Gifted Issues Discussion homepage Forums Twice Exceptional Coming off Prozac

We took DS12 off of prozac 2 weeks ago. At 10mg it seemed to have no appreciable effect, and at 20mg it seemed to cause panic attacks and higher levels of stress. His diagnoses for the last three years include anxiety, perfectionism, low self esteem, and highly-functional ASD.

For the last month DS has been complaining that he is bored, and nothing interests him. The only thing he wants to do is play video games by himself. While his grades have been good, getting him to do homework is a struggle. He has had a few outbursts in school, but not every day.

Yesterday and today he has been miserable. Plenty of whining, anger, and oppositional behavior. We've been taking a low key approach, not confronting him and trying to make it clear that we understand that he's feeling bad. We make many suggestions, but he refuses most of them. We're not fighting small battles, like when he takes a shower, and instead focusing on his overall issues and getting him to get at least some homework done.

I've never seen him this sad before. I'm not blaming all of it weaning him off the prozac, but that may have contributed. He wasn't very happy on prozac, but he's worse now. I'm hoping that this is just a phase we need to get through for a few more days...

I'm open for advice. Thanks.

Are you (or will you be) replacing the Prozac with another medication?

We are not sure yet. He is on clonezapam and abilify still.

Did you taper off slowly for several weeks or just stop suddenly? I know as an adult when I switch from one SSRI to another or want to stop all together my doc has had me cut dose in half for a few weeks, then go to every other day for several weeks, then every 2-3 days, until I get down to none at all. Usually takes me a good two months to taper. Then I start a new one about 2 weeks after none at all.
Anxiety, sadness usually comes on within a few days of taper and is very obvious to my family.
I do not take anything else with it, so not sure if the Abilify alone without the SSRI may be part of your childs moodiness. Good luck and hugs.

He was on a very low dose, so the doc said to just stop it and see what happens. I just checked and he's been off for 3 weeks now. These symptoms were occurring while on the prozac but they are worse now.

Obviously, everyone here is smart enough to choose their doctor's advice rather than that of some stranger on the internet. But I will add that when I tried to go off of Effexor (an SNRI), my GP told me to take it every other day, and it was a disaster. Maisey's advice works well (in my experience) with Prozac and other longer-lasting drugs, but for short half-life medicines, it basically puts you on a whipsaw withdraw-and-reintroduce cycle that is flat out dreadful to experience. I ended up taking apart the extended release capsules and dividing them into more capsules in order to taper the dose down below the smallest one available OTC. I have since read that a common strategy for Effexor is to first add Prozac, then stop the Effexor, then taper the Prozac.

You may want to Research it..but I think Prozac takes 25 days for it to be gone from ones system. So stopping it suddenly one would experience SSRI withdrawl symptoms and underlyng
Psych issues could be amplified.

Honestly, I am surprised that a Doc would suggest stopping Prozac without a taper. My SSRI only takes 6 days to be out of my system, but Prozac takes 4 x's longer.

I suspect the doctor has never come of an SSRI. It is not coming off heroin type sick (i assume) but it is unpleasant. I do cut pill in half tben quarters then every other day (by that time the dose isn't theraputic so it isn't noticeable. This doesn't work so well with prozac because of the capsules. I have had no problem with just changing type though and of the 3 i have used i liked prozac the least.

I thought that the long half-life of Prozac made it easier to discontinue it, not harder, because it has sort of a built-in taper over the long time it takes to get totally out of your system. But you can get a lot of information on this by Googling "discontinuation syndrome antidepressant".

I'm not surprised that a GP might suggest withdrawal without tapering, honestly-- but SSRI's really, really, REALLY shouldn't be withdrawn without one. Particularly in adolescent patients.

This is a patient population that hasn't been particularly well-studied with these meds, honestly-- so what works for adults may not be true with adolescents to begin with. Secondly, what IS known about the meds in this age range isn't always positive.

Eliz is right-- extended release meds have a natural "taper" in dosing, but at the same time, for some individuals, it isn't slow enough. Adolescents metabolize meds faster than adults do.

I'd call the doc about his symptoms. They sound concerning. Before you do, ask him about anything "weird" and new that he might be experiencing-- auditory or other sensory hallucinations aren't uncommon in adolescents upon withdrawal of SSRI's, and kids may not understand that those aren't signs that they are "crazy" so much as real withdrawal effects. Some people describe them as "popping" or "crackling" in the brain, etc.


Some tried and true non-drug methods of dealing with low affect this time of year-- I'd add this stuff pronto in your situation, btw:

1. Exercise-- IN NATURAL DAYLIGHT. No matter how overcast, it's still better to get that natural full-spectrum light.

2. MORE light-- full spectrum fluorescent bulbs can be had at any home improvement store-- beware that they can disrupt circadian cycles if you use them late in the day, but having one at your breakfast table or where he gets ready for school in the mornings might help.

Prozac is harder to taper the dose because it is a capsule not a pill.
i had brushing across the brain feeling and sound and thought I had a brain tumour.

Thanks everyone. He had a better afternoon. Managed to get some homework done, a shower, then had a fun time with his brother. He's still struggling with executive function and controlling his emotions, but we are happy (and exhausted) with his progress.

At this point, we have a psych appt a week from today so we'll have to play this week by ear.

It is so hard to tell how much of this is prozac and how much is puberty. Like I said, the symptoms started while he was on prozac, which lead us to conclude that it wasn't doing much if anything for him.

2 is easy. We even had a special light for my wife's SAD that we use. Not that it seems to help but we try anyway.

1 is hard. He outright refuses to exercise most days, though he seems to enjoy gym class at school. I'd love him to get more, but he's at that age that I don't want to force him - the motivation needs to start becoming intrinsic.

Could you get him out for a walk or hike with the family?

Yeah-- that's the thing with affective issues, though. It might never be "intrinsic" the way that everyone would hope, because that is part of being depressed-- not WANTING to do it.

We (occasionally) still have to remind DD that this is part of her routine. Having it be a habit makes it stick better. She runs her little dog in the mornings-- that way it's not optional.

We tried that three weeks ago, and the result was a screaming meltdown. He eventually came with us, and had a good time, but task initiation is a real problem. He feels as if he doesn't have control of his time and reacts very strongly to any perceived "work".

What is it he likes about PE at school versus walks? Perhaps he would enjoy geocaching, hiking with a purpose might be more meaningful to him.

I can understand this feeling, I'm not sure if my issues are just anxiety or anxiety comorbid with ASD, but when things don't happen in a predictable or expected way, especially when it comes to time, I get very anxious and upset.

How about just a ten minute stroll around the block before or after tea. Exercise doesn't have to be all or nothing and starting small helps.

Hi BSM,
Bumping this thread for hijack, possible discussion.

We are knee-deep in depression here. There seems to be a pattern in which ragweed/mold allergies set off a cycle into depression. He recovers and then spring allergies start the whole thing again. Admittedly, I'm just guessing.

DS isn't taking an SSRI because he had a weird reaction to Prozac and I thought it would be best to try something different over a school break.

I brought this up before, and there was some interesting discussion about it: DS psychiatrist offers DNA testing to help make better predictions about drugs. We just had his cheek swabbed and will have a new treatment plan in a week or so. Here are some things psychiatrist explained (I am not educated in science, so may paraphrase poorly):

The tests will provide some information about what stimulant class is likely to work best, and what would be smart to avoid.

Ditto for SSRI and SNRI.

Ditto other psych meds (mood stabilizers, antipsychotic, etc.)

We will receive a lengthy written report--I saw a sample and it's really cool.

None of that is really new info, but here are a couple of bytes:

Psych said DS' depression could (possibly) be more bipolar than unipolar, since he has a lot of anxiety and irritability mixed into it. He said in kids, it presents differently, and having a fast, unusual response to low dose of Prozac is a clue. If so, med implications are different.

And, this is the most interesting thing of all (to me). Psych said that fully 90% of kids on autism spectrum have a defect in the "MTHFR" gene, that causes problems metabolizing folate (B9). If you google that, there is stuff all over the place, science-y and holistic-y, etc. I won't pretend to understand or explain this in any depth, but folate has a lot of neuro importance. Doc explained very intensely and what I came away with is: if there is a genetic defect, it can affect both how the brain produces and uses important neurotransmitters like dopamine, norepinephrine, serotonin.

The testing DS is having will let us know if he has the MTHFR defect, among other important things having to do with drug metabolism (there are all sorts of ways drug metabolism can go awry).

There is a "medicinal food" called Deplin (by prescription only) that somehow bypasses the folate problem for people with this issue. If you google that, you'll find all kinds of people raving about how much better their antidepressants worked when supplemented with Deplin. I have no idea if they are shills or how real any of this is, but it's encouraging to me because (as far as I know) there is no downside to taking it.

The psychiatrist said--I think, don't quote me--that you can't rely on serum folate levels to detect a deficiency, something about the blood/brain barrier. Or maybe I read that somewhere else.

Also, newer antidepressant meds Pristiq, Fetzima, etc., evidently work to increase production and re-uptake, so if there is a problem with one or the other, the person is covered at both ends. <--please take my explanation loosely and feel free to correct me, anyone, if I've said anything glaringly inaccurate.

This is a commercial website, but it's the one for the lab DS' psych uses, and he assures me this is based on Mayo Clinic science and not quackery: genesight.com

The test is $330. They will bill insurance first, and if insurance won't pay--the company has a sliding scale, based on income.

As far as I know, this does have to be ordered by a physician, and the physician would have to understand how to use the report to create a treatment plan. DS' psychiatrist said it helps him make better predictions. Not a miracle cure, but helpful--we are hoping. Less suffering and more information can't be a bad thing.

Obviously, I have no idea if any of this is going to be helpful for my DS and ordinarily wouldn't even share the information, since we have no experience at this point. Since it is (relatively) inexpensive and noninvasive, and it sounds like he could possibly be helped by something as simple as a vitamin(!) it felt worth putting out there.

Eco,

I'd be interested in hearing how your son does with this type of diagnosis. As I may have mentioned before, our psych said that this research is very cutting edge and does not have any reputable results just yet. Still, I think about how much we might learn if we took a large number of 2e and neuro-typical kids under an fMRI and sequenced their DNA.

Anyway DS12 is doing a little better containing himself in school. He's been off Prozac for over 5 weeks. 2 weeks ago he had a major meltdown and this weekend he had issues but otherwise I'm seeing small improvements.

Nurse called and gave me some preliminary information, will have full report Friday.

I can't quote, specifics but here is the little bit I took (poor) notes about during quick phone call.

1--Something about COMT gene, more than one issue, associated with attention, mood, anxiety, etc.
2--Something else about sensitivity to SSRI drugs--"intermediate" metabolizer, quick google search reveals this is not worst case scenario, but not best, either.
3--Non-stimulant meds for ADHD recommended, non SSRI/SNRI for mood stuff.

Ready for this, BSM? Psychiatrist is recommending Abilify, because it stabilizes mood and has antidepressant qualities. I've asked question, why Abilify instead of Lamictal (just because, am nervous about it), but haven't heard answer yet.

Psych recommends staying on current stimulant for now, but may change to Wellbutrin later (not stimulant but acts on dopamine. Somehow).

I asked nurse if there was anything about the MTHFR gene and she said not in his notes, which probably means that is not an issue, or he'd have prescribed Deplin.

Anyhow, will update more as this unfolds...

Interesting. The thing to watch with Abilify is weight gain. We've kept the dose small because of that. We're not on a stimulant yet, as DS is not ADHD, thought with all of his EF problems I'd think one might help him focus.

The genetic testing is very new and it's important not to read too much into it. Intermediate metabolizer means it isn't broken down too quickly (meaning the dose may be too small) or too slowly (meaning the dose may be too large). It is mostly just telling you how the liver metabolizes things, which is only one part of the picture. Many other things affect how someone responds to different medications. I have done the genetic testing just because I wanted to have the information on liver enzymes out of curiosity. The results didn't match my experience with the different medications (I don't take any now but had previously). Amusingly, I also had the gene variant associated with lower risk of OCD when I used to have that severely. That's just my experience and doesn't mean the testing isn't useful, but it just isn't clear enough yet what some of the results mean and it just isn't enough to know which medications to choose even though it may help. There is a good review of the data that I can dig up again if anyone is interested (I posted it on another thread when this was discussed before). I'm glad I had it done, but there really isn't enough data to know how useful it will be and it concerns me that it seems to be getting promoted as able to do more than it can at this point.

DS psychiatrist allowed me to choose and so we're going with Lamictal for now--better SE profile and generic. Downside is it takes much longer to titrate and see if it's effective.

apm--I agree with your take it with a grain of salt attitude about this. My son has had a really difficult time with side effects on stimulants and his one SSRI attempt was short/unsuccessful, so I'm going with "what can it hurt?" The biggest risk I see, at this point, is if the physician relies on this technology alone.

DS' doctor said that one advantage of being a young psychiatrist is they are required to learn a lot about this in medical school. He didn't seem to be saying there's any magic here, just that it helps narrow the crapshoot a bit.

BSM--DS doesn't fully meet ADHD diagnostic criteria, either, but his impulsivity has been an ongoing issue, and he has pretty much zero EF. I don't think the stimulant really helps with some aspects of EF but it does help with *something*. I'll be interested to see if he has a positive response to the new medication, and if his anxiety is addressed, what that looks like.