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Offline Boo.

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Low Dose Prozac?
« on: June 25, 2014, 10:15:48 PM »
My body couldn't tolerate 20 mg of Prozac, so my doctor had me go back down to 10 mg. And then a different doctor (my psychiatrist) said it's extremely rare for such a low dosage to help people. But that she wants me to stay on it for a few more weeks to see if it helps, and if it doesn't, she's switching me to Lexapro.

This last few days, my anxiety has been A W F U L . I'm the most miserable I've ever been. And I've been on the Prozac for 3 weeks now. And I just wanna cry and I feel hopeless and I'm just not doing good right now.

So I wanna know if any of you have ever had HELP from 10 mg of Prozac. Before I message my psychiatrist begging her to please just let me start the Lexapro so hopefully it'll start kicking in faster than the Prozac is(n't) going to.

Could the increase in anxiety mean the Prozac is starting to do something? Or if it was actually kicking in, would I just start feeling better?
I know a lot of these are things I should just ask my psychiatrist but she speaks with such a heavy accent, I never have any idea what she's saying to me.. lol :(

Any help? Any hope?
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Re: Low Dose Prozac?
« Reply #1 on: June 26, 2014, 12:09:02 AM »
My body couldn't tolerate 20 mg of Prozac, so my doctor had me go back down to 10 mg. And then a different doctor (my psychiatrist) said it's extremely rare for such a low dosage to help people.

The usual minimum effective dose is 20mg. Prozac, as with all antidepressants works by promoting the growth of new brain cells and this takes a minimum amount of the drug to initiate and sustain.

Quote
Before I message my psychiatrist begging her to please just let me start the Lexapro so hopefully it'll start kicking in faster than the Prozac is(n't) going to.

Lexapro is likely to take as long as Prozac to begin working. There are no short cuts with this. You should ask your doctor to prescribe one of the benzodiazepines (BZDs) to help you cope with anxiety until the antidepressant kicks-in. If s/he's a benzophobe then ask for the prescription antihistamine hydroxyzine (Atarax, Vistaril). It is less potent than the BZDs, but can be strong enough.

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Could the increase in anxiety mean the Prozac is starting to do something? Or if it was actually kicking in, would I just start feeling better?

Unfortunately, I don't think it indicates anything about the drug, just your state of mind.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Never-Quit

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Re: Low Dose Prozac?
« Reply #2 on: June 26, 2014, 03:02:29 PM »
Hi Boo,  :action-smiley-065:

I took some time to read your previous post dating back to your first post on November 17, 2013 - You are 22, in Live in California where I also live  :action-smiley-065:

I know you have HA and Anxiety attacks, but did you ever get a proper diagnosis of your condition?

I would highly recommend that you take a self-quiz and information from the Anxiety Zone library:

You can take the results of the self-quiz and information with you - to your next doctor visit.

Here are the Links:

http://www.anxietyzone.com/NIMHpanic.pdf - Self Test for Panic Disorder.

http://www.anxietyzone.com/NIMHgad.pdf  - GAD – Self Test

http://www.anxietyzone.com/NIMHdepwomenknows.pdf - Depression for Women – self test

http://www.anxietyzone.com/NIMH317.406_F_TSH_treatable.pdf  - Depression is Treatable

http://www.anxietyzone.com/index.php/topic,26.0.html – Social Anxiety overview


On Prozac vs. Lexapro:

Since I have actually used both medications for years - Prozac and Lexapro.

I can tell you from own experiences, that Prozac is by far the most "stimulating" SSRI - I have ever taken, I had to start by diluting a 20 mg capsule into 8 oz of apple juice and was taking maybe 2 mg to start... I was slowly over several weeks brought to a dosage of 20 mg.   (this was back in 1980's)

Lexapro (a much newer medication) when I used it - was much easier to take - with a lot less side effects than Prozac, and I felt results as quickly as two weeks in Lexapro (full results in about 8 weeks) compared to Prozac (almost 12 weeks) before I got the full benefits.

Like Ian, mentioned in his post, I highly recommend that you ask your doctor for to include a benzodiazepine to control your anxiety, until Lexapro/Prozac starts to work.


My doctor explained to me that "Combination Medication Therapy" would accomplish the following:

1.   My doctor used both an Lexapro and a low dose of a Benzodiazepine - which really helped me immensely.  My doctor put on initially on half the normal dosage of Lexapro to start, since I tend to be more sensitive to medication than most.

2.   My doctor explained that the Antidepressants will take up to 4 to 6 weeks to begin relieving anxiety symptoms and in some people if used alone - it can actually increase anxiety initially during the first few weeks  (as It did with me…) .  Which is one reason I had such a hard time staying on any of the antidepressants.

3.   My doctor, further explained to me that the benzodiazepines he is prescribing - are fast acting anxiety blockers (bringing me relief within 30-60 minutes) to stop my anxiety attacks, and could also  help shield me from additional anxiety that may initially arise from the SSRI or Antidepressant that I was taking.



Combination Medication Therapy -

The strategy is to hold the individual on low-dose benzodiazepines (e.g., alprazolam 0.25 to 0.5 mg tid or qid plus antidepressant) for four to eight weeks. When the patient's panic has abated and antidepressant levels are adequate, the benzodiazepine can be slowly withdrawn.


Hope this helps,

I would print this information out, or make a notes of it, for your next doctor's visit.  Especially, since your Dr. has a thick accent  :winking0008:

Keep us informed on your progress!  You are on your way to getting better !!   :nature-smiley-016:

Feel free to send me a PM if you have any questions or need help  :action-smiley-065:
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Offline Boo.

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Re: Low Dose Prozac?
« Reply #3 on: June 26, 2014, 06:33:33 PM »
Thank you both so much.

My psychiatrist REFUSES to give me a benzo... She acts like she's giving me some cocaine that's laced with meth and LSD or something. -_- I have no history of having problems with drugs (legal or illegal) but she refuses.

My regular doctor actually prescribed me Klonopin a few weeks ago (I was having an awful day of panicking about everything/nothing and Psychiatry didn't have any appointments available for weeks..) and when the psychiatrist found out a few days ago, she went in and took it off my record and pretty much "shamed me" for ever taking it and "those kinds of meds are only like drinking alcohol... They don't help anxiety and they're very addictive, etc." I still take half of a Klonopin if I'm having a really bad night, but I don't think it helps with anything except making me sleep.

I emailed the psychiatrist after posting this last night (I was miserable last night) and she just emailed me back saying to go ahead and switch to the Lexapro now since I'm having such a hard time right now. No mention of giving me something low-dose in the meantime like I was hoping, though.

I called the psych department a few minutes ago and asked for a new psychiatrist (which they said will take up to 30 days so I should refer to her with any questions in the meantime lol). I did risk sounding mean and request that I get someone who doesn't speak with an accent though... I hope it doesn't end up taking THAT long.

I know I have OCD and health anxiety. And "regular anxiety." lol. I haven't been "diagnosed" with panic disorder, but I do have panic attacks (especially lately). I actually heard from my psych department that you have to have them consistently for 8 or 9 months in order to call it a "disorder?" Also I had an appointment with my therapist this week and we talked about reducing my anxiety (which I still can't for the life of me figure out how to do without the help of meds). Ahhh.
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Re: Low Dose Prozac?
« Reply #4 on: June 26, 2014, 08:18:42 PM »
when the psychiatrist found out a few days ago, she went in and took it off my record and pretty much "shamed me" for ever taking it and "those kinds of meds are only like drinking alcohol... They don't help anxiety and they're very addictive, etc."

Sigh!!! :(

Quote
I do have panic attacks (especially lately). I actually heard from my psych department that you have to have them consistently for 8 or 9 months in order to call it a "disorder?"

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, which is the mental disorders 'bible,' diagnostic criteria for panic disorder (codes 300.01 - Panic Disorder Without Agoraphobia, 300.21 - Panic Disorder With Agoraphobia, 300.22 - Agoraphobia Without History of Panic Disorder) is:

A. Both (1) and (2):

(1) recurrent unexpected Panic Attacks

(2) at least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

 a) persistent concern about having additional attacks

 b) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, "going crazy")

 c) a significant change in behavior related to the attacks

B. Presence or Absence of Agoraphobia

C. The Panic Attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

D. The Panic Attacks not better accounted for by another mental disorder, such as Social Phobia (e.g., occurring on exposure to feared social situations), Specific Phobia (e.g., on exposure to a specific phobic situation), Obsessive-Compulsive Disorder (e.g., on exposure to dirt in someone with an obsession about contamination), Post Traumatic Stress Disorder (e.g., in response to stimuli associated with a severe stressor), or Separation Anxiety Disorder (e.g., in response to being away from home or close relatives).


So at least 2 panic attacks at least one of which was accompanied by thoughts in either A(2)a, b, c, within a month qualifies as panic disorder. The 8-9 months claim is nonsense. If it's possible I suggest you go elsewhere for treatment.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Never-Quit

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Re: Low Dose Prozac?
« Reply #5 on: June 26, 2014, 10:39:57 PM »
Hi Again :action-smiley-065:

I agree with Ian - it is such 'nonsense'   ::)  and it is a sad but this is the new reality when dealing with Doctors and Psychiatrist. who are not taking the proper professional responsibility to treat their clients.  And because you are so young... doesn't help you get the respect from many doctors - again - so sad...  :(

I have indeed suffered my share of these so called "professionals" - with not providing proper diagnosis, care or proper medication for their patients, just to be dismissed and this in the last 30 years, and it's not getting better.

Any doctors that try to shame you or modify your medical records - is completely UNACCEPTABLE  - "she went in and took it off my record and pretty much "shamed me" for ever taking it and "those kinds of meds are only like drinking alcohol... They don't help anxiety and they're very addictive, etc."

This is IMO is non-professional conduct by a doctor - In California, we do have legal patient rights to get proper care and to file a compliant when necessary. 

In the state of  California, United States, we do we have many resources for patients to claim their legal right for proper medical care:

Here are some resources to have handy and contact if you are still having problems, that you even bother to get this information and bring it with you to your doctor appointments, can quickly change a doctor's demeanor and take you more seriously -  I know this from my own personal experiences with myself and getting help for my family members:

Here are some resources for Patient's Care Rights and Remedies - provided by the State of California, in the United States.  In recent years, state and federal legislators have responded to public concerns about threats to health care quality by enacting a number of new laws to help patients negotiate the managed health care system.

Make sure to printout some of the California State information sheets and complaint forms, and keep them in your own personal medical folder, that you will take with you to all future Doctor visits.  Even, if you do nothing else, but have these with you, it will communicate to your doctor/medical office - that you take your right to receive medical care seriously - and you will see a big difference in how you are treated :winking0008:

These links are all State of California, USA - Official Medical Links:


The California Patient's Guide Your Health Care Rights and Remedies" - published by:
Consumer Watchdog
1750 Ocean Park Blvd., Suite 200
Santa Monica, CA 90405
310-392-0522
310-392-8874 fax

Medical Board of California
http://www.medbd.ca.gov
Central Complaint Unit
1426 Howe Ave., Suite 54
Sacramento, CA 95825-3236
phone: (800) 633-2322


Department of Managed Health Care
http://www.dmhc.ca.gov
email: helpline@dmhc.ca.gov
California HMO Help Center
980 Ninth Street, Suite 500
Sacramento, CA 95814-2725
Phone: (888) HMO-2219 or (800) 400-0815
Fax: (916) 229-0465
(877) 688-9891 TDD   

Board of Psychology
http://www.dca.ca.gov/psych/
1422 Howe Avenue, Suite 22
Sacramento, CA 95825-3200
Phone: (916) 263-2699
 


Feel free to send me a PM message if you need any help or assistance in moving forward in claiming your right for proper medical care  :action-smiley-065:
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Offline Boo.

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Re: Low Dose Prozac?
« Reply #6 on: July 02, 2014, 01:08:21 AM »
I'm sorry for taking so long to reply to this - the last week has been an adventure. lol. Thank you so much for your help.  ;D

I called and asked for a new psychiatrist last week. The psychiatrist I had did quite a few unprofessional things (not only taking medications I'm taking off my record like I mentioned before, but also when I asked to switch, she called and asked why and interrogated me and seemed to try to guilt me into staying with her). I called and filed a claim against her for the phone call she gave me, but didn't think to say anything about the meds until after the fact.

They called me today with an appointment with my new psychiatrist (it's not until August) and I'm now trying to get in contact with him before the appointment (as in, ASAP) so I can ask him about starting something new (after all the stuff with the old psychiatrist, I don't trust anything she said to me..).

I feel so beat down right now. Between everything with the psychiatrist and having no idea what's true and what's not (she said that the time I've been on Prozac isn't "wasted time" and that Lexapro kinda "continues off of it" - I hope this is true because these few weeks have been awful). I'm scared to death of new medications (I'll end up starting a new thread once the new medication is actually prescribed by my new doctor asking for positive things about it so we can talk me into taking it lol).. I don't wanna wait another month or 2 or 3 for a new medication to maybe start working (even though I know it CAN take that long.. I just want hope that change can come before then cuz I feel like trash).

I had hope last week that the Prozac had kicked in... I had Thursday and Friday off and I felt soooooo good those days and "SURELY IT'S BECAUSE THE PROZAC KICKED IN" and then I came back to work this week and feel awful again.. LOL. So I guess it was just having time off, not the meds, that made me feel better. :/ I feel like I just went back a step lol! I was so excited that I was feeling better...

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Re: Low Dose Prozac?
« Reply #7 on: July 02, 2014, 01:15:11 AM »
Prozac takes at least 4-8 weeks to kick in.

And yes, it can make anxiety worse in the beginning.

I went back on Prozac recently, started at 10 mgs then bumped up to 20. Finally kicked in fully at the 3 week mark (on 20 mgs).

From what I've heard, it's working if your anxiety intensifies, or if you get a headache/tired in the beginning of the 20 mgs dose the first few weeks.

I like Prozac because if I do forget to take it, there is no discontinuation problems. It stays in the body a long time. But I'm writing down every day when I take it so I don't forget.

I hope it works out for you. :action-smiley-065:
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Offline Boo.

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Re: Low Dose Prozac?
« Reply #8 on: July 02, 2014, 10:47:32 PM »
Prozac takes at least 4-8 weeks to kick in.

And yes, it can make anxiety worse in the beginning.

I went back on Prozac recently, started at 10 mgs then bumped up to 20. Finally kicked in fully at the 3 week mark (on 20 mgs).

From what I've heard, it's working if your anxiety intensifies, or if you get a headache/tired in the beginning of the 20 mgs dose the first few weeks.

I like Prozac because if I do forget to take it, there is no discontinuation problems. It stays in the body a long time. But I'm writing down every day when I take it so I don't forget.

I hope it works out for you. :action-smiley-065:

I really wish my body would tolerate 20 mg!! :( I've been on it for a month now with no improvement (well with worsening actually). So if it's started getting worse, do you think that means it's starting to kick in? o.o I wonder how long until it starts HELPING lol.

Thank you!!! :)
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Re: Low Dose Prozac?
« Reply #9 on: July 03, 2014, 12:08:31 AM »

[/quote]

I really wish my body would tolerate 20 mg!! :( I've been on it for a month now with no improvement (well with worsening actually). So if it's started getting worse, do you think that means it's starting to kick in? o.o I wonder how long until it starts HELPING lol.

Thank you!!! :)
[/quote]

Yes, it seems to be if you're feeling worse, it's actually working, as I've been told. The trick is building up to 20 slowly. You've been on it for a while now...you shouldn't have any problem bumping up to 20...because your body has been on 10 mgs for weeks now.

Believe me, I'm extremely sensitive to medications.... 10MGs is a subclinical dosage. There are rare cases where 10 MGs can work...but you've been on that dose a while....so time to bump.

If you have the 10 mgs capsules, you can do it this way: Open one of the 10 mg capsules and pour half out to take with your other 10 mg so it will be roughly 15 mgs...do that for a week or so, then take 2 10mg capsules and you'll be at 20  :yes:  You can do this!  (oh, put the poured part of the capsule in applesauce..it doesn't really taste that bad. )
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Offline Boo.

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Re: Low Dose Prozac?
« Reply #10 on: July 03, 2014, 02:24:26 PM »
Yes, it seems to be if you're feeling worse, it's actually working, as I've been told. The trick is building up to 20 slowly. You've been on it for a while now...you shouldn't have any problem bumping up to 20...because your body has been on 10 mgs for weeks now.

Believe me, I'm extremely sensitive to medications.... 10MGs is a subclinical dosage. There are rare cases where 10 MGs can work...but you've been on that dose a while....so time to bump.

If you have the 10 mgs capsules, you can do it this way: Open one of the 10 mg capsules and pour half out to take with your other 10 mg so it will be roughly 15 mgs...do that for a week or so, then take 2 10mg capsules and you'll be at 20  :yes:  You can do this!  (oh, put the poured part of the capsule in applesauce..it doesn't really taste that bad. )

Ooh thanks! I'm still waiting for my new psychiatrist to contact me (phone, email, smoke signal, something..) so I can ask him about it too. :) I was even thinking maybe since they had me start with 1 pill every other day and then go up to 1 pill a day (to get my body used to it), it might make sense to do 1 every other day and 2 every other day to ease my body into taking 2 (but my mom said that wouldn't work so I don't know lol). I'll ask him about trying to go up to 15 mg for a week and seeing how that works out.. I don't like applesauce so I'll have to use some peanut butter or something. ;)

All I know is that when I went up to 2 a day (which lasted 5 days), I was MISERABLE. Waking up at 3AM with the worst nausea of my life is no fun.. lol. I lost almost 20 lbs in a week because all I could get myself to eat was saltines and plain tortilla chips.. So I hope the new psychiatrist can offer me a new solution so I can try to stay on the Prozac (especially if it's gonna start helping lol). It was after I went back to 10 mg that my anxiety got soooo much worse omg. I don't know if it was at all related, but that was what I noticed!!
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Re: Low Dose Prozac?
« Reply #11 on: July 03, 2014, 02:40:48 PM »
Yes, it seems to be if you're feeling worse, it's actually working, as I've been told. The trick is building up to 20 slowly. You've been on it for a while now...you shouldn't have any problem bumping up to 20...because your body has been on 10 mgs for weeks now.

Believe me, I'm extremely sensitive to medications.... 10MGs is a subclinical dosage. There are rare cases where 10 MGs can work...but you've been on that dose a while....so time to bump.

If you have the 10 mgs capsules, you can do it this way: Open one of the 10 mg capsules and pour half out to take with your other 10 mg so it will be roughly 15 mgs...do that for a week or so, then take 2 10mg capsules and you'll be at 20  :yes:  You can do this!  (oh, put the poured part of the capsule in applesauce..it doesn't really taste that bad. )

Ooh thanks! I'm still waiting for my new psychiatrist to contact me (phone, email, smoke signal, something..) so I can ask him about it too. :) I was even thinking maybe since they had me start with 1 pill every other day and then go up to 1 pill a day (to get my body used to it), it might make sense to do 1 every other day and 2 every other day to ease my body into taking 2 (but my mom said that wouldn't work so I don't know lol). I'll ask him about trying to go up to 15 mg for a week and seeing how that works out.. I don't like applesauce so I'll have to use some peanut butter or something. ;)

All I know is that when I went up to 2 a day (which lasted 5 days), I was MISERABLE. Waking up at 3AM with the worst nausea of my life is no fun.. lol. I lost almost 20 lbs in a week because all I could get myself to eat was saltines and plain tortilla chips.. So I hope the new psychiatrist can offer me a new solution so I can try to stay on the Prozac (especially if it's gonna start helping lol). It was after I went back to 10 mg that my anxiety got soooo much worse omg. I don't know if it was at all related, but that was what I noticed!!

Smoke signal here! :yes:

I would think every other day at 10 mgs...you could go to every day at 10 mgs...then...every other day at 20 mgs....

But, remember the Pepto Bismol for the nausea! And if you can, get a benzo for the temporary insomnia.

Seems that Prozac was working until you went back down to 10 mgs, right?

It's always worse in the beginning. I learned my lesson. I'm not stopping Prozac again.  :yes: 

Also, another thing that works for nausea are those things people use for motion sickness. When I ran out of Pepto one night, I put those SeaBands on. Worked like a charm.

I have a friend who sleeps with them on. (My acupuncturist told me that the point for nausea is also the same point meridian for anxiety). Double bonus there. :yes:
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Offline Boo.

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Re: Low Dose Prozac?
« Reply #12 on: July 03, 2014, 03:33:49 PM »
Smoke signal here! :yes:

I would think every other day at 10 mgs...you could go to every day at 10 mgs...then...every other day at 20 mgs....

But, remember the Pepto Bismol for the nausea! And if you can, get a benzo for the temporary insomnia.

Seems that Prozac was working until you went back down to 10 mgs, right?

It's always worse in the beginning. I learned my lesson. I'm not stopping Prozac again.  :yes: 

Also, another thing that works for nausea are those things people use for motion sickness. When I ran out of Pepto one night, I put those SeaBands on. Worked like a charm.

I have a friend who sleeps with them on. (My acupuncturist told me that the point for nausea is also the same point meridian for anxiety). Double bonus there. :yes:

I was thinking that too!! I'll ask though. If/when he ever contacts me.  :P And hope it doesn't start making me sick again.. lol. I do have nausea pills now (from having the issues a few weeks ago). I have no idea if they work or not, but they're worth a try if it comes back. :) Pepto seems to make my nausea worse actually.. lol. If I take Pepto, there's a 100% chance I'm gonna throw up after. I'm better off without it. :P I'll look into the sea sickness stuff too, I hear those lozenges are great for morning sickness nausea so they might help here too. :D Maybe the bracelet things will help also!

I don't think the Prozac ever actually "worked," my anxiety just got worse (worse than ever) when I went back down to 10 mg after being on 20... I don't think I was on it long enough at the time for it to actually start helping... I do have Klonopin right now (my regular doctor prescribed it to me for until the Prozac started helping because I was having a really hard time) and if I know I'm gonna have a bad night, I do take half of one so I'll be able to sleep better. (Like the night before last, I took it...) Now I'm paranoid about taking it though because yesterday I had a "brain zap" and someone said that could be related to the medication? I know those are also just regular anxiety-related so I don't know.. That's just another question to ask the psychiatrist. LOL. He's gonna call me expecting a 3-minute phone call about my medication and I'm gonna bombard him with like 25 questions... :P
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Online redapples

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Re: Low Dose Prozac?
« Reply #13 on: July 03, 2014, 03:42:24 PM »
I'd start smoke signaling the doctor!!!

Definitely bombard him with questions! He's making enough money! :yes:

Oh, right, I remember now- you never got to really feel the effects of the 20 mgs of prozac!

If Pepto doesn't work, plenty of other options.  :yes:

Prozac doesn't have a discontinuation syndrome like other SSRI's because it's got an extremely long Half Life....so yes, probably just you being a bit paranoid!

Ok. I'm out the door! Back later! Hope that doc calls you or you'll have to put an APB out on him!
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Offline Boo.

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Re: Low Dose Prozac?
« Reply #14 on: July 03, 2014, 03:54:43 PM »
I'd start smoke signaling the doctor!!!

Definitely bombard him with questions! He's making enough money! :yes:

Oh, right, I remember now- you never got to really feel the effects of the 20 mgs of prozac!

If Pepto doesn't work, plenty of other options.  :yes:

Prozac doesn't have a discontinuation syndrome like other SSRI's because it's got an extremely long Half Life....so yes, probably just you being a bit paranoid!

Ok. I'm out the door! Back later! Hope that doc calls you or you'll have to put an APB out on him!

Thank you so much for all your help. :) I'm definitely gonna bombard him with all the questions I can think of (I'm sitting here making a list now so I don't forget any lol).

I hope you have a great day!!
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