Brief Answer:
Information

Detailed Answer:
Hello and welcome,

No, not a fat lazy hypochondriac!

The most likely explanation for your symptoms is the discontinuation of the Prozac. When a person has been taking an SSRI for a long time as you have, withdrawal needs to be slow, over a period of weeks to months.

Fatigue is a very common side effect of discontinuation syndrome. Muscle pain is also very common. Arthralgias (joint pain) and swollen neck glands are not a common symptom for this, but it is possible that discontinuation syndrome is the cause of that too.

The standard approach to minimize discontinuation symptoms is to progressively taper (reduce) the dose by a fixed amount or percent for at least two to four weeks. For people who suffer discontinuation symptoms despite a gradual taper, it's recommended to extend the taper beyond four weeks, and depends upon the pace that the person can tolerate.

Management of discontinuation symptoms depends upon their severity and time of onset:

1. Mild discontinuation symptoms that occur despite a gradual taper can sometimes be handled by waiting it out.

2. If moderate to severe discontinuation symptoms occur during a two to four week taper, slowing the pace and tapering the drugs over 6 to 12 weeks.

3. If moderate to severe symptoms arise after the drug is stopped, the antidepressant is restarted at the dose at which there were no symptoms, and the taper is recommenced at a pace slower than the initial taper.

So - I recommend that you consider going back on the Prozac either at your previous dose, or half of that dose if you have been off of the Prozac for and then tapering as above. Best to do this with your doctor who can help by prescribing a lower dose, and monitoring your symptoms.

Usually when the SSRI is restarted, it is obvious that the symptoms were from discontinuation because they resolve quickly. Then you know it was discontinuation syndrome you were dealing with.

However, as swollen neck glands, joint pain, and fatigue can be from other causes too, such as an infection or autoimmune problem, if restarting the Prozac does not help in a couple of days, or if you are having fevers, then do go in to be seen.

To play it safe, it might be best to go in to be seen now anyway so that a doctor (and not a PA or NP) can examine your joints, check your temperature, and assess how sick you are, as without being able to do this, I can't tell. I can say that discontinuation syndrome is likely to be at the root of this, but I don't want to delay treatment for you if there is something else going on.

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Brief Answer:
Question

Detailed Answer:


Can you please tell me:

How long has it been since you were on the 10 mg every other day (i.e. when did you completely discontinue the Prozac)?

How long were you on the 10 mg every other day?

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Brief Answer:
Thoughts on this

Detailed Answer:
If you were without symptoms when you were on 10mg every day, then I recommend going back on that dose and continuing on that dose until you see your doctor. After your symptoms resolve and you want to try to taper again, you may need to go to 5 mg, such as with a pediatric syrup.

But I don't want to overlook other possible causes for your joint pain and swollen neck lymph nodes. So you may want to go into an urgent care clinic if you can't get in to see your own doctor sooner, to have those looked at.

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Brief Answer:
Your welcome

Detailed Answer:
You too, and I hope you feel better soon.

(And if you aren't feeling better soon, please don't wait to go in to be seen.)

Best regards and blessed Thanksgiving to you too,
Bonnie Berger-Durnbaugh, MD

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