Depression/Mental Health Forum
This expert forum is not accepting new questions. Please post your question in one of our medical support communities.
Avatar universal

Anxiety and Prozac

Dear Doctor,
I followed your advice to dampen the effect of the withdraw syndrom caused by the ending of Paxil CR.  I increased the dosage the first night by a half a pill, but was still left with uncomfortable side effects.  The next night I took a full additional pill which has left me with a total of 20mg of Prozac being taken.

This did wonders for the withdraw feelings, but the anxiety is over-whelming.  I was burning out my skin, shaking, fearful thoughts and feelings raced, and a buzzed feeling has taken over my body.

My question to you is, do you think that this anxiety will pass after a couple of weeks or do you think perhaps 20mg is too much for my anxiety?

How long of a chance do you give it?  You advice has been right on thus far, hope you can help me through the end.  The anxiety is almost unbearable, but if you think it will pass, I will stick it  out many, many thanks.
6 Responses
242532 tn?1269553979
I am glad the first part worked well for you, but regarding the dose, I want to warn you that you should be working with your doctor about these changes...I am providing information that I hope is useful, but I can not take medical responsibility in this forum.  That said, you might want to talk to your doctor about decreasing your dose to 10 mg. of prozac, and that should do the trick.
Avatar universal
I found if I took a benzo such as Xanax as needed only with Prozac, it was great.  Prozac alone does not cut it for anxiety. I hope you feel better.
Avatar universal
I appreciate the fact that you are not passing medical advice for us to use in replacement of a physicians care.  I don't take meds without his orders to do so.  The info I receieved from you gives my more knowledge and options for when I speak with my Doctor.  This gives me more options to weigh over when making a decision for change.

I don't hold you responsible for any of my treatment, only myself and my  own m.d.  But I am grateful to have an opportunity to speak with a dr. regarding my med and recovery questions.  Sometimes our drs. are not as easy to talk to or get a hold of when a question needs anwsering.
Avatar universal

Extract from Article by


Withdrawal from SSRIs is something to be done in consultation with your physician. You may wish to show this to your GP.

Over-rapid withdrawal may even be medically hazardous, particularly in older persons.

1. Convert the dose of SSRI you are on to an equivalent dose of Prozac liquid. Seroxat/Paxil 20mg, Efexor 75mg, Cipramil/Celexa 20mgs, Lustral/Zoloft 50mgs are equivalent to 20mg of Prozac liquid. The rationale for this is that Prozac has a very long half-life, which helps to minimise withdrawal problems. The liquid form permits the dose to be reduced more slowly than can be done with pills.

2. An alternative is to change to Clomipramine (Anafranil)100mgs per day. This comes in 25mg and 10mgs capsules, permitting a more gradual dose reduction than with other SSRIs. The 10mg capsules can be opened up and part of the contents emptied out permitting a gradual lowering of the dose.

3. Stabilise on either option 1 or 2 for a week, then halve the dose.

4. If there has been no problem with step 3, the dose can be further halved. Alternatively if there has been a problem from this point on the dose can be reduced even more slowly in weekly increments.

6. From a dose of Prozac 10mgs liquid or Anafranil 10mg, consider reducing by 1mg every few days over the course of several weeks - or months if need be. With Prozac liquid this can be done by dilution.

7. If there are difficulties at any particular stage the answer is to wait at that stage for a longer period of time before reducing further.

8. Withdrawal and dependence are physical phenomena. But some people can get understandably phobic about withdrawal particularly if the experience is literally shocking. If you think you may have become phobic, a clinical psychologist may be able to help manage the phobic problem.

9. Self-help support groups can be invaluable. Join one. If there is none nearby, consider setting one up. There will be lots of other people with a similar problem.

There is anecdotal evidence and some theoretical grounds to believe that another option is to substitute St John's Wort for the SSRI. If a dose of 3 tablets of St John's Wort is tolerated instead of the SSRI, this can then be reduced slowly
Avatar universal
SSRI adverse effects.  All SSRIs are clones of Prozac (the original SSRI), all carry the same risks.  


"Adverse SSRI Reactions

Recent medical studies show that that the brain levels of Prozac are 100 times greater than blood levels and it is believed that this is the case with the other serotonin reuptake inhibitors as well - evidence of toxic brain levels affecting behavior no matter what the blood levels demonstrate. As patients have continued to report, this accumulation is evidence that accumulation of drug residue will produce a delayed withdrawal and that it will continue to produce reactions, not only during the period of time the patient is using the drug, but for long periods of time after discontinuation of the drug use.

Brain wave patterns indicate patients are in a total anesthetic sleep state while appearing awake and functioning. Increasing serotonin - exactly what these drugs are designed to do - induces both nightmares and sleepwalk. Patients report over and over again that they have lived out their worst nightmare. And as with sleepwalk episodes, many have no recall or little recall of what they have done. Often someone must prove to them what they have done while they where under the influence of these drugs before they will believe it to be true. One patient stated that he could not detect during his two year use of Prozac what was real or what was a dream!

Seven to ten percent of patients do not have the liver function necessary to metabolize these drugs. Unfortunately even if they do have a functioning P450 IID6 liver system to metabolize the drugs, this group of drugs totally saturates that liver system so that the ability to metabolize the drug gradually becomes greatly impaired and the metabolism of other drugs becomes greatly impaired.

Stress or depression can be detected by elevated levels of cortisol, yet one single 30mg dose of Prozac clearly doubles the level of cortisol. This should in the long run double the patient's stress and depression. But that is not the only detrimental effect of elevated cortisol levels. This can cause a multitude of serious physical and emotional adverse side effects.

Giving these drugs to children is absolutely unconscionable for many reasons. One of the most obvious is that increased cortisol impairs the development and regeneration of the liver, kidney and muscles, as well as impairing linear growth. Yet, learning that even one parent was given this information would be surprising. PROZAC: PANACEA OR PANDORA?--Ann Blake Tracy

Here is the complete list of adverse reactions attributable to SSRI medications:

Vivid and violent dreams
Inability to detect dreams from reality (The world takes on an other-worldly aspect)
No emotions
Inability to feel guilt or cry
Loss of appetite
Rash; Breathing or lung problems
Heart fluttering
Shaking - jitteriness
Unusual energy surges at times producing super human strength (adrenalin rushes)
Memory impairment
Hair loss
Blurred vision or pressure behind the eyes
Inability to discontinue use of drug and increasing own dose
Cravings for alcohol, sweets, and other substances or drinking large sums of alcohol, coffee or other caffeinated drinks, diet pop with NutraSweet, etc.
Swelling and/or pain in joints
Burning or tingling in extremities
Muscle twitching or contractions
Tongue numbness and slurred speech
Chills or cold sweats
Muscle weakness
Extreme fatigue
Diabetes or hypoglycemia
Lowered immune system
Seizures or convulsions
Weight gain or weight loss
Mood swings
Altered personality
Symptoms of mania, ie., inability to sit still or restlessness, racing thoughts, acting silly or giddy (like a teenager again)
Sexual promiscuity leading to unwanted pregnancy or divorce
Irresponsibility, wild spending sprees, gambling, criminal behavior, shoplifting, embezzling, stealing, hostility, etc.
Blank staring
Inability to see any alternatives in situations
Aggressive or violent behavior
Wanting to ram other cars or driving irrationally
Impulsive behavior with no concern about consequences
Numbness in various body parts - legs go numb and right out from under patient
Sexual organs go numb making orgasm impossible
Pulling away from loved ones and others (isolating oneself)
No desire to be touched
Falsely accusing others of abuse - family members or acquaintances
Loss of spirituality
Feeling "possessed" or that something evil is inside
Self destructive behavior and suicidal ideation
Suicide attempts
Muscle tremors
Loss of co-ordination

Prozac Label (September, 1988)

Here is the information as it written on the label insert for Prozac:

Body as a Whole---Frequent: chills; Infrequent: chills and fever, face edema, intentional overdose, malaise, pelvic pain, suicide attempt: Rare: abdominal syndrome acute, hypothermia: intentional injury, neuroleptic malignant syndrome, photosensitivity reaction.

Cardiovascular System ---Frequent: hemorrhage, hypertension: Infrequent: angina pectoris, arrhythmia, congestive heart failure, hypotension, migraine, myocardial infarct, postural hypotension, syncope, tachycardia, vascular headache: Rare: atrial fibrillation, bradycardia, cerebral embolism, cerebral ischemia, cerebrovascular accident, extrasystoles, heart arrest, heart block, pallor, peripheral vascular disorder, phlebitis, shock, thrombophlebitis, thrombosis, vasospasm, ventricular arrhythmia, ventricular extrasystoles, ventricular fibrillation.

Digestive System---Frequent: increased appetite, nausea and vomiting: Infrequent: aphthous stomatitis, cholelithiasis, colitis, dysphagia, eructation, esophagitis, gastritis, gastroenteritis, glossitis, gum hemorrhage, hyperchlorhydia, increased salivation, liver function tests abnormal, melena, mouth ulceration, nausea/vomiting/diarrhea, stomach ulcer, stomatitis, thirst: Rare: biliary pain, bloody diarrhea, cholecystitis, duodenal ulcer, enteritis, esophageal ulcer, fecal incontinence, gastrointestinal hemorrhage, hematemesis, hemorrhage of colon, hepatitis, intestinal obstruction, liver fatty deposit, pancreatitis, peptic ulcer, rectal hemorrhage, salivary gland enlargement, stomach ulcer hemorrhage, tongue edema.

Endocrine System---Infrequent: hypothyroidism: Rare: diabetic acidosis, diabetes mellitus.

Hemic and Lymphatic system---Infrequent: anemia and ecchytmosis: Rare: blood dyscrasia, hypochromic anemia, leukopenia, lymphedema, lymphocytosis, petechia, purpura, thrombocythemia, thrombocytopenia.

Metabolic and Nutritional---Frequent: weight gain; Infrequent: dehydration, generalized edema, gout, hypercholesteremia, hyperlipemia, hypokalemia, peripheral edema; Rare: alcohol intolerance, alkaline phosphatase increased, BUN increased, creatine phosphokinase increased, hyperkaltemia, hyperuricemia, hypocalcemia, iron deficiency anemia, SGPT increased.

Musculoskeletal System---Infrequent: arthritis, bone pain, bursitis, leg cramps, tenosynovitis: Rare: arthrosis, chondrodystrophy, myasthenia, myopathy, myositis, osteomyelitis, osteoporosis, rheumatoid arthritis.

Nervous System---Frequent: agitation, amnesia, confusion, emotional lability, sleep disorder; Infrequent: abnormal gait; acute brain syndrome, akathisia, apathy, ataxia, buccoglossal syndrome, CNS depression, CNS stimulation, depersonalization, euphoria, hallucinations, hostility, hyperkinesia, hypertonia, hypesthesia, incoordination, libido increased, myoclonus, neuralgia, neuropathy, neurosis, paranoid reaction, personality disorder*, psychosis, vertigo; Rare: abnormal electroencephalogram, antisocial reaction, circumoral paresthesia, coma, delusion, dysarthria, dystonia, extrapyramidal syndrome, foot drop, hyperesthesia, neuritis, paralysis, reflexes decreased, reflexes increased, stupor.

Respiratory System---Infrequent: asthma, epistaxis, hiccup hyperventilation: Rare: apnea, atelectasis, cough decreased, emphysema, hemoptysis, hypoventilation, hypoxia, larynx edema, lung edema, pneumothorax, stridor.

Skin and Appendages---Infrequent: acne, alopecia, contact dermatitis, eczema, maculopapular rash, skin discoloration, skin ulcer, vesiculobullous rash; Rare: furunculosis, herpes zoster, hirsutism, petechial rash, psoriasis, purpuric rash, pustular rash, seborrhea.

Special Senses---Frequent: ear pain, taste perversion, tinnitus; Infrequent: conjunctivitis, dry eyes, hydriasis, photophobia; Rare: blepharitis, deafness, diplopia, exophthalmos, eye homorrhage, glaucoma, hyperacusis, iritis, parosmia, scleritis, strabismus, taste loss, visual field defect.

Urogenital System--Frequency: urinary frequency; Infrequent: abortion, albuminuria, amenorrhea, anorgasmia, breast enlargement, breast pain, cystitis, dysuria, female lactation, fibrocystic breast, hematuria, leukorrhea, menorrhagia, metorrhagia, nocturia, polyuria, urinary incontinence, urinary retention, urinaryurgency, vaginal hemmorrhagia, Rare: breast engorgement, glycosuria, hypomenorrhea, kidney pain, oliguria, priapism, uterine hemmorrhage, uterine fibroids enlarged.

*Personality disorder is the COSTART term for designating non-aggressive objectional behavior.

Postintroduction Reports: Voluntary reports of adverse events temporally associated with Prozac that have been received since market introduction and that may have no causal relationship with the drug include the following: aplastic anemia, atrial fibrillation, cerebral vascular accident, cholestatic jaundice, confusion, dyskenesia (including, for example, a case of buccal-lingual-masticatory syndrome with involuntary tongue protrusion reported to develop in a 77-year old female after 5 weeks of fluoxetine therapy and which completely resolved over the next few months following drug discontinuation),eosinophilie pneumonia, epidermal necrolysis, erythema nodosum, exfoliative dermatitis, gynecomastia, heart arrest, hepatic failure/necrosis, hyperprolactinemia, immune-related hemolytic anemia, kidney failure, misuse/abuse, movement disorders developing in patients with risk factors including drugs associated with such events and worsening of preexisting movement disorders, neuroleptic malignant syndrome-like events, pancreastitis, pancytopenia, priapism, pulmonary embolism, QT prolongation, Steven-Johnson syndrome, sudden unexpected death, suicidal ideation, thrombocytopenia, thrombocytopenic purpura, vaginal bleeding after drug withdrawal and violent behaviors.


Hyperserotonemia (elevated serotonin levels) can produce very serious complications medically, as well as serious neurologic and psychiatric disorders. Carcinoid syndrome and the serotonin syndrome are two medical conditions in which elevated serotonin levels are present. Carcinoid syndrome is a set of symptoms caused by the secretion of serotonin by carcinoid tumors, prostaglandins, etc. Symptoms include attacks of severe cyanotic flushing of the skin lasting from minutes to days, diarrhea, bronchoconstrictive attacks, sudden drops in blood pressure, edema, and ascites, which is an abnormal accumulation of serous fluid in the abdominal cavity, also known as abdominal or peritoneal dropsy. [From PROZAC: PANACEA OR PANDORA?, Pg. 87.]

Serotonin Syndrome

The serotonin syndrome is a hyperserotonergic state which is a very dangerous and a potentially fatal side effect of serotonergic enhancing drugs which can have multiple psychiatric and non-psychiatric symptoms. It is a condition which has been on the rise since the 1960's when we began using more and more drugs which directly affect serotonin. This is a toxic condition which requires heightened clinical awareness in order to prevent, recognize, and treat the condition promptly. Promptness is vital because, as we just mentioned, the serotonin syndrome can be fatal and death from this side effect can come very rapidly. This syndrome is a toxic hyperserotonergic state whose rate of incidence is unknown, but is on the rise. The suspected cause of that increase is the introduction of the new selective serotonergic enhancing agents in clinical practice - the SSRIs. This disorder, brought on by excessive levels of serotonin, is difficult to distinguish from the neuroleptic malignant syndrome because the symptoms are so similar. The neuroleptic malignant syndrome is a serious condition brought on by the use of the neuroleptic drugs.

The symptoms of the serotonin syndrome are (from The Serotonin Syndrome, AM J PSYCHIATRY, June 1991):

Sustained rapid eye movement
Overreaction of the reflexes
Rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot
Feeling drunk and dizzy
Muscle contraction and relaxation in the jaw
Muscle twitching
High body temperature
Mental status changes were frequent (including confusion and hypomania - a "happy drunk" state)
Loss of consciousness and death.

The serotonin syndrome is generally caused by a combination of two or more drugs, one of which is often a selective serotonergic medication. The drugs which we know most frequently contribute to this condition are the combining of MAOIs with Prozac (this should also include the other SSRIs) or other drugs that have a powerful effect upon serotonin, ie., clomipramine (Anafranil), trazadone (Deseryl), etc. The combination of lithium with these selective serotonergic agents has been implicated in enhancing the serotonin syndrome. The tricyclic antidepressants, lithium, MAOIs, SSRIs, ECT (electric shock treatment), tryptophan, and the serotonin agonists (fenfluramine) all enhance serotonin neurotransmission and can contribute to this syndrome. Anything which will raise the level of serotonin can bring on this hyperserotonergic condition. The optimal treatment for the serotonin syndrome is discontinuation of the offending medication or medications, offer supportive measures, and wait for the symptoms to resolve. If the offending medication is discontinued, the condition will often resolve on its own within a 24 hour period. If the medication is not discontinued the condition can progress rapidly to a more serious state and become fatal.

It should be apparent that the greater the enhancement of serotonin levels, the greater the chances of producing the serotonin syndrome. Therefore it is recommended that Zoloft, Prozac, Paxil, Luvox, Serzone, etc. not be used concurrently with each other or any other serotonergic drugs and that these serious adverse reactions should be expected with these combinations (Callahan, 1993). [PROZAC: PANACEA OR PANDORA?, p. 88.]"

Avatar universal
I was very interested in you information on Prozac. I've suffered depression with anxiety for several years because of life stress. Was on and off meds for a while (taking them ONLY when I couldn't cope) till things cleared up in my life. The last time (1 1/2 years ago) my doctor gave me Sarafem (female Prozac). I took it for 7 days, ended up in the hospital with possible siezures. Over several months of every test imaginable, they found nothing! A neurologist was concerned of an elevated ANA level that my doctor said was nothing. It's been two years, and after major life, diet, and emotional changes, I still have these "episodes". My stress level is nil and am a very happy person. I have had no problem with depression since the Sarafem, but have had all the symptoms of panic attack but lasting for many hours and not every attack is the same, the symptoms are always different. Every six months or longer it seems, I go through all the symptoms of MS for weeks, but during this time I feel no anxiety. I have no insurance so I quit going to the doctors, and being tight on money, I'm not sure which doctor I should spend my money on. I am convinced that the Sarafem either caused or triggered something, but they find nothing? Can that happen? Any information would be helpful.
Didn't find the answer you were looking for?
Ask a question
Popular Resources
15 signs that it’s more than just the blues
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Simple, drug-free tips to banish the blues.
A guide to 10 common phobias.
Are there grounds to recommend coffee consumption? Recent studies perk interest.
For many, mental health care is prohibitively expensive. Dr. Rebecca Resnik provides a guide on how to find free or reduced-fee treatment in your area