I’m after a bit of advice regarding AD’s from fellow takers and GP’s if available.

I’ve been on them for nearly a year now and haven’t had any problems with them up until now. Over the last week so my mood/ stated of mind has been fluctuating between big highs and low lows. They’re not constant and they can change as much as 10/ 15 times a day.

I’ve always taken the AD’s regularly, but I’ve just come back to work after two weeks leave and during that time I have forgotten to take my pills every day, sometimes missing 2 or 3 days at a time. Could this be why I am feeling like this at the moment or has my mind broke again?

The AD’s are Fluoxetine 20mg and I’m due for a review in October when my GP wants to talk about reducing my dose to wean me off of them, but after feeling like this over the last few days I feel I’m still not ready to come off them.

Any advice greatly appreciated.

Sounds about right. My moods go up and down like a yoyo when I forget to take mine.

I don’t take a full on AD, just mood stabilisers and a slight mood lifter, but when I occasionally forget to medicate the results are obvious to me within 12 hours.

fluoextine works when the level in your system has reached the ‘therapeutic dose’, missing most of your dose for a couple of weeks will probably mean that you dont have enough in your system to work effectively. couple of days missing out then taking 20mg will confuse your system even more than just stopping abruptly.

dont go googling ‘mood change 15 times a day’ as it wont take long to convince yourself you’ve developed rapid cycling bi-polar affective disorder… if i were you i’d focus on taking your prescribed dose each day and if you’re not feeling more stable in a couple of weeks get back to the GP sooner rather than later 🙂

HTH

What Phil said.

I’ve been on the same AD as you, on one occasion I missed it for 3 days. I felt crappy up and down a few days later. Unlike citalopram were you feel crappy the next day. Going back to work is enough to make your mood change anyway, least of all with missing your meds. Make a note of it and mention it to your GP if you feel you want peace of mind. I’m sure once your back on your dose you will feel ok again. Best of luck if you decide to come off then, keep well.

Hi MM,
It sounds like you have almost the right approach to these AD’s. Realising that you may not be ready to start coming off them is very sensible and realistic; too many people are in a huge rush to get off them.
BUT you must take them regularly! Same time every day is best.

Fluoxetine does have quite a long half life; so will stay in your system for several days but at a reduced amount.

A brief history of my very recent experience of Fluoxetine-
I had always been very independent, fit and healthy, ready to take on anything and thrived on a bit of stress and pressure. A number of big changes occurred in my life and I didn’t realise that I was beginning to struggle to cope with things.
By late 2009 I could not cope with life anymore. I had gone from a strong person to a wreck- afraid of life, crying in dark corners and thinking that I would be better off dead.
Was taken (forcibly!) to my GP. He prescribed Fluoxetine 20mg. For 6 weeks I felt worse (it was a daily battle to live), but then I started feeling a little better each day. After a few months I felt much better although tired a lot of the time. It also appeared that I was suffering from anxiety as badly as depression- CBT fixed that brilliantly, although it wouldn’t have worked without the AD’s too.

I stayed on the 20mgs for about 15months. Like you, I didn’t want to rush to get off them; I wanted everything else to be right first, then to come of the AD’s once and for ever.
GP suggested weaning me off them by just taking 20mg every other day. This did NOT work! After 2 weeks I felt dreadful. I worked out my own plan and stuck with it. Been off them for 6 weeks now, and I’m feeling ok. Have the occasional dip (mainly when my rubbish left knee stops me doing everything that I love)but doesn’t everybody? I worry during these dips that I have “learnt” how to be depressed, but I try not to dwell on that.
My plan for weaning was:
For 2 months I took 20mg for 2 days, but missed the third day.
After 2 months I missed 2 days and took 20mg on the third day.
After 4 months I stopped.
This all required some discipline- I marked up a year planner to help.

The GP’s idea of every other day was much too fast for me. Hope some of that may help.
Feel free to email me if you have any questions or just want a listening ear.

FFS, you’re not ready to come off them because missing a few has resulted in mood swings!!! Your body is addicted to them, you would feel the same missing out on any drug you were addicted to. See your doctor about reducing your dose now, not in October. Get some different meds if you really need to. Fluoxetine’s s***, as are other meds that increase your serotonin. How would you feel if you took a little bit of E every day???

Hope you get things back on track.

p.s. You’re not drinking any alcohol are you? The last time I was on them and went out drinking…Crazy, it involved police, cells and me thinking I could escape from them!

d45yth – that’s about as helpful as punching the guy in the face, then taking a dump in his cornflakes.

d45yth – that’s about as helpful as punching the guy in the face, then taking a dump in his cornflakes.

+1

d45yth:

fluoxetine isnt shit if it works for the individual taking it.

drinking alcohol and taking fluoxetine doesnt normally result in that kinda behaviour, might be worth catching up with your GP or any mental health services you might be involved with.

hope you’re feeling better now dude 🙂

d45yth – bit dickish there mate.

Fluoxetine (and other SSRIs) does not increase seretonin levels; it leaves you with a higher residual amount than you would. It prevents your body mopping up (re-uptaking) its seretonin to leave you with less than the next guy and therefore feeling a bit dark.

It only gives you what you are due naturally.

Professional hat on here: philconsequence is bang on.

d45yth:
Fluoxetine doesn’t increse your serotinin as such, it stops your brain taking it away too soon. Pharmacodynamics not the same as MDMA. Although i have known folk with bipolar get ‘high’ with antidepressants that is as much to do with their own illness interacting badly with the drugs. Perhaps that is where your opinions come from? If you don’t have an affective or bipolar illness, you shouldn’t be any ‘happier’ on fluoxetine than you were before you got depressed.

OP:
The bit about seeing your doctor before you come off your dose is good mind, anecdotally and in my professional experience SSRI’s can be difficult to ‘withdraw’ from for some folk, and of course we don’t know how depressed you were before you started. If you have been on them a year and tey have sort of helped, longer term studies tend to suggest your risk of relapse is lower of you give it another year or so than if you discontinue AD’s at this point. That doesn’t mean “don’t stop”, just go see your doctor with an open mind is all.

Hi, I’m sorry for putting my foot in it. I guess I shouldn’t be so ignorant and comment on things I don’t know a lot about.
I do have a hard approach to depression though, having been there myself and knowing others with it too. Some of who aren’t here today. This was with too much partying in our 20’s, which could be a totally different reason to the OP.

Julian – there is something in what you wrote but that’s all a long time ago now. Cheers.

I’m not completely ignorant to them as I was on them about 15 years ago so I’m aware of how to come off them.

d45yth, How I’m feeling is completely different to prolonged MDMA abuse and withdrawal and I don’t drink so no problems there. The AD’s don’t make me high just enable me to function like a normal healthy person should do.

A bit of history as to why I’m on them. 2009 through 2010 was a particularly hard time for my wife and I. Two cases of cancer in her family and two failed IVF attempts after 6 years of trying for a baby took it’s toll on my wife. At the time I was healthy and strong but because of the situation we were in all my energy went into supporting my wife and I blocked out my own feelings/ emotions. Eventually, after ignoring the signs that something might be wrong I went bang.

I have a very good GP who is not trying to rush me off of them. I went to see him a few months ago and we decided that I was still not ready to come off them and we’d have another review in October and if things are still not right then we’d look into CBT.

I was hoping that that how I’m feeling now was because of missed doses and by what you’re all saying it sounds correct. Hopefully in a few days I’ll start to feel better again. 🙂

MM,
Your experiences sound quite similar to mine.
CBT really, really helped me. I had it mainly for anxiety issues, but can see exactly how it can work for depression too.

I thought CBT was so effective, that I packed in my old career (electrical engineering) and have begun retraining. One day I hope to teach CBT. I really believe that everybody should have some understanding of it.

Tends to be a long waiting list though. My Clinical Psychologist recommended this book to me http://www.amazon.co.uk/Mind-Over-Mood-Change-Changing/dp/0898621283/ref=sr_1_1?s=books&ie=UTF8&qid=1314873311&sr=1-1

I found it to be very, very good. I had almost ‘fixed’ several of my problems before I eventually started the CBT course itself.
Reckon you get it. Work through it, and write stuff down when told to…. it works 🙂

Cheers Stanley. I have just ordered it.

good luck MM and everyone else reading this that are suffering but dont feel up to leaving a comment!

I read a post on the bike that worried me.
It was on Monday and was a few pages long.
One reply really got to me and made me think ‘Jeez , this guy is in trouble ‘
Sorry for the Hijack MM .
Not sure what to do , have no knowledge or if it was a wind up or not.
Dont really want to name the guy , or OP But dont want to do nothing either.
Tricky one

Missing doses of ADs is not a good idea – for some people it will make very little difference and for others it will disrupt their mood, anxiety, mood swings etc. No way to tell, some people can come off them easily when the time is right and for others it can be hell.

As others have said if it all settles down now you are taking them regularly then no worries if not go back to your GP.

My 2p worth.

Prozac has a very long half life compared with other ADs so in theory missing a dose or two should not have such a significant impact. You don’t need to do too much googling to see the drastic effects of missing a dose of Venlafaxine can have on some people which has a very short half life. But everyone is different and this is just a test tube theory. The plus side is Prozac is one of the easiest to wean off because of its long half life. And the literature abound with cases of GPs first switching to Prozac from another AD before stopping. Not saying it is prevalent or common practice but it is not controversial

AD’s also act very weakly on the brain, far less so than coffee, or alcohol or even paracetamol. Yes your body gets used to it, but my mood and energy improves significantly after my first Cappucino.

The future lies in Lamotrigine and anti-epileptic drug but also used as anti-depressant mood stabiliser 😆 But there is no evidence of its effectiveness in unipolar depression, but it has been a life saver for me and really turned my life around.

Best wishes MM and let’s hope in a few months time you can be drug free.

I think CBT is just a Capitalist plot to make us all adjust to their unbearable reality.If i forgot to take my medication,sleep disturbance would cause mood swings.At the very least.KEEP TAKING THE MEDICINE!

Singletrackmind, I’ve emailed you about this. It’s reassuring to know someone else was concerned.

Fluoxetine works on steady state principles in that the plasma concentrations build up over time until the rate of elimination is the same as the rate of absorption.

Missing 2 or 3 daily doses in a row could drop you below the steady state concentration that your body is used to and give you mood swings.

Weaning you off will be a different process as they’ll either decrease the dose – so bringing down the steady state concentration slowly, or they’ll increase the gap between doses ( or both).

Both of these result in the constant (well as constant as you can get with oral meds) concentration in plasma being lowered slowly so your body has time to adapt.

But – your doctor can tell you all of this with far more authority than most people on here. I’d talk to them.