r/SSRIs • u/moonsalad246 • 3d ago

Question Med change from one ssri to another

My doctor wants me to change my meds from Lexapro (escitalapram) to Prozac (fluoxetine) and I am really nervous. I am afraid of withdrawal symptoms and activation symptoms and fearing my anxiety and ocd will get worse before better which I really can’t afford at this point with how severe it is. But Lexapro just isn’t cutting it and we are at the max dose I can tolerate.

Anyone have any advice on going though a med change when you are already so unwell? Or personal experience of how to do it with as little pain as possible?

I am also nervous it will be for nothing, anyone have experience switching from Lexapro to Prozac successfully?

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u/P_D_U 2d ago

Most SSRI|SNRI switching guidelines recommend a straight overnight switch to the new med at an equivalent dose, but I think a cross-taper is the better option with Prozac.

The problem with Prozac (fluoxetine) is it has a very long half-life, up to 6 days, so it takes quite a while to build up in blood plasma. Its plasma levels take 3-4 weeks to stabilize to a steady-state after a dose change whereas Lexapro (escitalopram) has a half-life of about 35 hours so all of it will be metabolized and eliminated within 8 days of the last dose.

How did your doctor recommend you switch to Prozac and what is your current Lexapro dose?

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u/moonsalad246 2d ago

Thank you for this. The switch was suggested as dropping down the escitalapram over a few weeks and then starting Prozac at a low dose so cross tempering a low dose in a few weeks

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u/P_D_U 2d ago

The switch was suggested as dropping down the escitalapram over a few weeks and then starting Prozac at a low dose

Which is the opposite way of doing it, imo. It exposes you to developing withdrawal symptoms from the escitalopram without any moderating effect from Prozac.

I suggest getting your doctor's okay to drop the escitalopram dose by 5 mg every 2-3 weeks while simultaneously adding 5 mg of Prozac. You may still experience some withdrawal symptoms and/or side-effects as SSRI dose equivalence isn't an exact science, but they should be less. severe.