Are nightmares a symptom of SSRI discontinuation?

August 27, 2011 4:22 AM

You are not my doctor/psychiatrist: bizarre prozac/fluoxetine withdrawal symptom?

Background: female, 17 years old. I had been taking Prozac/fluoxetine since November of last year, and had been on 50mg daily since March. I took it for a host of different disorders - none of the doctors I'd seen would ever give me a concrete answer as to what I had, and it seemed to change constantly, but my diagnoses started out as major depressive disorder, panic disorder, and obsessive-compulsive disorder. Since then, there have been mentions of bipolar and various personality disorders, but I've never been able to get a straight answer out of anybody regarding these.

My psychiatrist is not a good one - she is invasive, dehumanizing, rude, and all-around unhelpful, and although I've told her this many times, nothing has changed. I tried to get a different one, but I live in a small town and she is the only adolescent psychiatrist who would take me. Recently I've felt that my depression is very much gone - it seemed to be a situational one and now that the situation has resolved itself, I've been quite content and able to function like I did before the depression.

Around three weeks ago, I decided to stop taking the Prozac. I read up on SSRI discontinuation and decided that I could probably quit cold turkey since it was stated that Prozac is the easiest antidepressant to quit. I was fine for about two weeks, but for the past week or so I've been having some very strange symptoms that I can't find any actual medical information on.

I've been having recurring nightmares, sometimes multiple times a night, about being held in a mental hospital, never being let out or told why I was there, and being unable to find a way out. I've had dreams about being in mental hospitals ever since my first visit to one back in November, but they were always very mild, neutral dreams. The dreams I had in the past made me think, "Oh, I'm in a hospital, not ideal but ho-hum, not much to do," but the ones I've been having recently have been more along the lines of "This hospital is a prison and the staff are sinister and I don't belong here oh god how do I get out there's no way out I'm going to die here they've got it all wrong they're going to kill me." I've woken up in a cold sweat every time, and been pretty much unable to move for about an hour after waking up, confined to lying there in the dark replaying the dream in my head over and over again.

I haven't been able to find any literature about nightmares being a symptom of SSRI withdrawal, but mine are starting to consume my thoughts a lot when I'm awake too, and so I've got two questions.

1. Are nightmares a possible symptom of SSRI discontinuation?
2. Is this a sign that I still need to be on the Prozac/should start taking it again?

posted by marriedtotacos to health & fitness (8 answers total)

1) I would think so, yes. I am not a doctor, but: Nightmares can be seen as a manifestation of anxiety combined with a shift or alteration of sleep cycles. Anxiety is definitely something that Prozac is related to, and changes in sleep are a noted side-effect of both taking and stopping-to-take these kinds of drugs. So I'd think that at least you can't exclude that this is related.

2) I AM NOT A DOCTOR. Not in itself, I would think. I AM NOT A DOCTOR. I'd view this as a transient side-effect, at least unless it doesn't clear up in a few weeks; If the original reason you started taking the drug reappears, I would personally consider that more of a sign that you want to get back on it.
posted by krilli at 4:44 AM on August 27, 2011

1) I have been taking Paxil/paroxetine, another SSRI, for years. If I miss one daily dose, it will often result in intense and disturbing dream experiences. My understanding it that for Paxil at least, this withdrawal effect is common.

2) What krilli said. Seems like gradual discontinuation may reduce this negative side effect, but you've already been off it for a while. If you're asking whether it's a "sign" - in the sense that your body is sending you a message to resume the drug - that's an interesting question that you'll have to answer for yourself, or better yet, with the help of a doctor. It's great that you're overall feeling better than when you started the medication, and too bad that your psychiatrist isn't meeting your needs. I'd encourage you to keep looking for a professional who will be more helpful to you.
posted by Snerd at 5:33 AM on August 27, 2011

Everyone is different, but I had the vivid, crazy nightmares whenever I've upped the dose of an SSRI.

But I love those dreams. (Well, I don't like them at the time, but they have such a positive effect on my general well-being-feeling overall that I love them generally. They allow me to live out my anxieties, work through them and come out the other end unscathed.)

But anyway, yes, they are a possible part of SSRI Discontinuation Syndrome. But don't worry about it just because of that. A syndrome is just a name for a collection of symptoms. It's not anything to worry about unless there is something to worry about. Nightmares, head zaps, volatile emotions and the like are just your brain getting used to not having the drug around.

What you need to do is keep your eye on the prize: you decided to try getting off the drugs, you are two weeks in, and except for the dreams, you are feeling pretty OK, right? Keep reminding yourself that your dreams are just really intense movies that your brain has constructed for you. They are your fears temporarily made "real". So it is normal and OK to be a little freaked out by them, because that's what your unconscious mind is TRYING to do. When you wake up and realize you aren't locked up or crazy, it is a relief. So like you do after an intense movie, work back through it, replay the scary parts, realize they aren't real and gather yourself together and face the day content in the knowledge that you really are going to be fine. The dreams are catharsis: the purge isn't pretty, but the feeling of renewal afterwords is what you are going for.

Should you resume the drug? That's for you and your doctor, but unless the depression feelings have returned, it doesn't seem like it.

As for finding a different doctor, at 17, you should be old enough that you don't necessarily need an adolescent-specific doctor. See if you can make an appointment with a different doctor; it doesn't hurt to try.
posted by gjc at 5:59 AM on August 27, 2011 [1 favorite]

Do you see a therapist, or just the psychiatrist? If you aren't seeing a therapist, it might be a good time to try that, if you have access to one (you can even try your school for this).

Dreams are funny things, and some people think they mean nothing (and most of the time, they really are just a random jumble of stuff your brain thought about or learned that day), and some people think they can be a clue that some other inner anxiety or other negative feelings are going on, and I tend to think (this is not my actual therapist opinion, just my person-who-is-interested-in-brain-stuff opinion) that when people have specific and recurring dreams, that they might have something upsetting going on that it might be helpful to talk to someone about.
posted by so_gracefully at 7:05 AM on August 27, 2011

Any of these drugs can create bad withdrawal symptoms that are often worse than the side-effects or the pre-existing condition. It takes about 6 weeks for it to get completely out of your system. Normally the best idea is to wean down and take certain vitamins concurrently, but since prozac is not one of the heavier-duty drugs, you will probably be okay finishing your cold-turkey quitting of it.

The one big thing to do is take certain vitamins. The symptoms you are having are also something that can happen with a B-vitamin deficiency, and taking these supplements can drastically decrease the withdrawal symptoms. Take B1, liquid B12, B complex, vitamin E, vitamin C, vitamin A, vitamin D, and a calcium/magnesium blend. The important ones are the B vitamins, but the other vitamins are important so that you balance your intake and don't create an imbalance -- a vitamin imbalance can create the same symptoms as a deficiency in the one you're missing.
posted by DoubleLune at 7:45 AM on August 27, 2011 [1 favorite]

Try lifting weights a few days a week and doing cardio the other few. I've found this helps me sleep better. It will also ensure that you're less likely to get depressed in the future.

Also, a temporary solution might be for your general practitioner to prescribe a mild sleep aid. Be aware, that most of the first-line sleep solutions they try are anti-depressants with a sedative side effect, which is not what you want. Also, I would be willing to bet that your GP might be reluctant to prescribe sleep aids to a 17-year-old, and it sounds like you're trying to cut your reliance to pills in general, so I'd try exercising first.

Meditating has never worked for me, but it works for some people. Before you try to go to bed, try thinking about a worst-case scenario re: mental hospital, and then think of all the reasons that would never happen. Caring, sensible people in your life who would stand up for you? You're smart, and have an interest in your own care, and would find a way out? Then end by meditating on something small in your life that makes you feel peaceful and happy: a place, an activity, an event in the past that made you feel warm and safe.

And sadly, most doctors are dehumanzing, at least in the sense that they don't want to listen to you or believe that you know what's going on with your body. You have my sympathy.
posted by thelastcamel at 8:48 AM on August 27, 2011

Yeah, the vivid dreams are a thing. I got switched to Prozac from Paxil when I got pregnant, and quit using it altogether pretty soon after the switch. Paxil has some really terrible withdrawal symptoms that kick in about two days after quitting cold turkey, but Prozac's don't kick in for about two weeks after discontinuation.

I stopped taking the Prozac without tapering, mainly because I just kept forgetting to take my pill. I found that by taking a half-dose when I had the symptoms at the two week mark, it would kick it back again, and I wouldn't have any problems for another two weeks. When I had symptoms, I would take half of what I took the last time. I haven't had to take any for about three months at this point, and overall, it was a pretty painless process. Especially compared to the Paxil withdrawal, which was hellish.

IANAD, IANAP, YMMV, etc.
posted by esmerelda_jenkins at 1:19 PM on August 27, 2011

Check out Will Hall's Harm Reduction Guide to Discontinuing Psychiatric Medication for some great information about what's going on with you.
posted by enzymatic at 8:23 PM on September 3, 2011 [1 favorite]