Fluoxetine Side Effects
Question:
«Good morning, my question is the following:
This is a person who has a mixed adjustment disorder for that he has been given Fluoxetine in the morning (in addition to Bromazepam
2-1-2 and Lormetazepam at night). Until now it seemed that the Fluoxetine had no effect on him, but just today (in week 4) he has managed to sleep better, he is calmer, but dizzy and with motor coordination problems and mental slowness. Is it normal or is it worrying? It is also advisable to lower the dose of the benzodiazepines (takes a little over a month)».
Answer:
First of all, thank you so much for your detailed description of the situation and I’m so sorry your friend feels this way. My advice around here should not be a substitute for following up with your regular psychiatrist, because I don’t know enough about you and your circumstances to give you personalized recommendations.
It is important to know, that antidepressants, such as Fluoxetina, usually take four to six weeks to have an effect. We don’t exactly know why that is the case, but it has to do with the genetic expression of the serotonin transporter and receptor. It takes a while before the suppression of the gene influences the serotonin in the brain.
People suffering from depression are short on that chemical messenger called serotonin. The most popular type of antidepressant (the SSRI) blocks serotonin from reabsorbing into brain cells, leaving more of it flowing around. Its job is to boost your mood.
In patients with severe anxiety, we sometimes cover this transition period (before the antidepressant works at its full effect) with benzodiazepines, such as the Bromazepam. The advantage is that it acts fast and reduces anxiety in the short term. This generally allows the patients to adhere better to the treatment and to cope better with the anxiety. Since Benzodiazepines cause dependence, it is only used as a short-term solution and monitored strictly by the physician.
In your case, it would be important to know the dosage of the Bromazepam that you are taking. But you are right, I would recommend that you slowly decrease the Bromazepam. It could be the source of the nausea and incoordination. Depending on when your anxiety is highest, but since you say that the person is starting to sleep better, the decreasing plan could start by only taking one tablet of Bromazepam at night, meaning 2-1-1. This step should last at least ten days before considering decreasing the medication further. Then I would recommend only taking one in the morning, 1-1-1. The rest should be discussed and adapted with your physician according to your well-being and health status.
Here is a short explanation of the Bromazepam:
- It belongs to a group that is called Benzodiazepines and is an intermediate-acting benzodiazepine. This means that the peak plasma levels of Bromazepam are reached between 0.5 – 4 hours and may be maintained for up to 12 hours.
Bromazepam, administered at low doses, relieves psychic tension, anxiety and nervousness. At higher doses it has a sedative and muscle relaxant effect. - In most cases only a short-term treatment with Bromazepam is necessary (in general it should not exceed four weeks).
- Restlessness, anxiety, insomnia, lack of concentration, headache and hot flushes may occur after cessation of administration, especially if you have been taking it for a long time. In general, it is not recommended to stop the medication abruptly, but to reduce the dose gradually, according to the doctor’s instructions.
- Drowsiness, dizziness, headache, ataxia are among its most frequent side effects.
- Prolonged use of bromazepam can cause tolerance and may lead to both physical and psychological dependence. That is the reason we are very careful with the prescription and monitor the dosage carefully.
- It is important to know that you should not consume alcohol since doing so can reduce the effectiveness of this medication and increase the risk of side effects.
I hope that this information is helpful to you and that your friend will feel better soon.
Sources:
* https://cima.aemps.es/cima/dochtml/p/79661/Prospecto_79661.html
* Baudry A, Mouillet-Richard S, Schneider B, Launay JM, & Kellermann O (2010). miR-16 targets the serotonin transporter: a new facet for adaptive responses to antidepressants. Science (New York, N.Y.), 329 (5998), 1537-41 PMID: 20847275
* https://www.medbroadcast.com/drug/getdrug/bromazepam
Division of Medicine
Psychiatrist
Children, adolescents and adults
Languages: English, German, French and Spanish
Alprazolam (Xanax)
Alprazolam is a tranquilizer, the fastest of its family. It shows effect in the course of five to ten minutes and lasts between three and six hours. This makes this medication an ideal fit for situations with high peak anxiety, i.e. panic attacks, specific phobias (fear of taking a plane,..). The downside of it being so effective, fast and having a slightly euphorizing effect is that it can be highly addictive. So, the quick and big feeling of relief is double sided.
What is Alprazolam used for?
Alprazolam is very helpful but has to be evaluated carefully when and how it is prescribed. It is used for the short-term management of anxiety disorders and panic disorder.
Alprazolam belongs to a class of medications called benzodiazepines.
There are different dosages such as 0.25mg, 0.5mg or 1 mg that are to be taken orally. Your doctor will assess the medication on a regular basis to find the most appropriate dosage for you and to limit prolongated use. It is advisable to increase and decrease the dosage slowly with the supervision of your doctor.
However, the relief is purely symptomatic, the underlying cause of the anxiety remains present and will resurface. The medication allows the intensity of the anxious peak to be tolerable.
When shouldn’t I use Alprazolam?
If you have daily anxiety or if the anxiety is caused by anticipation, i.e. not necessarily related to a specific event or situation. This is what we call a generalized anxiety disorder.
What side effects can this medication cause?
Alprazolam is one of the best tolerated tranquilizers but if the adjustment of the dosage is inappropriate, an excess can cause certain side effects.
The most common side effects are: Drowsiness, light-headedness, headache, tiredness, dizziness, irritability, dry mouth, changes in sex drive or ability, nausea, constipation
Alprazolam may cause other side effects. Please, always contact your doctor or seek emergency care if you have any unusual problems while taking this medication.
Can Alprazolam interact with other medication?
Yes it can, that is why it is crucial that you tell your doctor about any medication (for example contraceptive pill, antibiotics, heart medication etc) you are taking as well as your alcohol consumption. Alcohol can increase the risk of important side effects.
What should I have in mind if I take Alprazolam?
- Alprazolam can make you drowsy. Be sure to not drive a car or operate machinery until you know how this medication affects you.
- Alprazolam may be habit forming.
- Alprazolam may cause a physical dependence that is why it is important to never suddenly stop or increase the medication. Stopping the medication abruptly can cause withdrawal symptoms that may last for several weeks.
How do I stop taking Alprazolam?
Alprazolam, such as any Benzodiazepine, can cause dependence if used on the long term. That is why medical supervision is crucial.
If you stop the medication abruptly, it is very common to have a syndrome of abstinence (sweating profusely, trembling, nausea,…). It can even lead to a life-threatening situation requiring medical assistance.
If you stop gradually, which is highly recommended, we suggest medical supervision. You should never decrease more than 1/3 of the total dosage in each lowering step. Each step should at least last one week, sometimes ten days or two weeks depending on the tolerance and wellbeing of every patient. This time is to ensure that you don’t suffer from signs of abstinence.
Sources:
https://medlineplus.gov/druginfo/meds/a684001.html
https://cima.aemps.es/cima/dochtml/p/62791/Prospecto_62791.html
https://pubmed.ncbi.nlm.nih.gov/2029716/
Division of Medicine
Psychiatrist
Children, adolescents and adults
Languages: English, German, French and Spanish
Symptoms of Paroxetine withdrawl
Question:
Hello Sinews, My name is Mercedes, my consultation with the doctor is about my current state. I have been taking paroxetine for two years. The first year and a half of 20mg. And the last 6 months 10mg. In the last months of taking it I felt tired … Barely exercising. Another symptom was very heavy legs, cramps and tingling. I did an analysis to figure out what that fatigue was and they came out well. I consulted to the psychiatrist and he sent me to change my medication, I took Brintelly 5mg.
I have been on this new medication for 20 days. From there, more or less, I began to have severe headache, I’ve been with them for 11 days, the GP has seen me, the treatment they gave me has hardly done anything to me, I continue with headaches.
I spoke to the psychiatrist and stopped taking Brintelly 5mg. Now I do not take any antidepressants (I have been without anything for about 8 days).
Today I had a head tac and everything is fine. I have been diagnosed with a migraine. But my question is whether all of these headaches could be from withdrawal of paroxetine, and related to any withdrawal syndrome, after having it taken two years or with the taking of Brintelly. I would be very grateful to know your opinion. THANK YOU.
Answer:
Hello,
I am so sorry you are having such a hard time and thank you for your confidence. It is already a great relief that the CT scan and neurological exam came back normal. The symptoms you are describing very well may be related to a Paroxetine withdrawal syndrome. In fact, up to 20% of patients suffer intense physical symptoms with withdrawal from drugs in this family (SSRI type Antidepressants) and most especially Paroxetine.
Serotonin reuptake inhibitor (SSRI) withdrawal syndrome or withdrawal syndrome can occur when the antidepressant is stopped abruptly or taken irregularly. Generally, the patient must have taken the medication for at least one month for this situation to occur. This disorder usually begins between twenty-four and forty-eight hours after discontinuation of the drug. Symptoms peak on the fifth day and usually resolve within two to three weeks.
The main symptoms, as you describe so well, are dizziness, vertigo, headache, nausea, and flu-like symptoms, as well as anxiety, confusion, irritability, paresthesias, excessive dreams and insomnia. The risk factors that are often emphasized are poor compliance with treatment, previous withdrawal syndrome with another drug, concomitant medication, and alcohol consumption. The symptoms are uncomfortable, but do not pose any medical danger.
When a withdrawal syndrome occurs, we usually reintroduce the drug and then gradually withdraw it. Depending on the patient’s history, we will gradually reduce the medication, sometimes even only reducing a quarter tablet every three weeks, always keeping the patient’s well-being in mind. Also, avoid alcohol, stay hydrated and try to rest.
In your case, I recommend you talk to your doctor and evaluate your symptoms. If you still have the headache, it is perfectly possible to talk about the possibility of resuming the medication to lower it very, very slowly. Since you have been taking it for two years, your body is used to and reacts to the change in concentration of the medication.
Brintelly can be a relief because it is from the same pharmacological group, but I will take 10 mg for at least 3 weeks before slowly lowering it, the same lowering process as with Paroxetine.
Sometimes it helps to switch to Paroxetine in drop form, which allows this process to be managed and adapted very precisely, reducing the dose so slowly that the body does not notice the change.
In most cases, withdrawal symptoms are mild and disappear within several days, but in rare, severe and prolonged cases, the only treatment is, unfortunately, to restart the medication.
Also, if you ever need an antidepressant again, please let your doctor know if you have experienced any withdrawal symptoms, so he or she can make an informed decision. He or she will evaluate the risk and benefit of continuing to take the same medication or switching to another medication. Fortunately, there are many options available to secure the help you need.
My advice here should not substitute for follow-up with your regular psychiatrist, because after all, I don’t know you or your situation well enough to give you personalized recommendations. I can only tell you about my experience with patients suffering from withdrawal syndrome.
I sincerely hope I have been of help, and I send you my warmest regards.
Division of Medicine
Psychiatrist
Children, adolescents and adults
Languages: English, German, French and Spanish