Prozac/fluoxetine vs other ssris for ptsd

[Sweetleaf]

I have PTSD and panic disorder, right now I'm taking bupropion, propranolol, prazosin (when I go to bed), and a methylfolate supplement as my daily stuff.

My PTSD comes with a lot of derealization/depersonalization, and sometimes I get triggered and have flashbacks that can be extremely intense and panic inducing. It just takes the right (or wrong?) stimuli. Or EMDR reprocessing attempts, which isn't really going anywhere, because all we have to do is scratch the surface and we hit really bad, intense stuff, and I get dr/dp/flashbacks. It's all really interconnected too, so everything we try is just leading to the bad stuff.

Anyway.

My doc has been trying to convince me to consider using SSRIs but I've always been kind of hesitant. However, my symptoms are pretty bad, and it's an every day sort of thing, and all the meds I'm on aren't doing enough, even though they're helping. She is saying that a SSRI might help me derealize/depersonalize less, have less flashbacks, etc. as well as helping with other symptoms, like my panic attacks.

Is this true - do SSRIs reduce depersonalization and flashbacks and stuff? Is this your experience, if you've tried them?

Has anyone had them help reduce panic symptoms, or help with panic disorder specifically?

Those two things are making my life really difficult at the moment. Dissociative stuff and panic. I have some depression though it's definitely been reduced a lot from the meds I'm on already.

She's suggesting prozac, but said I'm welcome to suggest another SSRI if I would feel more comfortable taking it. She said that the withdrawal isn't as bad as some other SSRIs.

Would prozac be a good place to start? Would anyone be able to weigh in with their experience with it? Would another SSRI perhaps be a better choice, or have some benefit for my problems?

 

[EveHarrington]

I’ve never heard of SSRIs being used for those purposes. Mainly I’ve used them for depression. They never helped my anxiety.

 

[blackemerald1]

Same as @EveHarrington - also not heard of SSRI's being used for the purposes you have described. Idk if Prozac has multiple uses besides anti-depressants.

Are you going to reduce or come off the other medications before commencing the Prozac if you do decide to try it? I ask because how will you know what medication is doing what and some medications are compounded by using other medications too. So be careful for unintended side effects and consequences.

Have you considered that emdr may not be the right treatment for you at this time or possibly you are proceeding too quickly? If you stop this type of therapy do your symptoms reduce?

Medications are difficult to work out because everyone responds differently. I hope you find a way @Sweetleaf. :)

 

[Hopeforlife]

Hi @Sweetleaf that sounds tough. It’s difficult to get into EMDR work when everything seems to be adding to the flashbacks. I am on fluoxetine. Have been for 6 months. Main reason was that therapy was proving difficult as I was not very stable and disassociating a lot. Nightmares were horrific. My psychiatrist prescribed me these specifically to get rid of the nightmares in the hope that the extra sleep would help the rest of my anxiety and symptoms. Since taking them and playing around with dosage the nightmares are almost gone which in turn has helped that my tiredness and anxiety from the nightmares is not adding to my stress cup. I do believe they could help some people with depersonalisation and derealisation but everyone is different and what works for your symptoms might not work for someone else. It really is trial and error. I do feel they have given me the lift to start EMDR even though it’s a bit stop and start.

I first took a SSRI when I was 18 when I first was diagnosed with PTSD and I tried to take my life but this might not be the only factor which tipped me over the edge so I was extremely reluctant to start taking them again. I have had a pretty rough few weeks as my disease was all over the place. To begin with I was on 25mg then upped to 50mg but the pharmacist started giving me pills which were 50mg instead of 2x25mg. I didn’t realise and was taking two pills so 100mg. All sorted now though...

Talk with your therapist and psychiatrist and find out the best options and do what you feel comfortable with. Huge hugs. I know how confusing it can be to know what’s for the best.

 

[Sweetleaf]

Are you going to reduce or come off the other medications before commencing the Prozac if you do decide to try it?

I don't know, I meant to ask about that at the last session but she said nothing about coming off of other meds.

I am sort of hesitant to mess with my current meds in that they -are- helping, it's just I still have a lot of PTSD and panic disorder issues anyway. Bupropion and methylfolate supplements help me feel less depressed I think, like I'm not wanting to kill or injure myself anymore - which is why I am kind of hesitant to mess with it. I have depression still but it's not like, as big of a deal, as frequent, and it's not my main issue.

The propranolol helps make my panic attacks more bearable (even though they're still there and still horrible. Also, I shake a lot more without propranolol, and it makes fine motor skill tasks a lot more difficult if I'm shaking. Like signing my signature, writing on paper, playing piano, typing on a keyboard, etc. It's embarrassing when it's happening in public, and it used to happen a lot in public because I tend to feel really exposed and unsafe in public.

Then the prazosin has utterly changed my sleep, made it so I can actually get a whole night of sleep. Huge difference from before, waking up a zillion times per night, drenched in sweat, feeling horrible and panicked, fighting in my sleep, etc.

I would hate to mess with my current meds, and lose the benefits I have from them.

Meant to reply to this in the last message

Have you considered that emdr may not be the right treatment for you at this time or possibly you are proceeding too quickly? If you stop this type of therapy do your symptoms reduce?

I feel like it's something that works for me though, in that it's helped in the past. But that was before my old t betrayed me in a really bad way, and kinda made my PTSD explode for a while. She revealed my abuser was emailing her and read it to me... uuuugh f*cking moron. it was all manipulation and makes me feel terrified knowing he's very upset about me getting a restraining order and telling people that he raped and abused me, that he's still thinking about me, when I had mostly been thinking that he would probably just move on. uuuuugh.

I've been much more symptomatic since, and it was after that that I got diagnosed with panic disorder, and have been having basically daily panic attacks ever since.

So, I guess things are different from what they were like when EMDR was helping me.

But, I really want to keep trying, and I honestly am lucky to even have access to my pdoc, who gives me EMDR. Like, seriously lucky. I don't really have much options in regards to seeking other types of therapy, and I'd probably have to wait a long time or get lucky again to have that happen. She also seems to really understand PTSD and what I'm going through, I would hate to roll the dice with someone new.

I think I just need some symptom reduction and I'll be able to really start working on my trauma >.<

 

[blackemerald1]

Hi @Sweetleaf I am aware of that enormous f**k up with your T and the email. You did a thread about it here? Sorry if I got that wrong.

But yes ugh.. I have little doubt the panic disorder would be difficult to cope with. I tremble at times too and it's so, so bad..just so exhaustively bad. I haven't got the words... I feel for you.

It sounds like you have found a balance with your meds right now and I agree with you..I would be cautious of changing what you know already works. Please do ask what and how the Prozac would work in combination with your usual meds. It's a difficult decision to make. :hug:

 

[Sweetleaf]

Hi @Sweetleaf I am aware of that enormous f**k up with your T and the email. You did a thread about it here?

Yeah, I made a thread about it in the therapy section IIRC. Looking back, that was a pretty intense time, I'm glad I had the people here to help me with it.

She would be starting me off at 10mg dose on prozac, because I'm a poor metabolizer of it, so a smaller dose should be needed. I do like that she wants to start it off cautiously and slow. She's really trying to get me to do it though, even printed off a few pages from a book going over how it can help for PTSD. I think she intends to just add it onto my current meds, and she said she would be checking to see if/how it interacts with the other meds I'm on.

I am mainly concerned about having to go off of the bupropion and/or methylfolate. I think if I try it with my current meds, and it interacts poorly, I'll just drop the prozac instead of playing around with what I'm on now.

 

[blackemerald1]

Well I think if she is checking the combination effects out, taking you onto a low dose and slowly, monitoring you very closely.. you have a very good doc who is being cautious and responsible on your behalf too. Always a great combo to have imo:)

You sound like you're very sensitive to meds? How long until she thinks you will get to therapeutic levels? Obviously that is when you will be able to tell if it really does assist.

I'm really hoping it does assist.

 

[Sweetleaf]

You sound like you're very sensitive to meds?

Yeah, I have tended to be pretty sensitive to meds. Depends on the med ofc.

This last session we checked my genes related to some drug metabolism, which is something she does at her other job. I got my ancestry raw dna data back last week, and had a promethease report done on it - handy thing to have. I'm not like the worst off in regards to SSRI metabolism, but my SSRI metabolism is impaired compared to average. So kinda like a "meh" metabolizer instead of a good metabolizer.

We checked my genes related to propranolol metabolism and I also had some impaired metabolism there, which explains why a low dose like 10mg 3x a day had my blood pressure too low, and my pulse was at like ~42bpm resting. Now I take it once or twice a day and it's a good balance.

How long until she thinks you will get to therapeutic levels?

Agh, she didn't even talk about the notion of increasing the dose of it. I know that tends to be a thing with SSRIs. She's been wanting me to take SSRIs since I first saw her, lol. I think she's just focusing on getting me to just start it. I told her the first session, that I really didn't want to mess around with SSRIs and SNRIs. I still am very reluctant because I never ever wanted to take them in my life. I didn't want to need to take them either :banghead:

I didn't think I'd ever have a need for them.

I also didn't think I'd ever experience any of the horrible things I have. Years worth of traumas, culminating in being tortured to the point of psychosis. f*ck.

So maybe I need to be less reluctant to try SSRIs. :banghead: even though I find the idea scary and never wanted to take them. I never wanted trauma either, and I never wanted to have to heal trauma, but here I am stuck with it.

 

[blackemerald1]

Well for what it's worth...having a really conservative approach to taking any medications is, in my opinion, a very healthy approach.

I learned the hard way that not all doc's are on the ball and ripping off a script is just too easy sometimes.

You are correct... it's not like you ever wanted to go on medication. It is a last resort and certainly one you do not have to continue with if it doesn't do the job well enough or at all or side effects are not tolerable.

If you do decide to stop them let your doc know and get assistance coming off them because that can be a whole other battle in itself.:arghh;

 

[joeylittle]

I have PTSD and panic disorder, right now I'm taking bupropion, propranolol, prazosin (when I go to bed), and a methylfolate supplement as my daily stuff.

Buproprion will cause agitation and anxiety. If you have an anxiety disorder, the buproprion will generally make it worse.

Instead of looking to add another med, I would consider asking your psych about decreasing your buproprion, to see if that helps the anxiety come down. It's possible that the propranolol was somewhat managing the agitation effects of the buproprion, but is now not doing it well enough. The answer to that, though, is to decrease the buproprion.

I'm surprised your psych hasn't considered this already. Have they, and I just missed it?

 

[Sweetleaf]

I'm surprised your psych hasn't considered this already. Have they, and I just missed it?

She was wanting to take me off of it at first, but has become okay with leaving me on it because I feel like it helps, and I'm kind of afraid of messing with it.

My main issues are, it seems to help with my depression, and when I began taking it, my anxiety began decreasing. Maybe it's built up or something though?

I don't know if my current levels of anxiety could be blamed on bupropion, in that I started bupropion long before my old t f*cked me over - and it was when she f*cked me over, that I began having extreme anxiety/panic issues.

I also had my bupropion raised to 300mg at one point(before my old t f*cked me over) for like one week, and at that point I got extreme anxiety, hypervigilance, agitation, etc. - I didn't feel any of that when I went back down to 150mg, or when I started out at 150mg.

I felt a little of increased hypervigilance/anxiety/agitation when I was on stronger methylfolate supplements, which makes sense as it supplies the building blocks for neurotransmitters.

Lowering the methylfolate supplement dose seemed to make me hit a sweet spot in regards to the depression issues being reduced, while not triggering agitation and higher anxiety than what I normally experience.

I am actually kind of curious how I'd feel without the bupropion, seeing as I started using it like a couple weeks after the end of my trauma. I almost went off of it at one point - my pdoc didn't keep pushing though and I haven't reconsidered since. I haven't tried going completely off of it, just because I've been afraid of that making me return to how I felt before I went on it. That was an extreme time though, so I don't know what would happen now.