started keeping a log of all these brief periods and found they were getting a little longer each week

It is truly phenomenal the extent to which these drugs can affect the various other parts of the nervous system. 

 

I knew Hat would have a follow-up to that link. It really does help to know how it all fits together - even if it does go wrong once in a while.

Guys,

 

This is so frustrating.  My anxiety has been pretty high the last few days.  I had a good day yesterday but anxiety has been high last night and all day today.  I am having a lot of anxiety simply about the new medications and whenever my physical symptoms are flaring such as major headaches and vision issues (like they are today) then it immediately puts me in an anxious state.  Today is one of those days that feels like it will never get any better as the head pain is horrendous.

 

My two medications...

 

1. Zyprexa - I've taken 5mg about 23 days total.  I took it for 15 days then decided to stop after talking to p-doc about the weight gain.  He said it is very common to gain weight and didn't want me to be dealing with that along with this new depression from w/d.  I cut the pill in half and took it about 6 days then stopped.  After about 2 days I was having a harder time with sleep and morning anxiety.  Thus, I restarted taking it this last Monday night and up to this point.  That said, I can't get over that this appears to be a pretty lousy drug.  Again, there are horror stories about coming off Zyprexa just like Cymbalta.  It doesn't appear this is a drug that should be used consistently anyhow.  The big question - Do you think i need to taper off this at this point after ~23 days with some inconsistent use (some of those days @ 2.5mg and a couple days off completely) or can I just stop it now?  I don't want another withdrawal and I'm not excited about taking this long-term.  My p-doc said there is no withdrawal from Zyprexa so that is what my wife and family think and really think I should stay on it.

 

2. Prozac - Again, similar to Zyprexa, I'm struggling with the fear of doing more harm that good by starting this medication.  I want so badly to get through this Cymbalta w/d without being dependent on other drugs.  My ONLY exposure to antidepressant was Cymbalta for 17 weeks so I am now scared out of my mind about any and all of these medications.  I don't even want to bump up from 10mg to 20mg next week in fear of more issues than I'm already having.  I've also had daily thoughts since starting it about just going back to nothing and trying to ride this out.  Scared that Prozac is just prolonging healing.

 

I just don't know what to do...

Zyprexa withdrawal - Maybe your dr should try reading his/her medical journals.
https://www.ncbi.nlm...pubmed/28360793
https://www.ncbi.nlm...pubmed/17689164
https://www.ncbi.nlm.../pubmed/9298520
https://www.ncbi.nlm...pubmed/10917413
https://www.ncbi.nlm...pubmed/11221497
https://www.ncbi.nlm...pubmed/17213103
and there are many more.

I understand how that feels and I sympathize. I fought my withdrawal for 9 months and went through 6 different meds before I found one that worked. A good year to get things under control. Now I have spent the last 5 years coming off those "extra" meds but luckily they were not near as bad as Cymbalta. Prozac is no picnic but if taken slowly it is much easier than Cymbalta for MOST.

I can understand your situation completely. Of course you don't want to be replacing one hell with another. You are absolutely right to be thinking along these lines and this alone will be enough to keep your anxiety there for as long as it is. The anxiety is life circumstances, and when they start to level out, you will control it a lot easier - I promise. The smallest things can tip the scales so quickly and easily. You are a car running around on almost empty. Just that one distraction and you get to empty. Happens more than you think, so don't beat yourself up. Everything you are going through now will serve to help you later down the line. I know that sounds like a bit of a cliche, but it is true. Getting through this will make future withdrawals and symptoms far easier. 

 

I have gone through as many withdrawals as Hat, but I have done plenty to saw with no uncertainty that Cymbalta was the worse by far. Sure, others will react badly to others, but the general consensus is that you get through Cymbalta, you get withstand pretty much anything else. There was an article somewhere which stated that Cymbalta was the 8th most difficult drug to withdrawal round... and that beat heroin which was at 10th position!!

 

I read that during my withdrawal when I was about to throttle my p-doc at the time

Guys,

 

Merry Christmas and hoping that everyone is enjoying the day. 

Hoping to get some input on my status.  I've been having a rather drastic increase in anxiety in the last 6 consecutive days.  It starts about 8-9am with this feeling of inner restlessness / external shakiness that has not dissipated until late in the day (5-6pm).  I've taken an Ativan 4 of the last 5 days early in the afternoon to help it which does stop it pretty quickly.  My p-doc thinks it is likely a side effect of the Prozac as it is starting to build in my system (2 weeks on as of today) but he's not certain.  He instructed me to drop to 5mg of Prozac for 1 week to see how I respond.  I have taken the 5mg instead of 10mg Prozac today and yesterday.  I did not see any difference yesterday and today is another anxious day so far.  This constant anxious feeling is just horrible.  There isn't much in my life that should be causing this heightened anxiety with the exception of constant fear of whether I'll ever pull out of this dilemma.  The anxiety is bad enough that I'm now struggling in social situations the last couple of days.  This is quite a step back from the last 4-6 weeks in terms of the anxiety.

 

Another concern of mine is it could be a side effect of the Zyprexa but I didn't have much anxiety to this level until about 1 week after starting the Prozac.  The only other change around the same time is my brand of Magnesium as I'm waiting for my regular brand to arrive via mail.  I don't think that is causing the drastic increase in anxiety but throwing it out there.

I hate all this...not knowing whether I'm throwing fuel on the Cymbalta fire with these drugs or if they will eventually help.  

Is there anything that jumps out at you that might be worth noting?  

I'll be off Cymbalta 6 months as of next week which is a positive I guess.  I'm in one of those hopeless feelings of wondering if I'll ever get any better....

Driven

It could be the Prozac. It will take 4 to 7 days to tell though so be patient.

Zyprexa? Well possible, if I remember right you have only been on it a short while and on a low dose right?

Absolutely it could be the magnesium. What form is it in? Magnesium oxide, carbonate, chelated....

Many have that reaction when their magnesium levels get too high. You may need to get them checked. You can also go without the magnesium for 4 or 4 days and see what happens. Remember to only change one thing at a time and see what happens before changing anything else.

Merry Christmas Ho Ho Ho

Hat has pretty much summed out what I would have said. If the Mag is comparable to what you had before, it is unlikely and would be coincidental, but as said, there is an easy way to rule that one out, but I don't think it will be unless you have taking quite a high dose. Do you know what level of elemental magnesium in is each dose you are taking, along with the form?

 

It is worth noting that Prozac contains flouride, and flouride is a known substance to reduce magnesium levels. Low magnesium levels worsen anxiety. I'm just putting the pieces of the puzzle together. Not saying that this is what is going on, but if you DID suffer with low magnesium, then the Prozac is depleting it to an extent, so your previous dose of magnesium might not be enough. But this is for a blood test to decide.

 

Don't have enough experience of Zyprexa to comment - so that is all Hat.

Guys,

Not sure if it was the Prozac or magnesium but I've managed to calm this severe anxiety/restlessness that was hitting hard during the day for about 6 days total.  I'm thankful for that and appreciate the input above.  I reduced the Prozac down to 5mg and also got consistent on my magnesium dosage which I realized I was skipping completely a few days before that since i was out of my primary magnesium that I take.  Whether it was the Prozac or the mag, the inner restlessness has subsided quite a bit.  Not gone however, but back to what I would consider "withdrawal normal" at this point.  Gonna hang at 5mg Prozac a bit longer, hoping things stabilize a bit more.

On to Zyprexa.  I'm struggling with just the fact of being on this drug.  It is undoubtedly helping me sleep but I've read way too much to realize this is not a great medication to take long term, if at all.  I have been on it 1 month now at 5mg (bounced a bit at 2.5mg and a couple days at 10mg) and I'm frustrated about thinking I should stop in time to avoid a slow 10% taper or just realize that I need to be on it and commit to a slow taper when the decision is made to come off.  Yes, I have anxiety knowing that I'm the 1 month mark and that is roughly when the brain will become dependent on it.  My family that has been involved with my recovery has been very supportive but they aren't really understanding the side effects of an antipsychotic like Zyprexa.  They just know that I is calming me down and helping me sleep which has been good, and they are encouraging me to stay on it.  I just have this fuzzy brain feeling all day that seems a bit different from the normal Cymbalta w/d fog.  Also, I've gained about 15lbs in one month which is very unlike me.  A quick google search reflects weight gain as one of biggest side effects of Zyprexa.  

Do you think I can taper faster than 10% on the Zyprexa if I decide to come off it after my appointment next week?  I started it on 11/25.

 

Thanks,
Driven

Well Drive, the first thing that comes to mind is "one thing at a time". With what you are going through with the Cymbalta I am not sure this is the right time to do another withdrawal. My gut says just wait until the Cymbalta withdrawal is over. Your call though. You know your body better than I do.

FH, 

I hear you completely.  I do realize that my thoughts are bouncing all over the place in terms of these medications, fear, etc.  I'm having a very difficult time accepting the state that I'm currently in and I just want to make the correct decisions to aid in recovery.  I'm kicking myself about starting the Zyprexa and Prozac, even though it was a big, thought out decision with my wife, etc.

Now I feel like I can't distinguish what symptoms are from what...which is making me more anxious about meds.  Now, I just have this fuzzy brain/floaty feeling that is a bit different from what I've experienced up to this point.  I feel quite a bit more "out of it" than the last several weeks. 

I realize it is a crapshoot but do you think this heavier head fog is from Prozac after 2 weeks or Zyprexa for a month.  The intensity of this malaise feeling started about 3 days ago.  Maybe it is just the damn Cymbalta too.

Driven  

Typically the more meds you add that control neurotransmitters the less emotional issues and the more brain for, confusion and impaired cognitive state. Flip a coin. This is just a game of patience.

I'm with Hat here... he speaks from a position of experience with multiple meds. We have also seen it a number of times on the forum. I can see your perspective on the prospect of getting out before the Zyp takes hold, but dare I say it, that it may have already got there. I was told that Pregabalin took at least 7 days. After 4, it had me well and good.

 

The brain doesn't suddenly switch overnight and says "right, thats it - you are dependent" like a lot of people would have you believe. But from where you are, it is a question of whether removing it at the moment is going to be easier than removing it once the Prozac has kicked in fully. Personally, I would go with the latter option, but this is just my opinion. 

 

The bottom line we really do not know - just like I didn't know that 96 hours of Pregabalin would turn me into a nut-bucket. As much as I didn't like to hear Hat's words of "flip a coin" back in my withdrawal days, he does have a habit of saying it like it is

Guys,

 

Again, I really appreciate the insight.  Albeit, the cold, hard truth at times, I appreciate it a lot.

 

Truth is, I am feeling considerably worse in terms of head fog the last 3 days.  I've commented on here a few times during w/d about feeling like my head is in the clouds / floaty feeling but this recent fog is an entirely heightened feeling.  It also has a bit of nausea and dizziness unlike anything I've experienced since a few months back w/ Cymbalta.  The last 3 days have been a whole different level of feeling fuzzy/floaty.  I'm having a hard time with thought processing and simple sense of direction.  I'm feeling like it has to be either the new addition of Zyprexa or Prozac.  Dare I say I'm now feeling worse than before the addition of these drugs.  It does feel like my anxiety and low mood has gotten a bit better as I'm really only dealing with the extreme head fog.  That may be the low dose of Prozac kicking in at just under 3 weeks.

FH,
At what point did you cut bait on a drug due to it not working when you were heavy in w/d?  Did you stop/switch due to some symptoms getting worse or just no improvement?  I know you had a very intense w/d with a lot of fear, etc.  Did you have the extremely heavy fog/floating feeling when you were transitioning through the meds trying to get some stability?

Sometimes I wonder if my body is just not cut out for any of these drugs.  It does feel I'm extremely sensitive to them.  

Do you think this will all end someday and I'll get to feeling more normal?  Man it is really hard when the waves are crashing and the fear of making things worse with a drug merry-go-round.  

Thanks,

Driven

Driven, I fought it for about 4 months after my last dose before I gave in. I also had a lot of brain fog once I started switching meds. I don't know if I would call it extreme but it was pretty bad. I simply had to turn everything over to the wife to handle as I could not think rationally or make any decisions. On the other hand I only rarely had the floating feeling (thank God).

"Sometimes I wonder if my body is just not cut out for any of these drugs."

Personally I don't think anybody's body is cut out for these drugs. What a viscous circle.

"Man it is really hard when the waves are crashing and the fear of making things worse with a drug merry-go-round."

Oh how I know. It took me a year to finally get feeling better and 6 more years to wean off all the drugs they tried. People often come on this site and are suffering greatly. They ask if they should cross taper to somethin g else and then wean off of that. That is such a hard question to answer, I hate to see them going through the horrific suffering byt I also hate to see them switch to something else and it doesn't work or leave them in a state like you are experiencing. No easy answer.

FH,

Thank you.  When you weaned off the drugs that didn't work....did you follow the recommended 10% drop every 4 weeks or how did you handle the taper?  Especially if they were giving you potentially bad side effects?

Today has started with another incredible headache.  Feels like heavy pressure around my entire brain and I am very disoriented.  More so than last several weeks. It is also causing some pretty intense nausea and the feeling like I'm going to vomit.  I have an appointment today with my psychologist who is working closely with my psychiatrist (both new to me) and are trying hard to help me through this recovery.  I am at a loss at any next steps at this point but will discuss this with her.

I'm trying to determine if it is the Prozac or the Zyprexa.  It seems to start around mid-morning and has improved late afternoon.  I'm taking the 5mg of Prozac at 7am(ish) and the 5mg of Zyprexa around 8-10pm.

 

At this point, I'm really scared that I've "kindled" my brain or something.  Really scared.  Hoping that somewhere, somehow, I can get some relief.
 

Driven

I follow a different pattern of weaning since my Cymbalta torture. I will drop at the rate of 0.3% over a 3 day period and increase that rate by an additional 0.1% every 3 days until I notice withdrawal just beginning to show itself. I will then back off to my last previous dose until stable. I will then continue at that rate until off the med. So, as an example, I will wean at 0.3%, 3 days later 0.4% … etc. Then for example I may get to 1% every 3 days with no issues before starting to feel withdrawal. At that point I would back off to 0.9% drop and stay at that dose until fully weaned off the med and then take 1 month to heal and start reducing the next med I want to come off of. Some meds wind up taking 6 months and the longest that any have taken is 5 years. The idea is to go slow enough to have a decent life while doing your weaning.

 

Definitely sounds like the Prozac as it would be at mac levels around that time.

 

Will be back shortly with some more info.

Zyprexa - 2.44% report headaches
Prozac - 6.15% report headaches

flip a coin.

FH,

 

Thank you for all the good input. 

Hypothetically speaking, If it were you, how would you taper off the Prozac if you have been on it 20 days total (which is where I am as of now)?  I'm two weeks at 10mg and then dropped to 5mg after I was getting very intense anxiety/restlessness which has subsided for the most part. Or I may just try to skip a day tomorrow and see how the headache/disorientation responds.  I know skipping isn't recommended but something is sure going on to cause this head pain.  

I do agree that the timing of this coming on aligns with me taking the Prozac in the am.

 

Driven 

One thing you can try is to switch the Prozac from 7AM to 7 PM. If this switches your headache by 12 hours as well then you know it is the Prozac. You will need to keep this schedule for at least 3 days to be sure.

FH,

That makes a ton of sense...your brain is working better than mine for sure.  Thank you!

Now, if you were to taper off the Prozac after being on 20 days...how would you handle it?  

 

Driven

I think IUN pretty much hit the "nail" on the "head". lol
As far as reducing after 20 days that would normally be about a 1 month wean so drop 5 mg each week. Having said that most drs go too fast with the weans so I would consider a 2 month wean. Less stress on the body.

Guys,

 

Your input is solid.  I appreciate it.  We are going to hold a bit and see what happens with the Prozac and headaches.  FH, I'm only taking 5mg of Prozac now as we speak so taper would be from that starting point.

That said, we discussed my headaches in today's appointment.  While the Prozac might be the cause, she also brought up the term "rebound headaches" from my motrin / tylenol usage.  Embarrassingly, I've been taking A LOT of both since coming off Cymbalta due to the head pains.  I'm ashamed to say that I take on average 2000mg of Tylenol a day (2 500mg tablets 2x per day) and 1600mg of Advil a day (4 200mg tablets 2x per day)...alternating Tylenol and motrin every 3-4 hours on average.  This isn't every day but I'd say it is at least 5 days a week since July.  That is a very long time for that amount of use.  I've thought about possible "over use" a few times but it hasn't crossed my mind much.  The doctor believes that I may be experiencing "rebound headaches" due to over use.  This alone may definitely be causing or at least adding to the severe headaches/head fog.  I have an appt with my PCP on Thursday to discuss this further.  

 

Thanks,
Driven

Hmmm - lots of variables here. Personally I would have held out on the 10mg of Prozac, but given you are already at the 5mg mark, I am glad you are are holding there for the time being. Another thing we need to ascertain is whether there are interactions between the Tylenol/Advil with the Prozac - that would be another issue altogether. But the more doses are moved around, the longer this will take as levels need to settle...

 

How I long to be back off all these silly meds!!

"That said, we discussed my headaches in today's appointment. While the Prozac might be the cause, she also brought up the term "rebound headaches" from my motrin / tylenol usage. Embarrassingly, I've been taking A LOT of both since coming off Cymbalta due to the head pains. I'm ashamed to say that I take on average 2000mg of Tylenol a day (2 500mg tablets 2x per day) and 1600mg of Advil a day (4 200mg tablets 2x per day)...alternating Tylenol and motrin every 3-4 hours on average. "

That is a terrible burden on your liver as well as stomach. Not a good situation and she is right, the risk of the rebound headache is quite likely. Liver damage is a serious threat from Tylenol poisoning. Did she advise you to stop the nsaids immediately?

Guys,

 

I wanted to follow up with another update and get some input.  I am now just over the 6 month mark completely off Cym.  Hard to say there is any improvement as 1 step forward, 2 steps back, 2 steps forward, another 2 steps back seems like the path right now. I am pretty frustrated but I do believe I am a little better than around 3-5 month mark but it is SO SLOW.  I look back at those times in Oct-NOV and I was REALLY struggling.

1.  It has been 4 weeks since starting the Prozac.  I made the decision with my doctors to come off the Prozac last week after being on the 10mg for 2 weeks, 5mg for 1 week, and I am on my 2nd week at 2.5mg.  Yesterday I started alternating days at 2.5 and will step off after this weekend.  I am praying that I won't have much of an adverse effect with being on the low dose for such a short time.  Please be easy on me here with your input as I am pretty low at this point and frustrated with this medication merry-go-round.  I know your input seemed more in line with riding through the bumps that may be associated with the start-up of Prozac but it was really uncomfortable and almost felt like I was having and adverse reaction.   I was hoping the Prozac would help my symptoms but it definitely felt like there was a correlation with really intense headaches/head pain during the day and the anxiety was really intense.  Maybe it would have gotten better and I realize i didn't give it a chance and I'm going to have to live with that. 

 

2. I am still on the low dose of 5mg of Zyprexa and it appears this is unfortunately the medication that I will use to try to stabilize a bit on as I continue to ride through this Cym w/d.  I'm not excited at all about this drug but I am not prepared to handle another taper right now and it is helping my sleep.  I get 8 hours consistently and that is a HUGE improvement from a few months back specifically in regards to sleep.  I'm trying to stay positive that the low dose of 5mg is okay and the right decision at the time for me with this recovery.  My doctor keeps reassuring me that she uses Zyprexa often for protracted w/d whether it is benzos, opiates, whatever.  She acknowledges post acute w/d and wants me to have a good 3-6 months before we think about a SLOW taper off Zyprexa.

 

3.  Yesterday was a GOOD day.  It was the first day in several where I woke up with very light head fog, no headache or dizziness, and vision was really solid.  It lasted the ENTIRE day which is the first time I've have a FULL day of relief in many weeks, probably months.  I've had some windows of a few hours but nothing that lasted a full day.  I write this because I was so excited and for the first time in a long time I was able to not hyper-focus about this w/d and my mind eased back into pre-Cym state for a bit.  I was thinking about archery, working out, all of which are things that I love to do.  Talk about a window and then a wave, I woke up today with really intense dizziness and the fog/confusion is pretty intense currently.  I just feel ill.  How the heck can the brain do that from one day to the next?  I realize it may be the coming off the Prozac, some light supplement shuffling, or possibly just good 'ol Cymbalta letting me know it's not letting go.  

 

4.  In general, the last couple of weeks have really felt like I may have seriously damaged my brain as the sensations these few weeks feel different from the past 6 months (for the most part).  This is also part of the reason why I opted to come off the Prozac.  I'm praying I didn't do any further damage that I can't recover from.  

 

5. I have stopped the Motrin/Tylenol completely since last Monday.  Certainly no way to understand if the headaches I'm having are "rebound' headaches from too much of that over these months but I am committed to stopping usage to try and help recovery.  My PCP did say headaches could get more uncomfortable obviously upon cessation.  Just another wrinkle in this whole thing.

Guys,

Do you think this still just sounds like Cymbalta with these weird symptoms that just change over the course of time?  Do you think the good day yesterday is at least my body telling me it is slowly working toward getting things right?...and that it can and will eventually get things right?  The past 6 months have tested my willpower unlike anything I've experienced in my life.  I am still VERY fearful about not being able to recover. Will the iintense head fog/confusion dissipate over time?  I keep thinking about what you (FH) say about people REALLY struggle for 6-8 months before getting some reprieve with some being over a year or longer.  I was so excited about yesterday's great window but today has shattered that a bit.  My head feels so disoriented and light dizziness makes things very uncomfortable.  

 

Again, please be easy on me with the Prozac discontinuation.  I do feel a bit like l let you guys down and went against what was recommended in terms of riding over the "start-up" hump.  It is just so confusing and I'm trying hard to trust my new doctors which is not easy for me right now.

 

Thank you for your continued support.  

 

Driven

This is just my completely uneducated opinion but I think if you had one good day and everything fell into place, then you will have more. I don't know how long it'll be before you get another good day but it'll happen again, and then again after that probably a little sooner. I can definitely empathize with how crushing it is to have a worse day after a good one but no matter how much I told myself that good days will never come again when I was feeling down, they always did Making the most of the good days really helped me carry some optimism into the bad ones.